St.

Paul University Philippines

Tuguegarao City, Cagayan 3500

MASTER OF SCIENCE IN NURSING

Final requirements

Global Context and Global Initiatives in Nursing

Submitted By:

Christopher-ian D. Gonzales, RN

Submitted To:

Krishan M. Soriano, MSN

SPUP Graduate School Faculty
 1. Identify one current global health issue and write a discussion or reaction about the
said issue.

Physical Activity and Nutrition

Research indicates that staying physically active can help prevent or delay certain diseases,
including some cancers, heart disease and diabetes, and also relieve depression and improve
mood. Inactivity often accompanies advancing age, but it doesn't have to. Check with your local
churches or synagogues, senior centers, and shopping malls for exercise and walking programs.
Like exercise, you’re eating habits are often not good if you live and eat alone. It's important for
successful aging to eat foods rich in nutrients and avoid the empty calories in candy and sweets.
Food provides energy for physical activity. As you get more active and more fit, and/or as you
lose weight, your energy needs (how many calories you need) may change. To get the energy
you require, you need to get the proper amount of:
 Protein, which is needed to maintain and rebuild tissues such as muscles.
 Carbohydrate, which is the body's preferred source of energy.
 Fat, which also provides energy.
 Water, to replace water lost through activity.
Eating a diet that is varied, balanced, and moderate can provide you with all the nutrients the
body needs without getting too much or too little of any one nutrient.
 Balance means eating the recommended number of servings from each food group most
days.
 Variety within each food group (for example, eating different fruits from the fruit group
instead of eating only apples) ensures that you will get all the nutrients you need, since no
one food provides every nutrient. Eating a wide variety of foods will also help you avoid
eating too much of any substance that may be harmful.
 Moderation means eating a little of everything but nothing in excess. All foods can fit
into a healthy diet if you eat everything in moderation.
Those who are very active or who are athletes may have special nutritional needs. They usually
don't need more protein than other people, but they do need more carbohydrate (grains,
vegetables, fruits) than the amount recommended for the average person. Carbohydrate is stored
as ready energy in the liver and muscles, and this supply is used up very quickly during exercise.
Endurance athletes (such as runners and cyclists) need a particularly large amount of
carbohydrate. The carbohydrate needs to be eaten right before and during exercise, because the
body cannot store a lot of carbohydrate.
For a better understanding of your own nutritional requirements, talk to a sports
doctor or dietitian.

2. Identify a current health problem here in the Philippines and answer the following.

TUBERCULOSIS

A bacterial infection spread through inhaling any droplets from the coughs on sneezes of an
infected person. It mainly affects the lungs, but it can affect any part of the body, including the
tummy (abdomen), glands, bones and nervous system.

TB is a potentially serious condition, but it can be cured if it's treated with the right antibiotics.

Tuberculosis is a disease that can take human being into his grave if not treated on time. It is an
infectious disease in humans caused by Mycobacterium tuberculosis which belongs to the same
group of microorganisms as mycobacterium aticanum and mycobacterium bovis. Transmission is
through droplets released into the air from an infected individual through sneezing, shouting,
coughing and singing (Bynum 2012). Pulmonary tuberculosis is the most common form of post
primary disease. (Walter, College, Ralston, and Penman, 2014). Tuberculosis is one of the fatal
infectious diseases with a very high morbidity and mortality rate. According to Lawn and Zumla
(2015) tuberculosis accounted for about 25% of all deaths in Europe during the 19th century.
Despite the improvements in housing and sanitation the mortality rate for tuberculosis is almost
the same as it was a century ago with 50% of those infected dying (WHO, 2014). In 2014,
approximately 9 million people contracted tuberculosis and about 1.5 million died due to the
disease (WHO, 2015). Liberia with a population of about 3.5 million has tuberculosis
prevalence. Worse yet, the latest prevalence study revealed that the burden of TB is actually 1.6
times higher than previously estimated. It was found that ~59% of patients were not symptomatic
or did not seek care for their symptoms and thereby were not captured by the passive healthcare
system. Further, over half of the remaining patients sought out private providers (PPs). These
PPs significantly impair TB control due to inconsistent and inappropriate treatment. Despite the
obvious shortcomings of the private sector, patients lack a viable alternative because government
TB services suffer from severe staff shortages limiting operating hours, extending wait times,
and decreasing quality of care.

Tuberculosis remains to be one of the top leading causes of death in the Philippines. Yearly
millions of Filipinos die because of this culprit. Department of Health is aggressively working
towards the total eradication of the said disease.

The World Health Organization estimates that 9 million people a year get sick with TB, with 3
million of these "missed" by health systems
TB is among the top 3 causes of death for women aged 15 to 44.

About one-third of the world's population is believed to have latent TB. There is a 10 percent
chance of latent TB becoming active, but this risk is much higher in people who have
compromised immune systems, i.e., people living with HIV or malnutrition, or people who
smoke.

Symptoms of TB

Typical symptoms of TB include:

 a persistent cough that lasts more than 3 weeks and usually brings up phlegm, which may
be bloody
 weight loss
 night sweats
 high temperature
 tiredness and fatigue
 loss of appetite
 swellings in the neck

a. What country has the problem as the Philippines?

Africa is facing the worst tuberculosis epidemic since the advent of the antibiotic era. Driven by
a generalized human immunodeficiency virus (HIV) epidemic and compounded by weak health
care systems, inadequate laboratories, and conditions that promote transmission of infection, this
devastating situation has steadily worsened, exacerbated by the emergence of drug-resistant
strains of tuberculosis.

Africa, home to 11% of the world's population, carries 29% of the global burden of tuberculosis
cases and 34% of related deaths, and the challenges of controlling the disease in the region have
never been greater. The World Health Organization (WHO) estimates that the average incidence
of tuberculosis in African countries more than doubled between 1990 and 2005, from 149 to 343
per 100,000 populations a stark contrast to the stable or declining rates in all other regions during
this period. In 1990, two African countries, Mali and Togo, had an incidence greater than 300 per
100,000; by 2005, 25 countries had reached that level, and 8 of them had an incidence at least
twice that high.

The unprecedented growth of the tuberculosis epidemic in Africa is attributable to several

factors, the most important being the HIV epidemic. Although HIV is Africa's leading cause of
death, tuberculosis is the most common coexisting condition in people who die from AIDS.

b. Compare the strategies between the countries to alleviate the issue

The ability of African health care systems to respond to, manage, and contain the growing
number of cases of tuberculosis is constrained by limitations of funding, facilities, personnel,
drug supplies, and laboratory capacity. Although the President's Emergency Plan for AIDS
Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis, and Malaria have donated
large sums of money to help address Africa's health problems, most of the money has been
earmarked for HIV, with a lesser focus on tuberculosis.

Another critical factor concerns early diagnosis and treatment of tuberculosis, which limits the
spread of the disease and reduces deaths. Throughout Africa, diagnosis rests on the
microscopically detection of acid-fast bacilli in sputum, an insensitive technique that is
particularly ill suited to the detection of tuberculosis in HIV-infected patients, who have fewer
bacilli in their sputum and have more extra pulmonary tuberculosis than HIV-negative patients;
the WHO estimates that only half of all persons with smear-positive tuberculosis are identified.
Modern culture and nucleic acid–amplification systems are rarely available. As a result, many
people remain ill and contagious for prolonged periods before the disease is detected, and
thousands die without ever having received a diagnosis of tuberculosis. Unfortunately, even with
diagnosis, the average rate of successful treatment is less than 70%, far below the WHO target of
85%, making both relapse and the emergence of drug resistance common.

In the midst of this bleak situation, there is a glimmer of hope. In 2005, the African ministers of
health declared a “TB Emergency,” promising swift and concerted action to combat the disease.
And the global health community has increased its investment in tuberculosis control and
research. HIV activists, having achieved success in their AIDS awareness and funding efforts,
have set their sights on tuberculosis. At an international tuberculosis conference in South Africa
in November 2007, more than 3000 delegates brought a new level of attention and urgency to
Africa's unprecedented health problems. In the meantime, Africa's health care systems can adopt
new strategies for improving disease-control outcomes. Better use of existing, highly sensitive
culture techniques could reduce mortality rates associated with tuberculosis by 20% or
more,4 and implementation of treatment programs that meet WHO targets could have a
substantial effect on survival and transmission rates. Interventions directed at people with the
highest risk, including families of patients with tuberculosis or HIV infection could be extremely
effective.

The WHO, for its part, is promoting various interventions, including supplementation of sputum
smears with liquid tuberculosis-culture systems for patients with HIV, increased investments in
laboratory services, surveillance of drug resistance, and widespread use of preventive therapy for
HIV-infected persons. A new initiative launched by the WHO's Stop TB and HIV departments
emphasizes the three I's: intensified case finding, isoniazid preventive therapy, and infection
control.

PHILIPPINES
This study seeks to determine the incidence of latent TB in District 6 of Metro Manila as well as
the current rate of MDR-TB infection.  As latent TB infection often results from an active TB
infection that was incompletely treated, it is likely to be a risk factor for developing MDR-TB
(Espinal).  LTBI requires a different suite of drug treatments than MDR-TB, as MDR-TB does
not respond to some or all first-line drugs.  LTBI is asymptomatic, but under the current
physician guidelines posted by the National Tuberculosis Program of the Philippines, patients are
only sent in for testing if they are symptomatic.  As a result, LTBI prevalence is highly unknown,
despite its role in MDR-TB development. Effective drug therapies exist, and, according to the
Comprehensive and Unified Policy for TB Control in the Philippines, should be provided free
from the government.  Knowledge of LTBI prevalence, however, is relatively unknown, and
would be valuable for treatment. 
            This study also seeks to determine the incidence of MDR-TB amongst TB patients in
District 6 of Metro Manila.  The prevalence of MDR-TB in the Philippines may be underreported
due to the National Tuberculosis Program guidelines and current health infrastructure.  This
information, however, is vital to the proper management of MDR-TB cases. 
            Currently, there is a lack of LTBI and drug susceptibility testing in the Philippines, and
with its high population density and its poverty, District 6 of Metro Manila seemed to us a good
place to start to combat this dangerous lack of knowledge. Understanding these rates, we hope,
will help public health and government officials to combat the disease more intelligently and to
take greater strides toward eliminating it as quickly and efficiently as possible.  In addition to
helping through the uncovering of the rates of latent and MDR-TB, we hope the use of this Rapid
Molecular Diagnostic Test will prove the functionality of the diagnostic itself and lead to a
decrease in the amount of time and lab resources that it takes to perform the diagnostic.

c. Identify the key roles of various agencies about the issue.

The National Tuberculosis Control Program (NTP) works closely with all stakeholders - national
government agencies, public and private sectors, nongovernmental organizations, professional
societies, academe, patient groups, civil societies, and development partners - in the Philippines'
fight against tuberculosis, especially at this time of the COVID-19 pandemic.

The NTP has the following mandates:

1. Develop policies, standards, and national strategic plan

2. Manage program logistics
3. Provide leadership and technical assistance to the lower health offices/units
4. Manage data and use the information to inform programmatic activities
5. Conduct monitoring and evaluation

Long-Term Goal (2035)

Reduce TB burden by decreasing TB mortality by 95% and TB incidence by 90%.

 Medium-Term Goals (2022)

Reduce TB burden by:

 Decreasing the number of TB deaths by 50% from 22,000 to 11,000

 Decreasing TB incidence rate by 15% from 554/100,000 to 470/100,000
 Reduce catastrophic costs incurred by TB-affected households from 35% to 0%.
 At least 90% of patients are satisfied with the services of the DOTS facilities.

Specific Objectives by 2022

 Improve the utilization of TB care and prevention services by patients and communities.
 Reduce the catastrophic cost of TB-affected households accessing DOTS facilities to 0%.
 Ensure adequate and competent human resources for TB elimination efforts.
 Improve the use of TB data for effective TB elimination efforts.
 Enhance the quality of all TB care and prevention services.
 Increase to at least 90% of DOTS facilities that provide expanded integrated patient-
centered TB care and prevention services.
  Enhance the political stewardship through a high-level political commitment of national
government agencies and LGUs to implement localized TB elimination plans in
coordination with different sectors.

 The 17 Centers for Health Development (CHD), through its regional NTP teams,
manage the TB program at the regional level while the PHOs and city health
offices (CHOs), through its provincial/city teams, are responsible for the TB
control efforts in the provinces and cities.

 TB diagnostic and treatment services are part of the basic integrated health
services which are provided by DOTS (Directly Observed Treatment, Short
Course, current means of delivery of treatment Services) facilities which could
either be the public health facilities, such as the RHUs, health centers, hospitals;
other public health facilities, such as school clinics, military hospitals, prison/jail
clinics; NTP-engaged private facilities, such as the private clinics, private
hospitals, private laboratories, drugstores, and others. Community groups, such as
the community health teams and barangay health workers, participate in
community-level activities .

Since the World Health Organization declared tuberculosis (TB) to be a global health
emergency in 1993, global efforts to address TB have become more prominent, and
worldwide TB incidence and mortality rates have fallen. Still, in 2019, there were an
estimated 10.0 million new cases of TB globally, including 815,000 new cases in people
living with HIV.
 In response to the persistent challenges related to TB, including drug-resistant TB, the
U.N. General Assembly held its first-ever high-level meeting on TB in 2018 to discuss
these challenges and examine progress toward global goals, including ending the
epidemic by 2030.

U.S. government (U.S.) involvement in global TB efforts was relatively limited until the
late 1990s. Since that time, its efforts to address TB have grown, and now the U.S. is one
of the largest donors to global TB control.

U.S. TB activities reach more than 50 countries (including at least 20 of the 30 high
burden countries where most new cases are occurring), and focus on preventing,
detecting, and treating TB, including drug-resistant TB, as well as research and
development.

U.S. funding for global TB efforts was $332 million in FY 2021, up from $64 million in
FY 2001. Additionally, the U.S. is the largest donor to the Global Fund to Fight AIDS,
Tuberculosis and Malaria (Global Fund).

Interventions
The End TB Strategy, the internationally-recognized strategy for ending the TB epidemic,
outlines interventions aimed at decreasing TB-related morbidity, death, and transmission. They
include:

 early diagnosis of TB via sputum-smear microscopy,

 treatment (usually a six-month course of antibiotics for drug-sensitive TB) and patient
support for all people with TB,

 scaled-up diagnosis and management of MDR- and XDR-TB,

 systematic screening for and management of TB among people living with HIV and
others in high-risk groups,
 preventive treatment and vaccination for high-risk groups, and

 Research and development (R&D) of new tools (e.g., new TB diagnostics, drugs, and
vaccines) and improved approaches.
Other interventions include the development of policies and systems that support TB activities,
such as improved standardized data collection, quality assurance and rational use of drugs, and
monitoring and evaluation of outcomes; sustained political and financial commitment to TB
efforts; health systems strengthening; and increased health workforce capacity to respond to TB.

Global Goals

Since the 1993 declaration of TB as a global health emergency by WHO, major global TB goals
have most recently been set through:
SUSTAINABLE DEVELOPMENT GOALS (SDGS)

Adopted in 2015, the Sustainable Development goals (SDGs) aim to end the TB epidemic by
2030 under SDG Goal 3, which is to “ensure healthy lives and promote well-being for all at all
ages.”The SDGs are the successor to the Millennium Development Goals (MDGs), which
included a tuberculosis target under MDG 6: to halt and begin to reverse the incidence of TB by
2015.

END TB STRATEGY

Endorsed by governments at the 2014 World Health Assembly, the End TB Strategy set an

overarching goal of ending the global TB epidemic as well as targets for achieving, by 2035, a
95% reduction in TB deaths and a 90% reduction in TB incidence (compared with 2015 levels).
It builds on the earlier 2006 international Stop TB Strategy, in which WHO outlined the goal of
eliminating TB as a public health problem by 2050. The Global Plan to End TB outlines the steps
and resources needed to achieve the End TB Strategy’s goals and is periodically updated by the
Stop TB Partnership (an international network of public and private entities working to eliminate
TB).

NTP closely works with the 17 government offices and private organizations in
compliance with the Comprehensive and Unified Policy (CUP) issued by the Office of the
President in 2003. Under the framework of public-private mix (PPM) collaboration in
TB-DOTS, NTP collaborates with nongovernmental organizations, such as the Philippine
Coalition Against TB (Phil CAT), a consortium of 60 groups, and the 100-year-old
Philippine TB Society, Inc. (PTSI), and many others.

Various developmental partners and their projects provide technical and financial support
to NTP, such as the World Health Organization (WHO), United States Agency for
International Development (USAID), Global Fund Against AIDS, TB and Malaria
(Global Fund), Research Institute of TB/Japan Anti-TB Association (RIT/JATA), Korean
Foundation for International Health (KOFIH) and Korean International Cooperation
Agency (KOICA) and KNCV Tuberculosis Foundation.

3. Identify current research that pertains to global health issue and answer the
following.

Research is also needed in order to take an interdisciplinary approach to global health problems,
which are multi-faceted in nature. Health is a broad concept that is influenced by various social,
economic and political determinants.  While disease is caused by microorganisms, disease is also
linked to certain “inherently global health issues, such as water shortages, deforestation,
greenhouse gas emissions, increasing poverty, financial instability, trade, war and conflict etc.
For instance, a singular focus on HIV/AIDS ignores the many other dimensions of the disease:

“The HIV/AIDS pandemic, particularly in Africa, affects several vulnerable groups, particularly
women. Poverty, war and conflict, and ecological degradation are all important co-factors.
Liberalization, structural adjustment programs, and the aid policies of wealthy nations, which
constrain taxation revenue and equitable access to health services, are also determinants. Trade
agreements underpinning the HIV/AIDS pandemic relate to intellectual property rights (patents)
and accessibility of drugs, as well as the decline in “special and differential” exemptions that
poorer countries can invoke to protect their still developing domestic economies to ensure
greater growth and fairer distribution of its benefits. No single research project on HIV/AIDS
should be expected to incorporate all of these elements. A singular focus on HIV/AIDS,
however, obscures the important role of these and other co-factors of inherently global health
issues.”

Furthermore, perceptions of disease and healthcare vary with culture. In the developing world,
different stigmas may be attached to disease, which in turn may be attributed to a variety of
beliefs not commonly held by those in the Western world. Oftentimes, the stigma that
accompanies disease is so great that people are unwilling to seek treatment. Therefore, stigma is
a barrier to effective healthcare delivery which research seeks to eliminate.

“Although the particular negative attributes a society ascribes to a [medical] condition may vary
widely with the culture, there is a common thread of implied moral wrong. The stigmatized
individual is seen as an affront to the moral order, one who violates the norm, becoming a public
enemy who evokes fear, even fear for one’s life, and hence someone who must be put down – or
put out – literally isolated.
When a cross-cultural medical or public health intervention is to be implemented, research
should be conducted to examine the social factors that may impede the delivery of care. Without
a sound understanding of a community’s cultural psyche, many health workers find that
programs fail despite their best efforts and advanced technologies. To avoid such pitfalls, health
workers must conduct research to understand the cultural perceptions of disease in the
communities where they serve, and develop culturally-sound approaches to healthcare delivery.
 a. Explain the research’s initiative and purpose for global health

International health is used in regard to the numerous governmental and

nongovernmental organizations throughout the world that are concerned with human
health and disease. Those organizations broadly deal with health issues that involve both
economically advanced and less developed nations although the focus is frequently on
impoverished populations in both settings. Examples include the following: World Health
Organization, United Nations and its various agencies such as United Nations
Development Programs, United Nations International Children’s Emergency Fund and
United Nations High Commission on Refugees, the World Bank and NGOs supported by
Philanthropy such as the Welcome Trust. Those organizations work with national and
regional health authorities to address operational and research issues. The creation and
maintenance of those groups have resulted from moral, social, and financial obligations
and altruism ( Basch; Merson et al.)
International health also relates to biomedical research and health policy issues that cross
national boundaries and increasingly involve the participation of people who live in
developing countries. Bioethical issues arising from the conduct of research on people in
economically depressed regions have received much attention over the last several years.
This entry deals with ethical issues that have been sources of controversy and debate in
the context of international health. It focusses on issues outside of one’s own country, its
cooperation is bi- national embraces only few disciplines.

Emerging Issues in Global Health Globally, the rate of deaths from non-communicable
causes, such as heart disease, stroke, and injuries, is growing. At the same time, the
number of deaths from infectious diseases, such as malaria, tuberculosis, and vaccine-
preventable diseases, is decreasing.
Global health initiatives were established to tackle increasing global health threats,
reduce disparities within communities and between nations and contribute to a world
where people live healthier, safer and longer lives.

b. What can it contribute to society?

Global Health Initiatives (GHI) is improving lives around the globe by providing high quality
healthcare in collaboration with local partners to strengthen health systems in developing
countries.

Not only does better population health reduce losses due to morbidity and mortality, but the
modification of microeconomic behaviors related to anticipation of longer life expectancy fuels
increased savings and investment, as well as the transmission of improved human capital from
one generation to the next.
In performance assessment, outputs are defined as the goods or services produced by programs
or agencies and outcomes are defined as the impacts on social, economic, or other indicators
arising from the delivery of outputs. Typically, outputs are used to document the amount, quality,
or volume of use of the project's products or services.

While outputs are important to track, evaluation needs to focus on measuring outcomes that
reveal the extent and kinds of impact the project has on its participants. Impact could be reported
in the amount of change in behavior, attitude, skills, knowledge or condition of the target
population. For example, an output would be the number of microfinance loans distributed or the
number of loans repaid, whereas the outcome would be the number of microfinance participants
who have significantly increased their income or risen out of poverty due to the loans.  Similarly,
job training programs have an output of the number of people enrolled in the program.  The
outcome would be the number of people who were able to get a job due to the training program. 
Research is needed to identify both outcomes and outputs in order to identify best practices and
ensure funding.

c. What nations can benefit from this research and why?

The health impacts of globalization are simultaneously positive and negative, varying according
to factors such as geographical location, sex, age, ethnic origin, education level, and
socioeconomic status. Globalization is not an unstoppable force. Our key challenge is to create
socially and environmentally sustainable forms of globalization that provide the greatest benefits
and least costs, shared more equitably than is currently the case. The health community must
engage more directly in current research on globalization and encourage values that promote
human health. At the same time, those at the helm of globalization processes must recognize the
attending to health impacts will strengthen the long-term sustainability of globalization.

The spread of diseases does not stop at a country’s borders. With more people travelling to other
countries and living in crowded cities, it’s easier for germs to spread. Infectious diseases that
start in one part of the world can quickly reach another. Resistance to medicines such as
antibiotics is on the rise. This makes it harder to treat certain diseases. Natural and man – made
disasters create refugee populations with immediate and long-term health problems. Some of the
major diseases currently affecting countries are HIV/AIDS, malaria, zika, tuberculosis. Climate
change is also an international problem which can affect people’s health.

4. What strategy can we benchmark from other countries like USA, Switzerland,
ASEAN regions, United Kingdom help our own country in improving our health
care system.

Health Care System in the US:

The U.S. health care system is unique among advanced industrialized countries. The U.S. does
not have a uniform health system, has no universal health care coverage, and only recently
enacted legislation mandating healthcare coverage for almost everyone. Rather than operating
a national health service, a single-payer national health insurance system, or a multi-payer
universal health insurance fund, the U.S. health care system can best be described as a hybrid
system. In 2014, 48 percent of U.S. health care spending came from private funds, with 28
percent coming from households and 20 percent coming from private businesses. The federal
government accounted for 28 percent of spending while state and local governments accounted
for 17 percent. Most health care, even if publicly financed, is delivered privately.

In 2014, 283.2 million people in the U.S., 89.6 percent of the U.S. population had some type of
health insurance, with 66 percent of workers covered by a private health insurance plan.
Among the insured, 115.4 million people, 36.5 percent of the population, received coverage
through the U.S. government in 2014 through Medicare (50.5 million), Medicaid (61.65
million), and/or Veterans Administration or other military care (14.14 million) (people may be
covered by more than one government plan). In 2014, nearly 32.9 million people in the U.S.
had no health insurance.

This fact sheet will compare the U.S. health care system to other advanced industrialized
nations, with a focus on the problems of high health care costs and disparities in insurance
coverage in the U.S. It will then outline some common methods used in other countries to
lower health care costs, examine the German health care system as a model for non-centralized
universal care, and put the quality of U.S. health care in an international context.

Health Care System in the SWITZERLAND:

Switzerland’s health system has been described by some as the best in the world and is often
held up as a model for other countries.

The reasons are easy to see: Switzerland has an extensive network of doctors and clean, well-
equipped hospitals and clinics; waiting lists for treatment are short; patients are free to choose
their own doctor and usually have unlimited access to specialists; accident and emergency rooms
are rarely overwhelmed. That’s probably why around 90% of users report moderate or complete
satisfaction with the system.

Health Care System in ASEAN REGIONS:

The pressures placed on national healthcare systems by the recent demographic and
epidemiological transitions are amplified by the growing demands of an increasingly educated
and affluent population for high-quality healthcare. Many traditional health practices persist
alongside the use of new medical technologies and pharmaceutical products, presenting
regulatory problems in terms of safety and quality.

Countries in Southeast Asia and their health system reforms can thus be categorized according to
the stages of development of their healthcare systems. A typology of common issues, challenges
and priorities are generated for the diverse mix of health systems at different stages of
socioeconomic development.

Southeast Asia is a region characterized by much diversity. Social, political and economic
development during the past few decades has facilitated substantial health gains in some
countries, and smaller changes in others. The geology of the region, making it highly susceptible
to earthquakes and resultant tsunamis, along with seasonal typhoons and floods, further increases
health risks to the population from natural disasters and long-term effects of climate change.
Public policy in these countries cannot ignore such risks to health, which could have important
social and economic consequences. Regional cooperation around disaster preparedness and in the
surveillance of and health systems response to disease outbreaks has obvious advantages as a
public health strategy.

Concomitantly, all countries in the region are faced with large or looming chronic disease
epidemics. Even in the poorest populations of the region, non-communicable diseases already
kill more people than do communicable, maternal and prenatal conditions combined, with many
of these deaths occurring before old age.

Greatly strengthened health promotion and disease prevention strategies are an urgent priority if
the impressive health gains of the past few decades in most countries of the region are to be
replicated. Further growth and integration of the ASEAN region should prioritize enhanced
regional cooperation in the health sector to share knowledge and rationalize health systems
operations, leading to further public health gains for the region’s diverse populations.

Health Care System in UNITED KINGDOM:

The United Kingdom is a sovereign state located off the north-western coast of Europe. The
country includes the island of Great Britain, the north-eastern part of the island of Ireland and
many smaller islands. It has a population of 62,262,000 people and a reported GDP of $2.260
trillion Great Britain Pounds. The United Kingdom provides public healthcare to all permanent
residents, about 58 million people. Healthcare coverage is free at the point of need, and is paid
for by general taxation. About 18% of a citizen’s income tax goes towards healthcare, which is
about 4.5% of the average citizen’s income. Overall, around 8.4 percent of the UK's gross
domestic product is spent on healthcare (an amount of around 0.18984 trillion GBP). UK also
has a growing private healthcare sector that is still much smaller than the public sector.

The UK has a government-sponsored universal healthcare system called the National Health
Service (NHS). The NHS consists of a series of publicly funded healthcare systems in the UK. It
includes the National Health Services (England), NHS Scotland, NHS Wales and Health and
Social Care in Northern Ireland. Citizens are entitled to healthcare under this system, but have
the option to buy private health insurance as well. The NHS Plan promises more power and
information for patients, more hospitals and beds, more doctors and nurses, significantly shorter
waiting times for appointments, improved healthcare for older patients, and tougher standards for
NHS organizations. The UK's health care system is one of the most efficient in the world,
according to a study of seven industrialized countries. The Commonwealth Fund report looked at
five areas of performance - quality, efficiency, access to care, equity and healthy lives, The
Netherlands ranked first overall, closely followed by the UK and Australia. UK performed well
when it came to quality of care and access to care. The UK also ranked first in efficiency, which
was measured by examining total national spending on healthcare as a percentage of GDP, as
well as the amount spent on healthcare administration and insurance. In regards to access to care,
the study states: "The UK has relatively short waiting times for basic medical care and non-
emergency access to services after hours, but has longer waiting times for specialist care and
elective, non-emergency surgery."

5. Cite your references appropriately. Use APA format 6th edition.

1. WHO report 2007: global tuberculosis control: surveillance, planning, financing. Geneva:
World Health Organization, 2007. (WHO/HTM/TB/2007.376.)

2. Ansari NA, Kombe AH, Kenyon TA, et al. Pathology and causes of death in a group of
128 predominantly HIV-positive patients in Botswana 1997-1998. Int J Tuberc Lung
Dis 2002;6:55-63

3. Alka M. Kanaya, David V. Glidden, Henry F. Chambers. “Identifying Pulmonary

Tuberculosis in Patients with Negative Sputum Smear Results.” Chest (Vol 120: pg. 349-
355). 2001.

4.  “Clinical Practice Guidelines for the Diagnosis, Treatment, Prevention and Control of
Tuberculosis in Adult Filipinos: 2006.” Task force for Tuberculosis. 2006 Update.

5. A Comparative Analysis of United Kingdom and the United States Health Care Systems
Abbie McClintock Roe, MSHSA; Aaron Liberman, PhD, The Health Care Manager,
Volume 26, Number 3, pp. 190-212. 2007 Wolters Kluwer Health I Lippincott Williams
& Wilkins http://www.slideshare.net/abbiemc/A-Comparative-Analysis-of-the-UK-and-
US-Health-Care-Systems

6. Delisle, H., Roberts, J. H., Munro, M., Jones, L., & Gyorkos, T. W. (2005). The role of
NGOs in global health research for development. Health research policy and
systems, 3(1), 1-21.