Indonesia

National TB Program

Current status of integrated community based TB service delivery and the Global Fund work plan to find missing TB cases

Country Profiles

3

Annual TB incidence in Indonesia reach 1,020,000 cases.

The incidence rate of TB is 391 per 100,000 population.

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

11.000

Estimated %of TB cases with

MDR + RR-TB

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%

VISION An Indonesia free

of tuberculosis

MISSION TB Elimination in

Indonesia by 2030

NATIONAL STRATEGIC PLAN 2016 - 2020 Milestones toward TB elimination in Indonesia

02

03

04

05

06

Improving access to the quality TB services

Control of Risk Factors

Enhancing TB Partnership through

the Coordination Forum

Engaging Community in TB Control

Health System Strengthening

01 Strengthening Leadership in the District level Management

MAJOR TARGET

NATIONAL STRATEGIC PLAN 2016-2020

Milestones toward 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%

CSO Baseline 2018 2019 2020

Aisyiyah N/A

48.023 (35%)

75.749 (49%)

105.171 (63%)

Number of bacteriologically confirmed TB patients whose household contacts screened for TB

Number of notified TB cases (all forms) contributed by non-national TB program providers – community referral

CSO Baseline 2018 2019 2020

Aisyiyah N/A

40.109 (7,5%)

63.124 (10,5%)

87.643 (13,5%)

Performance Framework (PF) The Global Fund (Aisyiyah)

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

Suspect finding by cadre

Cadre Counseling

Sputum Examination

Examinati on (+)

HIV Test

HIV + Monitor Cadre

HIV

HIV -

Training PMO- TB

Success TB ALL

Smear -

X-Ray Gen-X

TB +

TB -

TB - NOT Success

Cadre Training

Cadre Recruitment

Recruitment PS-MDR

PS-MDR

TB-MDR Care

Activity Flow Chart of“Community TB-HIV Care” (CST)

Cadre Monitoring Meeting (2 Monthly)

Coordination Meeting on District Level (3 Monthly)

Provincial Coordination Meeting (6 Monthly) - Rakorwil

Clinical Signs +

Contact Tracing by Cadre

FINISH

National Coordination Meeting (6 Monthly / Annual)

Monitor Cadre PMO

SR SSR

IMPLEMENTATION ARRANGEMENT MAPPING

MAPPING OF CSO

LKNU

AISYIYAH

PELKESI

PERDHAKI

SPIRITA

PAMALI TB INDONESIA

PPTI PUSAT

LKC

DMI Dewan Masjid

Indonesia

YKB Yayasan

Kusuma Buana

PARTISAN (Red Institute)

YAPARI Yayasan

Pembinaan Remaja

YARSI TB CARE

JKM Jaringan Kesehatan

Masyarakat

PKPU

JAPETI Jaringan Peduli TB Indonesia

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

JAYAPURA CTP

PADANG PUSAKO

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

• 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)

SUPPORT FOR IMPLEMENTATION

01

02

03

04

05

NTP

PHO

DHO

Puskesmas

Cadre

Reporting System

23

Presumptive TB Form

TB 06

TB 03

TB 07, 08, etc.

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)

• 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

Mechanisms for coordination of community based TB Activities

Indonesia

National TB Program

Success story

36

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.

Surakarta City

Jayapura City Community Coalitions

Family Health Approach: Indonesia's “Knock the Doors”

Knock the Doors

Indonesia

National TB Program

Country work plans for community based TB activities

SSR

Monitoring

Orientation of

PMO

Case reward

payment

Validasi oleh

SSR

Patient data

distribution by

SSR

Recruitment

and Cadre

selection

Investigation

by cadre

(index cases)

Cadre

Training

Data of

estimated

patient ratio

2017

Training

Module*

Patient Data

in Puskesmas

Drop-Out/

Death

Recapitulation

by Monev SSR

cured

Coordination

with sub-

district//village

head involving

cadre

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

Monthly

Cadre

Mapping in

Sub District Suspect

reward

payment

Refer &

check at

puskesmas

Orientatio

n PMO

result +

(patient)

Child (<5 yo)

Elderly

suspect

Contact Investigation Suspect

Policy / service

changes and TB- HIV budget

improvements

Issue packing/campai

gn/public education

Lobby/negotiati

on/audiences

Legal drafting/counter

draft

FGD to Review regional policy

Meeting with philanthropy & private sector

Establishment of Alliance

(CSO Coordination

Meeting)

Development

of Policy Paper

Development

and updating of joint advocacy strategies for

HIV TB

Arrangement

and updating of situation analysis

/ public test

Workshop on Formation of

Academic Paper

Establishment of Advocacy

team

Preparation and

development of RAD

Monitoring of TB/HIV Services

Capacity building,

advocacy and fundraising

Advocacy Strategy

Indonesia

National TB Program

Thank You