Public Health emergencies in Indonesia; The Disruption of Tuberculosis Program during Pandemic

Public Health emergencies in Indonesia; The Disruption of Tuberculosis Program during Pandemic Photo: Pixabay

In the late 2019, the world was surprised by the disease that originated from China, named SARS COV-2 or known as Coronavirus that spread swiftly around the world. Since that time, the world has been busy fighting coronavirus. Many countries provide effort to protect their territories from the outbreak. One of the success stories came from New Zealand that on June 3, 2020, its government released a statement that it succeeds to make their country zero cases of COVID-19. On the earlier time of the outbreak there are some rumours that arose one noted that the virus cannot survive in a tropical country, and Indonesia is one of the tropical countries. March 3, 2020, was the first time the virus was officially found in Indonesia territories, and since that the country has been facing a public health challenge to stop the pandemic. In 2020 alone, around 1 million people were infected by COVID-19 in Indonesia despite the social distancing policies that were implemented both by the local and central government such as Indonesia large-scale social restrictions (PSBB), Community mobility restrictions (PPKM), and local lockdown. Indonesia experiences adverse effects of disruptions in health facilities and services during this pandemic. The doctors as the country’s front-liners collapsed, some of the primary health care can’t help but close during the pandemic due to the lack of resources and fright of COVID-19. One of the programs that were affected is Tuberculosis. Tuberculosis or known as TBC is one of the top 10 causes worldwide and the leading cause of death from a single infectious agent. Based on WHO Global TB Report 2020, globally an estimated 10.0 million people fell ill with TB in 2019 with a mortality rate of around 1.4 million people/ year around the world. Globally, the knock-on effects of the COVID-19 pandemic in 2020 are threatening to derail decades its progress in the fight against TB. According to the Global Fund modelling analysis, it projected an additional 6.3 million cases of TB and an additional 1.4 million TB deaths attributable to the COVID-19 pandemic between 2020 and 2025.

Tuberculosis or known as TBC is one of the top 10 causes worldwide and the leading cause of death from a single infectious agent


Based on a survey conducted by the National TB Program Indonesia in 2020, among 342 districts respondent 58% of them experience the program’s desperation since TB case notification has shown a reduction during the pandemic. It was affected by several causes such as movement restrictions, fear of catching COVID-19 infection in hospital settings, and the diversion of TB services which lead to people with TB symptoms to avoid accessing health care and not seeking treatment. This challenge faced by the TB program demands a progressive and innovative response and Government in collaboration with Civil Society Organization have taken actions to beat the obstacles.

Indonesia has experienced an increasing number of health infrastructure, including primary and referral health facilities. Puskesmas or Primary Health Centre (PHC) is important as the gatekeeper for medical cases as well as public health efforts. Within the TB control program itself, all the outreach, diagnosis to the services and treatment were implemented in the primary health care. Health workers in Puskesmas in a collaboration with the community health workers or as known as Cadres, provide an active case finding to find TB suspect in the society so they will be diagnosed and receive a proper treatment. Then, the monitoring treatment adherence is also conducted to maintain a better treatment result to the patients. Other than the therapeutic effort, the preventive effort also being implemented using the Contact Investigation program, this program is the tracing mechanism that is prioritized is to find close contact of people affected by TB then provide screening and if the result turns out negative the person who is living together with the TB patients will take precautions to prevent being infected by taking Tuberculosis Preventive Treatment. The TB program also makes use of technology and digital health as a tool for rising awareness on TB disease. Based on survey conducted by one of the Development Partners agency, TB got the 4th rank as the most asked questions during consultations in the telemedicine platforms.

The Minister of Health, Budi Sadikin, stated during the bilateral meeting with the Minister of Health from Saudi Arabia earlier of this year that the health management in Indonesia should be focused on prevention rather than cure, utilize digital health development such as Artificial Intelligence (AI) or Internet of Things (IoT) and create multi-stakeholder collaboration both with communities and private sectors.

“Our health system is too focused on healing the sick rather than maintaining physical fit, therefore we need to strengthen our preventive game” he stated on the meeting."

The effort provided by Health Facilities in the early stage of pandemic period reflected the fast and innovative response needed in the purpose of mitigation actions. If we refer to the statement of the Minister of Health, then the TB control program could be portrayed as one of the examples which implement all the three-focus point. It could be humble to say that Improving the TB program is equals to improving the public health system in Indonesia.

dr. Imran Pambudi is a National TB Program Manager in the Ministry of Health and an expert on Global Health

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