Objective

  In Japan, the low pass rate of Economic Partnership Agreements (EPA) foreign nurse candidates in the National Nursing Examination is a serious issue because it suggests differences in nursing practice between the countries. This study aimed to reveal the discrepancy in nursing practice between Indonesian and Japanese nurses.

Methods

  Questionnaires were sent to 9 hospitals to collect data from Indonesian and Japanese nurses working together. It included the “Self-evaluation Scale on Oriented Problem Solving Behavior in Nursing Practice” to measure the quality of problem-solving behaviors.

Results

  Participants were 17 Indonesian (8 males, 9 females; average age: 30.6 years) and 50 Japanese nurses. Of them, 9 Indonesian nurses had not passed the National Nursing Exam. No remarkable difference was observed between the Indonesian and Japanese nurses on any of the sub-scales of the problem-solving scale. However, after matching the groups with nursing experience years (by selecting Japanese nurses with an experience of less than 10 years, n＝22), a notable difference was observed in “Securing consent from the patient for providing nursing care,” with Indonesian nurses who had not yet passed the National Nursing Exam scoring significantly lower than Japanese nurses (p＝0.01 for the Wilcoxon test with Bonferroni correction). While Japanese nurses assist patients with activities of daily living, the patient’s family is mainly responsible for such care in Indonesia. Therefore, Indonesian nurses do not fully acknowledge their need to secure consent in providing daily life assistance to patients.

Conclusion

  Indonesian nurses who had not passed the National Nursing Exam scored significantly lower on “Securing consent from the patient for providing nursing care.” Therefore, it is recommended to provide them education to enable them to recognize the importance of practicing nursing based on nursing plans that consider patients’ needs.

Background

  The number of foreign tourists visiting Japan has increased to about 30 million people per year. 1.5% of them were injured or became sick during their travelin Japan and had to undergo medical treatment. Among the foreign tourists, 27% were not covered by travel health insurance.

Case

  A 40-year-old man from Southeast Asia who was visiting his relative in Japan experienced sudden hemiparesis and was diagnosed with cerebral infarction. During the initial treatment, it was found that the patient did not have health insurance and the relatives could not afford to pay the treatment costs. No other source of financial support was available to him During our consultations with the patient and his relatives about the medical treatment including medical expenses, he continued to be treated as an outpatient and it was aimed at an early return to his home country.

Discussion

  Foreigners, who are not covered under travel health insurance, could fall ill or sustain an injury during their stay in Japan. Appropriate medical care should be provided regardless of their ability to pay. However, a situation that could lead them to incur huge medical expenses from availing medical care should be avoided. For medical consultations of non-insured foreigners, it is better to consult the available systems and pay attention about feasible medical expenses. There is a need for a long-term vision of medical care to make a smooth transition from medical treatment in Japan to treatment in their home country.

Conclusion

  Although medical institutions can offer only a limited response, it is necessary to accumulate case examples from across the nation and prepare specific countermeasures and counselors.

Objective

  Preterm birth is the major cause for neonatal deaths in low and middle income countries. The aim of this report is to evaluate the proportions of deaths of moderate to late preterm infants born at 32 to 36 weeks of gestations as well as the neonates with low birth weights weighing from 1500g to 2499g among the total neonatal deaths and analyze their causes of deaths in Lempira province, the Republic of Honduras.

Study design

  A secondary analysis based on the data sets from the regional office of Ministry of Health.

Methods

  We obtained data sets on infant mortality from January 2015 to June 2017 compiled by a regional office of Ministry of Health in Lempira province. We then calculated proportions of each cause of death in the groups of newborn infants stratified by gestational weeks and birth weights.

Results

  During the study period, a total of 253 neonatal deaths were recorded, comprising 66.9% of the total infant deaths (n=378). The number of the newborn infants who died during early neonatal period was 201 (79.4%). The number of preterm newborn infants who died during neonatal period was 146 (57.7%) and 70 (27.6%) were born at moderate to late preterm periods. 103 (40.7%) were born with their birth-weights below 2500g, and the number of those weighing from 1500g to 2499g were 61 (24.1%). The leading cause of deaths of moderate to late preterm infants was hyaline membrane disease (n=25/48: 52.1%), as was the case with low birth weight infants weighing from 1500g to 2499g.

Conclusion

  It was shown that approximately one fourths of neonatal deaths occurred in moderate to late preterm infants in Lempira province during the study period. Approximately half of these preterm infants died of hyaline membrane disease, who could have been saved with simple and low-cost equipment such as bubble continuous positive airway pressure.

  The way of Public Private Partnerships in development including Global Health has been changing dramatically. Japan is also making efforts to promote Public-Private Partnership to promote the Japanese medical technology and services globally. Since the program schemes are varied, we collect the information mainly through WEB at July 2017 to compare the features of each program and policy. We made a list of programs conducted by Ministries and responsible organizations. The programs are categorized in two directions, inbound which means inviting foreign patients to Japan for treatment, and outbound which means exporting Japanese medical devices, medicines, system, and services. Those are also categorized in two groups by objective and content, support for establishing foundation/core facilities, and support for the system and human-resource development. We created the correlation diagram based on these categorizations to show the relationship between each scheme/program. Programs undertaken by different agencies such as the Cabinet Secretariat, Ministry of Economy, Trade and Industry, Ministry of Health, Labor and Welfare, Ministry of Foreign Affairs, Japan International Cooperation Agency seems comprehensive and exhaustive. Therefore, we can expect a bigger impact if the appropriate support through those programs were provided in right time, especially for the outbound support. There is a need for developing overarching strategy among each program to the target country based on the needs assessment, local adaptability of the technology and services. From the fact that it has become clear that issues related to developing private funds for development by public funds as priming water such as the motivation for investment behavior and the different results are different in the public and private sectors, it is necessary to clarify the guidelines in Japan in order to strengthen such Public-Private Partnership.

  Health service provision is one of the components in Universal Health Coverage (UHC). Medicines are vital for health services, and they should be affordable and accessible for safe and appropriate usage for everyone.

  This article is a report on the symposium “Medicines for UHC,” held in the academic meeting of the Japanese Association of International Health in December 2017.

  In Lao PDR, a study was conducted in urban and rural hospitals examining lists of available medicines, as well as their usage, distribution, and prices. The study showed that neurological medicines including anesthetics made up 29% of all medicines used in the urban central hospital, as it was one of the few hospitals that provided complex surgeries in Laos, resulting in a high concentration of patients. Anti-tuberculosis, ARV, and anti-Malaria medicines, as well as vaccines, were provided by Global Fund, GAVI, and other organizations, so that their costs were not included in the hospital’s procurement lists. While anti-microbial medicines only accounted for 13% of the medicines used at the urban central hospital, they accounted for 43% of those in rural hospitals, where most patients presented with upper respiratory and digestive infections. While the Ministry of Health sets the standards for evaluating and regulating the quality and cost of medicine, individuals can purchase medicines from private pharmacies without prescriptions, making it difficult to evaluate appropriate usage.

  Regarding the quality of medicines, distribution companies, health workers, and patients cannot distinguish between authentic and falsified or substandard medicines. As an example, after a study in Cambodia revealed the existence of inappropriate medicines, the Cambodian government required companies to provide results of dissolution tests.

  As the limitations on pharmaceutical regulatory authorities and their staff in developing countries impact their capabilities, we recommend supporting them in establishing effective pharmaceutical regulations internationally.