Progress report the national NTD-PC programme in INDONESIA

Progress report: the national NTD-PC programme in INDONESIA RPRG Meeting WHO SEAR Region

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Background Information • Geography and Population – Total population : 253. 375. 174 (est) – Ecological zones: tropical climate, and archipelagic geography • Political & Health Administrative Divisions: - First level : Province - Second level : District/city - Third level : Sub district

Historical Perspective ü LF : Brugia malayi, Wuchereria bancrofti, Brugia timori; endemic IU 233/511 districts/cities (Mf based) ü Vector (LF) : Mansonia, Culex, Anopheles ü STH : endemic in 511 districts/cities (all provinces) ü SCH : endemic in 2 districts (one province: Central Sulawesi)

Historical Perspective • LF control program for MDA - 1990 s : Standard DEC Regimen - 2002 : Single dose two drug regimen (DEC+ALB) Partially treated (IUs = sub district) - 2005 : Initial phase for fully treated (IUs= district), single dose two drug regimen (DEC+ALB), in Bangka Belitung Province • Drug distribution: Booth and house – to house distribution community based ( well-trained cadre), under health staff supervision

Historical Perspective • Clinical manifestation treatment : Individual dose, DEC 6 mg/BW/day for 10 days or 3 x 1 tablets per day for 10 days • Vector control : integrated with malaria and dengue control programme in area where LF endemic

National programme overview Indicator LF Year of inception of the national programme 2001 Target date for elimination District Total # administrative units requiring PC at the start of the programme 233 SCH 2020 Name of administrative unit for implementation of PC STH Total population requiring PC in the country 99. 694. 027 2010 1998 District Village 511 28 57. 516. 164 32. 374

(233) (171) (107) Total districts/cities : 511

PC Programme Financing 2013 Contributor Funding (US$) National government 642. 333 Sub-national government 992. 491 Internal donors (___) External donors (USAID) 2. 849. 532 Others ( GSK - WHO) 785. 074

PC programme achievements 2013 Targeted Achieved # people # administrative units for PC # people 87 35. 000 85 23. 393. 624 34 2. 567. 764 14 1. 104038 20. 452 28 10. 021 Targeted Achieved Total # sentinel and spot check sites surveyed (LF) 18 10 Total # sentinel sites surveyed (STH/SCH) 0 2 Total # IUs where stopping-MDA TAS implemented (LF) 18 18 Total # IUs which passed TAS and stopped MDA (LF) 18 15 Total # IUs where surveillance TAS implemented (LF) NA NA # IUs where hydrocele surgeries performed 0 0 # IUs where lymphedema and ADLA management provided 87 85 Activities MDA 2 (DEC + ALB) T 3 (ALB/MBD) for STH 1 st round PC # administrative units for PC T 3 (ALB/MBD) for STH 2 nd round T 1 (PZQ + ALB/MBD) No PC Required 28 T 2 (PZQ for SCH) Indicator M&E MMDP

Progress Towards STH scale up in Indonesia Pre-SAC&SAC target : 57. 516. 164

PC coverage, 2013 PC type MDA 2 (DEC + ALB) T 3 (ALB/MBD) for STH 1 st round T 3 (ALB/MBD) for STH 2 nd round # administrative units with units receiving reported coverage PC above target* # administrative units where coverage was verified** 85 51 10 14 10 NA 28 28 0 T 1 (PZQ + ALB/MBD) T 2 (PZQ for SCH) *65% for LF and 75% for STH **reported coverage was verified by coverage survey or similar independent activity

Impacts of MDA in Sentinel Sites (LF) # SS/SC sites Sentinel Sites <1% mf Sentinel Sites ≥ 1% mf Spot Check sites <1% mf Spot Check sites ≥ 1% mf Baseline surveys 0 10 0 0 Latest surveys (post-MDA) 7 0 11 0

PC Monitoring and Evaluation • At least the assesment survey to validating the reported coverage is done in the begining round of MDA (1 st or 2 nd round) • SAE protocol – Health center as front line to detect any SAE (24 hours standby) during 5 days MDA implementation – Community Cadres midwives health center hospital – National level ( task force for medical experts)

Form severe advere event

FLOW CHART FOR SAE REPORTING MINISTRY OF HEALTH National task for Medicak expert PHO Task force Medical expert Local Task force DIRECTOR GENERAL OF DC & EH Cq. Subdirectorate Filariasis & helminth control programme PHO DHO Health Centers Cadres/ community Hospital

LF Transmission Assessment Survey to stop MDA Progress to date in assessing transmission # # administrative units currently eligible for surveys to stop mass treatment 18 # administrative units where surveys to stop mass treatment were conducted 18 # administrative units where criteria was passed and mass treatment stopped 15 • Justification for stopping MDA without TAS in the above IU s • Integrated assessment of STH has been done in 2 pilot areas : Tapanuli Selatan and Pelalawan District

LF Transmission Assessment: Forecasting Year Number of IUs to Total number of be covered EUs TAS 1 TAS 2 TAS 3 ICT/LF ST Required* 2014 10 15 27 1540 - 1692 2015 6 12 18 1540 - 1692 2016 22 9 7 40 1540 - 1692 2017 23 6 19 48 1540 - 1692 2018 20 22 9 53 1540 - 1692 2019 5 22 6 33 1540 - 1692 2020 25 21 22 68 1540 - 1692 *sum of the total sample size required for each EU assessed;

Integrated Vector Management (LF) • Guideline is being developed • Currently vector control with dengue control and malaria control which using bednet has been implemented in Eastern part, IRS • monitoring and evaluation : Bednet use compliance, questionaire

LF MMDP – Strategy LF National policy exist? yes Organizational placement within the government (who is responsible? ) District health office How integrated with the health service? Under disease control unit in health center Training of service providers conducted (by who? How frequent? ) PHO and DHO, trainer from national programme Patient mobilization and registration (by who? How? ) Health pesonell staff and family (the 7 th visiting )

LF MMDP – monitoring and evaluation LF Describe how MMDP services are currently monitored and reported to the national programme Patient form record and follow up form How is “access” determined? Follow up through 7 times visiting patient Is there any quality assessment of provided services? NA

Best Practices • Of the 85 IUs have been implemented PC • 10 out of 85 IUs are new IUs (fully treated) • Advocacy and socialization is obviously the best way to raise local authority to support and financing PC • STH PC integrated with Vitamin A supplementation (Pre-SAC) • STH PC integrated with school health ( SAC) • MMDP has been done in every IUC which implementing PC

Challenges and “Issues” • More support is needed to scale up MDA in remaining endemic Ius • More support for capacity building (provinces and districts) • Diagnostic availibility for TAS activity ( ICT/Filariasis test strip and Bm. R 1 test) • LF – STH : evaluation for STH prevalence has not been implemented in every IUs • In one of pilot areas TAS – STH prevalence survey ; the prevalence of STH any infection is still high (63%). • MMDP monitoring should be improve in accordance with national guideline

Challenges and “Issues” • Some IUs prior to the 3 rd round cannot reach at least 65% of geographical coverage • In areas where MDA > 5 th round, not eligible to proceed TAS and stop MDA considered the geographical coverage when evaluation of prevalence has been carried out in Sentinel/Spot Check showed Mf rate <1 and 0% (what next) • The recommended intervention for IUs (partially treated) and already completed 5 years MDA

Programme Plan 2014 target 2015 target # administrative units for PC # people # administra tive units for PC MDA 2 (DEC + ALB) 112 53. 551. 645 193 T 3 (ALB/MBD) for STH 1 st round 110 T 3 (ALB/MBD) for STH 2 nd round 14 1. 104. 038 124 22. 152. 415 28 20. 452 28 65. 396 Activities PC # people 60. 524. 366 21. 048. 377 T 1 (PZQ + ALB/MBD) T 2 (PZQ for SCH)

34 14 1. 104038 Activities 2014 Target 2015 Target # districts/IUs where coverage surveys are planned for any PC diseases 57 # IUs where pre-TAS sentinel site and spot checks planned (LF) M&E 10 10 6 # IUs where TAS for stopping MDA is planned (LF) 10 6 10 57 # IUs where STH survey integrated with LF TAS planned # IUs where MMDP is to be evaluated (LF) # IUs where surveillance activities are to be carried out (LF) MMDP # IUs where MMDP services newly initiated (LF) IVM # IUs where IVM coordinated to target LF vectors

PC medicine request for 2015 　 required ALB (LF) ALB (STH) MBD DEC PZQ 60. 524. 366 151. 310. 915 118. 271 in stock in pipeline requested to WHO Procured from other sources (source, # tablets and target age group)

THANK YOU TERIMA KASIH 30