Earlier this month, the Global Fund to Fight AIDS, Tuberculosis and Malaria held its 31st Board Meeting in Jakarta, Indonesia. The country is home to 247 million people, making it the fourth largest population in the world. It also carries the fourth highest burden of tuberculosis globally. Yet, despite this burden and its struggles with poverty and unemployment, the country has worked to prioritize prevention and treatment efforts — making its National Tuberculosis Program a model of success.
With support from organizations like the Global Fund, which provided more than half of all funding for Indonesia’s tuberculosis program in 2012, deaths from the disease have declined approximately 4.1 percent each year since 1990. In addition, the Indonesian government now purchases all first-line tuberculosis drugs and is contributing to the procurement of costly second-line treatment for multidrug-resistant tuberculosis (MDR-TB). Indonesia’s Ministry of Health is also working to gradually transition from Global Fund financing as the government rolls out universal health coverage in 2014.
The Baladewa Clinic in Central Jakarta is a shining example of these efforts, and is known among locals as the place to be cured when presented with a cough. It’s a point of pride for Iriana Joko Widodo, wife of Jakarta Governor Joko Widodo and honorary board chair for the Indonesian Society Against Tuberculosis, a nonprofit organization that opened the clinic in 1978 to detect and treat the disease. The clinic has a cure rate of 84 percent; and, while this number is good, the fact that 16 percent of Baladewa’s patients with tuberculosis — and 10 percent of patients countrywide with the disease — do not get cured reflects continued challenges. Nurses at the clinic note that when patients begin to feel better, they sometimes fail to return for further treatment – promoting tuberculosis transmission and incubating drug resistance.
This behavior, of course, is not limited to the Baladewa Clinic or Indonesia. In 2012, an estimated 450,000 people developed MDR-TB as a result of not completing treatment or receiving poor-quality drugs; an estimated 170,000 deaths from MDR-TB were reported that same year.
Another challenge is providing comprehensive treatment where patients are co-infected with HIV. In 2012, TB-HIV co-infections resulted in significant global mortality: tuberculosis contributed to 20 percent of the 1.6 million global deaths from AIDS; HIV caused 25 percent of the 1.3 million global tuberculosis deaths; and only 57 percent of co-infected tuberculosis patients received antiretroviral therapy, the most powerful intervention for preventing illness, death and transmission.
Coming out of the board meeting in Jakarta, the stage is set for continued progress in the fight to control tuberculosis as a public health emergency. The Global Fund is working to build on this momentum and better address these challenges through new policies and its new funding model.
Notably, under new policies the Global Fund is requiring countries like Indonesia, with high co-infection rates of tuberculosis and HIV, to submit a single plan, or “concept note,” on integrated and joint programming for the two diseases. This concept note is intended to scale up and optimize HIV and tuberculosis programming to ensure patients benefit most from the suite of services they need.
The Global Fund is also seeking to engage more deeply with technical partners on the ground, through a country dialogue process, to seek and build into its grants new scientific data and knowledge on how to best address tuberculosis and HIV epidemics locally.
Although tuberculosis remains a serious threat, global efforts have helped reduce deaths from the disease by more than 40 percent in the last 20 years — putting the Millennium Development Goals’ target -- to reduce deaths by 50 percent by 2015 — within reach.
With its revised funding and implementation policies, the Global Fund is well poised to drive greater impact in fighting tuberculosis. These new initiatives will help the organization incentivize and enhance domestic support and promote tuberculosis and HIV co-investments to get us to the goal of reaching the three million people with the disease who go undetected each year.
To read more about how implementing countries like Indonesia are taking steps toward shared responsibility and increased accountability for the health of their people, read Friends’ Steps Toward Sustainability.