Implementation of Tuberculosis Revised District Public Private Mix (DPPM) Strategy in Medan and Denpasar

Description

Based on BPS data, the total population of the city of Medan in 2020 is 2,295,003. The number of health service facilities in Medan City consisting of 39 Public Health Center (Puskesmas), 41 auxiliary health centers, 10 government hospitals and 67 private hospitals. If you look at the data from the Strategic Plan Documents of Medan City Health Office 2006-2021, the numbers of new findings of TB cases in Medan City in 2015 reached 2,872 or experienced a decrease of almost 94% from the findings of new cases in 2014, which was 3047. The decrease in the number of new case findings raises a special question. Because based on the 2015-2019 National Medium-Term Development Plan (RPJMN), which sets health development targets, which sets a target for reducing pulmonary tuberculosis in 2019 with a prevalence of 245 per 100,000 population. Or if it is compared to the total population of Medan City, using this prevalence formula, the target of new findings in 2019 could reach 5,623 cases. Or if the role of private and public health service facilities is maximum, each health facility will handle 36 cases.

The city of Denpasar in 2020 based on data from BPS has a population of 962,879 people. While the number of health services in Denpasar City consists of 21 government and private hospitals and 11 health centers. As for the number of TB cases that recovered and treated in Denpasar City in 2019 was 2,011 and in 2020 it was 2,242 or an increase of around 231 in 2020. If the prevalence formula is used for the finding target as in Medan City, then in 2021 the potential new TB cases in Denpasar City will be 2,359 cases. Or 73 cases in every Health Service in Denpasar City.

The National TB Control Program (NTP) in Indonesia has made tremendous progress in controlling tuberculosis (TB). However, new challenges have emerged in recent years, including the large number of TB cases that remain unreported to NTP and non-NTP providers. Hence, there is a need to engage various health service providers in Indonesia effectively. The proposed breakthrough strategy is the Public-Private Mix (PPM) model. Currently, NTP has decided on a radical paradigm shift through the implementation of PPM initiatives by developing a comprehensive and holistic District-Based PPM Approach (DPPM). This approach aims to address the challenges and shortcomings currently faced in TB Elimination. This approach was built by increasing the roles and responsibilities of the Health Office and Puskesmas in coordinating various parties to carry out TB elimination.

The implementation of the DPPM USAID TB Private Sector (TBPS), carried out in support of the Government of Indonesia to be partners with health providers in the private sector, needs to increase its role. DPPM needs to be encouraged to further improve 1) collaboration between stakeholders in carrying out TB elimination; 2) involvement of private health service providers in TB elimination efforts; 3) utilization of Information Technology to provide good quality TB care between private and public service providers; and 4) Joint monitoring of TB Elimination efforts at their respective levels. Collaboration between the City Health Office (DHO) (and the district coalition PPM network) with primary and referral service levels needs to be improved. TBPS activities target five groups of private sector health service providers. Namely, general practitioners (GPs), health clinics, private hospitals, pharmacies, and laboratories. Apart from these five groups, this activity also targets the involvement of other sectors, such as delivery service providers, community leaders, Civil Society Organizations (CSOs), and Health Service Professional Organizations.

Objective:
Implementation of Tuberculosis Revised District Public Private Mix (DPPM) Strategy in Denpasar City and Medan City.

Outcomes:
Increased number of TB services with integrated recording and reporting systems.

Funding

USAID TBPS, based on the document FHI 360 Prime Award Number: 72049719C00001, 14 June 2021 – 28 February 2023 with a total budget of IDR 3.930.842.521, work location Denpasar, Medan.