Indonesia Current status of integrated community based TB service delivery and the Global National TB Fund work plan to find missing TB cases Program
Country Profiles
Annual TB incidence in Indonesia reach 1,020,000 cases. The incidence rate of TB is 391 per 100,000 population. 3
TB burden trends in Indonesia Before and after the National TB Prevalence Survey
Contact Tracing Screening in a Specific Population (urban poor, underserved area, Remote area etc) Drop Out follow-up (DOFU) Risk factor analysis Implementation of District Based PPM Mandatory Notification and Strengthening of surveillance Management of integrated TB services (HIV, DM, nutrition, smoking, elderly etc) Sync with National Insurance system
Case Detection Rate 2017
Treatment Success Rate 2017
Estimated of DR-TB burden (WHO 2017) Incidence MDR+RR TB 32.000 Estimated MDR+RR-TB cases among notified pulmonary TB cases Estimated %of TB cases with MDR + RR-TB 11.000 2.8% (new) 16% (Prev.Tx) Laboratory-confirmed cases 2.757 Patients started on treatment 1.931 Succes rate 51 % Situation Burden TB HIV incidence 45.000 Knowing HIV status 14% TB HIV on ART 28% Succes rate 60%
NATIONAL STRATEGIC PLAN 2016-2020 Milestones toward TB elimination in Indonesia VISION An Indonesia free of tuberculosis MISSION TB Elimination in Indonesia by 2030 01 Strengthening Leadership in the District level Management 02 Improving access to the quality TB services 03 Control of Risk Factors 04 Engaging Community in TB Control Enhancing TB Partnership through the Coordination Forum 05 Health System Strengthening 06
NATIONAL STRATEGIC PLAN 2016-2020 Milestones toward MAJOR TARGET TB elimination in Indonesia Indonesia END TB strategy key targets by 2030: Increase case notification from 32% in 2016 to 70% in 2020 Expand access to and utilization of Xpert MTB/RIF as primary diagnostic tool for at least 75% of presumptive TB patients by 2020 Ensure 80% of DR-TB patients are diagnosed and notified by 2020 Ensure 95% of diagnosed DR-TB patients are enrolled on treatment by 2020 Improve overall treatment success for DS-TB to 90% from 2017 onwards and for DR- TB to 75% by 2020 Increase proportion of TB patients with known HIV status from 15% to 50%, 60% and 75% in 2018, 2019, 2020 respectively, and ensure all co-infected patients are started on ART Provide IPT to at least 50% of child (< 5 yrs.) contacts of TB patients
National Indicator on National Strategy No Indicator Baseline 2015 Target 2016 2017 2018 2019 2020 Strategi 5: Increasing Community Participation to TB Control 5,1 Percentage of TB cases found and referred by community or community organizations 3,5% 8% 12% 16% 20% 20%
Performance Framework (PF) The Global Fund (Aisyiyah) Number of bacteriologically confirmed TB patients whose household contacts screened for TB CSO Baseline 2018 2019 2020 Aisyiyah 48.023 75.749 105.171 N/A (35%) (49%) (63%) Number of notified TB cases (all forms) contributed by non-national TB program providers community referral CSO Baseline 2018 2019 2020 Aisyiyah 40.109 63.124 87.643 N/A (7,5%) (10,5%) (13,5%)
Challenges in Engaging Community in TB Control Lack of public knowledge regarding TB symptoms and place to go for examination, diagnosis, and quality guaranteed treatment Limited involvement of the patients, former patients and families and the wider community in TB control Limited geographical coverage of civil society organizations and other stakeholders Socio-economic barriers TB patients to access TB care Still Low public awareness about the rights and responsibilities of TB patients High stigma among healthcare worker as well as in communities
Activity Flow Chart of Community TB-HIV Care (CST) Cadre Recruitment Contact Tracing by Cadre HIV + Monitor Cadre HIV Cadre Training Examinati on (+) X-Ray Gen-X HIV Test TB + HIV - Training PMO- TB Monitor Cadre PMO Success TB ALL Cadre Counseling Clinical Signs + TB - TB - NOT Success TB-MDR Care Suspect finding by cadre Sputum Examination Smear - FINISH Recruitment PS-MDR PS-MDR Cadre Monitoring Meeting (2 Monthly) Coordination Meeting on District Level (3 Monthly) Provincial Coordination Meeting (6 Monthly) - Rakorwil National Coordination Meeting (6 Monthly / Annual)
IMPLEMENTATION ARRANGEMENT MAPPING SR SSR
MAPPING OF CSO PPTI PUSAT LKC DMI Dewan Masjid Indonesia YKB Yayasan Kusuma Buana JKM Jaringan Kesehatan Masyarakat YARSI TB CARE LKNU AISYIYAH PELKESI PERDHAKI SPIRITA PAMALI TB INDONESIA PKPU PARTISAN (Red Institute) JAPETI Jaringan Peduli TB Indonesia YAPARI Yayasan Pembinaan Remaja
MAPPING OF PATIENTS ORGANIZATION (PROVIDE SUPPORT AND CONTACT INVESTIGATION FOR DR TB PATIENTS) MEDAN Pejuang Sehat Bermanfaat (PESAT) BATAM STORY BANJARMASIN BEKANTAN MAKASSAR Kami Rela Berjuang Bagi Jiwa (KAREBABAJI) GOWA DAENG TB PADANG PUSAKO JAYAPURA CTP JAKARTA Pejuang Tangguh (PETA) BANDUNG Terus Berjuang (TERJANG) SEMARANG Semangat Membara (SEMAR) MADIUN PETIR MALANG Pantang Menyerah (PANTER) SURABAYA Arek Nekat (REKAT) JEMBER Syukur Sabar Semangat Sukses (SEKAWANS) DENPASAR GAMELAN SIKA SIKA BERAKSI
SUPPORT FOR IMPLEMENTATION NTP develop guidelines and modules, Training of Trainers will be supported by Global Fund and CTB project Training of Trainers focusing in high burden areas 3 days training will be done in district level Stepwise integrated supervision (NTP -> PHO -> DHO -> Puskesmas) Reporting and recording in case finding and case holding For DR TB will use mobile-based application called EMPATI (e-mobile for DR TB patient)
Reporting System 01 NTP TB 07, 08, etc. 02 PHO TB 03 03 DHO TB 06 04 Puskesmas Presumptive TB Form 05 Cadre 23
IMPLEMENTATION TOOLS (AISYIYAH CADRE)
IMPLEMENTATION TOOLS (AISYIYAH CADRE)
IMPLEMENTATION TOOLS (AISYIYAH CADRE)
IMPLEMENTATION TOOLS (MoH)
IMPLEMENTATION TOOLS (MoH)
IMPLEMENTATION TOOLS (MoH)
IMPLEMENTATION TOOLS (MoH)
IMPLEMENTATION TOOLS (MoH)
IMPLEMENTATION TOOLS (MOBILE)
Mechanisms for coordination of community based TB Activities There is no formal coordination mechanism e.g. NTP-NGO coordination body Yet, there is an existing forum called Forum Stop TB Partnership Indonesia (FSTPI) consisting of CSO, Private Sector, Ministrials, Patient Organization, Professional Organization and individual
Indonesia National TB Success story Program
Gancang Aron New innovation called Gancang Aron has been launched by the Local Government of Banyuwangi Regency to provide a wider access and comfortable services to TB patients by deploying the pharmacy team to deliver TB medicine to the patients homes in person. They also visited the patients homes to directly observe while the patients taking TB drug, assess the environment, behavior and give education the household member. Gancang Aron means get well soon. As an acronym, it means avoiding long queues. The local government also collaborated with online ride rents to deliver TB medicine. The drivers completed a training in a pharmacy service before joining. 36
Surakarta City Jayapura City Community Coalitions
Family Health Approach: Indonesia's Knock the Doors
Knock the Doors
Indonesia National TB Country work plans for community based TB activities Program
Contact Investigation Child (<5 yo) Monthly Suspect Elderly suspect Cadre Training Patient Data in Puskesmas Training Module* SSR Patient data distribution by SSR Coordination with subdistrict//village head involving cadre Investigation by cadre (index cases) Orientation of PMO Monitoring Orientatio n PMO Refer & check at puskesmas result + (patient) Recruitment and Cadre selection Drop-Out/ Death cured Cadre Mapping in Sub District Data of estimated patient ratio 2017 Suspect reward payment Case reward payment Recapitulation by Monev SSR Validasi oleh SSR Validation and repoting to puskesmas by subdistrict coordinator coordination with department of health (dinkes)/healthcare center (puskes) each semester Coordination with Provincial Department of Health National Coordination
Advocacy Strategy Establishment of Advocacy team Arrangement and updating of situation analysis / public test Development and updating of joint advocacy strategies for HIV TB Development of Policy Paper Establishment of Alliance (CSO Coordination Meeting) Meeting with philanthropy & private sector FGD to Review regional policy Preparation and development of RAD Issue packing/campai gn/public education Lobby/negotiati on/audiences Legal drafting/counter draft Policy / service changes and TB- HIV budget improvements Capacity building, advocacy and fundraising Workshop on Formation of Academic Paper Monitoring of TB/HIV Services
Indonesia National TB Thank You Program