The challengeTuberculosis is the third leading cause of death in Indonesia and the country accounts for 10% of all worldwide TB deaths per year.
There remains a huge gap between the number of estimated cases and those detected and registered.
There is considerable misinformation and a lack of awareness about TB in the population at large. Stigma and traditional beliefs (such as that TB is a result of sins and misdeeds) and prevent patients from seeking care. For those who do seek treatment, there is often a perception that the free care available at government health centres might not be of high quality. However many private doctors prescribe expensive drugs for a shorter duration and do not monitor the completion of the treatment schedule. Once individuals start feeling better, they are likely to discontinue treatment. All of these factors contribute to under-reporting, case complications, additional infections, increased treatment costs and the possibility of drug resistance development.
CARE’s response
The MITRA project was established to improve TB control and treatment activities. It supports the Indonesian government’s National TB program and has three main objectives:
Creating sustainable community-based TB control structures
The project builds the capacity of community-based organisations to generate TB awareness in the community; identify volunteers to act as treatment observers; follow-up on patients who have stopped treatment early; and link suspected patients to the nearest available treatment facility.
Individuals in villages are identified and trained as volunteer health workers, then linked with treatment observer supervisors at government health centres for further support. The volunteers help to ensure the timely intake of medication; counsel patients regarding the importance of regular intake of medication; proper disposal of sputum; measures to prevent transmission; identify possible patients among family contacts and encourage them to seek diagnostic services. Over the course of treatment the observer also refers patients for regular sputum checkups and watches for symptoms of drug side effects.
TB education programs are conducted that target patients, their contacts and the wider community.
Strengthening the delivery capacity of the district and provincial TB program
District health centre workers are trained as Treatment Observer Supervisors so that they can more effectively manage TB-related activities.
The project coordinates and develops effective working partnerships with all key government, UN, and non-government organisations and associations that implement and coordinate TB activities. This ensures that issues like drug availability, diagnostic quality and training are addressed effectively.
Increasing private practitioner participation
Private practitioners are encouraged to participate in the TB strategy. They have access to a certified distance learning course, and upon certification, can access drug and microscopic facilities at the government health centres. They are linked with the community-based treatment observers and are supervised by the treatment observer supervisors from the district health centres.
Sector : Health and Nutrition
Location : Banten
Donor : USAID
Project Period : October 2005 – September 2009
Page last updated October 22, 2008
