1-2 Assistance Necessary to Promote People-centered Development that Supports Basic Human Life
Japan has proactively advocated the concept of “human security” to the international community, a notion that seeks to protect people from widespread and serious threats to the survival, livelihood, and dignity of humans and help them fulfill their abundant potential. There can be no quality growth without “human security.” The following introduces the dimensions that support basic human life, including health, water, education, culture, etc. through a people-centered approach.
(1) Health and Population
Many of the people living in developing countries cannot easily access the basic health services that are available day-to-day in developed countries. With regard to MDGs, the international community worked together to achieve the health-related goals (Goal 4: Reduce child mortality, Goal 5: Improve maternal health, Goal 6: Combat HIV/AIDS, malaria, and other diseases), but still more than 5.9 million children under the age of five die annually due to infectious diseases, nutritional deficiency, diarrhea, and other ailments. (Note 12) Over 280,000 pregnant women also lose their lives every year, unable to receive emergency obstetric care from skilled birth attendants, including obstetrician, gynecologist, and midwife. (Note 13) Furthermore, due to high rates of population growth, poor countries suffer from further poverty, unemployment, famine, poor access to and quality of education, and environmental deterioration.
In recent years there is a need for addressing new issues, for example, malnutrition, non-communicable diseases such as diabetes and cancer, and aging population and in SDGs adopted in the United Nations as the successors of the MDGs, Goal 3 is set as “Ensure healthy lives and promote well-being for all at all ages.”
In order to respond to the increasingly diversified health issues internationally and locally, it is important to achieve “universal health coverage (UHC)” to ensure that all people can access and receive the basic health services when they need them at an affordable cost.
<Japan’s Efforts>
| Health
Japan has been placing importance on efforts in the healthcare field that directly links to human security. In response to the establishment of the Development Cooperation Charter in February 2015, the Government of Japan established the Basic Design for Peace and Health as a guideline for global health policy in September. This policy aims to make full use of Japan’s expertise, technologies, medical devices, and services to: (i) establish a system to respond to public health emergencies such as the Ebola virus disease; and (ii) provide basic health services for all people throughout their lifetimes. These efforts are important also for the pursuit of the health goals identified in the 2030 Agenda. Moreover, in September 2015 the Government of Japan stipulated the Basic Guideline for Strengthening Measures on Emerging Infectious Diseases. The guideline presents the direction and priority actions for the next five years, in order to strengthen the measures against infectious diseases that could become global threats.
Furthermore, Japan has led discussions in the international community regarding the strengthening of health systems and the promotion of UHC. For example, infectious diseases were raised as a major topic of discussion at the G8 Kyushu-Okinawa Summit in 2000 for the first time in the history of the summit. At the G8 Hokkaido Toyako Summit in July 2008, an appeal was made on the importance of strengthening health systems. Moreover, at the G8 Muskoka Summit (Canada) in 2010, the Muskoka Initiative was launched to strengthen support for maternal and child health and Japan announced that it would additionally provide up to ¥50 billion, or approximately $500 million, over the five years from 2011.
At the G7 Ise-Shima Summit in 2016, the leaders agreed on the importance of reinforcing the capacity of the international community to respond to public health emergencies such as the infectious diseases, and promoting UHC, which is the key to responding to a wide range of health issues and offers better preparedness for emergencies, and reinforcing responses to antimicrobial resistance (AMR), and announced the “G7 Ise-Shima Vision for Global Health.”
Moreover, at a side event on UHC on the occasion of TICAD VI in August 2016, Prime Minister Abe stated his determination to contribute to strengthening responses as well as prevention of and preparedness against public health emergencies and to promoting UHC in Africa, while placing importance on the ownership and leadership of African countries, particularly through human resources development, in order to steadily implement the “G7 Ise- Shima Vision for Global Health,” an outcome document of the G7 Ise-Shima Summit in Africa.
More specifically, towards realization of “strengthening the capacity for response as well as prevention of and preparedness against public health emergencies” and “promotion of UHC in Africa,” Japan announced the implementation of assistance amounting to more than $500 million in Africa through the Global Fund, Gavi, the Vaccine Alliance and other organizations, to save the lives of more than 300,000 people, in connection with Japan’s pledge to contribute approximately $1.1 billion at the G7 Ise-Shima Summit through providing training to approximately 20,000 experts, policymakers, and managers against infectious diseases in local areas, including communities, through a variety of efforts including global joint research, and contributing to increasing the number of people who can access basic health services in Africa overall by approximately 2 million people through efforts such as giving priority support to countries that promote UHC that are a model for other African countries.
Furthermore, through the “UHC in Africa” (a policy framework), the “International Health Partnership for UHC 2030” (global platform) and others, Japan is strengthening collaboration with international organizations and civil society. In addition, Japan announced the improvement of nutritional status as a basis for health through such means as the launching an Initiative for Food and Nutrition Security in Africa (IFNA), and Nutrition Japan Public- Private Platform (NJPPP).
For more than 50 years, Japan has been providing a national health insurance system and has become a society in which people enjoy the longest healthy life in the world. Under the new guidelines, Japan continues to pursue the effective implementation of bilateral assistance, strategic collaborations with global initiatives of international organizations, the enhancement of domestic systems and the fostering of human resources.
| Public Health Emergencies (Ebola Virus Disease)
In a globalized world, infectious diseases spread beyond national borders easily and give serious impacts to the entire international community. The epidemic of the Ebola virus disease (EVD) in 2014 took many lives and resulted in the spread of infection to neighboring countries and the secondary infection of medical personnel. Thus the EVD outbreak turned out to be a major humanitarian, economic, and political challenge for the international community, leading WHO to declare a Public Health Emergency of International Concern (PHEIC) and the UN Security Council to adopt a resolution (Resolution 2177), which was the third resolution in the Security Council’s history concerning infectious diseases.
Japan has seamlessly provided a variety of assistance to affected countries and international organizations, including the dispatch of experts and provision of emergency relief goods in addition to financial assistance. Moreover, Japan supported the efforts to overcome the Ebola crisis through public-private cooperation such as the development of medicine, rapid test kits, and thermography cameras utilizing Japanese technologies.
The weak health systems in the region are considered to be one of the factors behind the EVD epidemic. Building a sustainable and resilient health system is crucial to control infectious diseases. Based on this view, prior to the EVD outbreak, Japan has prioritized development cooperation for health, an issue that is directly linked to human security, and has continuously striven to enhance health systems in West Africa under the banner of promoting UHC.
Japan is aiming to “strengthen the capacity to prevent, prepare for, and respond to public health crises,” of the African countries and realize an Africa in which all people have access to health services, and is swiftly implementing assistance that contributes to their social and economic recovery, including capacity building of medical staff, assistance for health fields such as improvement of medical facilities, infrastructure development, agricultural productivity improvement, and food security enhancement.
Furthermore, Japan, as a nation that proactively contributes to the peace and prosperity of the international community, closely collaborates with the discussions in the international community regarding establishment of the framework of the international community for responding to this kind of health crisis (the Global Health Architecture), including the High-level Panel on the Global Response to Health Crises established by the Secretary General of the United Nations, and has led discussions in fora such as the G7 Ise-Shima Summit and TICAD VI, while making a variety of contributions, including the participation of Japanese experts. In particular, on the occasion of the G7 Ise-Shima Summit in May 2016, Prime Minister Abe announced a contribution of $50 million to the WHO Health Emergencies Programme, and Japan has contributed $25 million of that amount before the end of the year. In addition Japan has contributed approximately $10.80 million to the Contingency Fund for Emergencies (CFE), and Japan had become its largest donor country as of December 2016. Moreover, in response to the support from the Government of Japan the World Bank took the opportunity of the summit to launch the Pandemic Emergency Financing Facility (PEF)* and Japan announced a contribution of $50 million for the PEF before any other country. Japan also led the establishment of the Standard Operation Procedures (SOP) by WHO to respond to emergencies in cooperation with the United Nations Office for the Coordination of Humanitarian Affairs (OCHA). In October 2015, Japan newly established the Japan Disaster Relief (JDR) Infectious Diseases Response Team, which aims to provide swift and effective assistance in countries where outbreaks are occurring.
| Promotion of UHC
UHC refers to all people being able to access and receive basic health services when they need them at an affordable cost. The achievement of UHC is important for narrowing disparities in healthcare services, meeting the basic health needs of all people, and enabling aid recipient countries to review and respond to their own health challenges, so the Government of Japan is working on the promotion of UHC. Furthermore, the Government of Japan has asserted the promotion of UHC as the “Japan Brand” in fora for international discussions. For example, Prime Minister Abe has expressed in addresses at the United Nations General Assembly and in related events that Japan would promote UHC. Moreover, because of these kinds of assertions by Japan, the 2030 Agenda adopted in September 2015 included the achievement of UHC as one of its global goals.
Prime Minister Abe took the opportunity of the United Nations General Assembly in September 2015 to state the necessity of international organizations, donor countries, and others sharing their expertise and strengthening their collaboration towards the strengthening of health systems in developing countries in order to promote UHC. In response to that kind of prompting, the establishment of the IHP3 for UHC 2030 (commonly known as UHC 2030), which further develops the previous aid cooperation framework in the health field, was supported by the G7 leaders in the G7 Ise-Shima Summit. Thus Japan has played a leading role in its establishment.
Furthermore, in TICAD VI Prime Minister Abe expressed priority support for countries capable of being a model for promotion of UHC, so that the pioneering efforts of UHC in Africa will become a model for other countries and spread to the entire African continent. In addition, the UHC in Africa jointly announced by the World Bank, WHO, the Global Fund and others indicates the useful approaches and specific actions that help with UHC achievement, and meetings to encourage its progress will be organized.
The Basic Design for Peace and Health stipulated by the Government of Japan in September 2015 states that Japan will continue to provide the support necessary to mainstream UHC in the international community. It outlines that Japan will promote cooperation that capitalizes on its experience, technology, and expertise, including through physical assistance, such as building hospitals, supplying medicines and medical devices, and through non-physical assistance, such as human resources development and system building. The Basic Design aims to achieve UHC that will “leave no one behind,” including poor people, children, women, persons with disabilities, the elderly, refugees and internally displaced persons (IDPs), ethnic minorities and indigenous people.
Basic health services under UHC comprise all services ranging from nutritional improvement, vaccination, maternal and child health, sexual and reproductive health, infectious disease control, NCDs control, and comprehensive community care and nursing care for the elderly.
For nutritional improvement, Japan has provided bilateral assistance through the frameworks of the promotion of breastfeeding and the training of healthcare professionals. Japan also extends multilateral assistance by way of cooperation through contributions to UNICEF and WFP. In other initiatives, Japan has participated in the international nutritional improvement initiative, Scaling Up Nutrition (SUN) as a donor country. In recent years, Japan has put efforts into implementing nutritional improvement programs in collaboration with private companies and in September it launched the Nutrition Japan Public-Private Platform (NJPPP). Through this platform, in cooperation with partners such as private companies, civil society, and academia, Japan contributes to nutrition improvement specifically by arranging an environment that can boost efforts made by Japanese food-related enterprises, etc. for nutrition improvement in developing countries. In addition, efforts for nutrition improvement led by Japan have begun to move into high gear. For example JICA took the lead in the launch of the Initiative for Food and Nutrition Security in Africa (IFNA) which aims to accelerate nutrition improvement in Africa.
Immunization is a proven means for controlling and eliminating infectious diseases with effectiveness and low cost, and it is estimated that 2 to 3 million lives could be saved each year. (Note 14) However, as many as 21 million children are unable to receive the necessary immunization. Since its first contribution in 2011 to Gavi, the Vaccine Alliance,* which was established in 2000 to improve the immunization coverage rate in developing countries, Japan has provided a total of approximately $53.8 million to this Vaccine Alliance. Gavi estimates that, in 15 years since its launch in 2000, 440 million children have been immunized with Gavi-supported vaccines and 6 million deaths have been averted. It aims to immunize a further 300 million children from 2016 to 2020 to save over 5 million lives. Moreover, in May 2016 the Government of Japan announced its further contribution of $76 million by 2020 to Gavi in order to promote these efforts. As for bilateral assistance, Japan will contribute to increasing the vaccination rates by providing assistance such as for vaccine production and management of vaccines, as well as for cold chain maintenance and management of cold chains.
Maternal and child health, which was included in the MDGs (Goal 4: reduce the under-five mortality rate; Goal 5: improve maternal health), has made significant gains, including the reduction of the under-five mortality rate and the maternal mortality rate, and increase in the percentage of births assisted by skilled midwives. Nevertheless, those Goals were regrettably not achieved and significant challenges also remain in maternal and child health in the SDGs. Japan aims to provide assistance focused on strengthening sustainable health systems* based on the principles of strengthening the schemes for providing comprehensive and continuous maternal and child care and ensuring the ownership of developing countries and increasing their capabilities. In pursuit of these aims, Japan implements efficient assistance in such countries as Ghana, Senegal, and Bangladesh. Through such assistance, Japan contributes to making the necessary services more accessible for women during pre-pregnancy (including adolescence and family planning), pregnancy, and delivery and for infants and children.
Furthermore, Japan is implementing activities utilizing Maternal and Child Health (MCH) Handbook as a means of improving maternal and child health, taking advantage of the experience and expertise of Japan. MCH Handbook can contribute to the Continuum of Care (CoC), from pregnancy, childbirth, the post-partum period (the period after the birth until the woman recovers to a similar condition before the pregnancy, usually about one to two months after birth), the neonatal period, infancy, and to early childhood. MCH handbook also provides health information to mothers, which can encourage the raising of awareness and behavior modification. With the cooperation of Japan, Indonesia, a country in which MCH Handbook has already been introduced nationwide, invited maternal and child health professionals from Kenya, Uganda, Cameroon, Palestine, Afghanistan, Myanmar, Laos, Viet Nam, and Timor-Leste and implemented training for the dissemination and promotion of MCH Handbook. Japan has contributed to holding international conferences on MCH Handbook by supporting the organizers and exchanging good practices and expertise among experts aimed at further dissemination of MCH Handbook.
In aid recipient countries, Japan works with other development partners, such as the United Nations Population Fund (UNFPA) and the International Planned Parenthood Federation (IPPF), to promote maternal and child health that includes sexual and reproductive health services, and thereby improving the health of a greater number of women and children.
Furthermore, in order to strengthen its international contribution to measures against aging, in 2016 Japan as the chair country took up aging as a topic of discussion within the framework of the G7 for the first time, and the outcome document stated initiatives for the promotion of Healthy and Active Ageing through cross-sectoral measures against aging and for sharing the expertise and experience of each country. In addition, at the WHO General Assembly in May 2016 Japan led the adoption of the Global Strategy and Action Plan on Ageing and Health 2016–2020 by WHO and the resolution to support its implementation, and the G7 Health Ministers’ Meeting in Kobe in September once again made clear that the G7 would support its implementation.
In addition to this, in November 2016 the Ministry of Health, Labour and Welfare (MHLW) invited officials in charge of social welfare, health and hygiene and employment policies in ten ASEAN countries, officials in charge of employment policies in World Association of Public Employment Services (WAPES) member states, etc. to hold a Joint Meeting of the 14th ASEAN and Japan High Level Officials Meeting on Caring Societies and the WAPES Workshop for the Asian-Pacific Region. This meeting had the theme of “Facilitating the participation and improvement of the accessibility of those who need social support,” and held discussions about efforts by governments, companies and regions to support independence, including encouraging employment, and for barrier-free measures and the improvement of the ease of access, etc., in order to encourage the social participation of senior citizens and persons with disabilities, etc. Furthermore, in 2014 and 2015 Japan held the ASEANJapan Regional Conference on Active Aging, where Japan shared with the ASEAN countries the expertise it has acquired by becoming a super-aging society ahead of the rest of the world and its efforts with respect to that situation, etc. and Japan has encouraged regional cooperation in this field.
| Responding to the antimicrobial resistance (AMR)
The antimicrobial resistance (AMR)* is a serious threat for public health, and in recent years the momentum of countermeasures has been growing. In response to the adoption of a world action plan for AMR at the WHO General Assembly in 2015, Japan formulated the National Action Plan on Antimicrobial Resistance in April 2016 in order to promote its own countermeasures. In the same month Japan hosted the Tokyo Meeting of Health Ministers on Antimicrobial Resistance in Asia and adopted the Asia- Pacific One Health Initiative on AMR comprising the four pillars of surveillance system and laboratory network, antimicrobial access and regulation, etc. The G7 Ise-Shima Summit also took up AMR as one of the pillars of its health agenda, and compiled policies for the G7 countries to work on in cooperation with each other. Moreover, at the High-level Meeting on Antimicrobial Resistance in the United Nations General Assembly in September the same year the “Political Declaration of the high-level meeting of the General Assembly on antimicrobial resistance” was adopted, which required each country and the related United Nations institutions to promote countermeasures and the Secretary General of the United Nations to establish cross-sectoral working groups.
| Other related matters
Strengthening measures against emerging and reemerging infectious diseases,* as well as ramping up for the final stage of initiatives to eradicate polio, continue to require international efforts. Furthermore, “Neglected Tropical Diseases”* such as Chagas disease, Filariasis, and Schistosomiasis affect approximately 1 billion people worldwide, and cause major socio-economic loss in developing countries. Since infectious diseases have impact beyond national borders, the international community must work as one to combat them. Japan is engaged in the implementation of countermeasures in close cooperation with the relevant countries and international organizations.
| The Three Major Infectious Diseases (HIV/AIDS, Tuberculosis, and Malaria)
Japan attaches great importance to supporting activities to fight the three major infectious diseases (HIV/AIDS, tuberculosis, and malaria) through the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund). The Global Fund was established as an organization to fight these three major infectious diseases and to build resilient and sustainable systems for health following the discussions on measures against infectious diseases at the G8 Kyushu-Okinawa Summit in 2000 under Japan’s presidency. As a founding father, Japan has provided financial assistance to the Global Fund since its establishment in 2002, and contributed approximately $2.53 billion to the Global Fund by the end of March 2016. Furthermore, in December 2015, Japan hosted the Global Fund’s Fifth Replenishment Preparatory Meeting in Tokyo, and helped facilitate fruitful discussions on necessary actions and resources towards the 5th replenishment period between 2017 and 2019. In May 2016, ahead of the G7 Ise- Shima summit, Japan pledged a total contribution of $800 million over the coming year for the Fifth Replenishment. The Global Fund has saved more than 20 million lives. Additionally, Japan provides supplemental bilateral aid to the Global Fund’s implementing countries, in order to ensure that measures against these three major infectious diseases are implemented effectively in those countries. Japan also strives to strengthen the health systems, community empowerment, and the policies for maternal and child health in those countries.
As bilateral assistance for HIV/AIDS countermeasures, Japan is providing assistance to spread knowledge to prevent new infections, raise awareness, widely provide testing and counseling, and enhance the distribution system of drugs to treat HIV/AIDS. In particular, JOCVs on Infectious Disease and HIV/AIDS Control are vigorously engaged in activities such as the spreading of knowledge and understanding of prevention, as well as the care and support of people living with HIV/AIDS, mainly in Africa.
The United Nations HIV/AIDS High- Level Meeting was held in June 2016 and the Political Declaration on HIV and AIDS: On the Fast-Track to Accelerate the Fight against HIV and to End the AIDS Epidemic by 2030 was adopted.
With regard to tuberculosis, Japan’s assistance has been focusing on those priority countries needing action, as well as those countries where the spread of the disease is deemed to be serious, as designated and recognized by WHO in accordance with the Global Plan to Stop TB 2006-2015. In these countries, Japan has been promoting a series of measures to fight tuberculosis, including the aspects of prevention, early detection, diagnosis and continuing treatment, as well as those measures to address co-infection of HIV/AIDS and tuberculosis. In July 2008, MOFA and MHLW announced the Stop TB Japan Action Plan, which was developed jointly with JICA, the Japan Anti-Tuberculosis Association, and the Stop TB Partnership Japan. Making use of the experience and technology fostered through its domestic tuberculosis countermeasures, and with the public and private sectors working closely together, Japan has strived to contribute to the reduction of the annual number of deaths from tuberculosis in developing countries, particularly in Asia and Africa, setting the target at 10% reduction of the number worldwide (160,000 people, based on 2006 figures). Based on the Global Plan to Stop TB 2011-2015 revised in 2010, Japan revised its own Stop TB Japan Action Plan in 2011. In addition, based on the new global strategy that WHO adopted in 2014 with the target years for achievement set between 2015 and 2035 (Global strategy and targets for tuberculosis prevention, care and control after 2015), Japan re-revised the Action Plan in July 2014 and confirmed that it would continue to work on measures against tuberculosis on a global level.
With regard to malaria, a major cause of infant mortality, Japan provides assistance for initiatives for anti-malaria measures involving the strengthening of local communities and assistance in cooperation with WHO.
| Polio
Polio is in the final stage of eradication. Japan works mainly in cooperation with UNICEF to eradicate polio with a focus on three polio-endemic countries (countries where wild polio has never been eradicated and is still spreading)—Nigeria, Afghanistan and Pakistan. In Nigeria, no cases of infection from the wild polio virus were discovered from 2014 onwards, but in August 2016 a case of an infection from the wild polio virus was reported. In response to this WHO carried out an emergency vaccination campaign in Nigeria and the neighboring countries (Cameroon, Central Africa, Chad, and Niger) in order to prevent the propagation of the polio virus.
In addition, Japan has provided support worth a cumulative total of more than ¥10.3 billion in Afghanistan since 2002 in cooperation with UNICEF. Furthermore, in Pakistan, Japan has provided assistance a cumulative total of more than ¥11 billion in coordination with UNICEF since 1996. In addition, Japan partnered with the Bill & Melinda Gates Foundation from the private sector to provide an approximately ¥5 billion ODA loan in August 2011 and ¥6.3 billion ODA loan in May 2016. Loan Conversion was adopted as a new approach for these ODA loans. Under this approach, the Gates Foundation repays the debt owed by the Pakistani government when targets are achieved. With the same approach, in 2014- 2015, Japan provided an approximately ¥8.3 billion ODA loan to Nigeria. Furthermore, in FY2015, Japan provided support of approximately ¥1.75 billion and ¥360 million respectively to Afghanistan and Pakistan.
| Neglected Tropical Diseases (NTDs)
In 1991, Japan took the lead by launching a full-scale effort against Chagas disease, which is also known as a “disease of poverty,” in Central American countries. Japan provided assistance to establish a system for dealing with Chagas disease vectors and contributed to reducing the risk of infection. Regarding Filariasis, Japan supplies antiparasitic agents as well as educational materials to provide knowledge and understanding to a large number of people. Meanwhile, Japan also conducts preventive education through JOCV activities in order to reduce the number of new cases and maintain the non-epidemic status.
Furthermore, in April 2013, Japan launched the Global Health Innovative Technology Fund (GHIT Fund), the first public-private partnership in Japan with the purpose to facilitate the development of new drugs for treatment of infectious diseases in developing countries including NTDs. The GHIT Fund aims to control infectious diseases in developing countries through the research and development (R&D) of low-cost and effective therapeutic medicine, vaccines, and diagnostic products, while promoting global cooperation with R&D institutions both inside and outside Japan.
Moreover, in May 2016 the Government of Japan decided to make a $130 million contribution for the purpose of promoting R&D of new drugs against NTDs and supply preparation and support of drugs.
- * Universal Health Coverage (UHC)
- This is the ability of all people to access to and receive basic health services when they need them at an affordable cost.
- * Health system
- Health system includes establishing mechanisms for governance, the improvement of healthcare facilities, the optimization of the supply of pharmaceuticals, the accurate measurement and effective utilization of healthcare information, financial administration and securing resources, resource mobilization as well as the development and management of personnel to operate these processes and provide services.
- * Pandemic Emergency Financing Facility (PEF)
- This is a framework for utilizing insurance mechanisms to mobilize private sector funds and carrying out quick and efficient funds mobilization when a pandemic occurs. Donor countries, etc. pay the insurance premiums to the insurance companies. In the case that the conditions agreed in advance are satisfied due to the occurrence of a pandemic, the insurance payout is instantly distributed to the developing countries, international organizations, NGOs, etc. from the insurance companies through the PEF, and allocated to the budget for the emergency response.
- * Gavi, the Vaccine Alliance
- Gavi, the Vaccine Alliance is a public-private partnership, which was established with the aim to save children’s lives and protect people’s health by increasing access to immunization in developing countries. Governments of donor countries, developing countries, relevant international organizations, the pharmaceutical industry, private foundations and civil society participate in this partnership.
- * Antimicrobial resistance (AMR) or antimicrobial resistance and infectious diseases
- Antimicrobial resistance (AMR) happens when microorganisms such as pathogenic bacteria and viruses, etc. obtain resistance to antimicrobial drugs, such as antibacterial and antiviral drugs, and the drugs become ineffective.
- * Emerging/reemerging infectious diseases
- “Emerging diseases” are infectious diseases which were not previously known and have been newly recognized in recent years, such as SARS (Severe Acute Respiratory Syndrome), avian influenza, the Ebola virus disease, and others.
“Reemerging diseases” are infectious diseases that had spread throughout the world in the past and subsequently saw a decrease in the number of cases, but have been on an increasing trend again in recent years such as cholera and tuberculosis. - * Neglected tropical diseases (NTDs)
- “Neglected tropical diseases (NTDs)” include 18 types of tropical disease, such as Chagas disease, dengue fever, Filariasis, and other diseases that are transmitted from parasites, bacteria, etc. The number of infected individuals has reached approximately one billion worldwide. Many of these diseases could either have been prevented or eradicated. As many of the cases are found among the poorest segment of the population, and for other reasons, social awareness of this issue is relatively low. Therefore, the development of diagnostic methods, treatment methods and new drugs, and the process of making them available to those in need are lagging. At the G7 Ise-Shima Summit in 2016 the G7 countries presented policies for encouraging R&D, and innovation in measures to combat NTDs (the G7 Ise-Shima Vision for Global Health).
- * The three major infectious diseases
- The three major infectious diseases refer to HIV/AIDS, tuberculosis, and malaria. Worldwide deaths from these diseases total approximately 3.6 million. The spread of these infectious diseases significantly impacts society and the economy, and is a factor that hampers national development. Accordingly, it is a serious threat to human security, and a global issue that must be addressed by the unified efforts of the international community.
- Note 12: Source: WHO “World Health Statistics 2016”
- Note 13: Source WHO, UNICEF, UNFPA, and the World Bank “Trends in Maternal Mortality: 1990 to 2010”
- Note 14: Source: WHO “Health topics, Immunization” http://www.who.int/topics/immunization/en
- Note 11: Debt rescheduling is one form of debt relief. Payment is postponed for certain period of time in order to lessen the burden of debt payment on the indebted country.
•Tanzania
The Project for Strengthening Hospital Management of Regional Referral Hospitals
Technical cooperation project (May 2015 – )
As Tanzania faces chronical shortages of healthcare human resources, pharmaceuticals, etc., the efficient operation of medical healthcare facilities and provision of quality healthcare services have become the issues. Many of the 27 regional referral hospitals (RRHs)*1 existing in the country have been operated without even a basic knowledge of hospital management and are unable to make good use of existing resources and formulate strategic hospital operation plans. Furthermore, there are problems such as lack of appropriate assessment systems on hospital functions and lack of management capability by the Hospital Advisory Board (HAB) comprised of citizens.
In this context, Tanzania has requested Japan to implement a technical cooperation project to strengthen the management capability of the RRHs, which face more issues than other public medical institutions do. The request was meant to further develop the initiatives supported by JICA that had intended to strengthen health administration capabilities at the regional level and to improve the quality of healthcare and medical services by adopting the KAIZEN method.*2 The project aims to improve management systems by strengthening the planning and management capabilities of hospital administrators, strengthening the function assessment system, and to provide quality healthcare services through streamlining by the KAIZEN method.
Since the commencement of the project, educational materials on management for hospital administrators and a training guide for instructors have been developed and 17 instructors have been fostered. In addition, training for the hospital administrators of all the 27 RRHs on subjects such as the formulation of annual hospital operation plans and financial management have been conducted. Furthermore, internal assessment tools for hospitals and guidelines stipulating the roles and functions of the Hospital Advisory Board were established, and 12 HAB instructors were also fostered. Regarding KAIZEN, fostering of 10 KAIZEN instructors and training for a total of 81 RRH employees at all 27 locations were implemented. The KAIZEN initiative has been implemented at a prefectural level.
As a result of such activities, a total of 22 officials from health ministries and hospital directors — 20 from eight African countries and two from Bangladesh — visited Tanzania for a study tour.*3 This is an example of Japan’s contribution to strengthening the capacities of many countries. The KAIZEN initiative of Tanzania has been appreciated internationally. In 2015, the KAIZEN application in the health sector was honored as a finalist for the DAC prize.*4 In 2016, it was introduced as an initiative that contributes to the SDGs in a publication on cases of South-South cooperation, compiled by the United Nations Office for South-South Cooperation (UNOSSC). (As of August 2016)
*1: “Referral hospitals” means hospitals that have departments and staffs specialized in planning and implementing clinical trials and research that require highly professional knowledge and experience involving difficulties in implementation. Referral hospitals are hospitals with well-established infrastructure.
*2: KAIZEN is an initiative that was cultivated and spread on the front line of Japan’s manufacturing industry. This method is now being gradually recognized internationally.
*3: Study tours include tours to observe and learn from the activities of organizations, companies, NGOs, and to survey and observe the new businesses of companies, and visits to trade shows. They consist mainly of tours to learn about social problems in developing countries, provide support and interact with local people.
*4: The DAC Prize was established by the OECD Development Assistance Committee (DAC) in 2014 to honor innovative initiatives that can be applied widely in developing countries.
•Tunisia
The Project for Renovation and Equipment Maintenance of Utique Nouvelle Dispensary
Grant assistance for grassroots human security projects (March 2015 – January 2016)
In Tunisia, against the background of the citizens’ enormous dissatisfaction with disparities and the high rate of youth unemployment, a citizens’ movement calling for political, economic, and social reforms began in December 2010, which led to a change of government. During this series of disturbances, the worsening of economic conditions spread throughout the entire country and problems such as even national medical institutions are unable to secure an adequate budget have been occurring.
Utique Nouvelle village is a farming village with a population of approximately 3,300 located approximately 50 kilometers northwest of the capital Tunis, and the Utique Nouvelle Dispensary, the only medical dispensary in the village, had provided medical care free of charge with the support of the Government of Tunisia.
However, as forty five years had passed since the construction of the dispensary, the building was in a state of disrepair and malfunctions including in electric wiring occurred, so it became difficult to maintain use of the medical equipment. Furthermore, basic instruments such as examination tables and weight scales became extremely obsolete, so there was an urgent need to reconstruct the dispensary and renovate the equipment.
For this reason, a Tunisian local NGO requested Japan’s assistance in the areas of reconstruction of dispensaries and provision of equipment where Japan has a successful track record.
Now, due to Japan’s support, the reconstruction of the dispensary and renovation of the equipment have been completed, and the total of approximately 3,750 residents who utilize the dispensary in a year have become able to receive appropriate medical care services.
•Kenya
Project for the Renovation of a Maternity Ward at Kiptulwa Dispensary
Grant assistance for grassroots human security projects (March 2015 – March 2016)
In Kenya, there are many women who have no choice but to deliver babies at home for reasons including medical equipment shortages in hospitals and dispensaries, shortages of human resources such as doctors and midwives and the high costs of medical care in private hospitals. The neighborhood residents living in the vicinity of Kiptulwa Dispensary, which is located in Bomet County in the southeast of Kenya, were no exception.
Construction of a maternity ward at Kiptulwa Dispensary began in 2011 with the support of the government, but the construction was suspended due to a fund shortage. For that reason, it had limited facilities and equipment and it could only accept a small number of expectant and nursing mothers, and was unable to provide adequate medical care services to the neighborhood residents.
Furthermore, the nearest hospital which has a maternity ward from the community of Kiptulwa is more than ten kilometers away and it is also a private hospital, so the consultation fees are high.
For that reason, approximately 90% of the local residents had no choice but to deliver babies at home. The delivery of babies at home in an unhygienic environment caused high mortality rates of mothers and newborn babies. The environment of the residents concerning the delivery of babies was tough with the problems such as hemorrhage during labor, blood poisoning, infectious diseases caused by the umbilical cord, disabilities such as infantile paralysis, and the risk of HIV transmission from mother to child.
Under such circumstances, Japan provided grant assistance for grassroots human security projects consisting of completion of the maternity ward, the construction of which had been suspended, and installation of medical equipment. As a result, medical care services for the local residents have greatly improved. The average number of babies born at Kiptulwa Dispensary in the past five years was 6.5 per year but after completion of this maternity ward, the number of babies delivered has risen dramatically with 33 babies born in just one and a half months.
The deliveries of babies at the highly hygienic clinic has contributed to reducing the risk to the bodies of mothers and babies during deliveries. It is expected that Japan’s project will contribute to improving the environment where mothers can deliver their babies free of anxieties.