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 11.000
among notified pulmonary TB
cases
Estimated %of TB cases with 2.8% (new)
MDR + RR-TB 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 VISION MISSION
An Indonesia free TB Elimination in
2016 - 2020 of tuberculosis Indonesia by 2030
Milestones toward
TB elimination in Indonesia

01 Strengthening Leadership in the District level Management

02 Improving access to the quality TB services

03 Control of Risk Factors

Enhancing TB Partnership through
04
the Coordination Forum

Engaging Community in TB Control 05

Health System Strengthening 06

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

Baseline Target
No Indicator
2015 2016 2017 2018 2019 2020
Strategi 5: Increasing Community Participation to TB Control

Percentage of TB cases found and

5,1 referred by community or community 3,5% 8% 12% 16% 20% 20%
organizations
 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)
Contact Tracing by Monitor Cadre
Cadre HIV +
Cadre HIV
Recruitment

Monitor Cadre
Examinati PMO
HIV Test HIV -
on (+)
Cadre Training
Training PMO- Success
X-Ray TB TB ALL
TB +
Gen-X
Cadre TB - NOT
Counseling Success TB-MDR
Clinical TB -
Signs + Care

Recruitment
Suspect finding Sputum FINISH PS-MDR
Smear - PS-MDR
by cadre Examination

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

DMI YKB JKM YARSI TB

PPTI PUSAT LKC Dewan Masjid Yayasan Jaringan Kesehatan CARE
Indonesia Kusuma Buana Masyarakat

LKNU

AISYIYAH

PELKESI

PERDHAKI

SPIRITA

PAMALI TB PARTISAN JAPETI YAPARI

INDONESIA PKPU (Red Institute) Jaringan Peduli Yayasan
TB Indonesia Pembinaan Remaja
MAPPING OF PATIENTS ORGANIZATION
(PROVIDE SUPPORT AND CONTACT INVESTIGATION FOR DR TB PATIENTS)

MEDAN BATAM BANJARMASIN MAKASSAR GOWA

Pejuang Sehat STORY BEKANTAN Kami Rela Berjuang Bagi DAENG TB
Bermanfaat (PESAT) Jiwa (KAREBABAJI)

PADANG JAYAPURA
PUSAKO CTP

JAKARTA
Pejuang Tangguh (PETA)

BANDUNG
Terus Berjuang (TERJANG)

SEMARANG
Semangat Membara
(SEMAR)

MADIUN
PETIR

MALANG SURABAYA JEMBER DENPASAR SIKA

Pantang Menyerah Arek Nekat (REKAT) Syukur Sabar Semangat GAMELAN SIKA BERAKSI
(PANTER) Sukses (SEKAWANS)
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
Community
Jayapura City
Coalitions
Family Health Approach: Indonesia's “Knock the Doors”
Knock the Doors
Indonesia
Country work plans for
National TB community based TB activities
Program
 Contact Investigation Child (<5 yo)
Suspect
Elderly
Monthly suspect
SSR
Coordination
Patient data
Patient Data with sub- Investigation
distribution by Refer &
in Puskesmas district//village by cadre
SSR check at
head involving (index cases)
puskesmas
cadre
Cadre
Training Orientation of
PMO Orientatio result +
Training n PMO (patient)
Module* Monitoring

Recruitment Drop-Out/
and Cadre cured
Death
selection

Cadre Validasi oleh

Mapping in SSR
Suspect
Sub District
reward
payment
Data of
estimated Case reward Validation and repoting
Recapitulation
patient ratio payment to puskesmas by
by Monev SSR
2017 subdistrict coordinator

coordination with department of health (dinkes)/healthcare center (puskes) each semester

Coordination with Provincial Department of Health
National Coordination
Advocacy Strategy
Development Issue
of Policy Paper packing/campai
gn/public
Arrangement education
and updating of
Establishment
situation analysis
of Alliance
/ public test
(CSO
Coordination Lobby/negotiati
Meeting) on/audiences Policy / service
Preparation changes and TB-
Establishment and HIV budget
Meeting with
of Advocacy development of improvements
Development philanthropy &
team RAD
and updating of private sector
Legal
joint advocacy drafting/counter
strategies for draft
HIV TB
FGD to Review
regional policy

Workshop on
Formation of
Capacity Academic Paper
building,
advocacy and
fundraising

Monitoring of
TB/HIV Services
Indonesia

National TB
Thank You
Program