4. In which ways is the initiative creative and innovative?
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This approach is creative because it has successfully mobilizing cross-sectoral cooperation through the involvement of the private sector, non governmental organizations, local governments and local communities to jointly tackle malaria.
This initiative is greatly innovative because the community-based pioneering endeavors in examination and treatment of malaria are made through Juru Malaria Kampung (JMK). Through JMK, the diagnosis and treatment of malaria can be performed quickly and accurately by the people themselves even though they reside in remote areas and in areas where there are no health care workers and health care providers available. This innovation is also based on gender equality because one of the requirements to become a JMK (Village Malaria Cadre) is being a woman and settled in the village concerned.
This initiative is also creative since antimalarial drugs packaging using the color system is only developed in this area, and it has not been developed before in Indonesia. With the color system, antimalarial drugs are packaged in a way that makes them easy to use by patients even though the patients are illiterate.
The implementation of this system also initiates changes in people’s behavior where it has become the habit of the people since more than 50 years ago to buy and take antimalarial drugs from traditional kiosks and stalls.
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5. Who implemented the initiative and what is the size of the population affected by this initiative?
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This program is run and funded jointly by BP-Tangguh LNG, an oil and gas company private operating in Bintuni Regency, its management carried out by local foundation, synchronize and coordinate the program led by the Department of Health and its implementation in the field carried out by health workers and the local community. The Global fund participate trough procurement and distribution of mosquito Nets. Cooperation and joint collaboration is carried out under one room at the office of the Government of the District Health Office Bintuni. With this partnership, the health service is run to reach approximately 60,000 residents in the district of Bintuni.
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6. How was the strategy implemented and what resources were mobilized?
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To support the implementation of the malaria program, the company (LNG Tangguh) allocates funds amounting to around Rp. 2,000,000,000 (USD 147,000) annually for support staff and the operational costs of the malaria program.
The funding allocation is supported by a grant from the Government (from the APBD, the regional budget) amounting to Rp 100,000,000 (USD 73,500) for logistics and quality assurance of the malaria program.
Additional aid funds have also been received from Global Fund amounting to 60,000,000 (USD 4,400) for baseline survey and Rp. 2,000,000,000 (USD 145,000) for the purchase and distribution of mosquito nets in 2014.
In addition, there is also the logistical support directly distributed by the Provincial Government Health Agency of West Papua and from the Ministry of Health of the Republic of Indonesia. All of these resources are allocated in a specific manner so that the funding sources do not overlap one with another.
As for the human resources, the personnel who are directly involved in the program are the Village Malaria Cadres (JMK), Company Malaria Cadres (JMP), laboratory personnel in Community Health Centers (Puskesmas) and in the Provincial Government Health Agency, malaria surveillance personnel, doctors, nurses and midwives in Community Health Centers (Puskesmas), community leaders, private practice doctors and pharmacy personnel.
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7. Who were the stakeholders involved in the design of the initiative and in its implementation?
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The Private company (BP-LNG Tangguh, an Oil and Gas Company) provides funding for the malaria program has appointed a Non-Government Organization or NGO as a representative of the company in implementing the malaria program in Bintuni Regency. The NGO prepares annual programs with the Government Health Agency, and the progress of the activities is monitored through weekly, monthly and annual reports.
To improve coordination in the implementation of the program, the NGO is given a special room along with the Division for Eradication of Communicable Diseases in the Government Health Agency Office. By working together under one roof, the NGO’s program and the Government Health Agency’s program can be in synergy and mutually support each other so that all programs that run are collaborative programs.
In each field visit, the team from the Government Health Agency and the team from the NGO work together with all community health centers, community health sub-centers and Village Malaria Cadres (Juru Malaria Kampung) and Company Malaria Cadres (Juru Malaria Perusahaan) to make the diagnosis and treatment of patients better.
In addition to the NGO, the Government Health Agency and the partner company, the stakeholders involved in the implementation of this program are doctors, nurses and midwives in community health centers that serve to implement the EDAT system that has been developed, as well as community leaders who also play a role in social marketing activities relating to the malaria program so as to encourage the behavioral change in the community. The Global Fund is also involved in the program by providing support in the form of 60,000 mosquito nets distributed to the entire population in Teluk Bintuni Regency. The Ministry of Health provides logistic support in the form of antimalarial drugs.
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8. What were the most successful outputs and why was the initiative effective?
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• Malaria morbidity rate decreased significantly from more than 87.5 per thousand of the population to less than 3 per 1000 population in 2016
• 60,000 mosquito nets are distributed to all residents in Teluk Bintuni Regency;
• 800-1,200 antimalarial drugs are packaged and distributed every three months throughout Teluk Bintuni Regency;
• More than 1,000 stalls and kiosks in Teluk Bintuni Regency no longer sell antimalarial drugs;
• More than 200 doctors, nurses, midwives and laboratory personnel have been trained on surveillance of malaria;
• 24 Community Health Centers (Puskesmas), 28 Community Health Sub-Centers, 8 Pharmacies in Teluk Bintuni Regency now perform diagnostic procedures and treatment of malaria correctly;
• 20 Village Malaria Cadres (JMK) are formed in remote areas;
• Memorandum of Understanding is made between the private company (BP) and the Regional Health Agency of Teluk Bintuni Regency to implement the malaria program ;
• Instruction of Head of the Government Health Agency is issued regarding the correct use of antimalarial drugs.
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9. What were the main obstacles encountered and how were they overcome?
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The main obstacle in the implementation of the EDAT system is the difficulty in maintaining the quality and consistency of the program. Teluk Bintuni Regency is composed of several sub-districts which are distant from one another; one is 100 km away from Bintuni City Center, another can only be reached by small plane with a capacity of 6-12 people, and some areas can only be reached by sea using the locals’ longboat in 2-6 hours.
Because these sub-districts are quite far and scattered in remote places, provision of quality assurance and assistance for the implementation of malaria surveillance by the malaria team in Community Health Centers (Puskesmas) and by the Village Malaria Cadres (JMK) is relatively difficult, and it takes several days to make one visit. To overcome this, the malaria team make scheduled visits once every 3-4 months for a remote place and once a month for a close place.
We developed a scoring system to measure staff performance and the progress of the malaria program. Every Community Health Center (Puskesmas) personnel and Village Malaria Cadre conducts an individual evaluation each month to review the progress of their own program. As a result, the Puskesmas personnel and Village Malaria Cadres (JMK) can find out their shortcomings, and make improvements gradually.
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