Indonesia is currently rolling out a national health insurance system, which includes the goal of making basic care available to all by 2019. Key related issues for the ADP have focused around development and implementation of policy approaches that are appropriate to national priorities and needs. The ADP has worked with the MOH, the Ministry of Law and Human Rights and the national competition authority (KPPU) on delivering an integrated approach towards multisectoral policy and decision-making, as related to improving the availability, affordability and accessibility of medicines and other health technologies, as well as the efficient delivery of these technologies.
The ongoing collaboration with these agencies supports the effective integration of public health perspectives into the national policy and legal frameworks, helping to animate a cadre of technical personnel within the various ministries with relevant capacities in policy review and analysis. The ADP has recently broadened its cooperation to a cross- section of government actors, whose varied areas of responsibility influence access and delivery, with the aim of enabling national stakeholders to identify and analyse priority issues for policy review. This intersectoral group provides an important forum to facilitate and promote regular exchanges and coordination between national stakeholders on relevant policy review processes.
National policymakers from various sectors have articulated their support for the ADP approach on promoting policy coherence. The ADP will continue to respond to requests from stakeholders and provide the relevant technical and policy support to enable intersectoral policy coherence.
The decentralized health services in Indonesia face persistent challenges at the local level, affecting service delivery. A recognized need exists to strengthen capacity for implementation research towards improved service delivery and robust, sustainable health services in general. Following prior support to strengthening of implementation research capacity at the Universitas Gadjah Mada (UGM), helping to establish it as a related resource centre in the region, the ADP has been working with UGM in supporting the MOH to conduct in-depth analysis of national capacity for implementation research.
Having assessed the country’s capability for implementation research, the ADP supported the MOH in reaching a consensus on an implementation research strategy on TB, malaria and NTDs. Implementation bottlenecks faced by the disease control programmes were mapped and the major factors responsible for a relatively limited implementation research capacity were identified. As a follow up to this assessment and the resulting framework for capacity-strengthening, a series of training activities will be delivered by the ADP in partnership with UGM, focusing on identifying and training managers and senior researchers to build their capacity for developing proposals for implementation research, resource mobilization and study implementation.
With an estimated 19,000 new multidrug-resistant TB (MDR-TB) cases annually, Indonesia has been identified as one of five pilot countries where bedaquiline is being introduced as part of combination therapy for MDR-TB in adults. In accordance with WHO interim guidance on the use of bedaquiline to treat MDR-TB, active pharmacovigilance measures must be in place to ensure early detection and proper management of adverse drug reactions. This has provided an entry point to support the development of tools, approaches and systems for active surveillance of adverse events of other new health technologies, including those that will be entering the Indonesian market in the near future.
The ADP continued to support the capacity strengthening of the National Pharmacovigilance Centre (NPC), including the participation of key staff members in a regional forum on pharmacovigilance for knowledge exchange and building of partnerships between pharmacovigilance experts in the region. The ADP has also supported capacity strengthening in active safety monitoring and pharmacovigilance within the national TB programme and the pharmacovigilance teams in hospitals, to ensure early detection and proper management of adverse drug reactions, with a specific focus on bedaquiline.
The National Agency of Drug and Food Control (BPOM) has identified ‘risk assessment’ and ‘crisis management’ as key capacity gaps in Indonesia’s pharmacovigilance system, and the ADP is currently holding discussions with the NPC on planning further trainings and technical support in this area.
With the national health insurance programme aiming to reaching full population coverage (253 million) by 2019, the government is focused on ensuring affordability and cost-effectiveness of health technologies. In this context, the ADP, in partnership with Thailand’s Health Intervention and Technology Assessment Programme (HITAP), introduced the Health Technology Assessment (HTA) approach to policymakers as a tool to inform the process of prioritization, selection and introduction of health technologies. The ADP supported the MOH in establishing the HTA committee (HTAC) within the Centre of Health Insurance to manage the HTA implementation process. Efforts by the ADP further extend to facilitating the institutionalization of HTA through the development and implementation of the national HTA roadmap and action plan, which includes strengthening the capacity of policymakers and key technical personnel to assess the need, effectiveness and safety of new health technologies.
The ADP and HITAP have also provided technical support to the HTAC in piloting the HTA approach on two new health technologies, which generated key evidence that will help reduce mortality and increase estimated savings of up to US$6 billion over the next five years. The HTA approach will be critical in generating best value for money and addressing equity considerations, and to inform the development of a health financing strategy to deliver the benefits package as Indonesia moves towards UHC.
The ADP is currently working with HTAC to finalize a series of policy briefs detailing the lessons learned and recommendations on strengthening the policy and process related to HTA.
A country assessment and consultations with stakeholders involved in the public procurement process, particularly the National Public Procurement Agency (LKPP), identified significant challenges faced by sub-national service procurement units. These challenges relate to effective decision-making around planning and procurement of new medical equipment and health technologies, and are largely due to limited product knowledge, and lack of information on quality standards and market prices. The ADP is supporting LKPP in addressing these impediments with the aim of improving the availability of new health technologies in the more geographically remote provinces, such as Papua, North Sulawesi and East Kalimantan, where expertise on new technologies and financial resources are limited. This included development of a training module on planning, procurement and distribution of medical and laboratory equipment and other new health technologies. This training module will be incorporated into the national standard procurement training programme and will be used for further training activities aimed at increasing capacities for planning and procurement in over 700 hospitals across Indonesia. The ADP has also supported the planning and procurement process for TB commodities and diagnostic equipment as part of the introduction and national scale-up of new TB medicines and diagnostics.
ADP Public Forum, Jakarta, 19 October 2016. Interview with Mr. Kozo Honsei, Charge d'Affaires ad interim (Deputy Chief of Mission), Embassy of Japan in Indonesia, on how the ADP contributes to the existing cooperation between the Government of Japan and Indonesia, and how the ADP contributes to the Government of Japan’s global health agenda.
Interview with Dr. Agus Suprapto, Head of the Centre for Research and Development of Public Health Efforts, Ministry of Public Health, Indonesia, on the key factors for strengthening implementation research in Indonesia.
|Human Development Index Ranking||110|
|Population total (millions)||253|
|Gross national income per capita (USD)||9,788|
|Population living below $1.25 a day (%)||16.2|
|Public health expenditure (% of GDP)||3.1|
|Life expectancy at birth (years)||69.9|
|Under-5 mortality rate (per 1000 live births)||29.3|
|TB prevalence (per 100,000)c||647|
|TB incidence (per 100,000)||399|
|Deaths due to TB (per 100,000)||49.5|
|TB case detection (%)||32|
|MDR-TB in new/re-treatment cases (%)||1.9 / 12|
|Estimated cases of malaria (per 100,000)||1621|
|Total deaths due to malaria (per 100,000)||2.6|
|Children aged <5 years with fever who received
treatment with any antimalarial (%) (2013)
|SAC population requiring PC for STH / coverage||39,041,065 / 11.0%|
|Population requiring PC for LF / coverage||92,591,397 / 23.4%|
|Population requiring PC for SCH / coverage||192,000 / 0.1%|
|Estimated incidence of dengue fever
(per 100,000)f (2013)
All data from 2014 unless where stated. SAC: school-aged children, PC: preventive chemotherapy; STH: soil-transmitted helminths; LF: lymphatic filariasis; SCH: chistosomiasis.