The implementation of community-based diabetes and hypertension management care program in Indonesia

Abstract

Since 2010, Indonesian government has initiated a chronic disease management program, Prolanis (Program Pengendalian Penyakit Kronis) targeted for diabetes and hypertension. The program is continued at the commencement of universal health coverage (UHC) in 2014. "This study aimed to report the utilization and cost of the implementation of Prolanis in Indonesia from 2014 to 2016, or two years since the commencement of Indonesian universal health coverage." Secondary data analysis was performed using publicly available data and data obtained from the national health insurance agency (BPJS); while data on disease prevalence were collected from basic national health survey. There was an increase trend of Prolanis participants, from around 11,000 participants in 2014 to more than 250,000 in 2016. More than 70% of participants were adults living in Java, however, the acceptance rate was very low in other area. Across different activities in Prolanis, physical activity was the most participated ones. In comparison to other regions, regions in Java were the most active area. The total expenditure for Prolanis program in 2016 increased almost triple from the annual cost in 2014. However, the cost per person was actually decreased more than 50%. Within two years of UHC implementation, there were increase covered participants and total costs, but cost per individual was decreased and there was significant difference in of cost between Java and outside Java. Further study and routine monitoring-evaluation process by health authority is needed to assess whether the cost difference would affect the service quality.

Change in clinical knowledge of diabetes among primary healthcare providers in Indonesia: repeated cross-sectional survey of 5105 primary healthcare facilities

“…37 The impact of this program on population-level diabetes management and control is still unknown and coverage outside of Java is low; however, the success of a program like Prolanis will likely be dependent on the level of diabetes knowledge among Indonesia's primary care providers. 38 This analysis has several limitations that are important to consider when interpreting the findings. First, we measured provider knowledge using healthcare vignettes, which may not represent the actual quality of care that healthcare workers provide.…”

“…37 The impact of this program on population-level diabetes management and control is still unknown and coverage outside of Java is low; however, the success of a program like Prolanis will likely be dependent on the level of diabetes knowledge among Indonesia’s primary care providers. 38 …”

Do urban/rural and educational differences influence diabetes patients’ risk of developing Common Mental Disorders? Indonesian cross-sectional Community Health Survey analysis

“…Therefore public awareness-raising and training for healthcare staff was instigated between 2005-2008 in two rural areas (Kediri City and Kediri Regency) to improve healthcare workers' ability to meet patients' needs. Social educators and health workers were trained and established diabetes awareness information posts in 26 districts (26,27).…”

“…The program included a variety of stakeholders involved in diabetes management and focused on prevention and increasing the capacity for diagnosis and management of diabetes. An extensive training program for doctors in the eld of diabetes was currently running as well (26,27).…”

“…To address the human resource capacity gap, awareness-raising, and educational activities for community members, the program comprised of training master level staff, nurses, educators, patients, and their relatives in diabetes management took place between 2011 and 2014. A community-based approach in the provinces of West Sumatra, Bengkulu, and Banten was developed to reduce the prevalence of NCDs and their risk factors with the main aims to provide early detection, counseling, and education for people with or at risk of developing NCDs (26,27) This analysis shows diabetes-related diagnoses patients with low education in rural areas have the highest risk for CMD which could hamper their adherence to diabetes treatment regimens. This result implies that tailoring mental health services in diabetes as well as other NCD treatment from the early stages should be a high priority, especially in the outer Jawa Bali region.…”