Stopping Tuberculosis in Indonesia

Indonesia, the fourth most populous nation in the world, is home to more than 200 million people. It is second only to India and China in its number of tuberculosis cases, and accounts for 6 percent of the global burden for this disease. Approximately 150,000 people die each year of tuberculosis in Indonesia.

In 2001, the National Tuberculosis Control Program managed to detect only 93,000 cases—approximately 16 percent of all estimated cases.

In 1994, Indonesia adopted the internationally recommended directly observed treatment, short-course (DOTS) strategy for tuberculosis control; and by 2001, all provinces and more than 90 percent of Indonesia’s public health facilities had adopted DOTS. However, an evaluation in 2000 concluded that weaknesses— including inadequate training, low-quality laboratory equipment, poor drug distribution networks and insufficient supervision of treatment compliance— persisted in spite of strong national political commitment.

A grant of almost US$22 million over two years from the Global Fund will allow Indonesia to address these gaps by building upon a successful partnership between the Ministry of Health and the private sector in 20 provinces throughout the archipelago.

Financing from the Global Fund will provide an uninterrupted supply of drugs which is vital to the implementation of DOTS in the poorest provinces; train health-care workers; promote partnerships between medical professionals and non-governmental organizations to introduce DOTS to hospitals, lung clinics and private medical offices; and establish intermediate laboratories in remote districts to bring more efficient diagnostic services closer to the communities they serve.

The tuberculosis program in Indonesia will draw upon community structures that already exist for people living with HIV/AIDS. Local non-governmental organizations have begun to expand their efforts to reach more people by using existing networks that currently provide services for people living with HIV/AIDS. By collaborating with activists in local communities throughout remote districts, existing structures will be used to teach community members to implement DOTS.

With US$1.5 million disbursed in June 2003, Indonesia has already trained more than 100 health-care workers for tuberculosis control and has expanded DOTS through non-governmental organizations in remote islands already engaged in the fight against HIV/AIDS.