Photo above: Health worker prepares to administer a vaccine to a child at a mobile vaccination unit (photo credit: UNICEF).
Jakarta, Indonesia –The country of Indonesia has begun a new strategy to use implementation and operational research to address significant bottlenecks in diagnosis and treatment of tuberculosis (TB), malaria and neglected tropical diseases (NTDs).
On 2 March, the National Institute for Health Research and Development in the Ministry of Health, in collaboration with Universitas Gadjah Mada and the Access and Delivery Partnership (ADP), launched the National Strategy for Implementation and Operational Research to Support Prevention and Control of TB, Malaria and NTDs 2016-2019.
The report was launched by Dr. Siswanto, Head of the National Institute of Health Research and Development. Emphasising the importance of promoting health research in Indonesia, Dr Siwanto stated that “research should be for the benefit of development, not only for the sake of science." Francine Pickup, the Deputy Director of the United Nations Development Programme (UNDP) Country Office in Indonesia, says the strategy “will have an impact on health policy-making and programming in Indonesia, and contribute to the efforts of the government in making gains in health”.
As newer, safer and more effective health technologies are introduced, Dr. Yodi Mahendradhata, Director at the Center for Health Policy and Management Universitas Gadjah Mada is convinced that “implementation and operational research is now more important than ever in strengthening our national health system, so that these technologies can reach as many people, and as quickly, as possible.”
In Indonesia, medicines, diagnostics and vaccines, especially those which were recently introduced to the health system, face significant bottlenecks in their effective implementation and delivery to those in need. Such challenges have contributed to the sustained disease burden of TB, malaria and NTDs in Indonesia, despite many years of effort and trillions of rupiah in investment. For instance, the utilization rate of GeneXpert machines, which were introduced to boost the detection of drug-resistant TB, remains low in many health facilities, leaving two-thirds of the 32,000 new annual cases of drug-resistant TB undetected.
Similarly, only half of the 71 million Indonesians at risk of contracting lymphatic filariasis, which is one of the 18 debilitating neglected tropical diseases listed by the World Health Organization, received preventive treatment in 2013.
Although there is high level of coverage for long-lasting insecticide-treated nets and Artemisinin-based combination treatment across Indonesia, the malaria incidence rate remains extremely high in a number of provinces, which suggests a lack of utilization effectiveness. These implementation bottlenecks often result from the low level of compliance by health professionals or patients; impeding behaviors and practices at the household, community and health facility level; and barriers inherent within the supply chain.
Implementation and operational research aims to identify and address bottlenecks in health service delivery and provide evidence to support the performance of health policies, programmes or interventions, all of which are necessary building blocks for Universal Health Coverage. Recognizing this urgent need to develop a systematic approach towards implementation or operational research in Indonesia, the National Institute for Health Research and Development in the MOH collaborated with the TDR Regional Training Center on Health Research at Universitas Gadjah Mada and the ADP in developing the national strategy.
The Access and Delivery Partnership (ADP) is a global project coordinated by UNDP, in collaboration with TDR, the Special Programme for Research and Training in Tropical Diseases based at the World Health Organization, and PATH. The ADP works with the Indonesian government and other low- and middle-income countries to strengthen their capacities to enable equitable access to, and sustainable delivery of, new health technologies for TB, malaria and NTDs.
“TDR is delighted to see the close collaboration among a wide range of stakeholders in Indonesia result in this strategic document,” said Olumide Ogundahunsi, an ADP project manager at TDR. “It articulates a path to addressing gaps and barriers against effective control and prevention of these three infectious diseases that place a heavy burden on the country.”
In closing, Dr. Joko Irianto, the Head of Public Health Department in MOH reinforced the importance of the national strategy, which is expected to "provide guidance for better integration and coordination in implementation and operational research."
At the launch event of the National Strategy on 2 March 2017 in Jakarta. Photo (from L to R):
Dr. Yodi Mahendradhata, Vice Dean for Research & Development, Faculty of Medicine, Universitas Gadjah Mada (Team coordinator for the development of the Implementation Research Strategy)
Dr. Siswanto, Head of National Institute of Health Research and Development
Dr. Marti Kusumaningsih, Sub-directorate of Malaria, Ministry of Health
Dr. Francine Pickup, Deputy Director, UNDP Indonesia
Prof. Ni Made Mertaniasih, Vice Dean on Collaboration and International Affairs, Faculty of Medicine, Universitas Airlangga
Dr. I Nyoman Kandun, Chief of Expert Committee on Lymphatic Filariasis and Schistosomiasis (former Director General of Disease Control and Environmental Health, Ministry of Health)
Dr. Olumide Ogundahunsi is an implementation research scientist at TDR
Agus Soetianto is Technical Officer at UNDP Indonesia