Thursday, 24 May 2018

Natalie Lamb and SheffWHO 2018: Facts about health in Indonesia

I had never before participated in a simulation event like The Sheffield World Health Organization Simulation 2018. I was really interested in giving it a go for two reasons, during my research I had investigated WHO policy and I was interested in seeing how it was formed and also because the topic was "Outbreaks and Pandemics: Addressing the Next Crisis", an area that is appealing to me, as a microbiologist.

This post is regarding the notes I made about the Indonesian health care system- it seemed a shame to throw them away after the event and I thought they may be able to help someone in the future (although they may very quickly become outdated, if they aren't already!).


HIV

  • 2011 the president committed to the UNAIDS "getting to zero" goal by scaling up treatment services
  • 2013 social marketing campaign to increase condom usage (but the numbers increased with people who inject drugs)
  • 2010-2014 National UK and AIDS Strategy and Action Plan- aimed to cover 80% of the impacted population with programmes of engagement. In 2016, these goals were not met still
  • 2015 National AIDS commission of Indonesia noted the need for increased investment into HIV prevention because modelling found that it was unlikely to achieve zero new infections and related deaths by 2030
  • 2016 Indonesia had 48,000 new HIV infections and 38,000 AIDS related deaths
    • Only 13% of the 620,000 people living with HIV have access to antiretroviral therapy 
    • 14% of pregnant women get treatment to prevent transmission to their children
    • The populations at risk: sex workers (5.3%), gay men (25.8%), people who inject drugs (28.76%), transgender people (24.8%), prisoners (2.6%)
    • 60% HIV treatment comes from Indonesia. 40% from foreign aid and NGOs
    • Only 14.8% of sex workers had HIV testing in the previous month in the UNGASS report 2004-2005
      • Sex work is illegal and condoms are proof of this illegal sex 
    • Investigated alternative techniques to stop spreading e.g. microchip tagging to track known infected individuals

TB
  • In the top 10 countries in the world with the highest TB burden
  • There is a problem with drug resistant TB
  • There is under reporting of TB in hospitals, maybe due to a low quantity of laboratory networks or specimen transportation
  • Integrating TB treatment into National Health Insurance
  • There is secure local government funding into TB, which will be used i future to increase case detection and diagnosis
  • 2015-2019 Challenge TB Project

Maternal Mortality
  • 2015 126 deaths per 100,000 live births
  • One of the highest rates of maternal mortality in South East Asia
  • Instruments are not sterile, leading to infections
  • Traditional healers are not always able to treat the complications of labour
    • They stick to traditional beliefs so are often preferred by women
    • They are cheap so are often preferred by women
    • In 2006 traditional healers were incentivised by the local government to refer preganant women to midwives
    • Traditional healers and midwives were encourgaed to work together
  • Transfer to local clinics can take too long
  • Extensive bleeding can result in eclampsia, infection, abortion and prolonged labour. There is a lack of safe donor blood
    • Attempts have been made to increase the awareness and willingness to donate blood

Solutions
These are some of my ideas to improve some of the health challenges in Indonesia, which I presented at the SheffWHO event. They are not to be taken as fact.
  • Decrease the incidence of communicable diseases (specifically TB, HIV/AIDS, malaria
    • Increase the quality of healthcare provision
    • Ensure the sustainability of the existing disease programmes
  • Start to investigate non-communicable diseases
    • Increase their monitoring and risk factors e.g. tobacco use, unhealthy diet, physical inactivity
    • Use exchange visits between countries or consultations to provide advice in implemented policies and programmes
  • Promote universal healthcare coverage
    • Complete small-scale WHO research into its success, for potential expansion into other regions
    • NGOs to cover the funding for the unemployed to widen the schemes catchment
  • Increase the number and quality of healthcare personnel
    • Provide better communication and transport to rural areas
    • Better distribute staff to rural areas
    • Open up borders for the recruitment of healthcare workers from outside Indonesia
  • Strengthen disease surveillance systems as a method of being prepared for the fallout of natural disasters

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