SITUASI DAN KEBIJAKAN TERKINI PENGENDALIAN TB

Indonesia National TB Program Presentation

Dyah Erti Mustikawati

5 Country with TB Burden (Global Tuberculosis Control, 2011)

1. India (2,300,000)2. China (1,000,000)3. South Africa

(490,000)4. Indonesia (450,000)5. Pakistan (400,000)

400.000-500.000 New Cases per year , 61000 Died by years(Global Tuberculosis Control 2011)

Global report 2011: Rank 9

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Ecuador

Georgia

Argentina

Bangladesh

Germany

Rep of Korea

Armenia

Russian Fed.

South Africa

Portugal

Latvia

Mexico

Peru

USA

Brazil

UK

Sweden

Thailand

Chile

Based on information provided to WHO Stop TB Department - January 2009

Spain

China, Hong Kong SAR

France

Japan

Norway

Canada

Italy

Netherlands

Estonia

Lithuania

Ireland

RomaniaIsrael

Azerbaijan

Poland

Slovenia

India

Australia

Mozambique

Vietnam

Ukraine

Moldova

Philippines

Botswana

Nepal

Islamic Rep. of Iran

Lesotho

Swaziland

Namibia

Countries with confirmed XDR-TB cases as of January 2009

Incidence, Prevalence & Mortality TB, 1990, 2007*) 2009**), 2010***),

*) Global Report TB, 2009 halaman 282

**) Global Report TB, 2010 halaman 171

***)Global report 2011

Per year Per

100.000 pop

Per day Per year Per

100.000 pop

Per day

Per year

Per 100.000

pop

Per day

Per year

Per 100.000

pop

Per day

Incidence all type TB

626.867 343 1.717 528.063 228 1.447 430 189 (45%) 1.178 430 189 (45%)

1.178

Prevalence all cases

809.592 443 ~ 565.614 244 ~ 660 285 (36%) ~ 660 289 (35%)

~

Incidence new smear + cases

282.09 154 773 236.029 102 647 NA NA NA NA NA NA

Mortality 168.956 92 463 91.369 39 250 61 27 (70%) 167 61 27 (70%) 167

TB cases

1990 2007 2009 2010

Target CDR RPJMN 73%, Global 70% Target SR RPJMN & Global

≥ 85%

*) sd triwulan 1

Target RPJMN 73%, Global 70%Catatan : Insiden BTA Positif =

Sumatera : 164 per 100.000 penduduk, Jawa : 107 per 100.000 penduduk, DIY-Bali : 64 per 100.000 penduduk, Kawasan Timur Indonesia (KTI) ; 210 per 100.000 penduduk

Target RPJMN & Global ≥ 85%

Komitmen politis1

Directly Observed Treatment Short-course

WHA 1991

The 5 elements of DOTSThe 5 elements of DOTS

2

Diagnosa denganmikroskop

3

Pengobatan dengan

pengawasan langsung

4

Jaminan Ketersediaan

OATYg bermutu

5

Monitoring

dan evaluasi

97 98 99 00 01 02 03 04 05 06 07 08 09 -

100,000

200,000

300,000

400,000

500,000

600,000

Challenges of National TB Control Program in Indonesia

Estimated ALL TB cases

TOTAL notified TB cases

New Smear Positives

New Smear Negatives

Re-treatment

Extra Pulm

Nu

mb

er o

f p

atie

nts

New Global Target: World TB Free 2050, indikator in-

sidence 1/1.000.000 or 10/100.000, SR > 90%,

CNR > 90%‘ GAP ’

10

VISION & MISION STRATEGIC ACTION PLAN MOH

MISSION

TO CREATE AND IMPLEMENT GOOD GOVERNANCE AT ALL LEVELS

VISIONHEALTHY SOCIETY

WITH SELF RELIANCE AND JUSTICE

TO INCREASE HEALTH STATUS OF THE COMMUNITY THROUGH EMPOWERING THE COMMUNITY INCLUDE PRIVATE SECTORS AND SELF RELIANCE GROUPS

TO PROTECT PUBLIC HEALTH IMPORTANCE BY SECURING THE AVAILABILITY OF COMPREHENSIVE AND INTEGRATED QUALIFIED HEALTH SERVICES , EQUITABLE AND AFFORDABLE ACCESS,

TO SECURE HEALTH FINANCE AND EQUITABLE DISTRIBUTION OF THE RESOURCES

RPJMN 2010 - 2014

VALUE : PRO PEOPLE, INCLUSIVE, RESPONSIVE, EFEKTIVE, CLEAN 11

Community empowerment and involvement is the first strategy!!

1. Increasing Universal Access to Quality DOTS Services

2. TB/HIV, MDR-TB, Childhood TB and reaching the other un-reach population (DTPK, Closed setting etc)

3. Implementing Comprehensive PPM model to ensure the involvement of all care providers towards quality TB care and treatment in compliance to ISTC

4. Empowering the TB people affected to get involved stategically in TB control

Supported with :

5. HSS for Improvement of service delivery system and management of TB program at all levels

6. Increasing commitment of central and local government on TB control program for sustainability

7. Increasing operational research, surveillance system, MIS and utilization of strategic information for policy action.

Management MDR + XDR Cases

1.Universal Access to Quality DOTS2.Programmatic Management of Drug

Resistance Tuberculosis (PMDT)

ObjectiveTo increase the systematic

engagement of all care providers including private

physicians in collaboration with the national tuberculosis

control program in the diagnosis, treatment and

notification of patients with tuberculosis.

Engaging All Care Providers

Significant proportion of TB Patients seeks treatment from Private Pratitioners/Sector

Jawa Bali Kalimantan Papua Sumatra Sulawesi0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Lain-lainRS khusus paruPraktik swastaPuskesmasRS swastaRS pemerintah

*Balitbangkes (2011)

TB Drugs Consumption at Private Market/Sectors*

Country Incidence Consumption of TB drugs 1st line at private market (%)

Proportion of loose TB drugs (%)

India 1,982,628 117 23

Indonesia 429,730 116 91

Filipina 257,317 86 16

Pakistan 409,392 65 36

Cina 1,301,322 23 98

Thailand 92,087 17 94

Russia 150,898 13 100

Vietnam 174,593 7 90

Bangladesh 359,671 7 11

Afrika Selatan 476,732 3 34

*Wells et al (2011)

6 Pilar Indonesia Public Private Mix (INA-PPM) Comprehensive Model

Penguatan Sistem Komunitas

- Fungsi sebagai advokator peningkatan pendanaan dan komitment,

- peningkatan awareness masyarakat, peran sbg public watch unt menjamin layanan DOTS berkualitas, peningkatan piagam pasien (hak dan kewajiban)

- Mobilisasi sosial, identifikasi suspek, demand creation , layanan TB di wilayah spesifik (daerah kumuh perkotaan,

Penjara/lapas) - Leading: LSM, Ormas dll- TA: FHI, other partners

Diagnosa TB yang Berkualitas

- Penguatan Jejaring dan QA laboratory (public and private) DST, Kultur dan mikroskopik

-Leading: Dit BPPM dan Sarana Kesehatan

- TA: KNCV dan JATA

Pelayanan Rumah Sakit Publik/Swasta

- Pendekatan: Akreditasi Rumah Sakit (Penerapan SPMRS TB-DOTS

dan mekanisme referral ke layanan DOTS berkualitas

- Leading: Dit BUK Rujukan- TA: KNCV

Pelayanan DOTS di DPSdan Spesialis

- Pendekatan: ISTC rewarding/ cumulative

credits, sertifikasi /lisensi- Leading: IDI

- TA: ATS

OAT dan penggunaan secara rasional

- Pendekatan: Penegakan hukum/law enforcement- Leading: IAI (ikatan

Apoteker Indonesia), BPOM, Dirjen Binfar

- TA: USP dan MSH

Penguatan Pelayanan DOTS Dasar di

Puskesmas- Pendekatan: Penguatan sistem

surveilans dan MIFA, Peningkatan Kualitas layanan, meningkatkan

cakupan TBHIV, menjangkau masy di wilayah DTPK, meningkatkan rujukan

ke layanan DOTS berkualitas- Leading: NTP

- TA: WHO, FHI and other partners

Must Act Now Before It is Too Late

International Health Regulation (IHR) Public Health Emergence International Concern (PHEIC)

• The revised International Health Regulations (IHR), adopted by the World Health Organization (WHO) in 2005, create a legal framework among nations for collaboration in response to international public health emergencies.

• The broad objective of the IHR, which has been accepted by 194 member states, including the U.S. is to improve the ability of all countries to detect and respond to public health threats like SARS, pandemic influenza, or other conditions that have the potential to threaten populations worldwide.

• The IHR requires signatory nations to notify WHO of (1) any event that may constitute a public health emergency of international concern (PHEIC); or (2) any significant evidence of public health risks outside their territory that may lead to or cause the international spread of disease.

• The IHR also requires nations to expand their national health surveillance capacities and implement certain measures for regulating international traffic at airports and other entry points.

• Some countries has been using the IHR to control TB, MDR TB, or XDR TB and apply it as a PHEIC., and globally there is, precedent for considering MDR and XDR TB as potential PHEICs.

• The U.S.?New Zealand, Australia, Korea etc have notified WHO of cases with drug-resistant TB who travelled internationally by commercial aircraft as a potential PHEIC.

INCREASING MDR THREATENS OUR NATION STRENGTHS AND MAY INFLUENCE

ECONOMIC SITUATION

THANK YOUTERIMA KASIH