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Use of ITNs/LLINs is the main
vector control measure. During 2008-2010 a total of 4.41 million LLINs were distributed (Fig. 2).
The IRS activity in the country is very limited and is applied only for
outbreak management and occasionally for reducing malaria transmission in
highly endemic areas. ACTs and RDT are being used since 2005. During 2010, 671 681 ACT courses were distributed (Fig. 3).
Click on the image to enlarge
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| Fig
2 :Cumulative Availability of Effective ITNs
&LLINs in Indonesia, 2005-2010
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Fig.
3: Distribution of ACTs and Malaria Deaths in
Indonesia,
2005-2010
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The malaria situation is worsening since the last few
years. The malaria surveillance system is weak and needs to be strengthened.
However, the country is planning to eradicate malaria from Java-Bali, Bintan and Batam. Indonesia is
a large and geographically complex nation. The annual need for resources is
around US$ 24 billions but there is a huge gap between availability and need.
The National Malaria Control Programme (NMCP) is receiving assistance from GFATM and Unicef (Fig 4). During
2010, country received around 19.77 million. The expenditure pattern of the country is depicted in Fig. 5. The detailed data for 2010 is not
available.
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Click on the image to enlarge
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| Fig.
4 : Availability of Funds by Source in Indonesia, 2003-2009
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Fig.
5 : Details of Expenditure by
Type in Indonesia,
2009
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Goals and Targets:
To
reduce malaria morbidity and mortality until the disease is no longer a
public health problem in the country.
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Targets
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Baseline data in 2005
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2010
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To reduce the morbidity by 50%of the rate
in 2000 by the year 2010
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4.02 / 1000
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2.01/ 1000
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To reduce the mortality by 75%of the rate
in 2000 by the year 2010
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0.54/ 100000
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0.14 / 100000
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All suspected malaria cases should be
tested and all confirmed cases treated with efficacious treatment
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46.5%
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90%
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All malaria outbreaks should be detected
and reported
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100%
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100%
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Malaria elimination in Jakarta, Bali and Batam
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Prepare strategy and implement for
elimination
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Control strategy:
 Passive
Case Detection , clinical diagnosis and treatment
and Active Case Detection, laboratory
diagnosis is limited in Java-Bali area.
Treatment in the periphery through health centres
and malaria treatment post by volunteers.
Vector
control: selective IRS, bednets, larviciding, biological control and source reduction.
DDT has
been replaced by synthetic pyrethroid, carbamate and OP, permethrin is used for bednet
impregnation.
Achievements and Initiatives
New Drug Policy has been implemented since 2003
Outbreaks prevention and early containment in disaster area (earthquakes,
floods, outbreaks, etc)
New strategic plan 2009 – 20014
Expansion of partnership: donors, medical professions, private, etc
Issues and Challenges:
Drug resistant P. falciparum malaria is
spreading.
Lack of resources, and trained professional staff.
Monitoring and evaluation of activities under taken at provincial and
district level.
Microscopic services and finances required for implementing changes in
anti-malaria drug policy are very costly; and since alternative drugs have
not been available, improving therapeutic efficacy of the existing anti
malarial drugs will be a challenge.
Emergence of mono and multi-drug resistance in P falciparum
and chloroquine resistance in P. vivax
may have contributed to this rise in malaria.
Chloroquine resistance in P vivax is a serious problem in Irian
Jaya (Papua) Province. The programme has evaluated mefloquine and artesunate monotherapy and these drugs have produced good
therapeutic efficacy.
The main reason for the deteriorating malaria situation
were the economic crisis that commenced during 1996-97 has adversely
affected malaria control programme, particularly
vector control activities. In the absence of vector control, epidemics have
occurred in some parts of the country.
The lack of intersectoral action and negligible
community participation has contributed to the failure in vector control.
Increasing population mobility has caused malaria and often drug
resistant strains to spread to various parts of the country.
Inadequate self-treatment, poor compliance of three-day chloroquine treatment; inadequate monitoring of drug
resistance; drug failure,
decentralization of malaria control programme,
relaxation of malaria surveillance system and lack of quality drugs may have
all contributed to and compounded the problem of malaria control.
Partners and donors
Global Fund
UNICEF
WHO
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