倡导

  WAPN+ facilitated a treatment literacy and advocacy training forum in Bangkok, Thailand, at the end of September 2010. The training was attended by 22 participants from 13 countries in the Asia Pacific region.

  Treatment literacy can be defined as understanding HIV/AIDS and all aspects of antiretroviral therapy (ART), including types of ARV drugs, how they work, ARV side effects, treatment adherence, HIV drug resistance and other issues. Treatment literacy is essential to ensuring that people living with HIV are well informed and in a position to participate more actively in treatment, including communicating treatment needs to health care providers.  It is also important to have the knowledge and capacity to hold governments accountable and to ensure they improve the quality and accessibility of health services and the quality of ARV treatment.

The attached report provides a full account of the 3 day forum.

Organization: APN+

Weblink: http://www.apnplus.org/main/Index.php?module=news&news=64


    2010年9月WAPN+在泰国曼谷开展了治疗教育和倡导的培训。来自亚太地区13个国家的22人参加和培训。

    治疗教育包含HIV/AIDS和抗逆转录病毒治疗(ART)的方方面面,例如ARV药物的类型、药效、副作用、治疗坚持度、HIV抗药性,等等。治疗教育能够保证艾滋病毒携带者的知情权,并帮助他/她们积极地参与治疗,例如与医护人员针对治疗需求进行沟通。同时,艾滋病患也需要监督政府,推动其提高卫生服务以及ARV治疗的质量与可达性。


详细信息请参考为期三天的培训报告:Report WAPN TL Training 30 Sep-2 Oct 2010_New.pdf

机构: APN+ - 亚太艾滋病感染者网络



    从HIV/AIDS被发现以及成为全球健康隐患至今已有整整三十年了。

    自第一例艾滋病案例于1981年6月5日被诊断至今,已有三千万人死于这种疾病。全球领导人于上周一集聚一堂,共同对艾滋问题进行回顾与展望。虽然最新的联合国报告指出全球抗击艾滋的努力有效地降低了新增感染率,尤其是在亚太地区效果显著,但本地区仍然非常脆弱。

主持人:Sen Lam
演讲者:联合国艾滋规划署,亚太区代理司长JaneWilson



Wilson:艾滋病毒携带者的数量保持稳定,相比较2001年,新增感染者的数量确实下降了20%。因此我认为这对我们来说是一个非常重要的讯息。通过为高危群体提供高质的治疗服务,艾滋病的流行程度锐减,这个巨大的改变是我们共同的努力的结果。

    柬埔寨是全世界八个能够实现全国80%人口获得ART(抗逆转录病毒治疗)普及治疗的国家之一,这是一个非常大的成就。

    泰国对母婴之间的病毒传播的预防覆盖率也达80%。印度所取得的成就更为巨大,特别是在南印度地区。总体来说,2001年至2009年间,全球新增感染率下降25%,而在印度这一数值超过50%。如果考虑到印度的人口比例,这就是一个非常重大的发现。我认为需要强调的是,所有的这些成就都是通过一点一滴积累起来的。你也许听说过在那些地区开展的很多大型项目,医疗服务的提供、与当地政府和社区之间所建立的强大的合作关系都对项目的成功起了关键的作用。

LAM: 那么你能不能简单地给我们介绍一下太平洋地区的情况?

WILSON: 太平洋地区的数据又有所不同。从2001年至2009年,艾滋病毒携带者的数量从2万8千人升至5万7千人。和亚洲相比较,这些数值并不高,但是对于本地区来说,这确实是一个不小的数字。对于某些社会来说,影响是巨大的。这个地区非常多样化。如果你从整体来看,巴布新几内亚是本地区艾滋流行度最高的国家,感染率达0.9%,但该数值目前日趋平稳,这是共同努力的成果。该区域艾滋感染主要通过性行为传播,特别是在巴布新几内亚。但同时我们也看到注射吸毒也是主要感染途径之一,尽管数值相对较小,但在某些社区和国家却造成很大的影响。

LAM:考虑到亚洲各国发展的不同程度,以及其它社会经济因素,我们是否可以做出这样的假设:即使我们取得很多成果,但该地区仍将非常脆弱?

WILSON: 这真是个非常好的问题,因为当我们谈论覆盖率这个问题时, 尽管整个区域治疗率达31%,东南亚地区更是达到43%,但是更为重要的是如何维持现有的治疗率,如何保持我们目前所取得的成果。总体来说,性工作者、注射吸毒者、男男性行为者以及跨性别者是最容易感染艾滋病毒的群体,我们必须保证艾滋预防和治疗项目的持续性。例如,目前很多国家正在商讨自由贸易协议,这将严重威胁到病患获得药品的途径,这些协议将对整个区域产生可怕的影响。

LAM:你并未提及社会和文化因素,亚洲很多国家都设有严格的反毒品和反同性恋法律,对于性工作的立场也非常严苛。这些因素是否对艾滋病毒感染者来说构成巨大的挑战呢?

WILSON:毫无疑问,这些因素产生的影响非常巨大。我认为各国政府正逐渐意识到这些问题。很多国家,例如中国、越南、印尼,已经开始对政策进行修改,美沙酮项目和针头交换项目正在各地大量展开。我觉得总体来说,公共卫生官员已认识到性工作是一项职业,从人类出现的那一天就一直伴随着我们。但还是有很多案例,在该地区一些国家仍然保留殖民时期遗留下来的法律。我们必须废除这些过时的法律和政策,以便让大家在区域能够自由地活动,使那些携带艾滋病毒的人能够不受歧视,自由地接受预防、治疗、关爱和支持服务。

LAM: 我知道在这些国家很多项目经费都来自外国援助,而非该国自己的财政。这将也是未来发展的趋势吗?

WILSON:这确实令人担忧,特别是在某些国家,例如越南正逐渐成为中等收入国家,该国一直都非常依赖海外捐赠,但将来也许无法获得相同的捐赠。如果病人开始进行抗逆转录病毒治疗,那该治疗必须保持一生,一旦停止病人的健康将受到危害。如果病人产生抗药性,但又必须服药,那么他们只能选择那些昂贵的二线药物。因此维持目前的抗逆转录病毒治疗的管制非常重要,保证每个病患都能持续治疗,这也是预防艾滋非常重要的方法。


Asia Report 翻译

原文链接: http://www.radioaustralia.net.au/connectasia/stories/201106/s3236705.htm




It's thirty years since HIV AIDS was identified and recognised as a global health threat.


Thirty million people have died since the first AIDS case was reported on 5th June 1981. World leaders gather in New York on Monday, to look at the way forward, even though the latest United Nations report says the response to the global HIV-AIDS epidemic has resulted in a significant fall in new infections.

Asia and the Pacific registered some of the best results in stopping new HIV infections, but the region remains extremely vulnerable.


Presenter: Sen Lam
Speaker: Jane Wilson, acting director, UN AIDS, Asia and the Pacific

WILSON: The number of people living with HIV remains stable and new infections are actually twenty percent lower than they were in 2001. So I think that's a very important message to get across. They've turned their epidemics around, and they're providing quality services to their most at risk populations, so really making a very big difference. Cambodia's one of only eight countries worldwide, to have reached eighty percent universal access to anti-retroviral therapies, so that's a real success story.

Thailand also has a coverage of eighty percent for prevention of parent to child transmission services. India's really making quite significant strides, particularly South India. Compared to 2001 to 2009, overall, the average is that rates of infection have fallen by twenty-five percent globally, but India's rate of new infections has fallen by over fifty percent. And when you consider the population scale in India, that's a very, very significant finding. And I think what we say is, alot of this has been achieved by scaling up. You perhaps have heard of some of the very large programmes that are operating there. Many more points of service delivery, very strong partnership with the community and the government. This is the way these things have been achieved.


LAM: And Jane, can you give us a quick snapshot of what's happening in the Pacific?

WILSON: The Pacific, we're talking about very different numbers, as you'd know. I mean, we have between 2001 and 2009, from 28-thousand people living HIV, to 57-thousand. So if you compare with Asia, these are not large numbers, but for the Pacific, these are very significant numbers. And it can have a very major impact on their specific societies. It's a very diverse region. if you look over all, Papua New Guinea has the region's largest epidemic, with the prevalence rate of point-nine per cent but that is gradually starting to level off, so there is some progress being made in the Pacific. It is largely being driven by sexual transmission, particularly in Papua New Guinea and over all, but we are seeing injecting drug use, which is described as a small but significant factor, as becoming apparent in some communities, in some countries in the region.


LAM: And Jane, given the socio-economic factors and the uneven levels of development in Asia, may we assume then, that if gains have indeed been made, that the region is still extremely fragile?

WILSON: That's a really, really good question, because while we can talk about coverage rates, for example of treatment of thirty-one percent overall, and in Southeast Asia of forty-three percent, maintaining these treatment rates, maintaining the progress that we've reached is extremely important. Over all, the communities that are the most vulnerable to HIV, that is sex workers, people who inject drugs, men who have sex with men and transgender people, we really need to make sure that programmes aimed at prevention and treatment are maintained, and that challenges for treatment are dealt with. For example, some of the current free trade agreements being negotiated at present, really have tangible threats to accessible drugs, which would have an appalling effect on the region.


LAM: You touched a little on social and cultural factors, that many Asian countries have strict anti-drug and anti-gay laws, and also a tough stance against sex work. do these factors pose a huge challenge to HIV sufferers?

WILSON: They're absolutely massive. And I think governments are gradually becoming much more aware of these factors, and you've got significant changes of policy in countries like China, like Vietnam, like Indonesia, where methadone programmes, and needle exchange programmes are being rolled out. I think public health officials are overall, aware that sex work is a profession that's been around as long as man has been on the earth. But there're still in many cases, outdated laws. In many cases, handed down from colonial pasts, in some cases not, but these kinds of laws and policies really need to be overtaken so that people can move around the region freely, those people living with HIV and also access treatment, care and support and prevention, without experiencing discrimination.

LAM: And Jane, I understand that many of these countries don't spend their own money; that much of the funds for treatment and other programmes come in the form of foreign aid. Is that likely to be an issue in the future?

WILSON: It's extremely worrying, particularly in some countries - we take Vietnam, which is becoming a middle income country and they're very reliant on international donors and then, can't access donor funding in the same way. People when they go on anti retroviral therapy need to maintain it for the whole of life, and if they stopped taking drugs, of course their health suffers, they become resistant, and if they have to start taking drugs, they have to go to more expensive second-line drugs, so it's extremely important that drug regimes, anti retroviral regimes are maintained and that people can continue treatment, because that's also a very good way of preventing HIV infection.


Weblink: http://www.radioaustralia.net.au/connectasia/stories/201106/s3236705.htm

NAIROBI, 7 June 2011 (PlusNews) - Epidemiologist Elizabeth Pisani raised eyebrows in 2008 with her book, The Wisdom of Whores, a frank account of her experiences working in the field of HIV/AIDS, from the politics of raising money to conversations in the backstreet brothels of Bangkok. She spoke to IRIN/PlusNews:


Question: Why have HIV prevention efforts failed to curb the spread of the pandemic?

Answer: Prevention has failed for many reasons. One is that we didn't actually start prevention until we had reached such a critical mass of HIV infection that prevention was always going to be difficult. The higher the prevalence in the population, the more effective prevention needs to be just to keep levels constant, let alone lower prevalence.

Globally, we missed some really easy wins when it comes to HIV prevention. One was needle exchange programmes for injecting drug users. Countries which have adopted these policies and adjusted their laws to accommodate them have virtually wiped out HIV among these populations. Unfortunately, a lot of countries have chosen not to do that, including the US and Russia.

Another easy win is providing commercial sex workers with condoms, lubricant and sexually transmitted infections screening; this isn't promoted nearly enough, particularly in sub-Saharan Africa, even though the evidence shows that it is fairly easy to achieve very high levels of condom use in commercial sex.

We've been very selective about our use of different HIV prevention methods. Prevention tools must work in four major ways in order for them to succeed - they must work behaviourally, technically, politically and financially - if any one of these things is missing, prevention won't work. Abstinence, for instance, works technically - you are definitely not going to get HIV through sex if you abstain - but behaviourally, studies tell us that abstinence doesn't actually work very well, so telling people to cross their legs for the rest of their lives isn't really going to prevent HIV.


Q: What is the truth within the HIV response that we're ignoring and why?

A: One of the great distortions is the gender thing; we've spent a lot of time acting like it's all about innocent women versus wicked men, when in fact it is impossible for heterosexual transmission to occur in the millions without both sexes being involved. The fact is, women like to get laid too. In sub-Saharan Africa, young women entering marriage are more likely to be the infected partner; more men will infect HIV-negative wives while married, but still, about one-third of new infections in marriage are a result of women infecting their husbands.

This fantasy of the innocent woman has led to some misdirected programming such as women's empowerment programmes and microfinance - both of which are useful, just not in the case of HIV. What should have been done is extremely aggressive promotion of condoms and sexual health services, especially in the context of sex work, much earlier on. We're still not focusing enough on commercial sex.

We've dichotomized HIV epidemics as generalized and concentrated, but even in generalized epidemics, commercial sex work contributes a much higher proportion of new HIV infections [than the general population].

Q: Treatment as prevention - is it the answer to ending the AIDS pandemic?

A: I think treatment is the answer to ending AIDS, but I don't think it is the answer to ending HIV, which is an important distinction. I don't think that it is financially feasible to scale up treatment to the levels it needs to reach in the population in order to end HIV transmission.

For those of us who worship at the altar of the randomized control trial, the recent HPTN 052 study gave us very good evidence that HIV treatment reduces infectiousness, something we've known for a while. But it has only proven this at an individual level; it doesn't tell us about the population level, whether the low viral load can be maintained in the entire population on treatment for the entire lifespan of this population while still ensuring newly infected people - who are highly infectious - are not infecting other people.

In addition, the study excluded people who were not able to adhere to treatment - that meant drunks, people who travelled for work and so on, did not participate in the study. People in the study were in a well-supported trial situation, and we don't know if we can feasibly recreate such a situation in the real world.
This is not to suggest that we shouldn't treat more people, and treat them earlier than we do at the moment. It is bound to reduce the infectiousness of people infected with HIV so it will certainly have an impact, but because treatment allows people to stay alive and sexually active for much longer it won't, in itself, be enough to wipe out new infections.

Q: In your book, Wisdom of Whores, you make the case that in Asia, HIV prevention should focus on high risk groups such as sex workers and IDUs. In East and Southern Africa, where HIV is much more generalized, what is the best way to approach HIV prevention?


A: I genuinely don't know what to do for HIV prevention in sub-Saharan Africa, and if anyone else has got ideas that really work I don't see them being put into practice. I would predict that incidence is unlikely to fall, and there's a fair chance that it will rise.

On the other hand, if it is possible to provide and keep expanding treatment at a higher CD4 count and sustain it without it undermining the progress of other health and development issues, then HIV may not - eventually - be such a big deal. Members of the 'AIDS mafia' - such as myself - won't say that HIV is not a big deal because we come from the generation of AIDS, when people died, which was a very big deal. But today, if HIV treatment is affordable and available and an HIV-positive person is in a well-managed situation, truthfully, HIV is really not that big a deal.

What I mean is it is not a big deal for an infected individual; it is a huge deal for health systems and tax-payers who have to manage the epidemic, and there is a real threat of drug-resistant strains emerging and taking us right back to the age of AIDS.


Q: In Wisdom of Whores, you say in the past the epidemiological data on HIV was presented in ways that aimed to cause alarm and spur increased AIDS funding. Has this changed - is the data we see today more reflective of the truth about the state of HIV?

A: I think it's getting harder to beat up the statistics the way we used to, and perhaps there has also been a realization that it can be counterproductive to the work you are doing - you might get the money but you can't do what you need to with it.

There is a greater realism compared to the earlier years, and I think there is less distortion even than five years ago. Perhaps lessons are being learned, or perhaps I've just been out of the UN system for too long to see what's going on.

Weblink: http://www.plusnews.org/report.aspx?reportID=92915



流行病学专家 Elizabeth Pisani2008年撰写的《妓女的智慧》(The Wisdom of Whores)一书引起了巨大反响,书中披露了其多年来在艾滋领域工作的经验,内容涵盖了从筹款的政治艺术到在曼谷与按摩院性工作者的交流等。IRIN/PLUS NEWS对她进行采访。

(Q=问题/A=回答)

Q:为什么我们对预防艾滋所作出的努力没有成功的阻止该病毒的流行?

A:失败的原因有很多。其中一个是我们直到艾滋开始大面积感染和传播之时才开始进行预防工作,到那时一切都变得非常困难。如果流行度越高,我们对有效的预防的需求就越大,这样才能保持感染面积不会继续增大。

就全球范围来说,在艾滋预防方面我们错失很多良机。其中一个是针对注射吸毒人员的针头交换项目。实施相关政策、并对法律作出适当调整的国家最终有效地降低了该群体的艾滋感染率。不幸的是,包括美国和俄罗斯在内的很多国家并没有选择这么做。另外一个机会是为有偿性工作者提供安全套、润滑油以及性病检查。尽管证据显示在色情行业中要实现安全套高使用率并非难事,但这项工作并没有很好地开展,特别是在非洲撒哈拉以南地区。

对于不同的艾滋预防方法我们相当的精挑细选。如果要获得成功那么必须得从四个方面来完善艾滋预防方法:行为方面、技术方面、政治方面以及财政方面,如果缺失其中任何一面,那么整个方法都行不通。举例来说,从技术上来说,如果一个人禁欲那么他/她将完全不会感染上艾滋病毒,但是从行为方面考虑,相关研究指出完全禁欲是不太可能发生的,因此如果向公众宣传后半辈子只要夹紧腿做人就能预防艾滋是行不通的。

Q: 在对抗艾滋的过程中我们忽略了什么?为什么?

A:社会性别是整个抗艾过程中最大的误解之一。我们一直把妇女看做无辜的,而男人总是万恶之源,但事实上一个巴掌拍不响,如果没有双方的参与,异性之间的性行为是无法传播的。实际上妇女也可能是传染源。在非洲撒哈拉以南的地区,刚刚结婚的年轻女性更有可能是被感染一方,新婚的男人通常是病毒的传播者,但新增感染者中仍有大约三分之一的案例是妻子传染丈夫。

妇女被当成无辜的受害者这一观念对很多项目设计产生误导,例如针对妇女的赋权项目以及小额贷款项目。这两种项目都非常有用,但对于解决艾滋问题效果并不大。我们更应该花大力气做的是倡导安全套的使用以及提高性健康服务,特别是在色情业,这些工作都应该更早开展。我们对商业性的色情行业仍没有投入应有的关注。

对于艾滋病传染问题,我们总是采取两等分的态度来看待--一般化或集中化,但是即使一般化该问题,新增艾滋感染案例中,比起一般大众来说,性工作者的感染占了更高的比例。

Q:在你的《妓女的智慧》一书中,你提到在亚洲,艾滋预防应该关注高危群体,例如性工作者和注射吸毒人员。在东非和非洲南部,艾滋病毒更是一个全民问题。那么到底什么才是最好的艾滋预防方法?

A:老实说,我并不知道在非洲撒哈拉以南地区要采用何种方法预防艾滋感染,我也并不认为有其他人发现了更好的方法。我预测感染率不但不会降低,反而有上升的可能性。
从另一个方面来说,在对其它健康和发展问题不造成影响的情况下,如果有可能在CD4细胞值更高的时候提供和扩大治疗,那么艾滋病毒最终将不会是什么大事。"AIDS Mafia"的成员,例如我自己,不会随便说"艾滋病毒并不是什么大问题"这样的话,因为我们是经历过艾滋感染爆发高峰期的一代人,病人的死亡可不是一件小事。但是现在如果每个人都有途径接受治疗并能够承担治疗费用,并且每个感染者的病情都能得到很好的控制,那么艾滋病将不再是一个大问题。


Asia Report 翻译

原文链接:

http://www.plusnews.org/report.aspx?reportID=92915

(KPL) Over 20 journalists of broadcast media and newspapers attended a workshop on anti-HIV/AIDS efforts by the media and the HIV/AIDS and Sexually Transmitted Diseases Prevention Centre over the last one year.

  The meeting held at the Lao Women's Union, in Vientiane Capital drew the attendance of Deputy Head of HIV/AIDS and Sexually Transmitted Disease Prevention Centre, Dr. Chanthone Khamsibounheuang.

  Dr. Chanthone said that the workshop was very important to review the implementation of the HIV/AIDS and sexually transmitted disease prevention over the last one year and set new plan for the year to come.

  Over the last one year, we advertised condom use and danger of HIV/AIDS for target groups mainly homosexuals, prostitutes and sex buyers through newspapers, TVs, radios and brochures.

  In addition, we held training-of-trainers course on same sex relations among men and condom use.

  The participants of the two-day workshop learned the role of the Lao media in publicizing anti-HIV/AIDS campaign.

Weblink: http://laovoices.com/2011/05/09/anti-hivaids-campaign-reviewed/

老挝抗艾倡导活动回顾

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 KPL Lao News Agency

(KPL)在过去一年中超过20名来自传播媒体和新闻媒体的记者参加了由艾滋与性传播疾病预防中心组织的抗艾工作培训坊。

该培训在位于老挝首都万象的老挝妇女联合会举行,艾滋与性传播疾病预防中心副主席Chanthone Khamsibounheuang博士也参加了会议。

Chanthone博士表示该会议为回顾上一年所开展的艾滋与性疾病预防工作提供了很好的平台,同时也提供机会对下一年相关的工作做出规划。在过去的一年中,我们通过报纸、电视、广播和宣传手册对目标群体(主要包括同性恋者、性工作者与嫖娼人员)进行使用安全套的宣传教育。另外,我们为培训者提供有关男男性行为者和安全套使用的培训教育。为期两天的工作坊让参与者了解到老挝媒体在抗艾运动中的作用。


Asia Report 翻译

原文链接: http://laovoices.com/2011/05/09/anti-hivaids-campaign-reviewed/
  In 2010, the Population Services International (PSI) program, Sun Quality Health (SQH), and its sister network of village health workers, Sun Primary Health, performed more than 2.1 million client consultations in Myanmar. John Hetherington, who has managed the network since 2007, talked to CHMI (Center for Health Market Innovations) about how--in the second-poorest country in the Asia-Pacific region--SQH has assembled one of the broadest service packages of any social franchise network operating today in an attempt to provide high quality, well regulated priority health services to local people.


CHMI: You offer a wide range of services under the Sun Quality Health brand. How do you select the services the brand will include?
John Hetherington: With a backbone of 1200 doctors in more than 200 townships, we can be entrepreneurial. We first ask, is there a need not being met? And is there an opportunity for a network of providers to offer that service? In Myanmar, the largest health concerns - malaria, family planning, pneumonia, diarrheal disease, TB - are either too expensive to treat, or doctors don't provide the right quality service. As in many places, we started with reproductive health and family planning, where there is a natural fit for social franchising.

Why is it that so many social franchising programs start by offering family planning?

JH: I think family planning is unlike other services because everyone from 15-49 is potentially a client - meaning, they are theoretically all fertile -- and this makes it different than addressing diseases which require many more inputs to be efficient, targeting, testing, etc., particularly in Asia, where many of the big diseases tend to be concentrated epidemics. With FP, you have the potential to offer (almost) anyone you interact with something that can be of service to them. You have the potential for large scale impact without the precise geographical targeting that you would need to treat an epidemic.


Without using the media to market to clients, how does your franchise attract clients?

JH: Advertising for medical services is illegal. Here, as in many countries, there are lots of people who go to their local doctors when they are ill or think they are ill. Many of these doctors have practiced for 20-30 years without continuing medical education. These are the doctors we retrain, so [with their clients] we have a captive audience, in a way.
How do you set prices?

JH: We set prices in a way that they are not a barrier to the poorest person we want to reach in the given target. We make services available at a price people are expecting--50 cents to a dollar for a malaria treatment, versus the five to six dollars it would cost otherwise. If we were not subsidizing these services, doctors would not provide them, or they might give patients the wrong drugs--give an injection, for example.

Speaking of which, how do you ensure quality?
JH: Social franchising is more complex to manage than other channels of social marketing--you need higher levels of training, monitoring and supervision.

On our staff, we have close to 80 doctors that, on average, visit each of the 1200 clinics every six weeks. They observe service delivery and answer the franchisee doctors' questions. We also send mystery clients to assure that the level of service quality remains intact. We use vignettes in training.

These techniques ensure that [franchisees] are not gauging people with prices or giving the wrong treatment. However, we don't own these clinics. We hope the training around good hygiene, infection prevention, client relationships, and counseling improves overall practices, since we don't monitor health areas outside the SQH basket of services.

Is it difficult to get providers to participate?

JH: No - their business increases. Their reputation is better, they have more services to offer, and their customers can get an IUD for 50 cents instead of 50 dollars.
In Myanmar, the public sector is not able to serve the needs of most people; 80-90% of people go to the private sector for health care. This is not unique. The private sector, while used by everyone, is atrocious in most places. With proper management, however, it can be made to do less harm--and even do very good work.
I have had surrealistic conversations with some country officials or [global health policy makers] where someone asks [a policy maker], what is your national protocol for first-line treatment for malaria? Yet, if you look at the data, 99% of people go to a pharmacy and buy drugs off the shelf. Some have to have a philosophical shift to understand this.

Describe your relationship with the Myanmar government.

JH: There is always a give and take between an NGO and the government. We have a longstanding relationship with the government in Myanmar and some of our staff are former civil servants. [Officials] appreciate that we are improving the quality of services by providing continuing medical education where there is none, and reporting on treatments not captured by the national health management information system.
The health minister has also seen the impact of Sun Quality Health. It's not minor--it's providing something like 25% of all family planning services, and we are detecting and treating more than 12% of all TB cases nationally.
We heard you are now offering screening for cervical cancer, which is very unusual even though 80% of cases occur in the developing world.

JH: Our franchising director at the time, Dr. Nyo Nyo Mihn learned a couple of years ago at a medical quality conference funded by one of our donors that you can screen [for abnormal cells] with acetic acid and treat abnormal cells with cryotherapy using Co2 in low resource environment, all without electricity. PSI's innovations fund allows us to be entrepreneurial without massive amounts of money, so we are now beginning training.

Some people in the health ministry are concerned that private sector doctors should be doing something they consider to be a hospital service. But almost no one is doing cervical screenings anywhere, so again, there is a choice of doing nothing, or doing something in partnership with the health facilities that are actually being accessed by people.

We are also piloting a basic package of anti-retroviral therapy with 100 clients, which hasn't yet been done in social marketing.

You also provide TB screening and treatment.

JH: Starting this intervention in 2004 was our biggest gamble. A recent study showed that the TB prevalence in Myanmar is five to six times higher than what was previously estimated. Now, our franchise does more than 12% of all case detection and treatment in the country.

Recently, in a village meeting, a woman spontaneously came up to us in tears. She told us she had been dying from TB and the treatment she got from a government clinic wasn't working for her. A PSI health worker told her to go to a [Sun Quality Health] doctor. She said, 'I'm healthy now and you saved my life'. I was thinking, that's one person, and there are 17,000 people every year getting that service that would otherwise die, and give TB to eight other people.

Yet, you still have people outside the country saying you can't work ethically inside the country, and the regime here can also be xenophobic. We can negotiate between those two things--the government doesn't see [the program] as impinging on their sovereignty and the opposition doesn't see it as giving succor to the regime. This model would be interesting to use in other difficult political situations, perhaps in Zimbabwe.


Organization: the Population Services International (PSI)

Learn more about Social Franchising

Weblink: http://healthmarketinnovations.org/blog/2011/may/26/how-engage-private-sector-doctors-deliver-high-quality-and-affordable-priority-care


CHMI

    国际人口服务组织(the Population Services International),Sun Quality Health (SQH)组织与其姐妹组织--Sun Primary Health乡村健康工作者网络于2010年在缅甸全国提供超过210万次健康咨询服务。于2007年接管该项目的John Hetherington接受健康市场创新组织(Center for Health Market Innovations-CHIMI)的采访,介绍SQH如何在缅甸--这个亚太地区最贫穷的国度之一,基于目前可利用的社会特许经营网络,集合最广泛的服务为当地人群提供高质、管理完善的医疗服务。

CHMI:贵机构以Sun Quality Health为商标提供各种各样的服务,你们是如何选择将要提供的服务类别的?

JH:我们遍布在全国超过200个乡镇的1200名医生能够支持我们开始工作。我们首先会询问是否有需求?如果某个资源网络有能力填补该需求空缺,是否能够为其提供机会?在缅甸,痢疾、计划生育、肺炎、腹泻以及肺结核是最大的健康问题,这些疾病要不就是治疗费用过于高昂,要不就是医生无法提供高质量的服务。在很多地区,我们首先开始提供生殖健康以及计划生育服务,这类服务对于社会特许经营来说比较容易实现。

CHMI:为什么很多社会特许经营项目都以计划生育项目开始?

JH:我认为计划生育和其它服务不一样,因为每一个年龄在15-49岁之间的人都是我们的潜在客户,理论上说她们都有怀孕的可能性。因此,计划生育项目与那些对高效的、目标性和实验性的投入要求更多的疾病防治项目有所不同,特别是在亚洲地区,很多这类疾病都是传染性的。计划生育项目几乎能够为你接触到的每个人提供一些适合她们的服务。和流行疾病项目不同,计划生育项目不需要严格地以地理面积来锁定服务目标群体,也能产生很大的影响力。

CHMI:既然你们不利用媒体来宣传,那是如何吸引顾客呢?

JH:对医疗服务做广告是违法的。和很多国家一样,在这里大家通常都找本地的医生看病。很多医生已经行医20-30年了,但在这段时间中却没有持续接受相关医疗教育。我们对这些人进行培训,这样做也同时能留住他们的老顾客。

CHMI:你们如何定价?

JH:对于项目锁定的目标群体中最贫困的人来说,我们所设定的价格不会对他们造成任何障碍。我们所提供的服务的价格都保持在人们的预期范围内:疟疾治疗我们每次收费50美分至一美元,其它地方对该项服务的收费大约是五、六美元。如果我们不补贴这些医疗服务,医生将拒绝诊断病患,或者有可能不对症下药。

CHMI: 说到这里,你们如何保证医疗质量?

JH:社会特许经营比起其它种类的社会营销管理起来都更为复杂,需要更高级别的培训、管理和监督。我们整个医生团队人数将近80人,平均每六个星期对1200个诊所逐个访问。他们观察诊所医生的工作情况,并解答他们所提出的问题。我们也派遣一些"便衣"病患去就诊,以检查医疗质量是否能保持一致。

用这些方法能够确保特许经营方不乱向病患收费,也能保证医疗服务的质量。但是这些合作的诊所并非我们所有。我们希望通过对卫生学、传染预防、客户关系以及咨询服务开展培训来提高医疗特许经营的实践的整体效果。

CHMI: 让医护人员加入这个项目是否困难?

JH:不,事实上他们的工作量增加了,声望也越来越大,所提供的服务也越来越多。现在他们的顾客花50美分就能够买到一个节育器(IUD),而过去需要美元。在缅甸,公共医疗无法满足大部分人的需求,80-90%的人在私营医院接受医疗服务。这种情况并不罕见。然而大多地方的私营医疗机构却非常糟糕,但如果能够对其进行适当的管理,这些机构将能够为公众提供很好的服务。

CHMI:请向我们描述你与缅甸政府的关系?

JH:非政府组织(NGO)与政府之间永远是合作与让步并行。我们与缅甸政府已结成一个长期的关系,这个项目里也有很多工作人员曾经是公务员。我们通过持续地提供医疗教育来改善服务质量,并对治疗的情况进行及时的汇报,这些工作目前在缅甸仍是一片空白,因此政府对我们的工作表示欣赏。

缅甸卫生部部长也看到了Sun Quality Health项目的影响力。我们的计划生育服务占该服务全国总量的25%,我们也对全国12%的肺结核病例开展追踪治疗,这并不是个小数目。


Asia Report 翻译

组织: the Population Services International (PSI)-- 国际人口服务组织

了解社会特许经营(Social Franchising


原文链接: http://healthmarketinnovations.org/blog/2011/may/26/how-engage-private-sector-doctors-deliver-high-quality-and-affordable-priority-care


 

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