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

Countries with confirmed XDR-TB cases as of January 2009

The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the WHO concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. WHO 2005. All rights reserved

Argentina Armenia Azerbaijan Australia Bangladesh Botswana Brazil Canada Chile

Italy Japan Latvia Lesotho Lithuania Mexico Moldova Mozambique Namibia Russian Fed.

China, Hong Kong SAR Czech Rep. Ecuador Estonia France Georgia Germany Ireland India Netherlands Nepal Norway Peru Philippines Poland Portugal Rep of Korea

Slovenia South Africa Spain Swaziland Sweden Thailand UK USA Ukraine

Islamic Rep. of Iran Israel Romania

Vietnam

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

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

1990
TB cases Incidence all type TB Prevalence all cases Incidence new smear + cases Mortality Per Per year 100.000 pop
626.867 343

2007

2009

2010

Per Per Per Per Per Per Per Per Per day Per year 100.000 100.000 100.000 day year day year day pop pop pop 1.717 528.063 228 1.447 430 189 (45%) 1.178 430 189 1.178 (45%)
~

809.592

443

565.614

244

660 285 (36%)

660

289 (35%) NA

282.09

154

773

236.029 91.369

102 39

647 250

NA 61

NA 27 (70%)

NA 167

NA 61

NA

168.956

92

463

27 (70%) 167

*) Global Report TB, 2009 halaman 282 **) Global Report TB, 2010 halaman 171 ***)Global report 2011

*) sd triwulan 1

Target CDR RPJMN 73%, Global 70% Target SR RPJMN & Global 85%

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

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

Target RPJMN & Global 85%

The 5 elements of DOTS

Komitmen politis
4
1

Jaminan Ketersediaan OAT Yg bermutu

WHA 1991

Diagnosa dengan mikroskop

2

5 3

Directly Observed Treatment Short-course Monitoring

dan evaluasi

Pengobatan dengan pengawasan langsung

Challenges of National TB Control Program in Indonesia

600,000

500,000

Number of patients

400,000

300,000

New Global Target: World TB Free 2050, indikator insidence 1/1.000.000 or 10/100.000, SR > 90%, CNR > 90%

Estimated ALL TB cases

GAP

TOTAL notified TB cases New Smear Positives New Smear Negatives Re-treatment Extra Pulm

200,000

100,000

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

RPJMN 2010 - 2014

VISION & MISION STRATEGIC ACTION PLAN MOH

M I S S I O N

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,

Community empowerment and involvement is the first strategy!!

HEALTHY SOCIETY WITH SELF RELIANCE AND JUSTICE

VISION

TO SECURE HEALTH FINANCE AND EQUITABLE DISTRIBUTION OF THE RESOURCES

TO CREATE AND IMPLEMENT GOOD GOVERNANCE AT ALL LEVELS

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

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 DOTS 2. Programmatic Management of Drug Resistance Tuberculosis (PMDT)

Engaging All Care Providers

Objective
To 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.

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

100% 90% 80% 70%

60%
50% 40% 30% 20% 10% 0% Jawa Bali Kalimantan Papua Sumatra Sulawesi

Lain-lain RS khusus paru Praktik swasta Puskesmas RS swasta RS pemerintah

*Balitbangkes (2011)

TB Drugs Consumption at Private Market/Sectors*

Country Incidence Consumption of TB drugs 1st line at private market (%) 117 116 86 Proportion of loose TB drugs (%) 23 91 16

India Indonesia Filipina

1,982,628 429,730 257,317

Pakistan
Cina Thailand Russia Vietnam Bangladesh Afrika Selatan
*Wells et al (2011)

409,392
1,301,322 92,087 150,898 174,593 359,671 476,732

65
23 17 13 7 7 3

36
98 94 100 90 11 34

Penguatan Pelayanan DOTS Dasar di Puskesmas 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
-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

Pelayanan DOTS di DPS dan Spesialis

- Pendekatan: ISTC rewarding/ cumulative credits, sertifikasi /lisensi -Leading: IDI -TA: ATS

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

OAT dan penggunaan secara rasional

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

-Pendekatan: Penegakan hukum/law enforcement -Leading: IAI (ikatan Apoteker Indonesia), BPOM, Dirjen Binfar -TA: USP dan MSH

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 YOU TERIMA KASIH