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INTRODUCING DOTS PROGRAM IN PRISON A CASE FROM INDONESIA

INTRODUCING DOTS PROGRAM IN PRISON A CASE FROM INDONESIA

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INTRODUCING DOTS PROGRAM IN PRISON A CASE FROM INDONESIA

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  1. INTRODUCING DOTS PROGRAM IN PRISON A CASE FROM INDONESIA POLICY ACTION PLAN HPA 430 MUHAMMAD HATTA

  2. Agenda INTRODUCTION tb program IN INDONESIA Why prison ? IMPLEMENTATION RESULTS

  3. In 2004, • 4,9 million new and relapses TB cases all around the world • Estimated global incidence rate is 140 cases per 100,000 population(Source : WHO TB Global Report, 2006)

  4. Pop. 238 million 33 provinces(similar with state in US ) More than 400 cities/counties

  5. 5 COMPONENTS DOTS Political/Management Commitment 1 TB diagnosis through sputum microscopy WHA 1991 Quality and complete TB Drug supports 2 4 3 5 Directly Observed Treatment Short-course Supervised treatment Reporting & Recording

  6. NATIONAL TB PROGRAM IN INDONESIA • More than 500,000 new TB cases , make it the second most killer of Indonesian adult after cardiovascular diseases • DOTS Program has been implemented since 2005 in Community Health Center (Puskesmas) • National Strategy 2006 – 2010 : DOTS Expansion

  7. There are more than 7,000 Puskesmas . They act as Community Health Center and Primarily Health Care Center(PHC’s) . Minimally it has 1 physician/senior nurse , 2 midwifes and 1 laboratory technician. • 1150 Hospitals in 2005, and they’re taking responsible for the secondary and tertiary referral systems. Almost 85% of the hospitals are state-owned (RSUD) • (Source : MOH RI Report, 2007)

  8. COUNTY /CITY HEALTH OFFICE PROVINCIAL HEALTH OFFICE NTP (MOH) PHC – PUSKESMAS COUNTY/CITY Hospitals (RSUD) TB REFERRAL SYSTEM • Monitoring & RR • Logistics • Monitoring & RR • Supervised • Primary Healthcare Services • Community Health Services • AFB Staining • DOTS • Specialized Medicines • Secondary Health Services

  9. Why Prison ? DOTS Expansion : “Improving TB control in prisons may lead to better national programmes indicator” (Coninx 440) A research conducted by Health Research Institute MOH in 3 selected Jakarta’s prisons found out that TB prevalence is 7 times higher than in general population(HRI MOH , 2005) Over crowding issue  High transmission and TB infection Limited access to HC Services - not involved in the National TB referral system - limited prison health budget (average $5 /year/person) Re-emerging diseases with HIV AIDS and MDR TB

  10. Indonesia’s Prison(2006) All prison, including detainee center, is state-owned under Directorate General of Prison System under Ministry of Law & Human Rights In 2006 There are 397 prisons with it’s capacity 80,962 crowded by 118,543(avg.) prisoners Health providers : - Physicians : 169 - Nurses : 348 Almost 65% of them are part time healthcare provider (DG of Prison System Report, 2007)

  11. NAD (20) North Sumatra (32) East Kalimantan(8) North Sulawesi (2) North Maluku (6) South Kalimantan (10) Maluku (13) Central Kal (7) West Kal (10) Papua (14) Map of prisons in Indonesia West Sumatra (18) South Sumatra (16) Bengkulu (4) Lampung (10) Banten (10) Jakarta (4) Gorontalo (1) Central Sulawesi (10) West Java (20) East NT (15) South East Sulawesi (5) Central Java (39) West NT (7) East Java (36) South Sulawesi (26) DI Yogyakarta (5) Bali (9)

  12. OVER CAPACITY ISSUES

  13. PRISON SYSTEM AND NTP

  14. ORGANIZATIONAL CHART DG OF PENITENTIARY SYSTEM MOL & HR DG OF PRISON SYSTEM SECRETARY OF DG REGISTRATION & STATISTIC AFFAIRS HEALTH AFFAIRS COMMUNITY INVOLVEMENT WORKSHOP AND PRODUCTION SECURITY AND LAW ENFORCEMENT NARCOTICS AFFAIRS

  15. THE STEPS TAKEN Asessment and piloting project Identified Stakeholders Establish Working Group of TB Control of Prison Developing & Disseminating Guidelines Integrating Prison in the TB Referral Network Develop IEC Materials Fundings to expand coverage

  16. HIV AIDS ASSESMENT IN 10 SELECTED PRISONS 2006

  17. IDENTIFIED STAKEHOLDERS Dir. of Health Affairs DG of Prison System MOL&HR NTP & NAP Department of Community Health Services MOH NGO’S - TB Coalition Assistant Project (TBCAP) - ICRC - Gorgas TB Initiative , University of Alabama at Birmingham(GTI-UAB) - Family Health International (FHI) RO Indonesia - National Narcotics Agency - Global Fund

  18. DEVELOPING WORKING GROUP TB IN PRISON WG TB in Prison consisted of stakeholders plus prison’s directors as host of the meeting Funded by Dir. Health Affairs DG of PS Meet every 3-6 months Have a workplan that revised every year

  19. Developing guidelines DOTS Strategic Plan in Prison Funded by TBCAP-USAID National guidelines : Case Management of DOTS in Prison Funded by ICRC

  20. Prison RSUD PUSKESMAS County/City HEALTH OFFICE EXTERNAL LINKAGES DOTS IN PRISON • Basic health services • Case findings • Specialized Medicines • Secondary Health Services • Primary Healthcare Services • Community Health Services • AFB Staining • DOTS • Monitoring & RR • Logistics

  21. National Insurance for the Poor (Jamkesmas) Similar with Medicare/Medicaid in US Cover the poor people (76,4 million) for the primary healthcare services in Puskesmas Definition of poor : income less than 1 dolar a day, have no house, and only have meals 1 times a day Categorized prisoners as poor people ? Minister of health ‘s Decree No. 1185/Menkes/SK/XII/2009 : involving prisoners in Jamkesmas

  22. BEBAS TBBELENGGU BUKAN ALASAN UNTUK SAKIT TB BEING BEHIND BARS IS NOT AN EXCUSE TO SUFFER BECAUSE OF TB Proposal to Global Fund (TB Component) Development of BEBAS TB Website http://bebastb.yolasite.com/

  23. IEC MATERIALS Raise the community awareness of TB infection in prison Advocacy to other stakeholders (non-WG) Limited amount, due to the lack of fundings

  24. North Sumatra (3) East Kalimantan(1) South Kalimantan (1) North Sulawesi (2) PRISON WITH DOTS 2009 Bengkulu (4) East Java(3) Banten (6) Jakarta (4) Bali (3) South Sulawesi (3) West Java (8) DI Yogyakarta (2) Central Java (1) TOTAL PRISON WITH DOTS = 42

  25. References Coninx et al. Tuberculosis in prisons in countries with high prevalence. BMJ 2000; 320 : 440 doi: 10.1136/bmj.320.7232.440 (Published 12 February 2000). Retrieved on 1 March 2011 on http://www.bmj.com/content/320/7232/440.full.pdf National Strategic Plan of TB Control in Prison, DG of Prison System, DG of Prison System, Jakarta 2007 National Guidelines of TB Case Management in Prison, DG of Prison System, Jakarta 2008

  26. Thank you – Gracias - Terimakasih ?