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AREA OF WORK
SURVEILLANCE, PREVENTION
AND MANAGEMENT OF NONCOMMUNICABLE DISEASES 1
Country Issues and Challenges :
Currently, an integrated effort is going on to develop the National Strategy on NCD Control, adapting the Global and Regional Strategy. The three major components are adopted, i.e., surveillance of risk factors, integrated health promotion and reform of service delivery. This document is expected to be finalized by the end of 2003.
WHO STEPwise approach to Risk Factor Surveillance has been translated into Bahasa Indonesia during the biennium 2002-3. STEP 1 has also been incorporated in the National Socio Economic Survey - Health Module as part of the National Health Survey (SURKESNAS). In addition, with joint funding from SEARO and Country Office, WHO stepwise approach has been used in demonstration areas aiming at development of community-based approach in NCD control. In addition, these instruments had been introduced to local governments and also universities to enhance the adoption of these instruments for further implementation. However, a national strategic plan on surveillance of major NCDs still need to be developed to achieve a consensus in NCD surveillance. The differences in the approach of diseases based and risk factor based surveillance should complement each other and receive proportionate interest.
A demonstration project is under way in Depok jointly funded by SEARO and Country Office to develop community-based approach in prevention and control of major NCDs. This is a long-term project, especially if we want to see behavioral changes. Therefore, consistent efforts should be put in place to enable us to reach conclusion.
In biennium 2002-3, preliminary meetings had been conducted to establish a national network for prevention and control of major NCDs. While public sector/MoH remains the primary agent for this movement, there is a great potential in the private sector such as NGOs that are very active in prevention and control of NCD risk factors. Therefore, the network should be further supported.
The challenge now is to continue the efforts and to advocate to major stakeholders to enable the country to anticipate the incoming epidemics of NCD.
Expected Contribution :
- National strategic plan for NCD prevention and control implemented
SURVEILLANCE, PREVENTION
AND MANAGEMENT OF NONCOMMUNICABLE DISEASES 2
Country Issues and Challenges :
Indonesia is still lagging in the effort to attack blindness due to cataract. In the biennium 2002-3, several government officials had received training in Eye care programme management in Madurai and other places. A national strategy for blindness control has just been released, therefore this should be strongly supported, and especially that Vision 2020 is not a top priority programme in the country.
Expected Contribution :
- Technical support in implementation of the national strategy for prevention and control of blindness.
TOBACCO
Country Issues and Challenges :
Indonesia has experienced one of the largest increases in cigarette consumption in the world - 47% during the 1990s. Cigarette smoking is rapidly increasing in Indonesia. About 69.1% of Indonesian men 20 years or older smoke regularly, with higher rates in rural areas (74.0%). Among boys surveyed in Jakarta secondary schools, 69.3% had already tried cigarettes. Regular smoking among 15 to 19 year old boys increased from 36.8% (1997) to 42.6% (2000).
In compliance with the WHA52.18, Indonesia activity participated in the Framework Convention on Tobacco Control (FCTC) with other UN Member States. In 2003, the GOI will ratify the international treaty on tobacco control.
WHO will support the institutional structures to carry forward the key legislative and policy elements of a strategic plan, in cooperation with a range of government ministries, NGOs, and parliament.
Expected Contribution :
- Comprehensive national tobacco strategy adopted and being implemented.
INJURIES AND DISABILITIES
Country Issues and Challenges :
Injuries and violence has become a public health issue. Data from Susenas shows that the incidence of accidents alone is 0.5% translating to 1 million people. In addition, injuries and violence related to political instability is perceived to be high in conflict affected areas. In the meantime, there is no focal point identified within the MoH. It is well understood that coping with the issue of injuries and violence calls for a multi-sectoral approach. However, health has a very strategic position in this area. WHO SEARO has developed several documents related to this, which can serve as a reference to build policy and capacity in dealing with this issue. WHO has highlighted this issue by releasing the World Report on Violence and Health in 2002.
Expected Contribution :
- National policy for prevention of injuries and violence developed.
MENTAL HEALTH AND SUBSTANCE ABUSE
Country Issues and Challenges :
Mental health problem becomes a more prominent issue lately in the country, part of it due to the launching of World Health Report 2001 on Mental Health. This is coupled by recent changes in the MoH - Mental Health Directorate from hospital based to more community based approach. Therefore, in biennium 2002-3, WHO has supported the development of National Mental Health Policy and its strategic plan. Despite this effort, mental health programmes still do not receive sufficient budget. In addition, decentralization that started to be implemented in 2001 complicates the problem. Confusion is also raised as there is no model in the country about district mental health programme that can be used as an example.
WHO-HQ recently developed management tools to strengthen district mental health programme via the Mental Health Policy Project. Currently there is an effort to translate and adapt two modules of the series, i.e., Planning and Budgeting of Mental Health programme and Organization of Mental Health services. This adaptation is expected to be finalized in 2003. In 2003, a training workshop has been successfully conducted, involving participants from the center and also provinces in Java and Bali to introduce the modules and use the modules to develop mental health programmes. In 2004-5, some other modules will also undergo the same approach. In addition, some training modules for prevention and primary care givers in the area of mental health and substance abuse have been developed and trained in several provinces. However, there is no feedback and monitoring of its implementation.
Substance abuse becomes more prominent in the last few years. The government had taken efforts but still not very effective. WHO country office works partially on this issue, a number of guidelines had been developed for narcotics addiction but there is a growing understanding that narcotics is very much related to other substance abuse such as alcoholism. The challenge now is also to increase awareness and develop national guideline in coping with alcoholism and other substance abuse such as metamphetamine etc.
Expected Contribution :
District mental health programmes strengthened
National guidelines and tools for the management of mental and neurological disorders and substance abuse updated and field tested.
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