Indonesia

Tuberculosis (TB) has surpassed HIV and AIDS as the number one infectious killer worldwide, and in many countries, TB remains a major cause of death, sickness, and poverty. Major challenges to TB care and control include increases in drug-resistant TB (DR-TB) and reductions in donor funding.

It is crucial, therefore, that governments develop sustainable TB care and control delivery and financing mechanisms in the context of universal health coverage (UHC) programs.

Earlier this month I presented on this topic and MSH’s experience supporting TB program costing, economic analysis, and financing in Indonesia, at the 10th National TB Programme Managers Meeting in the Western Pacific Region in Manila, Philippines. With assistance from MSH under the US Agency for International Development (USAID) TB CARE I project, the Indonesian government has been a leader in South East Asia in terms of projecting financing needs, looking at cost-effective interventions, and working with the private health sector and national insurance scheme to expand coverage and ensure quality of care.

This post originally appeared on the MSH at the Third Global Symposium on Health Systems Research conference blog.

On September 30 – October 3, 2014, nearly 3,000 researchers, program managers, and policy makers convened in Cape Town, South Africa for the Third Health Systems Research Symposium (HSR2014) to review evidence and research focused on improving people-centered health systems and service delivery. A key component to strengthening health systems and improving health outcomes is through health care financing mechanisms.

MSH staff are commemorating World TB Day through awareness-raising activities around the globe, including in Afghanistan, Cambodia, Ethiopia, Ghana, Indonesia, and Nigeria. Here are photos (some from 2013) with activities this year.

Afghanistan - TB CARE I

During this year’s World Tuberculosis Day (WTD) celebration in Afghanistan, MSH’s TB CARE I project team will reach more than 21,000 individuals with tuberculosis (TB) advocacy and awareness activities. The project staff plans to distribute over 8,530 banners, notebooks, and posters on TB control to politicians, health workers, and community members. Additionally, the TB CARE I Afghanistan team will travel to the 13 project-supported provinces to help field-based staff plan and facilitate WTD celebrations at health centers in their communities. The project staff will also support staff from the National TB Program (NTP) and other stakeholders in planning and participating in WTD celebrations at 26 schools and 600 and communities.

TB CARE I Indonesia, The Global Fund to Fight AIDS, Tuberculosis and Malaria, and Indonesia’s National TB Program (NTP) organized a mass-mobilization World TB Day event on March 24, 2013, called "Run 4 TB".

This 5K race drew thousands of runners, bikers, walkers, and observers.

(Photo credits: KNCV/TB CARE I)

In recent years, commitments from the government and major donors have led to improved tuberculosis (TB) control in Indonesia, with reductions in both prevalence and incidence. The nation’s economic status has also improved; however, this has caused many donors to reduce their contributions to the nation’s health programs.  Compounding this financial challenge is the rising prevalence of drug resistant strains of TB that further tax the health system with the cost of expensive services and medicines needed to care for these patients.

Management Sciences for Health (MSH) under USAID’s TB CARE I project, is assisting the Ministry of Health’s National TB Program (NTP) to develop ways to increase domestic financing for Indonesia’s TB control initiatives. Possible solutions include: increased contributions from national health insurance and government budgets, corporate social responsibility programs, and improvements in cost-effectiveness and efficiency.

Sunday, March 24, 2013, is World TB Day, and MSH staff and partners are promoting global efforts to stop TB throughout the week.

Here are highlights from some of our activities around the world:

The Afghanistan TB CARE I team is working with the national TB program (NTP) to conduct celebration events at 290 health facilities and communities in 13 USAID-supported provinces. TB messages will be aired through local telephone companies to approximately one million people throughout the nation. TB CARE I is also identifying and publicly rewarding high-performing health workers.

The Bangladesh SIAPS TB team will participate in a national rally on March 24 with all TB partners and stakeholders within the NTP network, as well as in a press conference, workshop, and scientific session.

The October edition of MSH's Global Health Impact newsletter (subscribe), features stories of people, communities, and countries on the road toward universal health coverage (UHC).

The vital role of the essential package for health impact

Each year, as many as 64,000 people die from tuberculosis (TB) in Indonesia. Although the Ministry of Health’s (MOH) National TB Program (NTP) has made great progress over the last few years, the country is still one of twenty-two high TB-burden countries in the world. Indonesia is also one of the twenty-seven countries considered to have a high burden of multi-drug resistant TB (MDR-TB). In 2011, the nation reported 6,100 cases of MDR-TB.

Donor funding has been a major factor in the success of Indonesia’s TB program over the last few years, especially The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) grants.  Indonesia has, however, progressed economically and is now a relatively low priority for Global Fund grants, which are expected to end or reduce significantly by 2015.

Despite Indonesia’s economic growth, the sustainability of the TB program will be a major challenge without support from this critical donor, especially during the funding transition period.

In the 1990s many Brazilian patients infected with tuberculosis (TB) were not being cured, despite starting treatment. Some patients stopped taking their medication, which led to the reemergence of TB. In 1993, the World Health Organization declared that TB was a global emergency. Eventually, a multi-resistant strain of TB surfaced, making it even more difficult to fight the disease.

These occurrences --- referred to as “chronic cases” --- became apparent in some Brazilian states, but health units lacked standardized management systems to treat these cases of TB.

Centro de Referência Professor Hélio Fraga (CRPHF), which is Brazil's National Tuberculosis Reference Laboratory, took control of TB surveillance in 1994. CRPHF defined a more effective treatment scheme and a national network to register and monitor the chronic cases in 1999. CRPHF builds human capacity through training and carries out operational and epidemiological studies. They also evaluate TB and other lung disease control activities and function as a Macro Regional Reference Lab.

Cross-posted from the UHC Forward blog. 

To support the efforts of countries that have committed to making substantive universal health coverage reforms, experts in many areas of financial protection must continually share in dialogue and debate.

To this end, the Results for Development Institute, in partnership with the Rockefeller Foundation, is pleased to announce the launch of UHC Forward, a new website that tracks and consolidates key health coverage information from hundreds of sources into a one-stop portal with feature news, events, and publications related to the growing global universal health coverage (UHC) movement.