Indonesia, a nation with a rich tapestry of cultures and a population exceeding 270 million, faces a formidable adversary in tuberculosis (TB). Despite the government’s commitment to eliminate TB by 2030, the path is fraught with obstacles that are medical, social, economic, and cultural in nature.
The Burden of Disease Indonesia ranks second globally in TB burden, a reflection of the disease’s deep entrenchment within the country1. The fight against TB is not just a battle against a bacterium but also against the socio-economic factors that facilitate its spread.
Medical Challenges The medical challenges are manifold. The quality of laboratory networks, the transport of specimens, and the low detection rates of multi-drug-resistant TB (MDR-TB) are significant hurdles2. Additionally, co-infections with TB and HIV remain inadequately addressed, further complicating treatment and prevention efforts2.
Socio-Economic and Cultural Barriers The uneven distribution of the population, coupled with cultural and traditional diversity, poses unique challenges. These are exacerbated by the country’s natural disaster-prone locations and a two-layer decentralized governance structure, which complicates the implementation of a unified health strategy1.
Strategic Approaches In response, Indonesia has outlined six strategic approaches: strengthening government commitment, improving access to quality TB services, intensifying preventive measures, expanding research and innovation, enhancing community contributions, and bolstering program management1. These strategies are ambitious and require concerted efforts from all sectors of society.
Progress and Recommendations, Recent reviews have shown progress, with most challenges from the 2020 review being addressed. Despite setbacks from the COVID-19 pandemic, Indonesia has maintained a robust TB care and prevention program3. However, the nation is not on track to meet the 2030 elimination target. The driving forces behind TB in Indonesia include under-nutrition, smoking, diabetes mellitus, and HIV infection3.
To accelerate progress, recommendations include improving case notification data quality, strengthening health information system linkages, and implementing accurate disease burden estimation activities3. Moreover, there is a need for enhanced TB screening, active case finding, and the development of a communication plan to mobilize communities3.
Conclusion The journey towards TB elimination in Indonesia is complex and challenging. It requires a multifaceted approach that addresses medical, social, economic, and cultural factors. With steadfast commitment and collaboration, Indonesia can overcome these challenges and move closer to a TB-free future.
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