Getting Safe Medicines to the Patients Who Need Them
State-of-the-art diagnostics, rigorous procedures and compassionate community volunteers join to fight TB in Indonesia
“I make sure to take my medicine every day, to keep myself and my kids healthy,” *Suswandi says while holding his oldest son, who is 7, in his lap.
Suswandi was diagnosed with tuberculosis (TB) and HIV in the same year. He wears a face mask at all times, something he says both of his kids found strange at first. “I’ve been coming to Puskesmas Kramatjati, [a primary care center specializing in TB and HIV services] for three months. I go every day to take medicine for TB to make sure I’m getting healthier.”
Recognizing that many aspects of the system must come together to ensure patients like Suswandi receive safe and effective TB and HIV services, USAID partners with the Government of Indonesia to build and strengthen a network of pharmacies, laboratories, hospitals and primary care clinics that work together to provide comprehensive TB and HIV services.
Suswandi heard about Kramatjati through a community support group supported by USAID. Volunteer health workers associated with the health facility conduct outreach in the community and lead weekly meetings to discuss with patients the often-isolating and baffling issues they face, such as misperceptions about HIV and TB, how to use their government-provided health benefits and the challenge of taking the large doses of pills required to manage their illnesses.
Suswandi joined the group after a neighbor connected him with one of the volunteer health workers. The support group then connected Suswandi with the formal health system, where USAID assists the government to improve medicine safety and delivery.
Previously, treatment for patients like Suswandi may have been delayed for weeks or months; he might have been tested for TB at a clinic, but might not have returned within a week or two to discover his status.
Because the clinic where Suswandi sought treatment was using a machine for rapid diagnosis called GeneXpert, he was able to find out his TB status in a matter of hours. GeneXpert shortens the testing and diagnosis window to less than two hours, and can be done on-site. USAID has supported GeneXpert since 2011. By the end of 2017, the Government of Indonesia with support from the Global Fund and USAID, had increased the number of GeneXpert machines across the country to 533. That translates to a 43 percent increase in the number of TB cases detected nationally over six years.
Suswandi’s GeneXpert results indicated drug resistant TB, or DR-TB. DR-TB requires a more complex series of tests to ensure patients are properly treated, which can only be performed in certain qualified labs. Fortunately, Indonesia now has a network of 13 quality-assured labs for DR-TB testing established with USAID support and internationally accredited, such as the Balai Besar Laboratorium Kesehatan — Health Laboratory Center (BBLK), in Surabaya, Indonesia. The BBLK lab not only tests for DR-TB, but also provides training for other regional laboratories on state-of-the-art diagnostic practices.
Suswandi’s test results were used to ensure that he received the most effective treatment mix possible. He was prepared by his doctors and community support groups to receive more intense daily medications for a longer duration. These medications had to be of the highest quality to cure him of the disease. Suswandi continues to take his daily medications and is expected to complete his full treatment in August 2019.
When medicines are produced with poor quality ingredients, without good manufacturing practices or stored under hot and humid conditions, they are can be ineffective. Patients who consume these poor quality medicines often suffer severe side effects, develop drug resistant diseases or even die.
Recognizing the public health importance of this issue, USAID partnered with the Indonesian national medicines regulatory authority, the National Agency of Drug and Food Control (BPOM), the Ministry of Health, and local TB medicines manufacturers to train them on innovations and standards for screening, testing and quality assurance to ensure that the TB medicines provided by the government public health clinics are of the highest quality possible. Patients like Suswandi can thus be confident that the health system is providing trustworthy and effective treatments for their disease.
USAID in partnership with Indonesia helps to ensure that all TB and HIV patients, like Suswandi, receive quality diagnostics and the care and treatment services needed to keep themselves and their families healthy.
*Suswandi’s last name wasn’t used to protect him from stigma associated with TB and HIV.
About the Author
Trenton White was a Health Systems Advisor in USAID’s Office of Health Systems.
