REVIEW OF
NATIONAL VECTOR CONTROL POLICY IN INDONESIA
WI NARNO & BANGKI T HUTAJULU
• 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
PROFILE OF INDONESIA
Top Ten Health Problem Priority:
1. Malaria
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
Low Moderate
Free 1 dot = 50 Kasus 1 dot = 250 kasus High
0 0‐1 1‐5 5‐49 50‐100 > 100
API o/oo
Malaria Klinis, SD Diperiksa, Malaria Positif Tn 2000 – 2008 (Jan‐Mei)
0 500,000 1,000,000 1,500,000 2,000,000 2,500,000 3,000,000 3,500,000
Keterangan :
1. An.aconitus 6. An.barbumbrosus 11. An. kochi 16. An. Maculatus 21. An. subpictus 2. An.annularis 7. An. flavirostris 12. An.punctulatus 17. An.minimus 22. An. sinensis 3. An.balabacensis 8. An.farauti 13. An.ludlowi 18 An.nigerimus 23. An. umbrosus
4. An.barbirostris 9. An.karwari 14.An.letifer 19. An. parangensis 24. An. vagus 5. An.bancrofti 10. An.koliensis 15. An.leucosphyrus 20. An. Sundaicus 25. An. tessellatus
1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 14 15 15 16 16 16 17 17 18 19 20 20 20 20 21 21 21 21 22 22 23 24 24 25 25
PENYEBARAN VEKTOR MALARIA DI INDONESIA 2008
SUMBER
DAYA
PENDUKUNG
GF R1 in Tsunami Relief Program for MCP In Aceh and North Sumatera :
GF R1 (5 Provinces), For MCP in Eastern Indonesia = $ 23 JUTA ( termasuk NAD &
Nias)
Incidence Rate (IR) dan Case Fatality Rate (CFR) DHF Menurut Tahun di Indonesia,1968-2008 (30 Juni)
0 20 40 60 80 19 68 19 70 19 72 19 74 19 76 19 78 19 80 19 82 19 84 19 86 19 88 19 90 19 92 19 94 19 96 19 98 20 00 20 02 20 04 20 06 20 08 Tahun IR dan C F R
IR (per 100.000 pddk) CFR(%)
1.01
0.76
71.18
Peta Insidensi DBD Menurut Provinsi
in Indonesia, 2007
<5 5-19 20-50 >50
NAD SumutSumbar Riau Kepri Jambi Sumsel Babel Bengkulu Lampung Banten
DKI Jakarta Jabar
Jateng DIY Jatim Kalbar Kalteng Kalsel Kaltim Sulut Gorontalo Sulteng Sulbar Sulsel Sultra BaliNTB NTT Maluku Malut
Papua Barat Papua
0 0,5 1 1,5 2 2,5 3 3,5 4 4,5
Case Fatality Rate (CFR) DBD Menurut Provinsi di Indonesia, 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 2.Cx.gelidus 3.Cx.vishnui 4.Cx.annulus 5.Cx.fuscocephalus 6.Cx.bitaeniorhynchus 7.Cx.quinquifasciatus 8.An.annularis 9.An.vagus 10.An.kochi 11.Armigeres subalbatus Kapuk,Bogor,Lombok,Semarang Bogor,Kapuk,Lombok Kapuk, Pontianak Pontianak Kapuk, Semarang Semarang Semarang Lombok Lombok, Semarang Semarang Semarang ’72-74,85;75;85;93
’75; 85; 85
’85 ; 85
STRATEGIC
ISSUE
ON
VECTOR
BORNE
DISEASES:
1) OUTBREAK (RE/NEW EMERGING DISEASES) : SEASION, POPULATION MOVEMENT, PHISICAL ENVIRONMENT CHANGE
2) ENTRANCE OF NEW EMERGING DISEASES/VECTOR BORNE DISEASE (BY INTER‐NATIONAL TRAFFIC)
3) ROLE OF SECTORAL & COMMUNITY SUPPORT NOT YET OPTIMUM
4) DESENTRALIZATION Æ LACK OF PROFESSIONAL STAFF & OTHER RESOURCES
5) EPIDEMIOLOGICAL MAPPING (ASPECT OF CASES, VECTOR)
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)
Pesticides used in Public Health
susceptibility status of target organisms
safety to humans
impact on the environment
WHO recommendations
application equipment
method of application
cost
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)
Bacillus thuringiensis H- 14 1200 I TU/ ltr S Methopren I GR 1.8 % G 72 mg/ m2 Pyriproxifen 0.5 G 2 g/ m2
Permethrin 10% EC
Space Spraying
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)
Temephos 1 % G 10 gr/ 100 ltr Metoprene 1.3 % G 72 mg/ m2 Piriproksifen 0.5 G 2 gr/ 200 ltr
Larvicides
Abate 1%
sand granules
ADULTICIDE
0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 0 200000 400000 600000 800000 1000000 1200000 1400000 1600000
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
1994/ 1995 1995/ 1996 1996/ 1997 1997/ 1998 1998/ 1999 1999/ 2000 2000/ 2001 2001/ 2002
Number of house sprayed vs Malaria incidence
INSECTICIDE USED (IRS) FOR MALARIA 2004-2006
INSECTICIDE USED (SPRAYING) FOR DENGUE/DHF 2005-2006 Lambda cyhalotrine, alpha cypermetrine
etofenprox
carbamat
pyretroid
PartnerÎ Support each others
Central Province District/
Municipality
ORGANIZATION
PROVINCE
DISTRICTS
CENTRAL
CDC DIVISION
VBDC SECTION / UNIT
CDC DIVISION
VBDC SECTION MOH
ROLE FUN CTI ON COOPERATI ON
CEN TRAL
PROV I N CE
D I STRI CT
Motor on Vector Control at national , international link and donor.
•Policy & strategy formulated
•Guidelines, standard, moduls
•Sosialisation
•National Campaign
•Study operational &application
•Asistance & Consult
- Networking natnl, intern’l functional
- Working groups.
Motor on Vector ccontrol in province level
Organize &
implement on Vector control at District level
-Networking regi’l /
province
- Work groups.
•Planning,, Coordination , Organize ,
Actuating, Monitoring & Evaluation
• Implementaion
•Supervise, Monev at District level.
•Develop infra structure
-Cooperation.
-Work groups.
ROLE : CENTRAL, PROVINCE & DISTRICT/MUNICPLTY
ERA DECENTRALIZATION
•Develop & ajust guideline & modul at province level.
•Evaluate
•Sosialisation
•Province campaign.
MOH Min Of Env Min Of Agricltr
NFDC
VBDC
Center for
License & I nvest
PHO PFDC
Prov Agric Off Prov Env Off
Distr Agric Off DHO Distr Env Office
National pesticides Commission Provincial Pesticide Monitoring Comm District Pesticides Monitoring Comm N A T I O N A L P R O V D I S T
Min Of Agricltr
Governor
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.
STRATEGIES
1. Capacity
building,
2. Collaboration
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.
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.
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:
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
To
Establish
Public
Health
Pesticide
&
Resistance
Networking
PROPOSE
A
NATIONAL
CENTRALIZED
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
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
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.
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
No Place Species tested insecticide mortality Year Province/Distric/subdistric (no of test) 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 ) 2002 2 SouthSul/Makassar/kasi-kasi Ae.aegypti Malathion 0,8% 76,53%(115) 4.16% 2002 3 West kalimantan/Pontianak/
west Pontianak Ae.aegypti Malathion 0,8% 87% 4.76% 2002 4 South Sumatera/Palembang/
sekip Ae.aegypti Malathion 0,8% 79.41% 0% 2002 5 Yogyakarta/Yogya city/
No .
Province Species tested
insecticide mortality status year
1 West Java
An.aconitus
Lambda
cyhalothrin
0,05% 96,1% tolerant 2005 2 West Nusa
Tenggara
An.subpictus
Lambda
cyhalothrine
0,05% 100% susceptible 2005
An.subpictus Bendiocarb 0,1% 100% susceptible 2005 3 West
Kalimantan An.nigerimus Etofenprox 0,5% 100% susceptible 2005
An.nigerimus
Deltamethrine
0,05% 100% susceptible 2005
No .
Province Species tested
insecticide mortality status year
1 North Sulawesi Ae.aegypti 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
5 Bali Ae.aegypti Malathion 0,8% 71,92% tolerant 2005
Malathion 5% 100% susceptible 2005
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
REQUESTS THE VBDC OF INDONESIA AS
STRATEGIC POLICY DISCUSSION RELATED
