The Jakarta Post
Malaria case numbers across the nation have been declining annually with the government’s scaled-up prevention efforts against the transmission of vector-borne diseases. Yet, the Health Ministry recently reported that the 2014-2018 decline in malaria cases has stagnated, indicating that the national malaria program has bottomed out in terms of both reducing cases and eliminating malaria in the most challenging regions and conditions.
Although the report cites a significant overall decline in malaria cases, infection rates have increased in Indonesia’s easternmost provinces of Papua and West Papua. Papua has recorded an annual increase in its contribution to the nation’s incidence rate of malaria, with Papua accounting for 79 percent of all malaria cases in 2018.
Indonesia recorded 222,085 malaria cases last year, with Papua reporting the largest number of infections with 176,070 cases. East Nusa Tenggara (NTT) ranked second with 18,386 cases, followed by West Papua with 7,957 cases. Worse, Papua recorded the highest number of malaria infections in pregnant women in 2018 with 1,769 cases.
This report has shown us for the umpteenth time the devastating health challenges faced in Papua and West Papua, which also have Indonesia’s lowest human development index at respectively 60.06 and 63.74. Why do people in our easternmost regions keep bearing the brunt of the nation’s health inequalities?
Recent tensions in Papua have amplified the alarm at the highest level, with President Joko “Jokowi” Widodo reiterating the government’s commitment to continued infrastructure and human resource development in Papua. The Aug. 16 incident of racial abuse against Papuan students in Surabaya, East Java, that triggered protests and riots shows how chronic development gaps can be ignited at the drop of a hat. The protests, some of which turned violent, highlight the need for change in the government’s approach to improving public health and welfare in Papua and West Papua.
The reported annual decline in malaria cases is a relief, particularly in regencies and cities with high malaria endemicity — an annual parasite incidence (API) of more than five confirmed cases per 1,000 people. But all regencies and cities in Papua still record APIs of above 50 and 100 cases per 1,000 people. An API of above 50 cases per 1,000 people has been recorded in the two regencies of Nduga and the Yapen Islands as well as Jayapura city. Meanwhile, the five regencies of Boven Digoel, Jayapura, Kerom, Mimika and Sarmi have an API of above 100 per 1,000 people, which emphasizes the need for a more aggressive campaign against the disease.
Some low endemicity regencies have not signaled a trend toward malaria elimination in the last six years, amid challenging conditions, such as vast mining sites, large-scale plantations, wide forested areas and the high mobility of local populations.
“Support from cross-sector stakeholders is essential to ensure that the malaria program can reach communities under these special conditions and eliminate malaria transmissions there,” Anung Sugihantono, the Health Ministry’s disease control and prevention director general, said in an interview in Jakarta on Aug. 5.
With the World Health Organization setting a 2030 malaria elimination target, of particular concern should be the implementation of malaria intervention programs in all areas.
Given the archipelagic geography, Anung said the government had taken an “island-based approach”, through which malaria elimination strategies would be based on the level of endemicity in a particular region and be applied in stages from the regency/city administrative levels to the provincial and then to the regional and national levels.
The government expects that the WHO can declare Java and Bali malaria-free by 2023, followed by Sumatra, Sulawesi and West Nusa Tenggara in 2025, Kalimantan and North Maluku in 2027, Maluku and NTT in 2028, and Papua and West Papua in 2029. Finally, it expects Indonesia to gain WHO certification for malaria elimination by 2030.
Indonesia’s partnership with bordering countries like Papua New Guinea (PNG) and Timor Leste will hopefully boost the country’s efforts to tackle malaria in border areas.
A recent increase in malarial infections in PNG has threatened to undermine its success in reducing malaria cases and deaths. Cross-border collaboration will be critical with PNG’s resurgence of malaria, according to Asia Pacific Leaders Malaria Alliance CEO Benjamin Rolfe. “You can’t eliminate malaria if your neighbors are not eliminating it, and if your neighbors want to eliminate malaria, you have to make sure that you’re not exchanging infected mosquitoes across the border,” Rolfe told The Jakarta Post.
With its numerous islands and many people moving among them, Rolfe said, Indonesia should prioritize close coordination and cooperation across areas and with neighboring countries in its malaria prevention program.
Indonesia surely has the capacity to battle malaria and achieve WHO malaria elimination status by 2030. Funding for the malaria program comes from the state budget as well as foreign grants from organizations such as the Global Fund, the WHO and the United Nations Children Fund, UNICEF.
Given Indonesia’s highly diverse environment, it’s time for the country to focus on collaboration and cooperation across regions in its fight against malaria.
The problem is how to ensure that local authorities are empowered enough to make their own decisions and implement targeted intervention methods, such as insecticide-treated bed nets, indoor residual spray for vector control, and rapid testing, diagnosis and treatment for populations at most risk. This issue requires an urgent response.