'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. (005)