Republic of Indonesia

Transcription

1 Republic of Indonesia National Tuberculosis Program Remarks by the Honorable Ministry of Health on the Recommendation of the Tuberculosis Joint External Monitoring Mission February 2013 First I would like to express my sincere appreciation and thanks to all JEMM team members for your efforts to evaluate the progress of the TB Program in our country, Indonesia. Regarding the report presented by the JEMM 2013 team leader, we, in the Ministry of Health of Indonesia appreciate your inputs and are aware of the issues presented by the team leader. Ministry of Health is committed to reaching the Millennium Development Goals and is making all efforts to meet the targets. Based on the recent evaluation by Coordinating Ministry of Social Welfare (Kemenkokesra) and the National Planning Board (BAPPENAS), the TB program is among those programs that are meeting the targets of the Medium Term National Development Plan (RPJMN). However, the achievement of MDGs is one of the first steps towards meeting the ultimate target of tuberculosis elimination and I am aware that Tuberculosis control is still facing many 1

2 challenges in my country. My response to your recommendations is as follows: Recommendation 1: Introduce the policy of mandatory notification of tuberculosis patients to have a reasonable estimate of incidence and a reliable measure on the size and the trends of tuberculosis burden that should include a national vital registration system. I strongly agree with this recommendation and I will take necessary steps to implement mandatory notification for tuberculosis. Indonesia is one of the largest high burden countries that contributes to the global burden of tuberculosis. We also realize that it is crucial to have reliable data in order to be able to measure the performance and impact of our control activities. Considering this importance and the complexities of making TB a notifiable disease we will take several steps; first we will review the relevant required regulations. Secondly, we will conduct a feasibility assessment for the introduction of this regulation. Ministry of Health will also take into consideration the experiences of other countries and seek expert technical assistance to speed up the introduction. We will establish a framework including a plan of action for mandatory notification of tuberculosis. 2

3 Recommendation 2: Instruct the provincial health authorities to develop, finance and implement action plans for accelerating diagnosis, notification and treatment of drug-resistant tuberculosis and decreasing the financial burdens to these patients. I have already endorsed the National Guideline for Programmatic Management on Drug Resistant Tuberculosis (PMDT) through Ministerial Decree no 13/2013. I am happy to inform you that two of the eight provinces currently implementing PMDT have already intiated the development of provincial action plans with financial contribution from local governments. The absence of provincial PMDT action plans in the other six provinces has resulted in a lack of commitment and ownership of the provincial health authorities and other stakeholders. As a consequence the local support to reach the target of PMDT has been difficult to achieve. Ministry of Health will send a formal letter to all Governors and Provincial Health Authorities requesting their support for accelerated expansion of quality PMDT services. Ministry of Health will also instruct all provinces to develop PMDT provincial action plans in line with the National PMDT long term plan including its targets. We will also engage with the Ministry of Social Welfare and provincial 3

4 governments to explore possible avenues to leverage support for MDR TB patients. We will ensure that the enrollment for TB treatment does not induce further financial burden for MDR TB patients. Recommendation 3: Issue a decree on financial sustainability for AIDS, Tuberculosis and Malaria services to ensure adequate domestic budget allocations, and define roles and responsibilities for the provincial and district levels. To address this recommendation, I will use a three-prong approach. First I will issue a circular to all provincial health authorities with the instruction to include ATM in the budget requests, in line with exit strategy. Secondly, the Ministry of Health will coordinate with Ministry of Home Affairs (MOHA) to issue a regulation for provincial and district governments to allocate budgets for ATM. Thirdly, the National Planning Beaureu (Bappenas) in coordination with Ministry of Health will provide guidance to the Provincial / District Planning Beaureu (Bappeda) to include ATM in the annual budgets. In addition, it is expected that the inclusion of the target for the Case Notification Rate in the new district Minimum Service Standards (SPM) will oblige the local governments to allocate budgets for tuberculosis control. At the same time, the Government is in the process of revising the Government Regulation (PP 38/2007) on distribution of Roles and 4

5 Responsibilities between government authorities. Ministry of Health will ensure that ATM is included in the distribution of these roles and responsibilities. Recommendation 4: Ensure early and universal access to quality care for all forms of tuberculosis in adults and children including every individual, irrespective of drug resistance and HIV status. All National Tuberculosis Control Programme guidelines and SOP s will be reviewed to ensure these are in line with the latest international recommendation and also focus on diagnosis and management of smear negative, extra pulmonary, childhood tuberculosis and those with TB- HIV co-infection. The National Tuberculosis Control Programme will ensure these guidelines are adhered to during supervision, monitoring and evaluation at the level of implementation. I will promote that all diagnostics needed to assure quality care will be included in the BPJS (National Health Insurance) scheme. Recommendation 5: Address staffing needs for the implementation of all components of the 5

6 National Strategy for tuberculosis control, and ensure that they are met in the development plans for human resources for health at central, provincial and district levels. Ministry of Health will introduce innovative and creative methods for training and learning, including e-learning and other web-based technology to address the current training needs in our country Ministry of Health will strengthen the role of Provincial Training Teams (PTT) to support capacity building at local level and make maximal use of peereducators from programme and professional societies. Health Workforce planning and production is under the responsibility of the BPPSDM (Board for Manpower Development). The BPPSDM is in the process of exploring alternative ways of making more staff available for TB control such as the involvement of assistant nurses and through task shifting. We will estimate the staffing needs for TB control in the context of overall health workforce development. We will also make sure that those needs are reflected in plans at all levels. We will collaborate with partners to develop short and long-term solutions to address staff shortages through various forms of contracting. Recommendation 6: Instruct the provincial health authorities to scale up TB/HIV collaborative activities for increasing HIV testing and counseling among tuberculosis patients and ensure all TB/HIV co-infected patients receive antiretroviral 6

7 treatment and cotrimoxazole preventive therapy. The Ministry is very much aware of the rising epidemic of HIV in the country and already has planned for the scaling up of both TB and HIV activities in all provinces. The DG of DC and EH will ensure the 7

8 strong coordination between NTP and NAP from central level down to the implementing facilities to strengthen the linkage. The joint planning, surveillance, implementation support, monitoring and evaluation of TB and HIV programs will ensure that TB-HIV collaborative activities are implemented in all ART hospitals and PHCs. This will ensure strong linkages in the health facilities of other government agencies like prison, military and also with the private sector, civil society organizations, self-help groups and communities. The Ministry will ensure that the targets for TB patients tested for HIV and patients co-infected with TB-HIV receiving ART and CPT are achieved according to the National TB-HIV action plan. The activities include TB intensified case finding among PLHIV, scaling up of IPT, strengthening TB- IC in TB-HIV settings, implementing PITC, and others. All your recommendations have come at the right moment. Next month we will conduct the National Health Coordination Meeting (Rakerkesnas), where all provincial and districts healt authorities will participate. At this meeting I will present all your recommendations and our responses for follow up actions. I trust that all your recommendations will be addressed by the responsible entities. Once again thank you for your valuable inputs and advise. I hope you have enjoyed your stay. 8