National Strategy for NCD Prevention and Management in Indonesia

4.3. National Strategy for NCD Prevention and Management in Indonesia

  To ensure the achievement of the targets set in Indonesia’s 2015-2019 National Medium Term Development Plan (RPJMN) and the Ministry of Health’s 2015-2019 Strategic Plan (RENSTRA), a national strategy for NCD prevention and management in Indonesia is needed. The strategy must refer to the global strategy and the south-east Asian regional strategy, subject to the necessary adjustments to suit with the challenges and issues and capacity of the Indonesian people.

  Referring to the strategy recommended by WHO, the national NCD prevention and management strategy consists of four pillars, namely: 1) Advocacy and partnership; 2) Health promotion and risk reduction; 3) Health systems strengthening, and 4) Strengthening of surveillance, monitoring and evaluation and research. The logical framework of Indonesia’s NCD Prevention and Management Strategy (SN-PP-PTM) can be referred to in Figure 4.4.

  Implementation of the national NCD strategy will be affected by: 1) direction taken by the national development policy and strategy, 2) national development policy direction, 3) regulatory framework, 4) institutional framework, 5) financing framework, and 56) the global, regional and national strategic environment.

a) Advocacy and Partnership

  Activities in this area of strategy include advocacy and cross sector partnership to increase and accelerate the mitigation of NONCOMMUNICABLE DISEASES. The focus of the activities in this area is on: (i) increasing intensity of advocacy, (ii) strengthening partnership with the community and across sectors and ministriesinstitutions, and (iii) efforts to build leadership capacity at all administrative levels. The output expected from this area is an increased political commitment and the functioning of a ministry coordination mechanism which can effectively ensure the availability of resources to implement the program on a sustainable basis.

  Advocacy is needed to ensure understanding of the role of every related sector and institution Advocacy is needed to ensure understanding of the role of every related sector and institution

  Figure 4.4. Logical Framework of NCD Prevention and Management in Indonesia

  Health Promotion and Risk Reduction

  CERDIK. The environment should be set up in a way so as to provide space for the public to make the right choices and avoid factors that may cause health problems, including NONCOMMUNICABLE DISEASES.

  Additional, controlling of the risks of NCD should be applied through a life-course approach. Therefore, such measures sis recommended to be introduced during the early childhood years, adolescence, productive period and to the senior years. Bearing this in mind, school is an important institution in the campaign to prevent NCD at an early age and during adolescence. The School Health Campaign (Usaha Kesehatan Sekolah or UKS), which among others promote clean and healthy living or implementation of CERDIK within the school community, including the teachers, school administrators, and students. UKS personnel at the schools, PUSKESMAS and local government offices play a major role in these activities, including to act as role models. It is recommended that the NCD prevention and management component of the UKS be made as a compulsory program of the PUSKESMAS so that risk control and early detection can be implemented during the early years. Meanwhile, for the targeted productive age and geriatric groups, NCD prevention and management can be carried out through the “Posbindu PTM” program at the workplace and through community groups, and integrated into the Posbindu PTM and Posyandu Lansia.

  Malnutrition during pregnancy will affect fetus development and low birth weight babies (BBLR) who can potentially grow to be stunted infants and become adults with risks of suffering obesity, diabetes and cardiovascular disease.

b) Improve NCD management and strengthen Health System Strengthening

  Effective NCD prevention and management requires a robust health system that can guarantee intensive interaction among healthcare networks at all levels, from the primary, secondary to the tertiary levels, including promotion-preventive services as well as palliative and rehabilitative treatments of NCDs. An effective primary healthcare service is key in a successful management of chronic disease. As such, all healthcare facilities at the primary level must gradually be enabled to provide healthcare service for NCD cases in an integrated manner.

  strengthening to be as effective as possible, synchronization needs to be done with the National Health Insurance scheme.

  At the general level, a reorientation of the healthcare system is needed to enhance the outcome of healthcare services for chronic cases, which can be undertaken among others through the following: (i) raising the competence of the health workforce; (ii) enhancing operational efficiency and effectiveness of primary healthcare facilities; (iii) strengthening the referral system; (iv) encouraging the community, families and patients to undertake prevention and treatment in a self-reliant manner; and (v) utilizing information technology.

c) Surveillance, Monitoring and Evaluation and Research of NCDs and their risk factors

  In principle, the output expected from this pillar is an increased availability and use of data for policy development and programs, as well as in the selection of NONCOMMUNICABLE DISEASES prevention and management activities at the national and the sub-national levels.

  Strengthening of surveillance is aimed at improving the availability of data on the risks and other determinants of NCD, morbidity and mortality rate, as well as strengthening of monitoring system to evaluate NCD prevention and management programs and activities.

  Strengthening through integrating NCD surveillance measures into the Health Information System and regular collection of data covers behavioral risks as well as metabolism risks such as alcohol consumption, physical exercise, use of tobacco, unhealthy diet, obesity, high blood pressure, blood sugar. Such data should also include health determinants such as the marketing of cigarettes and alcoholic products. The collected data should present gender, age, economic status to monitor trend of the disease and progress of the program.

  Research on policy and public health relating to NCD is greatly needed to assess the impact of the various activities that has been designed, from advocacy, partnership, health promotion to primary healthcare system strengthening, on the various indicators before measuring the outcome such as prevalence of smoking among the 15-18 year age group. Given that NCD prevention and management require strong cross sector support, an NCD surveillance, monitoring and evaluation and research network is needed that can provide

  Table 4.2. SectorsInstitutions having a role in NCD Prevention and Management

  Use of tobacco

  1. Monitoring of compliance with the prevailing

  o Coordinating Ministry for

  products

  regulations:

  Human and Culture

  • Cigarette packaging and label

  Development

  • Implementation of smoke free zone (KTR)

  o Ministry of Industry

  • Restrictions on cigarette commercials

  o Ministry of Education and

  • Utilization of cigarette duty to control tobacco and

  Culture

  NCD prevention and management

  o Ministry of Religious Affairs

  2. Finalize pending regulations:

  o Ministry of Manpower

  • Regulation on the Use of Tax and cigarette duty

  o Ministry of Finance

  • Regulation to increase cigarette tax and duty

  o Ministry of Interiors

  • Smoking free zone for regions adopting such

  o NGOs, Professional

  regulation

  Bodies o Sub-national Government

  3. Identification of required regulations: o Development Partners

  • Cigarette advertisement ban

  o Ministry of Trade

  • Penggunaandistribusiketersediaan produk tembakau

  4. Anti-smoking mobilizationcampaign

  5. Intensive health education, among others through UKS, workplace

  Dangerous

  5 Implementation of regulations on consumption of

  o Coordinating Ministry for

  consumption of

  alcoholic drinks:

  Human and Culture

  alcohol

  • Implementation of regulations relating to tax and

  Development

  pricing policy to restrict consumption of alcoholic

  o Ministry of Trade

  drinks

  o Ministry of Religious

  • Implementation of regulation to impose drinking

  Affairs

  age limit

  o

  • Regulation to limit supply and access to alcoholic

  o Ministry of Education o Ministry of Education

  o Ministry of Youth

  o Public education through multi media

  Sports o Social mobilization for public campaign and o Ministry of Education and

  community sports

  Culture o Ministry of Public Housing o Ministry of Interiors o NGOs, Sub-National Government

  Unhealthy Diet

  1. Increase production: