“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
ADP has focused on policy approaches that support and strengthen the JKN (National Health Insurance program), including strengthening capacities for the conduct of health technology assessments. In addition, ADP has delivered capacity-strengthening interventions to the regulatory system to enable the introduction of bedaquiline, a new treatment for MDR-TB. The support of ADP to strengthening pharmacovigilance (PV) capacities paved the way for an active surveillance system that will be relevant to the introduction of other health technologies in the future. In line with the integrated approach, ADP has worked across the various sectors to ensure that capacities and systems are strengthened, including through the conducting of IR to identify and address bottlenecks to the use of new diagnostics for TB and MDR-TB, and in improving technical and allocative efficiency in the procurement systems.
Since the early stages of ADP, a primary outcome in Indonesia has been the establishment of a policy review mechanism that contributes towards a coherent and enabling policy and regulatory framework. ADP facilitated partnerships between the MOH, the Ministry of Law and Human Rights and the national competition authority (KPPU), as well as the National Public Procurement Agency (LKPP) and the National Drug and Food Control Agency (BPOM) – for cross-sectoral decision-making on issues related to innovation, competition and cost-containment.
Indonesia's National Strategy for Implementation and Operational Research for Prevention and Control of TB, Malaria and NTDs (2016–2019) was developed through a collaboration between ADP, the National Institute of Health Research and Development in the MOH and the Centre for Tropical Medicine at Universitas Gadjah Mada. The strategy now guides the prioritization of research and training for the management and control of TB, malaria and NTDs, with the aim of enhancing introduction and scale-up of new health technologies. Arising from this, a project was initiated to improve the use of the Gene Xpert technology to increase detection and diagnosis of MDR-TB, which is currently only at 7 percent of an estimated 32,000 new cases per year. Although it is the standard rapid diagnostic for MDRTB in Indonesia, high operational and maintenance costs, and the need for trained personnel have been barriers to the effective use of the technology.
Indonesia is one of the first countries to pilot the introduction of bedaquiline as part of a combination therapy for MDR-TB in adults. One of two new TB medicines to be approved in 50 years, bedaquiline has the potential to offer a significant breakthrough for the treatment of MDR-TB, with a much shorter treatment regime and higher cure rates than other current treatment options.
Since WHO guidance requires active PV measures to be in place for the use of bedaquiline, active safety monitoring capacity was jointly identified by the PV unit within the BPOM and the national TB programme as a priority area. ADP support and training for 172 health care providers and pharmacists from BPOM has contributed significantly to MOH efforts to roll out bedaquiline in a number of hospitals and to updating the standard treatment guidelines for TB to include bedaquiline.
Another priority for ADP in Indonesia is the institutionalization of the HTA as a systematic priority-setting process. To achieve this outcome, ADP has strengthened national capacities for economic evaluations and systematic assessment of new technologies and supported the development of a national HTA road map by the Government of Indonesia.
In this context, ADP has partnered with HITAP of Thailand in a South-South initiative to support the integration of HTA into priority-setting and the selection of new health technologies in Indonesia. Such South–South cooperation, along with partnerships with a broad consortium of technical partners, such as WHO and iDSI, has resulted in strengthened capacity within the MOH to conduct HTAs. Pilot evaluations related to end-stage renal disease (ESRD) and hypertension treatment options, conducted jointly with the MOH and the technical partners, generated evidence and recommendations on the cost-effective selection of new treatment approaches. For example, the HTA for renal dialysis for ESRD indicated the potential for cost savings of up to IDR 86 trillion (an estimated US$6 billion) over five years, if the first-line treatment was changed to a more cost-effective option.1
Since 2013, ADP partners have worked towards enabling regional and provincial procurement units to make effective planning and procurement decisions for new health technologies. This was achieved through strengthening the pool of experts who can support regional and provincial procurement units in planning for and procuring new health technologies. ADP partners collaborated with LKPP to support procurement and supply chain management for medical equipment by improving access to information on technical and quality standards and prices.
A training module on planning and procurement of medical and laboratory equipment, developed through ADP partnership with LKPP, will be used in ongoing training programmes for provincial and district planning and procurement personnel. The training module will be integrated into the national procurement training programme, making it accessible to planning and procurement personnel in over 700 hospitals at the provincial and district levels.
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.
|Country profile a|
|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)||23|
|TB epidemiology b|
|TB incidence (per 100,000)||319|
|Deaths due to TB (per 100,000)||44|
|TB treatment coverage (%)||53|
|MDR-TB incidence (per 100,000)||9|
|Malaria epidemiology c|
|Cases of malaria (per 1000)||5|
|Deaths due to malaria (per 100,000)||1|
|Children aged <5 years with fever who received treatment with any antimalarial (%) (2013)||1|
|NTDs epidemiology d|
|Population at risk of LF / coverage of PC||61,617,614 / 71%|
|Population at risk of SCH / coverage of PC||22,675 / 23%|
|Population at risk of STH / coverage of PC||55,458,305 / 44%|
All data from 2017 unless stated. PC: preventive chemotherapy; STH: soil-transmitted helminths; LF: lymphatic filariasis; SCH: schistosomiasis.