Indonesia needs a healthcare revolution

Some promising news lies in the pages of a recent study by the Health Ministry: Hypertension, one of Indonesia's most common non-communicable diseases (NCDs), has decreased in prevalence between 2007 and 2013, according to the Ministry's data. While new measuring systems may slightly skew the results, the study suggests that increased awareness about NCDs as serious health threats has contributed to a reduction in new hypertension cases.

Unfortunately, NCDs remain the number one cause of death in Indonesia, and worldwide. They continue to kill more than 36 million people annually, with nearly 80 percent of NCD deaths — that's 29 million — occurring in low- and low-middle income countries like Indonesia. Each year, more than 2.5 million people in Southeast Asia die from a non-communicable disease. Why is such a serious health crisis not a major public priority?

Maybe NCDs would gain more attention if we understood them as more than a health threat: They are also a tremendous economic burden. In Indonesia, where the prevalence of infectious diseases like bacterial diarrhea, typhoid, dengue, and malaria is also high, NCDs place an additional strain on an over-burdened and underfunded healthcare system. NCDs increase poverty, impede development, threaten health systems and are a major cause of disability and health inequality, according to the ASEAN Noncommunicable Disease Network in 2013.

NCDs are also largely preventable. The majority of premature deaths in Indonesia could be prevented with lifestyle changes. Tobacco use, the harmful use of alcohol, unhealthy diet, and a sedentary lifestyle are primary risk factors for cardiovascular diseases, cancers, respiratory diseases, and diabetes — diseases that account for 80 percent of NCDs worldwide, according to WHO. Indonesians are living longer, and the middle class is growing. But this does not mean Indonesians are getting healthier. The aging population faces a host of chronic diseases that will continue to threaten Indonesia's development.

But change is possible. It is in our capacity to be healthier. We can reduce risk factors for NCDs by limiting tobacco and alcohol use. We can improve our diet by cutting back on salt, saturated fat and sugar, and we can incorporate more physical activity into our daily lives. In fact, according to a report by Richard Horton published in The Lancet (2013), such changes may prevent more than 37 million deaths worldwide by 2025.

But in order to promote lifestyle change on a national scale — as well as effectively monitor and treat patients already suffering from NCDs — Indonesia needs a healthcare revolution. Since 2006, disease predominance has shifted from communicable diseases such as malaria and tuberculosis (TB) to NCDs.

Indonesia needs a clinical approach to NCDs that differs from that of acute illnesses. Intervention must be holistic; it must prioritize self-management, long-term treatment, and palliative care. New innovations in self-screening, for example, will help patients to monitor their own bodies for warning signs and help doctors to detect disease earlier for more effective treatment. Innovations in imaging technologies will improve detection and intervention procedures and increase NCD patient survival rates.

Collaboration is key to the healthcare revolution: Technological innovations from private companies provide crucial contributions to the efforts of healthcare providers and local national governments to provide appropriate healthcare. Those innovations, applied to the entire cycle of healthcare — from prevention, screening and diagnosis through to treatment and observation — should focus on combating NCDs.

In 2012, Philips Healthcare hosted a series of seven roundtable discussions on non-communicable diseases in cities across Southeast Asia. This was followed in 2013 with the joining of policy thinkers, academics, and clinicians to establish the ASEAN NCD Network, which published a report highlighting effective case studies in NCD prevention and treatment in our region.

Three programs identified by the Network are operating in Indonesia: The "See & Treat" Cervical Cancer Screening program, for example, has introduced the Visual Inspection with Acetic Acid (VIA) method to detect cervical cancer. This allows healthcare providers to detect pre-cancerous cells with the naked eye using a common household ingredient: vinegar. In a country where a woman dies as a result of cervical cancer every hour, the impact of this affordable and easily implemented innovation will be unprecedented. In fact, over a 15-year period, a similar program in India resulted in a 31 percent reduction in cervical cancer deaths.

Then there is the Ramadhan Diabetes Camps, initiated by Aman Pulungan for the comprehensive management of Type 1 diabetes among children. With initial funding provided by the World Diabetes Foundation (WDF), Aman and his colleagues helped to facilitate training for doctors and nurses in T1DM and Diabetic Ketoacidosis (DKA), roadshows at schools and family events, diabetes camps, and parent support groups and mass media campaigns to increase awareness about pediatric diabetes.

This is especially important during the month of Ramadhan: Diabetic children who wish to fast can learn how to count calories, inject the right dosage of insulin, and properly monitor their blood sugar levels.

Finally, in a partnership between the Indonesian Society of Endocrinology (Perkeni), Indonesian Diabetes Association (Persadia), Indonesian Diabetes Educators Association (Pedi) and Directorate of NCD Control for the Health Ministry, the Community Diabetes Strengthening Program seeks to improve the capacity of preventing, detecting and treating diabetes. Healthcare professionals interested in diabetes care, including general practitioners, internists practicing in provincial or district hospitals, and health educators in local hospitals and community health centers (Puskesmas) are identified for intensive diabetes care training.

These successful NCD prevention and treatment programs share several factors in common: They demonstrate the importance of partnerships, community ownership, momentum, sustainability, flexible financing and scalability. Of course, all innovations need to be locally relevant. We cannot copy-paste screening and treatment procedures from well-resourced, developed countries. Healthcare providers need innovations that are practical in Indonesia.

Indonesia's Health Ministry has made a commitment to supporting the prevention and early detection of NCDs. Insufficient infrastructure and human resources — particularly the lack of specialists — remain challenges, as does a lack of sufficient private sector involvement. The ineffective deployment of healthcare funding must be addressed, and incentives provided for the private sector, in order to solicit more investments in NCD prevention and treatment.

The government must prioritize health in policymaking; politicians should focus on national wellbeing and galvanize all sectors to combat NCDs. By addressing NCD impacts, Indonesia can lead the healthcare revolution, at home and across ASEAN.

source: www.thejakartapost.com