A comparative study of health

policy in Asia: a case of dengue

prevention and control in
Taiwan and Indonesia
(work in progress)
Dwiartama, A., Ahmad, I., Anggraeni, T., Yusmalinar, S.,
Faridah, L., Putra, R.E., Wibowo, I., Fibriani, A., Ramdan, H.
  Introduction
 Aims and objectives
 Context: country profile
Outline  Health care system in the two countries
 The case of dengue and dengue surveillance and control
 Lessons learned: differences and some alignments
 Looking forward
BACKGROUND

World
distribution of
dengue: 1991 vs Covering wider areas
2016 (and latitudes) than
previously occurred –
effect of climate
change?
 Gubler, 2014: Dengue and Dengue Fever
 A shift of focus from infectious diseases to non-communicable
diseases (NCDs)
Global  Increased global travel
resurgence of  Dramatic urban growth with changing lifestyles: water
use/storage, plastic waste, tire, etc., particularly in tropical
DHF: Why? developing countries such as Indonesia
 Policy changes: from mosquito control to emergency response
programs
  Surveillance methods: mostly passive (relying on clinical
reporting)
 Recent shift to active surveillance: success story in Singapore
(http://www.dengue.gov.sg/), the Philippines
(http://www.dost.gov.ph/), and Brazil (InfoDengue) (Codeco et al.,
SURVEILLANCE 2016)
SYSTEM FOR DHF: AN  In Singapore, a compulsory involvement of citizens towards
INTERNATIONAL Dengue monitoring
PERSPECTIVE
 In the Philippines, involving active participation of 45,000 public
schools to monitor mosquito populations
 Further development to modelling and prediction (early warning
systems) – risk factors: Climatic, Household, Individual Host
(Racloz et al., 2012)
  Increasing attempts to build and inter-national dengue prevention
and monitoring programs: collaboration between neighboring
countries and countries with intensive population mobility
PROBLEM  The case of Southbound policy: Taiwan and Indonesia
 Can the same strategy be implemented in two different sets of
STATEMENT, national contexts?
 What are the factors that may influence the success and failure of
AIMS AND strategy implementation in those different contexts?
OBJECTIVES  What can be learnt together?
 The objective of this paper is to understand the health policy and
country-large context in the implementation of dengue
prevention/surveillance programs between Taiwan and Indonesia
  Country profile:
 Geography, ecology and climate
 Demography
 Economy and culture
 Administrative and policy
 Health and diseases
 Health system context:
SETTING THE  Health governance structure
 Policies, programs and priorities
CONTEXT  Specific cases: dengue prevention programs in Bandung and
Taichung

Using health policy analysis framework (triangle framework:

content, actor, context, process; Walt & Gilson, 1994)
 Taiwan
 An island country, area of
35,808 km2
 Altitude 0 – 3,952 m
Country  Separated into 2 contrasted
profile: regions: the east mountainous
area and the west plain area
geography  Lat: tropics of cancer
 Climate: marine tropical to
subtropical, East Asian
monsoon
 Rainy season during the
summer of May and June, hot
humid June-Sept, rain during
winter (Nov-March)
Indonesia
 An archipelago with 17,504
islands, total land 1,904,569
km2, total land and sea around
5 mill. km2
 Altitude: 0 – 4,884 m
 Lat: equator
 Climate: tropical monsoon,
tropical savanna climate,
subtropical highland climate
 Wet and dry seasons; the
difference can be only slightly
(Sumatra, Kalimantan) or
pronounced (NTB, NTT); dry
monsoon (June-Oct), wet
(Nov-March)
 Annual temperature and rainfall: Taiwan

Annual temperature and rainfall: Indonesia

 Taiwan Indonesia

 Population (est.): 261,115,456

 Population (est. 2018): 23,780,452
 Density: 138/km2
 Density: 650/km2
DEMOGRAPHY  GDP (2019): $622.1 billion
 GDP (2019): $1.1 trillion
AND ECONOMY  GDP/cap: $26,160
 GDP/cap: $4,210
 Gini ratio: 39.5 (medium)
 Gini ratio (2017): 34.1 (med)
 HDI (2017): 0.694 (medium)
 HDI (2017): 0.908 (very high)
 Main economy: service
 Main economy: manufacture
(43.6%), industry (39.3%),
(agriculture 2%)
agriculture (13.1%)
 Taiwan Indonesia

 National Executive
 Special Municipality
 Mountain indigenous district  National
 District
 Province (34)
ADMINISTRATIVE  City  Regency (kabupaten) and City
DIVISION  County (kota)
 County-administered city  District (kecamatan)
 Urban township
 Urban village  Subdistrict (kelurahan/desa)
 Rural township  RW
 Mountain indigenous township
 Rural village  RT

 Neighbourhood
 Taiwan
 Cover a wide aspect of
welfare: education, medical
BUDGET and healthcare, welfare
ALLOCATION  Allocation of government
spending (2017): $6.79 billion
(10% of total spending)
 For medical and health care:
$661,275; more than 70%
goes to social insurance
Indonesia
 Specific on medical and
healthcare; other Ministries
include Ministry of Education,
Ministry of Social Welfare
 Allocation of government
spending (2019): $8.72 billion
(5% of total spending)
 Allocation for social welfare:
$4.18 billion
 Allocation for education: $2.5
billion
 Taiwan Indonesia

 HIV/AIDS

 Tuberculosis

Priority in  Tuberculosis  Pneumonia

Communicable  Dengue  Hepatitis

 HIV
diseases  Malaria
 Hepatitis B and C
 Dengue
 Seasonal influenza
 Seasonal influenza

 Avian influenza

 Neglected diseases (kusta, frambusia, filariasis,

chsitosomiasis)
Control of
communicable
diseases in
Taiwan
 Ministry of Health

Control of
communicable Provincial
Health Agency
Provincial
Government

diseases in
Indonesia Regency/City Health
Agency
City Council

District,
Puskesmas / Community
Subdistrict,
Health Centre
RT/RW
Climatic condition and seasonal gaps

priority level for dengue within the list of

communicable diseases Four
identifiable
budget allocation for dengue prevention and differences
control relative to the total government spending

a command-and-control model of national to local

coordination
  Community volunteerism: involvement of community members in
monitoring dengue, through the support of Taiwan’s CDC
 Integrated dengue surveillance and health information system:
Some shared Indonesia is moving towards this, while Taiwan has used the
system longer
similarities and  Quadruple helix: academic-government-private sector-
community collaboration in dengue management; in Indonesia,
lessons this is still fragmented
learned
 With the situation in Indonesia, Regional Health Agency needs to
play a major role in the surveillance, prevention and control of
dengue
Thank you Discussions?