Do The Survey, Do The Duty

 SURVEILLANCE SYSTEM & THE ROLE OF MEDICAL DOCTOR IN PANDEMIC PREPAREDNESS

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Surveillance is the ongoing, systematic collection, analysis, interpretation, and dissemination of data regarding a health-related event for use in public health action to reduce morbidity and mortality and to improve health.

(Center for Disease Control and Prevention/CDC)

"Why is surveillance needed?"

Surveillance serves as an early warning system of which it helps to identify public health emergencies. It also guide public health policy and strategies besides documenting the impact of an intervention or progress towards specified public health targets/goals. This system at most, understand or monitor the epidemiology of a condition to set priorities and guide public health policy and strategies.

The effectiveness of surveillance depends on its functions which represents by the table below:

Detection and notification About health events

Investigation and confirmation The epidemiological, clinical and/or laboratory matters of any case or outbreak.

Data collection and consolidation About the pertinent data

Data analysis Done routinely and also having the creation of reports

Feedback About the  information to those providing the data

Feed-forward The forwarding of data to more central levels reporting data to the next administrative level

A surveillance system is an information loop or cycle that involves 3 main roles which are the health care providers, public health agencies, and the public. The loop shown here is the summary to briefly explain how the things going between the 3 roles.

One of the many examples of uses of surveillance can be seen in Thailand. Thailand was host to one of the largest epidemics of avian influenza (bird flu) identified in eight Asian countries in early 2004. 

Later that year, the disease spread from birds to humans, killing almost all the infected people. Recognizing the global threat posed by such a disease, the Thai Ministry of Health, in partnership with field epidemiologists and WHO, supported laboratory studies that showed that the disease was being spread from human to human.

The Thai example was critical in raising public awareness of the possibility of a global catastrophe caused by avian flu. It also showed that the disease can be controlled with proven epidemiological methods; including rapid, on-site investigation by trained specialists and good communications.

"Medical doctor in pandemic preparedness"

One critical role of medical doctors of which may have been underplayed in importance, is to educate, manage and communicate with the public. In a survey of the public organized by the College of Family Physicians of Canada, an overwhelming majority of the respondents indicated that they should be able to turn to their family doctors for information and advice in the event of a serious medical emergency such as a widespread influenza outbreak (source: Influenza pandemic and the duties of healthcare professionals).

As trusted and credible sources of information, medical doctors play an important role in guiding the public even on mundane decisions such as whether and how to seek medical help. Public guidance increases in ethical significance during a potential or actual pandemic. Therefore, medical doctors should be well-informed about the spectrum of clinical presentations and severity of the pandemic matter. Doctors have to be one of the most up- to- date individuals ever :)

Furthermore, as primary medical care providers, doctors care for and report suspected or confirmed infectious diseases that threaten the health of their patients and the populations in which their patients reside. By identifying outbreaks through screening, diagnosis and reporting, doctors play a major role in helping to reduce the severity of outbreaks.

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References:

• "Surveillance, response and the role of public health informatics", lecture by dr Luthfan Lazuardi, M. Sc., PhD
• WHO: Public Health Surveillance
• Disease Control Priorities Project (DCPP): Public Health Surveillance

The Power of Maintenance

Ever wonder how the licensing and standardization actually are in the quality regulation, especially for the doctors? In this post, I'll briefly explain the matter including what standards are actually important to be listed down to.

  "REGULATING QUALITY"

A physician is amongst the health personnel which refer any person who devoted themselves in the health sector and have knowledge and / or skills through education in the health sector, which to a certain type requires authority to carry out health services. (Peraturan Pemerintah RI No. 32 th 1996)

THE REGULATION PROCESS 

1. Certification

From educational institutions. It's just the way how things going on for me. I'm studying medicine in University of Gadjah Mada, and after 5 years here, I'll have my Medical Doctor certificate. Insya Allah:)

2. Competency test

MTKP i.e. the provincial health personnel board. This is important in such a way to ensure that doctors are not a health personnel just because of their tittle or certificate, but also because of their knowledge, skill, and ability to really perform as ones.

3. Registration

KKI i.e. Indonesian Medical Council. It's somewhat like letting ourselves to be officially being acknowledged in the field. Well.. WELCOME TO THE CLUB:)

4. Practice permit

Government at district level. The analogy is like having a driving silence to drive a car legally.

5. Credential

Under the hospital medical board. It's an attestation of qualification, competence, or authority issued to an individual by a third party with a relevant. It may include academic diploma, academic degrees, certifications, or identification documents.

6. Clinical privilege

Board of director:)

•Besides obtaining medical practice permit (from government), h, health personnel is responsible on other obligations which is especially to comply with professional standards.

• –Education standards: The physician is graduated from a medical a school.
• –Competency standards: Performing jobs and role as a physician based on appropriate guidelines.
• –Service standards: Able to provide the service that patients are entitled to receive.
• –Ethics standard: Performing role in good and suitable moral value. 

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My second point, SURVEILLANCE will be posted soon. Thank you very much..

Reference:"Physician Regulation", lecture by dr. Rukmono Siswishanto

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From Health Care with Love

"CLINICAL GOVERNANCE, PATIENT SAFETY, AND EQUALITY IN HEALTH CARE"

Patients are the consumers which have their own rights; be it on medications, treatments, safety, and so on. In this post, I'll share my understandings based on the notes I made on how much the Health System is set up in rolling the red carpet for the patients:)

Quoting from Prof. dr. Laksono Trisnantoro when he conducted our practical session about SYSTEM THINKING, "Every complex things have system which followed by subsystems that strengthening it". For Health System, Clinical Governance is one system which works by maintaining and improving the quality of patient care. One of the best examples for its implementation is the national quality standards in delivering care: clinical guidelines based on evidence.

Clinical Governance to which I can simplified is a vehicle that takes us from a problem to solution:

Problem -----> Clinical Governance -----> Solution

The strategies employed to achieve quality and excellence, are those of teamwork, leadership, ownership and communication. All key skills to utilize when attempting to bring about changes to health care and more particularly in shared care services.

There are 4 main pillars in Clinical Governance based on the lecture given by Prof. dr. Adi Utarini: Consumer value, Clinical risk management, and Professional Development and Management, and Clinical Performance and Evaluation. Some other sources I found give out 7 main pillars, and even 11, but as to go through those, the fundamental pillars are actually the same.

Clinical performance and evaluations help to reach the target through Clinical Indicators which measure those, such as AHRQ, WHO-PATH, or ACHS.

Aim of Clinical Indicator:

2 types of clinical indicators:

 

Sounds too wide, isn't it? But well, indicators come in level, hence narrowing the aspect of management, therefore, more effective initiatives :)

  

All health care providers, both institutional and individual, must make every effort to ensure that every person who seeks their medical care is offered competent, sincere, and equal treatment options.

With all these, the aims are managed to be reached or at least, very close :)

• Ensuring appropriate access and high quality
•  Provide the best care for all patients
•  Protect patients from unexpected risk 

As the aims are reached, it directly or indirectly protects and leads to patient's equality. Patient's equality is fact that all the people have the right to receive health services. You can read my post about WHO declaration (Health for all by the year 2000) in the topic og GLOBAL HEALTH SYSTEM, discussing about patient's equality in global aspect:) As you can see in Indonesia for example, in every level of the country- district --> provincial --> national;  there are health system facilities, care, and regulations being provided thoroughly.

All of all, when clinical Governance works, it allows us to make the service changes or improvements that we want to see happen. It's not only improving the quality of care for the patients, but also provides a better experience for us. This in fact, supports the equality of utilization, distributing according to need, equality of access, and equality of health which by far, enables the strong EQUITY IN HEALTH CARE:)

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References:

• "Quality Framework, Clinical Governance, and Patient Safety": Lecture by Prof. dr. Adi Utarini, M. Sc., MPH., Ph.D
•  Substance Misuse Management in General Practice (SMMGP): Clinical Governance 
• Engaging the Elements of Clinical Governance

The Way How Care Is Showed part ii

This post is actually a continuation of my previous post, "The Way How Care Is Shows" as health Insurance and Managed Care have are technically correlate to one another. The root of the topic tree for me to elaborate here is,

"THE CONCEPT OF MANAGED CARE AND VARIOUS ROLES OF THE LOCAL GOVERNMENT"

What is MANAGED CARE?

Referring to Bashir Mamdani, Meenal Mamdani in the book of "Managed Care in the USA: History and Structure", managed care combines financing and delivery of health care in a single entity with the aim of improving quality of care while controlling costs.

After listened to the lecture given by Mr. Gatot Subroto (PT.Askes KCU Yogyakarta) and through further reading about it, I understand managed care as a system that controls the financing and delivery of health services to members who are enrolled in a specific type of health care plan. Read further as I'm giving the examples and explanations of the plans provided for a better understanding about this thing:)

 What's the purpose? Any GOALS to set up to?

To ensure that:

• providers deliver high quality care in an environment that manages or controls costs.
• the care delivered is necessary and appropriate for the patient’s condition.
• care is provided by the most appropriate provider and settings.

In general: To eliminate inappropriate tasks and ensure that cost effective practice is adapted.

How does it works?

Briefly say, managed care works through modifying the actions of doctors (or other professionals initiating care) to reach its goals.

Do managed care have any level of its implementation or success?

It's measured in a way of growth of its maturity from 1st Generation to 5th Generation.

Generations	Main points
1st	i.    Retrospective utilization review Doctors do something --> they review it --> they correct it ii. 2nd opinion programme Comparing one provider to another Eg. Dr Taufiqah is having a patient with a heart problem. She discussed it with Dr Nazshua and he suggested that the patient needs an open heart surgery. Dr Taufiqah then asked Dr Djoko who had been a cardiologist for 20 years to get his opinion. Dr Djoko will do the examination and he’ll decide the management.
2nd	Increase use of capitation and gatekeeper (Primary Care Provider) by ensuring that the reference system is really works.
3rd	i.      Management of high cost cases         ii.      Providing or profiling Eg. Comparing one Rumah Sakit to another Rumah Sakit of the same class level.       iii.      Clinical practice Guidelines
4th	i.      Increasing interest in health outcomes         ii.      Health plan report cards (league)       iii.      Health system integration       iv.      Improved information system and system monitoring
5th	i.         Anticipatory case management       ii.         Targeted disease management     iii.         Outcomes- based reimbursement     iv.         Community- based needs assessment

*The examples I gave are based on my understanding by what the guest lecturer conveyed. Please correct me if I'm wrong. Thank you very much*

• ASKES in Indonesia are now reaching between the 3rd to 4th Generation.
• The 4th Generation features are now developing in US.

What are the major types of Managed Care plans?

Health Maintenance Organizations (HMO)	Preferred Provider Organizations (PPO)	Point of Service (POS)
HMO + Health care providers --> “Provider Network” A contracted provider provides services to health plan members at discounted rate in exchange for receiving health plan referrals.	PPO + Health care providers --> “Provider Network”	POS + Health care providers --> “Provider Network”
Members must only see providers within this network to have their health care paid by the HMO.	Members have no gatekeeper nor do they have to use an in- network provider for their care.	1.Often called an HMO/ PPO hybrid or an “open- ended” HMO 2.It’s called “point- of- service”: Members choose which option (HMO or PPO) they will use each time they seek health care.
Members select a Primary Care Physician (PCP) i.e. the gatekeeper.	Offers members “richer” benefits as financial incentives. Eg. If Miss Taufiqah sees an in- network family physician for a routine visit, she only has a small co- payment or deductible. If she sees a non- network family physician, she has to pay as much as 50% of the total bill.	Encourage, but don’t require members to choose a PCP.
Most restrictive because providing members the least choice in choosing a provider.	Less restrictive than HMOs in the choice of health care providers.	Offers more flexibility and freedom of choice.
Provide members with a greater range of health benefits for the lowest out- of- pocket expenses.	Require greater out- of- pocket payments from the members.	Members who choose not to use their PCPs for referrals (but still seek care for an in – network provider) still receive benefits but will pay higher copays and/ or deductible than members who use their PCPs.

All of all, this intended to reduce the cost of providing health benefits and improve the quality of care :)

Frankly speaking, before I had a discussion about this, I actually confused on how POS really works. Reading alone 2, 3 times made me dizzier@_@ Hence, a bunch of THANKS to my group members (Group 8 For The Win~) for giving a good explanations about it during the tutorial sessions and to our tutor, dr. Luthfan Lazuardi for the kind assistance.

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References:

• "MANAGED CARE", Guest Lecture by Gatot Subroto (PT.Askes KCU Yogyakarta)
• "Physisician Income and Its Impact on Quality: GROUP 8 TUTORIAL SESSIONS (Week 2)
• Advantages & Disadvantages of HMO, PPO & POS Plans 

The Way How Care Is Showed

My today's post is about:

"THE USE OF HEALTH INSURANCE IN FINANCING MEDICAL HEALTH SERVICE"

  

What is Health Insurance?

• It is basically a promise by an insurance company or health plan to provide or pay for health care services in exchange for payment of premiums.
• form of collectivism by means of which people collectively pool their risk, in this case the risk of incurring medical expenses.

In Indonesia, PT Askes Indonesia is one of the social insurance company that carries out health insurance to its members who are mainly civil servants and non-civilian. Their children are also guaranteed up to the age of 21 years. The retiree and his wife or the husband is also guaranteed for life.

Beyond the categories above, there are other health insurances provided:

Jamkesmas Jaminan Kesihatan Masyarakat	Programme of the Government Under Department of Health for low-income people financed by the state budget (APBN)
Jamkesda Jaminan Kesehatan Daerah Jamkesos   Jaminan Kesehatan Sosial	Under the provincial and district governments. Eg: In South Sumatra province, it’s called Jamsoskes.

Trust me, if you ever had to pay for health services yourself, you might be shocked with how high the cost are. In fact, most people will not be able to afford to pay for major health services themselves. Lets just take myself as an example on the use of health insurance in financing medical and health service:)

I was admitted in JIH in the previous May for Dengue Hemorrhagic Fever. The total of my 5 days of hospitalization, doctor's fee (Jasa visit Dokter Spesialis i.e room visit specialist), the medications, supplements, all those diagnostic and laboratories procedures, and many other things in the list costs me Rp 14 million (and plus plus plus). I am the member of Takaful Indonesia Insurance and under specific terms and conditions, I only had to pay around Rp 400 000 which goes to the supplements and extra bedding for extra people to stay with me during my stay. It's a jackpot having to pay only that much for a good, first class service:)

Simply say, we won't get stuck paying for the entire bill. Why? Because we are insured against the high cost of medical care in the event that we need it.

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References:

• "MANAGED CARE", Guest Lecture by Gatot Subroto (PT.Askes KCU Yogyakarta)
• "Physisician Income and Its Impact on Quality: GROUP 8 TUTORIAL SESSIONS (Week 2)
• Advantages & Disadvantages of HMO, PPO & POS Plans 

A PENNY for A GIFT OF SERVICE

"THE PAYMENT SYSTEM AND MECHANISM FOR PAYMENT IN RELATION TO THE PROFESSIONAL ROLES OF MEDICAL DOCTORS"

This topic had been such a hot topic during my group tutorial session. It's always something to put much interest on when it comes to MONEY, don't you think? :) I would like to dedicate a special thanks to the Indonesian friends in my group: Shendy Isyanto and Widyantri Wulandini for their many information shared with us about how doctor's payment in Indonesia is actually is.

Provider Payment Mechanism or simply put as the way of paying the doctors (and other health care-related bodies) are generally categorized into two types:

Let’s focus our discussion on Doctor’s payment which becomes one the most important aspect in DOCTOR’S LIFE SATISFACTION.

 

Notes: minus cost of providing practice and income tax

We move on to each of these income sources. I hope this table I made allowing an easier understanding for everyone :)

SALARY	FEE- FOR- SERVICE	CAPITATION
Monthly payment	Service- based payment	“Per- member- per- month” rate
Medical treatments are not influenced by economic incentive	Market forces mechanism	A fixed payment remitted at regular intervals to a medical provider by a managed care organization for an enrolled patient
Pros
Easier planning and budgeting	·         Increase patient satisfaction as doctors give more attention ·         Doctors are happy as income depends on the productivity	·         For Doctors: Doctor is paid by the insurance company for being listed as that patient's primary provider, even if no services are provided. It’s fixed, monthly. ·         For health insurance companies: Helps control the costs of health care, since providers will not likely recommend unnecessary procedures if they are responsible for the cost of these services.
Cons
Doctors may not deliver service to the fullest because he’ll get his salary regardless how poor his service is.	·         Hard to make a standard fee ·         Tendencies for supplier induced demand ·         Increase health inflation	Decrease patient satisfaction as doctors pay less attention

“FEE- FOR- SERVICE”

Impacts in Indonesia:

1. No standard income (unlimited incentives)

The wide variety of how the payment is made causing confusions of what is the exact appropriate payment for doctors. A doctor works in more than one hospital and more working hours certainly get higher payments compared to a doctor working otherwise. This kind of situations for instance, as what you can see in Indonesia; leads to the increasing gaps of the income between doctors .

 2. Supplier Induced Demand

Doctors intentionally increase the demand of hospital care based on economic incentive, not patient needs. For example, the essential management for patient having non specific low back pain is the prescription of NSAID (one of the analgesics example) and proper rest. But a doctor may inappropriately asked the patient for imaging test or physiotherapy, etc.

“CAPITATION”

I have given the definition and some explanations of capitation on the table above and perhaps my understanding correlated well with the concept:)

It's basically can be like, let say, I have 100 members from Insurance Company Gadjah Mada. The capitated rate is Rp 60 000 per member per month, meaning, I'll receive Rp 6 000 000 per month from Insurance Company Gadjah Mada to manage its 100 members regardless of the number of times that the 100 patients require my services or the amount of health care expenses I incur during this visit.

Many of the patients (insured members) may rarely see me, but I'm paid by the Insurance Company Gadjah Mada for being listed as the patients’ primary provider, even if no services are provided. It's like winning a lottery, eh? ^^

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References:

• "Provider Payment Mechanisms", Lecture by dr. Laksono Trisnantoro and dr. Sigit Riyarto
• "Physisician Income and Its Impact on Quality: GROUP 8 TUTORIAL SESSIONS (Week 2)
• The American Heritage® Medical Dictionary
• McGraw-Hill Concise Dictionary of Modern Medicine
• AMERICAN COLLEGE OF PHYSICIANS: Understanding Capitation
• Case management: a practical guide to success in managed care 

An ice for a hot coffee

A much larger and more explosive Merapi eruption occured on 1am, Friday, November 5, 2010. I was in a truly deep sleep I didn't realize the thunder clatter- like sounds of the volcanic eruptions heard by my housemates. 

I woke up as usual for my Subuh prayer, had my breakfast, then I did my study. I was bothered by nothing but the gray ashes which had been filling the atmosphere since days ago. My housemates and I gathered in our pallor for a together- breakfast while watching the news which most broadcasting about the eruptions. Then I felt the heat of worrying and scared. 

Malaysian Embassy had us evacuated that morning, at 9.45am to be exact. It was an experience I shall reminisce till forever. The ashes, the eruptions, those emergency situations..

It’s very unfortunate that UGM were closed that all of us missed the opportunity to have a guest lecture from the Ministry of Health. I hope we'll still have the chance to have a talk with people from such department.

PRAY FOR INDONESIA

Global Health System

First and foremost, I have to be honest that I actually have trouble to talk about this topic. It seems like this topic is too wide and have a great continuum ahead of which I feel pretty small to even dipping my toe into. So I take the lecture of "Globalization in Health" by Dr Yodi Mahendradhata as the main guideline for me to point- to- point talking about this topic. His slide- show are quite simple but he presented us a very interesting lecture bringing us to explore about Health System going back to history till today's world:) I read more on those he told us and I truly appreciate any suggestions and advises if there is any other thing I should find out.

Now lets' have a story- telling time with me:)

EVOLUTION OF GLOBAL HEALTH

"WHO"

In my very first post; F.O.R.E.W.O.R.D, I told you honestly that the first thing which flashes in my mind when it comes to Health System is WHO.Indeed anyway, WHO is a big character in the Global Health so I'll start the story with WHO itself, and directly moving on to other points related.

The embryo of WHO is OIHP, stands for L'Office International d'Hygiene Publique which was established in France. OIHP was created in December 1907, while, the League of Nations (UN) established the Health Organization of the League of Nations in Geneva in 1919.

Right after World War II (1945), the UN Conference on International Organizations in San Francisco voted to establish a new international health organization. The International Health Conference in New York approved the Constitution of the World Health Organization a year later, which would carry on the functions previously performed by the League and the OIHP.

WHO did not come into existence until 7 April 1948, when its constitution was ratified by the required 26 UN member states. And as we can see today, Baby WHO is now a Big- guy in Health System:)

"COLD WAR EFFECT"

The Cold War began with the end of the World War II. It was a period of tension and hostility between the US and the Soviet Union (1945 - 1960). To quote from Dr. Yodi Mahendradhata, it was the event of the splitting of Europe and US. It was called the Cold War because there was no active war between the two nations, which was probably due to the fear of nuclear escalation.

WHO and UN were somewhat at the same side of which US was going against to. At that time, malaria matter was such a big black dirt on a piece of white cloth. Malaria cases were so high that it caused the decrease of economy so the principle was that, the economy would be better as the malaria cased being managed.

The real agenda behind malaria matter were actually the political and economic reasons. The ability to handle critical problem of the world indirectly shows strength and power. US insisted that they could eliminate malaria. WHO and UN backed off so US held the global malaria eradication which was merely based on DDT spray. It was indeed a total failure..

There was also malaria eradication in Indonesia. In 1959, during the period of which President Sukarno was in charge in the country, Malaria Eradication Commando was formed under Ministry of Health. Yes, it also based on DDT spray. It was something truly positive about the effort made:)

"HEALTH FOR ALL by the YEAR 2000"

"Health for all by the year 2000" is the WHO slogan fruited from the Declaration of Alma-Ata in 1978, referring to the access to the basic health services as part of the fundamental human right.

"The Conference strongly reaffirms that health, which is a state of complete physical, mental, and social wellbeing, and not merely the absence of disease or infirmity, is a fundamental human right and that the attainment of the highest possible level of health is a most important world-wide social goal whose realization requires the action of many other social and economic sectors in addition to the health sector."

Alma-Ata Declaration, 1978

Personally, if you ask me, I give two thumbs up upon this idea. I somewhat see this as a generous gift to EVERYONE with not much terms and conditions to meet with. I believe we all agree that this is a perfect example of a socialist figure.

This so- called socialist idea however, was strongly disagreed by the capitalist figures. World Bank, USAID (United States Agency for International Development), UNICEF, Rockefeller and Ford Foundation challenged the Alma- Ata Declaration in Bellagio conference, 1979. In 1982, UNICEF launched "The Children revolution" to compete with WHO.

"THE CHILDREN REVOLUTION"

  
Specifically, the Child Survival and Development Revolution, was launched by UNICEF as a drive which was said to save the lives of millions of children each year.  The ‘revolution’ is based on 4 simple, low-cost techniques:

• Growth monitoring
• Oral rehydration therapy
• Breastfeeding
• Immunization

Well.. I never think that those had been made or formed are bad. Those had actually been providing us for a beneficial living ever since, I admit. But the fact that there are quite not so clean reasons of why this and that were actually given to us make me pretty aggrieved, by heart....

World slowly crawling into the Neo- liberal Era, an era which filled with economic crisis and many country collapsing or even collapsed, especially when there was a petrol crisis in 1970s. So many countries reached to point where they have to borrow money.. This condition was a jackpot to Big Power with Big Money group as they could make a benefit out of the neediness of other pathetic countries. World Bank , IMF (International Monetary Fund), and US Treasury offered a "solution" for the money problem which was called as "Washington Consensus".

"WASHINGTON CONSENSUS"
GLOBALIZATION, DECENTRALIZATION, AND HEALTH

The basic principle of this consensus is the lending of money for any country to borrow but as a compulsory change, the country have to implement the 3 principal recipes which they made:

1. Drastic cuts in public spending, including health to reduce inflation and public debt.
2. Privatization in all sectors
3. Decentralization

These may seem to be an ideal methods of problem- solving, but definitely won't goes well to every matter. But that's the must- take terms and conditions for any country who make loan from them. The analogy is like, 

"I don't care what's your disease or illness but this is the drugs you must take."

So with this, over time, World Bank gets bigger and bigger especially in the aspect of their power as more and more countries clinging on to and take their policies. The influence of World Bank becoming more and more huge, greater than that of the WHO.

"ONE FIGURE WITH ONE GREAT POWER"

One of the many things which had my interest dragged into is The Bill and Melinda Gates Foundation, a foundation named after Bill Gates himself and his wife.

We all are somewhat well introduced to who Bill Gates is: The world's richest man. Even in the field of health, this man has power which is bigger (and dollars which is lots thicker..) than the World Bank and even WHO. He is by far, the biggest single payer in Global Health.

His approaches are technically what we can expect from a very intelligent, Microsoft founder: TECHNOLOGY as the most important fundamental principle to solutions in Global Health.

It's a good thing to have a generous rich man who care for others but it's certainly not a good thing to have a rich man who spend in any way as he wishes without any control. And yes- no one, nothing deserve to control him of which this can lead to imbalance be it in the management of Global Health or in the expenditures or funding mechanism.

To me anyway, I vote for his effort:) I hope though, that he has people with the most appropriate credibility to work with him in sailing the foundation and he is truly sincere to bring good to the people:)

Take a tour:)

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References:

• "Globalization in Health", lecture by Dr. Yodi Mahendradhata, M. Sc
• The World Health Organization (WHO): Creation  
• COLD WAR 1945- 1960
• Health for all beyond 2000