“Given the increasing communicable and non-communicable disease burden in Indonesia, we anticipate many new health technologies to be introduced to address these diseases. There is a need to monitor the safety of these new technologies, and we have learned from the ADP on how to set up active pharmacovigilance and improve our capacity to manage [adverse drug reactions] in the future.”
Dr. Siti Abdoellah Head, Sub-Directorate of Surveillance and Risk Analysis of Therapeutic Products, National Agency of Drug and Food Control, Ministry of Health, Indonesia
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 activities for the ADP have focused on the development and implementation of policy approaches appropriate to national priorities and needs, and to strengthen the financial sustainability of the national health insurance scheme, which will cost in excess of US$15 billion a year once it is fully implemented.1 Sustainability of the insurance system can contribute to better health outcomes for patients in need.
The ADP has worked with Ministry of Health (MOH), the Ministry of Law and Human Rights and the national competition authority on delivering an integrated approach towards multisectoral policy and decision-making to improve the availability, affordability and accessibility of health technologies. The ongoing collaboration with these agencies supports the effective integration of public health perspectives into the national policy and regulatory frameworks, helping to animate a cadre of technical personnel within the various ministries with relevant capacities in policy review and analysis.
Working through the National Institute for Health Research and Development, the ADP has helped the MOH develop an implementation research strategy to deliver health technologies to as many people as quickly as possible. For example, current rates of detection and diagnosis of MDR-TB are very low, with only 7 percent of an estimated 32,000 new cases2 being laboratory confirmed and treated. Hence, a key priority in this strategy relates to the scale up of the Gene Xpert rapid diagnostic machine for MDR-TB.
The ADP also partnered with the national pharmacovigilance centre to enhance capacity to monitor and manage adverse drug reactions, particularly for the introduction of bedaquiline, a new treatment for MDR-TB. With ADP support, the national pharmacovigilance centre has been conducting cohort event monitoring of bedaquiline treatment at three pilot sites, which exhibited a high rate of success within five months (88 percent of MDR-TB patients had culture conversion). Moreover, strengthened pharmacovigilance capacity also enabled the early detection and appropriate management of cardiac-related adverse events in a small proportion of patients (10 percent).
The ADP also collaborated with the MOH to institutionalize the Health Technology Assessment (HTA) approach, and conduct pilot evaluations on selecting the most cost-effective and appropriate health technologies for the country. These pilot evaluations generated evidence on key measures that can help reduce morbidity and mortality, as well as achieve significant cost savings on treatment and care.
The ADP has supported the development of a procurement training module to address the supply chain challenges of medical devices and laboratory equipment. This module will be used as part of the national training manual for training provincial and district staff in over 700 hospitals across Indonesia. Such training is expected to ensure the availability of essential equipment for the timely and accurate diagnosis of TB, malaria and NTDs, particularly in geographically remote provinces.
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||113|
|Population total (millions)||258|
|Gross national income per capita (USD)||10,053|
|Population living below poverty line (%)||8|
|Public health expenditure (% of GDP)||1|
|Life expectancy at birth (years)||69|
|< 5 mortality rate (per 1000 live births)||27|
|TB incidence (per 100,000)||395|
|Deaths due to TB (per 100,000)||50|
|TB treatment coverage (%)||33|
|MDR-TB incidence (per 100,000)||12|
|Cases of malaria (per 100,000)||505|
|Deaths due to malaria (per 100,000)||0.7|
|Children aged <5 years with fever who received treatment with any antimalarial (%) (2013)||3|
|Population at risk of LF / coverage of PC||71,241,075 / 51%|
|SAC at risk of SCH / coverage of PC||4236 / 26%|
|SAC at risk of STH / coverage of PC||38,231,303 / 32%|
|Dengue incidence (per 100,000)||~ 80|
All data from 2016 unless stated. SAC: school-aged children; PC: preventive chemotherapy; STH: soil-transmitted helminths; LF: lymphatic filariasis; SCH: schistosomiasis.