'Stick and carrot' approach suggested for dengue eradication

Leony Aurora The Jakarta Post Jakarta

A long-term dengue fever eradication program should include rewards and punishments to encourage local communities to keep their environments free from possible mosquito breeding grounds, an observer said.

The former chairman of the Indonesian Medical Association, Kartono Mohamad, suggested on Tuesday the government provide incentives to communities that were able to eliminate the larvae of the Aedes aegypti mosquito, which spreads dengue fever.

On the other hand, the government could impose fines on the owners of houses where larvae was found, Kartono said.

"We can emulate Singapore, which fines homeowners S$500 (US$294) for failing to eliminate the larvae," he told The Jakarta Post.

Kartono welcomed the Ministry of Health's long-term plan announced last week to increase public awareness of dengue and eventually eradicate the disease.

"However, we should question what their concrete measures are for achieving these targets," he said.

The ministry's plan includes the recruitment of 70,000 nurses to fight dengue fever, the treatment of patients and the education of people on how to stop the spread of the diseases.

The project is expected to cost over Rp 1 trillion ($119 million), though their is still no schedule for its implementation.

Kartono said the responsibility for eradicating dengue fever rested with local administrations and communities, especially local officials and community leaders.

"Communities will only be motivated (to fight dengue) when there are leaders who can motivate them," he said.

World Health Organization representative for Indonesia Georg Petersen also said local communities had to take the lead in battling dengue fever.

He said the organization did not have a specific program to fight dengue, adding that the Indonesian government had more experience in dealing with the disease.

Meanwhile, in response to the current dengue outbreak, the Ministry of Health has formed a team to assess conditions, develop programs and coordinate their implementation with local administrations.

Although the team is still waiting for a ministerial decree outlining its tasks, it has already been at work for two weeks, according to its executive director, I Nyoman Kandun, who is also an expert staff member on health, the environment and epidemiology at the health ministry.

"We will coordinate efforts, including cleaning possible breeding grounds and treating the sick," he said, adding that the available funds for the eradication of dengue fever this year would be between Rp 30 billion and Rp 50 billion.

The government has committed to pay the hospital costs of poor dengue patients treated in the third-class wards of hospitals. To qualify, patients must acquire a letter from their neighborhood unit head affirming their economic status, or present their health cards to the hospital.

"So far, no hospitals have applied for reimbursement," said Nyoman.

So far this year, 344 people have died from dengue fever and 19,904 have been infected. About 25 provinces have been hit by the disease, with Jakarta having the largest number of patients followed by West Java.

This Friday, the health ministry plans to hold a meeting with the governors of Indonesia's 32 provinces to encourage them to promote greater community participation in the battle against dengue.