REVIEW  OF  NATIONAL  VECTOR CONTROL  POLICY IN INDONESIA

WINARNO & BANGKIT HUTAJULU DIRECTORATE OF VBDC DG DC & EH, MOH INDONESIA

PROFILE OF INDONESIA

• • • • • •

No. of Islands : 17.000 Population : 227, 3 million Area : 1.100 x 1500 miles sqr No. of Province : 33 No of District : 430 Life Expectancy : 67 year

Top Ten Health Problem Priority: 1. Malaria 2.Tuberculosis 3. HIV AIDS 4. DHF 5. Filariasis

6. ARI 7. Leprosies 8. Immunization 9. Diarrhea 10.Reproductive Health

General information Population : 227.328.509 people Population at risk:  107,785,179 (49,6%) Endemic districts : 310 (70,3%) No. of malaria cases  has reported : 2.5 million/yr  Predicted about :  10 millions of cases/years

PETA ENDEMISITAS MALARIA TH. 2007

API  o/oo

0

0‐1

1‐5

Free

Low

Moderate

5‐49

50‐100

High

> 100

1 dot = 50 Kasus 

1 dot = 250 kasus

Malaria Klinis, SD Diperiksa, Malaria Positif Tn 2000 – 2008 (Jan‐Mei) 3,500,000 3,000,000 2,500,000 2,000,000 1,500,000 1,000,000 500,000 0 2008 (JanMei) Klinis Malaria 3,178,212 2,737,927 2,660,674 2,482,906 2,335,585 2,113,265 2,167,028 1,774,845 543,126 SD Diperiksa 1,880,418 1,604,573 1,440,302 1,224,232 1,109,801 982,828 1,246,324 930,029 355,924 Positif Malaria

2000

2001

2002

2003

2004

2005

2006

2007

256993

267,592

273,793

223,074

268,852

315,394

347,597

311,789

93,830

•

PENYEBARAN VEKTOR MALARIA DI INDONESIA 2008

18 11

19 17

22

20

25

13

14 16 14

25

15

2

16

23

15

5

21 10 6 21

1 24 1

22

3

16

20

20

17 4 7

20 21

24

Keterangan : 1. An.aconitus 2. An.annularis 3. An.balabacensis 4. An.barbirostris 5. An.bancrofti 

6. An.barbumbrosus            11. An. kochi                   16. An. Maculatus 21. An. subpictus 7. An. flavirostris  12. An.punctulatus 17. An.minimus 22. An. sinensis 8. An.farauti 13. An.ludlowi          18  An.nigerimus 23. An. umbrosus 9. An.karwari 14.An.letifer        19. An. parangensis      24. An. vagus 10. An.koliensis 15. An.leucosphyrus    20. An. Sundaicus 25. An. tessellatus

8

9 12 21

SUMBER DAYA PENDUKUNG

GF R1 in Tsunami Relief Program for MCP In Aceh and North Sumatera :

GF R6 Areas : $ 57 JUTA

GF R1 (5 Provinces), For MCP in Eastern Indonesia = $ 23 JUTA ( termasuk NAD & Nias)

VEKTOR DEMAM BERDARAH DENGUE

Incidence Rate (IR) dan Case Fatality Rate (CFR) DHF Menurut Tahun di Indonesia,1968-2008 (30 Juni)

80

71.18 IR (per 100.000 pddk) CFR(%)

40

29.36 20

1.01

Tahun

2008

2006

2004

2002

2000

1998

1996

1994

1992

1990

1988

1986

1984

1982

1980

1978

1976

1974

1972

1970

0 1968

IR dan CFR

60

0.76

Peta Insidensi DBD Menurut Provinsi in Indonesia, 2007

50

IR=incidence rate (per 100,000 penduduk)

Case Fatality Rate (CFR) DBD Menurut Provinsi di Indonesia, 2007 Papua Papua Barat Malut Maluku NTT NTB Bali Sultra Sulsel Sulbar Sulteng Gorontalo Sulut Kaltim Kalsel Kalteng Kalbar Jatim DIY Jateng Jabar DKI Jakarta Banten Lampung Bengkulu Babel Sumsel Jambi Kepri Riau Sumbar Sumut NAD

0

0,5

1

1,5

2

2,5

CFR (%)

3

3,5

4

4,5

MASS DRUG ADMINISTRATION (MDA) ON 2007

• Planning of MDA 2007: 98 district in filariasis endemic targeting 30 million pop • Realisation of MDA th 2007: 47 district filariasis endemic, covered 9.576.215 pop

VEKTOR JAPANESE ENCEPHALITIS Species

Lokasi

Tahun

1.Cx.tritaeniorhynchus

Kapuk,Bogor,Lombok,Semarang

’72-74,85;75;85;93

2.Cx.gelidus

Bogor,Kapuk,Lombok

’75; 85; 85

3.Cx.vishnui

Kapuk, Pontianak

’85 ; 85

4.Cx.annulus

Pontianak

‘85

5.Cx.fuscocephalus

Kapuk, Semarang

’85; 93

6.Cx.bitaeniorhynchus

Semarang

’93

7.Cx.quinquifasciatus

Semarang

’93

8.An.annularis

Lombok

’85

9.An.vagus

Lombok, Semarang

’85; 93

10.An.kochi

Semarang

’93

11.Armigeres subalbatus

Semarang

’93

STRATEGIC ISSUE ON VECTOR BORNE  DISEASES: 1) 2) 3)

OUTBREAK (RE/NEW EMERGING DISEASES) : SEASION, POPULATION  MOVEMENT, PHISICAL ENVIRONMENT CHANGE ENTRANCE OF  NEW EMERGING DISEASES/VECTOR  BORNE DISEASE (BY   INTER‐NATIONAL TRAFFIC) ROLE OF SECTORAL & COMMUNITY SUPPORT NOT YET  OPTIMUM

4)

DESENTRALIZATION Æ LACK OF PROFESSIONAL STAFF  & OTHER  RESOURCES

5)

EPIDEMIOLOGICAL MAPPING (ASPECT OF CASES, VECTOR)

6)

VECTOR CONTROL AS A ONE OF MAIN ACTIVITY FOR VBDC MUST  BE RATIONAL , EFFECTIVE, SUSTAINABLE, ACHIEVABLE

MAIN ISSUES  FOR VECTOR CONTROL  • HRD  ‐ Medical Entomologist which comprehensive oriented . ‐ Technical & Functional Training & Education • DEVELOPMENT OF INFORMATION SYSTEM ‐ Reactivation of Vector  Surveillance in District level.

‐

Networking of Surveillance & Vector  control

• PROVIDE OF MATERIAL & SUPPLIES • PROGRAM INTEGRATED ‐ Integrated Vector Surveillance (IVS) ‐ Integrated Vector Management (IVM) 

Pesticides used in Public Health susceptibility status of target organisms safety to humans impact on the environment method of application application equipment cost

WHO recommendations NATIONAL Pesticides Commission

Malaria - Alternative Pesticides Bifenthrin 10% WP (0.025 gr/m2) Alpha-cypermethrin 5% WP (0.025 gr/m2) Bendiocarb 80 %WP (0.2 gr/m2) Deltamethrin 5% WP (0.02 gr/m2) Lambdasihalotrin 10% WP (0.025 gr/m2) Etofenprox 20%WP (0.1 gr/m2)

Permethrin 10% EC Deltametrin 2.5 %

Bacillus thuringiensis H-14 1200 ITU/ltr S Methopren IGR 1.8 % G 72 mg/m2 Pyriproxifen 0.5 G 2 g/m2

Space Spraying DHF Alternatives

Pesticides

ADULTICIDE

Malathion 96 % (500 ml/ha) Cyflutrin 50 % EC (75 ml/ha) Cypermetrin 25 % ULV (400 ml/ha) Lamdasihalotrin 25 EC (75 ml/ha) Permetrin S Bioalterin 10/1.5 OS (100 ml/ha)

Abate 1% sand granules

Larvicides Temephos 1 % G 10 gr/100 ltr Metoprene 1.3 % G 72 mg/m2 Piriproksifen 0.5 G 2 gr/200 ltr

Number of house sprayed vs Malaria incidence 1994 - 2001 0.9

1600000

0.8

1400000

0.7

1200000

0.6

1000000

0.5

800000

0.4

600000

0.3 0.2

400000

0.1

200000

0

1994/ 1995 1995/ 1996 1996/ 1997 1997/ 1998 1998/ 1999 1999/ 2000 2000/ 2001 2001/ 2002

Rmh Disemprot

1360258

1403368

1196334

801962

444353

189261

135460

125760

Kasus dlm API

0.17

0.07

0.08

0.12

0.3

0.52

0.81

0.62

0

INSECTICIDE USED (IRS) FOR MALARIA 2004-2006 etofenprox carbamat

Lambda cyhalotrine, alpha cypermetrine

INSECTICIDE USED (SPRAYING) FOR DENGUE/DHF 2005-2006 pyretroid

organophosphate

Central

Province

District/ Municipality

PartnerÎ Support each others

Action gradually, Coordinate,Community involve

ORGANIZATION CENTRAL

MOH VBDC DIRECTORATE

PROVINCE

CDC DIVISION VBDC SECTION / UNIT

DISTRICTS

CDC DIVISION VBDC SECTION

MINISTRY OF HEALTH

DIRECTORATE GENERAL CDC&EH

VBDC

ROLE : CENTRAL, PROVINCE & DISTRICT/MUNICPLTY ERA DECENTRALIZATION ROLE

FUNCTION •Policy & strategy formulated

Motor on Vector Control at national , CENTRAL international link and donor.

Motor on Vector PROVINCE ccontrol in province level

•Guidelines, standard, moduls •Sosialisation •National Campaign •Study operational &application •Asistance & Consult

•Develop & ajust guideline & modul at province level. •Evaluate •Sosialisation •Province campaign. •Asistance &Consult • Planning,, Coordination , Organize , Actuating, Monitoring & Evaluation

DISTRICT

Organize & implement on Vector control at District level

• Implementaion • Supervise, Monev at District level. • Develop infra structure

COOPERATION

- Networking natnl, intern’l functional - Working groups. -Networking regi’l / province - Work groups. -Cooperation. -Work groups.

N A T I O N A L

P R O V D I S T

MOH

Min Of Agricltr

Center for License & Invest

VBDC

Min Of Env

Min Of Agricltr

National pesticides Commission

NFDC

Governor Prov Agric Off

PHO

PFDC

Prov Env Off

Provincial Pesticide Monitoring Comm District Head

Distr Agric Off

DHO

Distr Env Office

District Pesticides Monitoring Comm

CHALLENGES • Decentralization impacts on procurement of  insecticides. • Massive used of pesticide in agriculture will  impact on vector resistance to public health. • Weak on vector resistance monitoring. • Weak of rule and regulation on standardization.

STRATEGIES 1. Capacity building, 2. Collaboration 3. Exchange information

CAPACITY BUILDING • • • • •

Assessment on Integrated Vector Management (IVM)  activities. Develop Minister of Health decree on Vector Control. Workshop and TOT on Guidelines Management Public  Health Pesticide. Standardization public health pesticide monitoring. Strengthen monitoring and evaluation on public health  pesticide use.

COLLABORATION INTRA HEALTH SECTOR COLLABORATION: • Integrate Vector control activities as a sub system of health.  • Harmonized resources used for integration. • Commitment needed for budget allocation to achieve the integrated  objectives. • Integrated program approach could be managing properly to  achieve mutual objectives. INTER‐SECTOR COLLABORATION • Establish the partnership and inter sector collaboration • Mutual objectives, strategy, monitoring and evaluation and  budgeting.  • Identify roles of each partner.  • Government policy on partnership and collaboration

EXCHANGE INFORMATION INTRA HEALTH SECTOR: • Used the network available within ministry of Health to  share information between Vector Borne Diseases Control,  Food and Drug Control, NIHRD, Environmental Health INTER SECTORS: • Used the existing network to share information between  Ministry of Health, Ministry of Agriculture, Ministry of  Environment, Universities, Pest Control association and  other network, WHO, Private sectors. OTHERS: • Establishing system on information exchange:  communication network, IEC and others.

ACTION PLAN • Training public health pesticide management  guidelines. • Standardization public health pesticide &  resistance monitoring. • Development other legal instruments for public  health pesticide managements.. • To establish public health pesticide & resistance  networking

To Establish Public Health Pesticide  & Resistance Networking

PROPOSE A NATIONAL CENTRALIZED  REPORTING SYSTEM FOR VECTOR CONTROL  PESTICIDES IN INDONESIA

WORK PLAN ELECTRONIC REPORTING SYSTEM  ACTIVITIES 1. REVIEW AND REVISE OF EXISTING REPORTING SYSTEM  TOOLS FOR MALARIA & DHF VECTOR CONTROL PESTICIDES 2. TO DEVELOP SOFTWARE AND HARDWARE OF DATA BASE  VECTOR CONTROL PESTICIDES USAGE  3. STRENGTHENING CAPABILITY OF MANPOWER FOR DATA  MANAGEMENT 4. WORKSHOP  SOSIALIZATION & TO DEVELOP AGGREEMENT  IN REPORTING SYSTEM PROGRAM 5. IMPLEMENTATION REPORTING SYSTEM BY ELECTRONIC 

TARGET ACTIVITIES • Target  Area : Start from National level consist  of  33  Provinces ; and extend to all District & Municipality  Level • Target Health Institution : Center Vector Control Data  Base, PHO, DHO, Port Health, BTKL • Target of Intersector Institution: Agricultural, Private  sector  • Scope of Information : Number & history  insectisides   usage, Resistance states, Coverage

RESISTANCE MANAGEMENT  • Insecticide usage in selected area priority (high  endemic, outbreak). • Monitoring and evaluation during application  (operational process, entomological impact,  epidemiological outcome) • Rotation insecticide use periodically. • Detection of resistance status of vectors was done  by WHO standard. • Monitoring resistance status of applied insecticides  was done in several locations.

Discriminating concentrations of Insecticides for adult mosquitoes (one hour  exposure‐WHO/CDS/CPC/MAL/98.12)

a.

Half an hour exposure

b.

Four hours exposure

c.

Two hour exposure for Anopheles sacharovi

d.

0.1% for anpheles sacharovi

e.

Two hour exposure

No

Place

Species tested

insecticide

Province/Distric/subdistric

mortality (no of test)

Year Control

MALARIA 1

Riau/Batam/Nongsa

An.sundaicus

Bendiocarb 0,1 %

100% (149)

2002

2

NTT/Kupang

An.subpictus

Permethrin 0,75%

100%(95)

0%

2003

An.subpictus

Lambda cyhalothrin 0,05%

100%(102)

0%

2003

An.subpictus

Bendiocarb 0,1%

100%(112)

0%

2003

DENGUE 1

Bengkulu

Ae.aegypti

Malathion 0,8%

68,59% (83 )

2

SouthSul/Makassar/kasi-kasi

Ae.aegypti

Malathion 0,8%

76,53%(115)

3

West kalimantan/Pontianak/ Ae.aegypti

Malathion 0,8%

Ae.aegypti

Mantri jeron 6 7

4.16%

2002

87%

4.76%

2002

Malathion 0,8%

79.41%

0%

2002

Ae.aegypti

Malathion 0,8%

76.59%

0%

2002

North Sulawesi/Manado

Ae.aegypti

Malathion 0,8%

82.50%

0%

2002

North Sulawesi/Manado

Ae.aegypti

Malathion 5 %

0%

2003

west Pontianak 4

South Sumatera/Palembang/ sekip

5

2002

Yogyakarta/Yogya city/

100% (104)

(Malaria, 2004)

(Malaria, 2005) No

Province .

Species tested

mortality

status

year

96,1%

tolerant

2005

Lambda cyhalothrine 0,05% An.subpictus

100%

susceptible

2005

An.subpictus Bendiocarb 0,1%

100%

susceptible

2005

An.nigerimus Etofenprox 0,5%

100%

susceptible

2005

Deltamethrine An.nigerimus 0,05%

100%

susceptible

2005

1 West Java An.aconitus 2

West Nusa Tenggara

3 West Kalimantan

insecticide

Lambda cyhalothrin 0,05%

No

Province .

1

North Sulawesi

Species tested

Ae.aegypti

insecticide

mortality

status

year

Malathion 0,8%

27%

resistant

2005

Malathion 5%

100%

susceptible

2005

2

DI Yogyakarta

Ae.aegypti

Malathion 0,8%

100%

susceptible

2005

3

West Kalimantan

Ae.aegypti

Malathion 0,8%

68,67%

tolerant

2005

4

East Java

Ae.aegypti

Malathion 5%

68%

tolerant

2005

Malathion 0,8%

100%

susceptible

2005

Malathion 0,8%

71,92%

tolerant

2005

Malathion 5%

100%

susceptible

2005

Malathion 0,8%

28%

resistant

2005

5

6

Bali

South Sumatera

Ae.aegypti

Ae.aegypti

REQUESTS THE VBDC OF INDONESIA AS STRATEGIC POLICY DISCUSSION RELATED WITH VECTOR CONTROL PESTICIDES AND CLIMATE CHANGE No

Contents

Yes

No

Comments

(1)

Provide technical support

Yes

WHO Technical Assistant to setting data information system; operational study.

(2)

Mobilizing financial resources

Yes

Advocacy and Socialization to all stakeholders; Identification potential partners.

(3)

Work w/ other organizations

Yes

Broadening Involvement of all potential partners and community.

(4)

Potential standing recommendation

Yes

Mapping of Vector Borne Disases related with climate change. Improvement of community awarrenness to anticipate VBD outbreak related with climate change

(5)

Submit proposals

Yes

WHO technical assistant to develop proposals; Involve of all related sector and program