'Puskemas' play key role in TB fight
'Puskemas' play key role in TB fight
The Jakarta Post, Jakarta
Community health centers (Puskesmas) are at the forefront of the
increasingly successful fight against tuberculosis in Indonesia,
according to experts.
Since the health centers began actively participating in anti-
tuberculosis programs in 2002, the rate of recovery for
tuberculosis patients has increased from 69 percent in 2001 to 76
percent in 2004, said Rosmini Day, the acting director of
directly transmitted disease control at the Ministry of Health.
At about 30,000 Puskesmas in Indonesia, tuberculosis medicine
is provided at no cost to patients. The centers also monitor the
patients and make sure they take the medicine for a six month
period, she said on Friday.
"The medicine is provided for free to all patients, regardless
of their economic status. The Indonesian government contributed
about Rp 50 million in 2004 to pay for the medicine. We also
receive a contribution of US$5 million every two years, or $2.5
million a year, from a global fund."
Jan EJ. Voskens, senior consultant of the Royal Netherlands
Tuberculosis Foundation, said the relative success of the
Puskesmas in curbing tuberculosis could be attributed to the
application of the World Health Organization (WHO) strategy
called Directly Observed Therapy Short-Course (DOTS).
The DOTS strategy cure rate is up to 95 percent, even in the
poorest countries, according to WHO.
The strategy focuses on five key elements, which are:
government commitment to sustained tuberculosis control,
detection of tuberculosis cases among symptomatic people with
sputum smear microscopy tests, six to eight months of regularly
supervised treatment (including direct observation of drug-
taking), regular and uninterrupted supply of high-quality anti-
tuberculosis drugs and an effective reporting system to monitor
treatment progress and program performance.
Voskens said the Puskesmas were more involved than hospitals
in the treatment of tuberculosis.
"Doctors are often stubborn and still use old methods instead
of DOTS in treating TB," Voskens said.
"Switching doctors and medicines is not advisable," Voskens
added, "as it will cause multi-drug resistance, in which curing
can be very costly."
He added that a six-month treatment for tuberculosis cost
about $10 per patient, while in resistance cases a patient could
expect to spend about $20,000 for the bulk purchase of anti-
resistance drugs, or up to $40,000 for every private purchase.
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