TB battle hampered by geography and lack of funds

Anwar, a 32-year-old accounting professional, never thought he would contract tuberculosis (TB), a disease usually associated with poverty and urban squalour.

He told IRIN he had had a persistent cough for a few weeks last year and then one day saw blood in his sputum.

"I went to a hospital and had an X-ray and a Mantoux test. I was shocked when the doctor said I had contracted TB," Anwar said. The Mantoux test involves injecting 0.1ml of tuberculin purified protein derivative (PPD) into the inner surface of the forearm.

"I thought TB only infected very poor people," he told IRIN.

Anwar is among those who were lucky enough to have detected the disease early and received proper treatment. He was declared cleared of the disease after six months.

Inadequate funds

On average, 300 Indonesians die from TB every day, according to the health ministry, despite the fact it is a curable disease and medicines are free in public health centres. The health ministry described the situation as "unacceptable".

Photo: ReliefWeb

Indonesia, an archipelago of 17,000 islands, is the world's fourth most populous nation with 230 million people

Indonesia's fight against tuberculosis is being hampered by inadequate funds and its sprawling geography, said Jane Soepardi, a senior official at the health ministry.

Last year Indonesia failed to meet a target set by the World Health Organization (WHO) to detect at least 70 percent of active TB cases, said Soepardi, head of the sub-directorate for immunisation at the directorate of disease control and environment health.

According to the WHO's 2008 global TB report Indonesia ranks third on the list of 22 "high-burden" tuberculosis countries after India and China, with half a million new TB cases a year.

Mission impossible

"Making Indonesia TB-free is a mission impossible," Soepardi said.

Indonesia, an archipelago of 17,000 islands, is the world's fourth most populous nation with 230 million people.

In 2006, its TB detection rate exceeded 70 percent for the first time. It slipped to 69 percent last year, Soepardi said.

But Soepardi was optimistic Indonesia could again achieve the WHO target this year.

Indonesia's five-year TB plan aims to expand equitable access for TB patients to quality diagnosis and treatment, treat two million people and save 500,000 lives by 2010, according to Indonesia's National Integrated TB Control Movement.

The plan also seeks to involve NGOs, professional associations and religious groups to help spread awareness about TB.

No TB surveillance has been conducted on people with HIV/AIDS, who are prone to TB due to their weakened immune system, according to the movement, which also said no figures were available on drug-resistant cases of TB.

Mismanagement

Soepardi told IRIN: "We obtain almost 60 percent of the funds [to deal with TB] from foreign donors and because of our dependency, whenever there is mismanagement, the donors can halt the funds." She said such mismanagement stalled progress and made it difficult to reach their targets.

Photo: Obinna Anyadike/IRIN

The capital, Jakarta. According to the WHO, Indonesia ranks third on the list of 22 "high-burden" tuberculosis countries with half a million new TB cases a year

Soepardi said the country's decentralised government also complicated efforts to combat TB. "Due to financial constraints some regions do not give priority to controlling TB," she said, adding that others did not impose the Directly Observed Therapy Short Course (DOTS) strategy, whereby TB patients must meet healthcare workers every day or several times a week and take the medicine in their presence to ensure compliance.

DOTS was introduced by WHO in the early 1990s and has proved an effective strategy for successful treatment of TB.

As of January 2007, 37 percent of Indonesian hospitals had implemented DOTS although not all with strict daily compliance requirements, according to the health ministry.

"Efforts to make DOTS nationally accepted have not really been successful," said Soepardi. "Some doctors think that DOTS is not an effective strategy."

"This is one of the problems we are facing as a young democracy. Everybody seems to think they have the right to claim that their method is the best."

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