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The undiagnosed majority: A call to action for Indonesia’s health system

Formal reporting that includes explicit figures for both diagnosed and undiagnosed prevalence is essential for not only implementing national health screening initiatives, but also to assess, improve and innovate such programs to ensure their effectiveness.

Dian Kusuma (The Jakarta Post)
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Sat, December 21, 2024

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The undiagnosed majority: A call to action for Indonesia’s health system A health worker takes the blood pressure of a pregnant woman on June 4, 2024, at a Posyandu (integrated health services post) in Gondoharum village, Kudus, Central Java. (Antara/Yusuf Nugroho)

A

flagship policy introduced by the administration of President Prabowo Subianto is offering free hypertension and diabetes screenings for individuals aged 50 and above. This initiative seeks to address a critical gap in Indonesia’s healthcare system, as these conditions rank among the leading causes of death, both globally and nationally.

The burden on the health system is immense: In 2023 alone, the Healthcare and Social Security Agency (BPJS Kesehatan) recorded 20 million claims for heart disease amounting to Rp 17.6 trillion (US$1.07 billion) and 3.46 million claims for stroke, costing Rp 5.2 trillion.

This policy is a crucial step toward mitigating these life-threatening conditions and their economic impact.

The Basic Health Research (Riskesdas) 2018 and the Indonesia Health Survey (SKI) 2023 both report diagnosed prevalence based on interviews and total prevalence based on measurements, but do not provide explicit figures for undiagnosed prevalence. Instead, the difference between total prevalence and diagnosed prevalence is taken as the figure for undiagnosed prevalence.

According to these reports, the prevalence of diagnosed hypertension was 8.36 percent (25 percent of total prevalence) in 2018, and increased slightly to 8.6 percent (28 percent of total prevalence) in 2023. This indicates that 75 percent of hypertension cases in 2018 and 72 percent in 2023 were undiagnosed. However, these estimates may not account for individuals with controlled blood pressure previously diagnosed with hypertension, potentially affecting the total prevalence figures.

Formal reporting, including diagnosed and undiagnosed prevalence data in national surveys, policy briefs and fact sheets, is essential for assessing the effectiveness of health screening initiatives, particularly in developing countries like Indonesia. Health systems in such settings often prioritize maternal and child health or infectious diseases, inadvertently sidelining noncommunicable diseases (NCDs).

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For instance, Malaysia provides an excellent example through its National Health and Morbidity Survey (NHMS), which reports both the diagnosed and undiagnosed prevalence of conditions like hypertension, offering a complete picture of total hypertension prevalence. Undiagnosed hypertension is defined as individuals who had not been previously diagnosed but recorded an average systolic blood pressure of ≥140 mmHg and/or a diastolic reading of ≥90 mmHg during the survey.

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