Photo credit: WHO/TDR/Ogundahunsi

Aiming to reduce high-burden rates of tuberculosis (TB), malaria and neglected tropical diseases (NTDs), Indonesia has launched an implementation research strategy to address significant bottlenecks in diagnosis and treatment of the diseases. The effort is supported by TDR within the Access and Delivery partnership (ADP).

A lack of access to treatment and services, especially in remote parts of Indonesia, remains a critical challenge:

  • Over a million people are currently living with TB, making up more than 10% of the world’s TB burden;

  • Of the estimated 32 000 new cases of drug-resistant TB in the country, only about a third of these cases were detected;

  • In a country with a high malaria burden, less than 1% of children with fever in malaria endemic provinces were treated with appropriate anti-malarial drugs; and,

  • In 2013, only half of the 71 million people at risk of contracting lymphatic filariasis, a debilitating NTD, got preventive treatment.

“Optimizing access to health solutions that prevent, treat or cure these infectious diseases is the purpose of the strategy,” says Olumide Ogundahunsi, ADP project manager at TDR.

“It is not enough to develop and produce medicines, vaccines and other health technologies that can cut rates of disease or treat a patient who is suffering, you have to have the health worker capacity and operational ways and means to effectively deliver tools for impact,” he explains.

Top gaps and priorities for implementation research

A panel of Indonesian experts involving health officials, health practitioners, academics and stakeholders identified and ranked priority health challenges and gaps to address in the strategy.

TB: How to improve TB case finding and reporting by health service providers, including better detection of child cases, is a key question. More effective treatment support for TB and drug-resistant TB patients by NGOs is also highly ranked.

Malaria: How to better implement malaria control programmes across a variety of health settings needs to be investigated. This is followed by the need to build medical, lab and other health worker competencies for more effective control efforts.

Leprosy/yaws: These NTDs are grouped together and given prominence because they are found in most areas of Indonesia. Top areas for research are the mapping of regional funding commitments to elimination efforts, and exploring how community participation can advance leprosy case finding.

Filariasis, schistosomiasis and helminthiasis: The overarching implementation question to advance control is how to engage the public, including school children, and motivate cross-sector support to screen, prevent and eliminate the diseases. How to better integrate prevention and treatment with other NTD control is another top-ranked challenge.

Gaps in implementation research capacity: To develop and explore these questions effectively, and drive impact, country capacity to conduct implementation research is required, according to the strategy. Quantitative and qualitative mapping of research capacity among academics and health workers is a primary step, which will inform capacity building and drive impactful work.

A list of all research questions for each of the diseases is available in the full strategy document.

Research that improves access

“Implementation and operational research is now more important than ever in strengthening our national health system, so that technologies can reach as many people, and as quickly as possible,” says Dr Yodi Mahendradhata, of the Universitas Gadjah Mada (UGM), a leading ADP partner in Indonesia.

“If the barriers to access and delivery are overcome, the country will better positioned to achieve impact in the various health programmes,” says Ogundahunsi. “The right systems in place will also position the country to take up innovative health solutions that are on the horizon,” he says.

Stakeholders of the disease control programmes will meet in May at Indonesia’s GMU in Yogyakarta, an ADP partner and TDR-supported regional training centre, to develop action plans aimed at addressing the research agenda. 

About TDR within ADP

TDR provides technical assistance and support in implementation research and drug safety monitoring to target countries as part of this broad, multi-partner effort to strengthen capacity in low- and middle-income countries to improve access to and delivery of new health technologies (drugs, diagnostic tools and vaccines) to prevent, treat or cure TB, malaria and NTDs.

ADP is led and coordinated by the United Nations Development Programme (UNDP), in collaboration with TDR and PATH, and support from the Government of Japan.

The ADP is a five-year project, running from April 2013 to March 2018.

This news story was originally posted on the Special Programme for Research and Training in Tropical Diseases (TDR)’s website