The spread of diphtheria in a number of regions shows that there is a big problem in public health service.
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Kompas/Heru Sri Kumoro
Diphtheria vaccinations are administered at Syarif Hidayatullah Hospital in South Tangerang on Wednesday. The vaccinations, for children aged 1 to 19, are being given for free until Dec. 29.
JAKARTA, KOMPAS – The spread of diphtheria in a number of regions shows that there is a big problem in public health service. The fact that a health information system has not been built in Indonesia makes the government’s response in handling the extraordinary occurrence seem reactionary and slow.
“The government has not invested enough in building a public health system and maintaining the quality of health of the children of Indonesia,” said Ede Surya Darmawan, chairman-elect of the Indonesian Public Health Experts Association, in Jakarta, on Friday.
The lack of investment has resulted in the government\'s unawareness of the rise in the number of diphtheria cases in a number of regions. The government only began to react once there was a surge in cases and after the disease started to cause deaths.
The Health Ministry said from January to November, 593 patients had been treated and 32 people had died as a result of diphtheria, which has spread to 19 provinces. However, at of the end of December, or a month later, the total number of diphtheria cases has reached 903 and has spread to 28 provinces. This leaves only six provinces that have yet to report cases of diphtheria.
The surge of diphtheria cases should have been a concern of the government from the early stages. Various data published by the government, such as the Indonesia Health Profile and the National Social Economic Survey, show a decline in immunization coverage.
An increase in the number of children with incomplete vaccinations is found particularly in the poor areas of cities.
Health Ministry data shows that from 2011 to 2016, immunization coverage continued to decline and has not been able to match the highest immunization coverage in the last nine years, which was 93.6 percent in 2010.
In fact, the 2015 Indonesian Annual Report from Unicef has reminded us that Indonesia is the country with the fourth-highest rate of unvaccinated children or those with incomplete vaccinations. An increase in the number of children with incomplete vaccinations is found particularly in the poor areas of cities.
The importance of high immunization coverage in order to prevent the spread of infectious diseases can be seen from the diphtheria cases that have emerged in Jakarta.
Nina Dwi Putri, a pediatrician from the Infection and Tropical Pediatrics Division of the University of Indonesia Medical School – Cipto Mangunkusumo Hospital (FKUI-RSCM), said most of the children infected with diphtheria in Jakarta are those aged 1 to 19 years old. As many as 43 percent of cases happen to those whose basic immunization is incomplete, 7 percent to those that have never received immunization and 44 percent to those whose immunization record is unclear.
“The facts show that the low immunization coverage can [contribute to] the spread of diseases,” she said.
Apart from being responsible for providing promotion service and disease prevention, Puskesmas must also provide therapy.
Reactionary
Diphtheria is only one of the infectious diseases that needs swift response from the government. The response by the government to various extraordinary occurrences of infectious diseases in the past also seems to have been reactionary and lacked anticipation.
To prevent the spread of diseases, improved public health efforts (UKM) in community health centers (Puskesmas) must be the main foundation. However, since the start of National Health Insurance in 2014, Puskesmas also became the frontline provider of individual health efforts (UKP).
This meant a heavier burden for Puskesmas. Apart from being responsible for providing promotion service and disease prevention, Puskesmas must also provide therapy. Because curative aspects come with a clear budget, many Puskesmas are now focused more on curative efforts and less on its promotion and preventive functions.
“If Puskesmas still want to be used as the frontline protectors of public health, Puskesmas need to be improved,” Ede said. Other than increasing their budget and improving their human resources, Puskesmas also need to improve its image and dignity.
The health information system of puskemas also needs to be improved. That way, when there is a surge in a disease, the puskesmas data can immediately be used as a basis for policy-making by the local administration and even the government.
Kompas/Heru Sri Kumoro
Diphtheria vaccinations are administered at Syarif Hidayatullah Hospital in South Tangerang on Wednesday. The vaccinations, for children aged 1 to 19, are being given for free until Dec. 29.
Adult vaccination
Meanwhile, the facts show that diphtheria does not only attack children. As many as 18 percent of diphtheria patients in 2017 were adults aged between 19 and 40. “So, the diphtheria vaccine for adults is important to prevent the spread of the disease,” said FKUI-RSCM Jakarta Allergy Immunology consultant Iris Rengganis.
The diphtheria vaccine for adults is even more important for those who have not received immunization or did not receive complete immunization. It is also important to be given to adults that are in or traveling to diphtheria-endemic regions and live in areas that are densely populated and unhealthy.
As opposed to the diphtheria vaccine for children in the outbreak response immunization (ORI) program, which is covered by the government, the diphtheria vaccine for adults must be paid for privately by each individual.
For adults, the diphtheria vaccine used is the tetanus-diphtheria (Td) vaccine. Those that have received complete diphtheria immunization only need to get a Td vaccination once every 10 years.
If the immunization record is not complete, it is better to receive vaccination in accordance to the government’s ORI schedule.
