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Country Profiles – Indonesia
With a population of 231 million, Indonesia
carries the third highest TB burden globally. After achieving a case
detection rate of 73% in 2006, Indonesia slipped out of the target zone in
2007, reporting a case detection of 68%*. This is in part attributed to the
temporary cessation of Global Fund support for nine months. However, the
overall notification rate dipped only by two points to 119/100 000,
demonstrating that sustainable mechanisms are in place. The treatment success
rate for the cohort of patients registered in 2006 was 91 %. The country has
adopted the new Stop TB Strategy and finalized the second national strategic plan
(2006-10) for TB control, including all the components of the new strategy. Tuberculin
surveys and mortality studies are on-going.
Around 2% of newly diagnosed TB cases are estimated to
have developed multi-drug resistance. A drug resistance survey is currently
ongoing in Central Java and is planned for East Java.
Efforts to develop and strengthen the national laboratory network are
underway, with the assistance of the SNRL at Adelaide, Australia.
Intermediate reference laboratories are being established in an additional
seven provinces. National programmatic guidelines, treatment guidelines,
training materials and modules for staff for MDR-TB management have been
developed. A GLC approved project is in place and it is expected that MDR-TB
cases will be enrolled by early 2009.
Indonesia
has an overall low prevalence of HIV, but has concentrated epidemics among
high-risk population groups in most provinces. TB-HIV collaborative
activities have been initiated in a few high HIV prevalence areas of the
country.
The TB programme has scaled up public-private
partnerships and hospitalcommunity DOTS linkages; 560 public and medical
college hospitals have been involved by the TB control programme. In
addition, 408 prisons and 119 military hospitals have also been involved.
Teaching of the principles and practices of DOTS has been integrated into the
medical school curriculum. The ISTC has been endorsed by the professional
associations and widely disseminated. ACSM activities are being scaled up in
different provinces of the country.
A comprehensive HRD plan is in place and a focal point
for HR has been designated at the central level. Drug management remains
suboptimal and needs strengthening. The NTP’s plan and budget are aligned
with the national health sector development plan. However, there are
challenges due to the decentralization of health services down to the level
of each district in the country, and because of cuts in overall government
budgets.
The Indonesian programme receives support from several
sources including the Global Fund, Tuberculosis Coalition for Technical
Assistance (USAID), and DFID. Technical assistance is being provided by WHO,
KNCV Tuberculosis Foundation, Management Sciences for Health, FHI, JICA and IMVS,
Adelaide.
Major achievements
 Second
Five-Year Strategic Plan (2006-2010) being effectively implemented;
Hospital involvement scaled up - including
endorsement and roll out of ISTC;
Specific guidelines developed for
hospital-DOTS linkage, TB-HIV, –TB in workplaces, ACSM, Paediatric TB etc);
First
Drug-resistance survey (DRS) finalized in one provincel
EQA
accreditation of four laboratories for culture and DST;
GLC
application approved and DOTS-plus pilot sites in preparation;
TB-HIV
collaborative activities initiated in some high burden areas; and
Use of
FDCs expanded to all provinces.
Major challenges and constraints
Problems of access and geographic terrain in
the eastern part of the country;
Low
commitment from local governments in terms of financial contribution;
Temporary cessation of GF support in 2007
affected operational activities;
Suboptimal quality of DOTS implementation in
hospitals, private clinics and practitioners;
Emergence of TB/HIV in high HIV prevalence
provinces;
Inadequate human resources due to high turn
over and zero recruitment policy; and
Repeated emergency procurements of drugs due
to lack of sustained government funding.
Planned
activities
Strengthening provision of TB services in
hospitals, including roll out of ISTC to professional societies and
organizations;
Strengthening capacity of provincial
laboratories for culture and DST, with proper accreditation;
Strengthening and expanding TB/HIV
collaborative activities in highrisk provinces;
Establishing and then scaling up MDR TB
management in future;
Conducting DRS surveys in other provinces,
based on experience gained in the DRS survey done in Central
Java;
Continuing capacity building in the priority
areas for fully implementing the Stop TB Strategy through conducting
trainings, work shops, exchange visits etc; and
Strengthening procurement and TB drug supply
management, through capacity building and advocacy for sustained funding.
TB epidemiological profile, Indonesia
TB Unit of the WHO Regional Office for South-East Asia
* The new smear positive case detection rate is 71% when
calculated using the most recent national population figure which is 225 642
000.
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