Like most developing countries, Indonesia is experiencing an epidemiological transition in which the burden of non-communicable diseases (NCDs) is rapidly increasing. A diabetes prevalence of 4.6% (believed to be an underestimate) is taking its toll on the country in terms of economic costs, health and human suffering. The most important, modifiable risk factors for diabetes and other NCDs are widespread in some areas of Indonesia, and the NCD-prevalence is expected to increase dramatically within the next two decades. Action is needed to raise awareness about prevention and control of risk factors as well as disease monitoring and management. In line with the government policy on decentralisation and district autonomy, the MoH has established a decentralised health care system. The main goal of the decentralised system is to accommodate community aspiration and initiative. To bring attention to NCDs, advocacy networks need to be strengthened, and local government bodies provided guidance and support to develop need based, locally tailored health policies and strategies. The aim of this project is to reduce the prevalence of diabetes and other NCDs as well as associated risk factors through an integrated community-based approach in the provinces of West Sumatra, Bengkulu and Banten.
The project builds on experiences with a community-based intervention approach (CBI) from a pilot project conducted in 2001 in the municipality of Depok. The 2001 project managed to improve the NCD risk factor profile of the population considerably. The prevalence of obesity, hypertension etc. was significantly lowered and more local financial resources were allocated to the area of NCDs. This current project is designed as a pilot project to be implemented in the provinces of West Sumatra, Bengkulu and Banten. It seeks to prevent the major NCDs by geographically expanding the integrated CBI programme adopted in 2001. If the project is successful it will be incorporated into the national programme of the MoH and thus expanded to the remaining 30 provinces of Indonesia. The main goal of the CBI approach is to empower the community and to utilise resources at local level. The activities are not limited to clinical care and cut across different sectors, populations etc. This consideration of general conditions, local tradition and resources in the community will among other things ensure ownership and sustainability. The project is intended to provide information on "best practice" in terms of raising awareness and involving communities actively in prevention and control of diabetes and other NCDs. The approach will be comprehensive and integrated across common risk factors and diseases as well as across services and disciplines. The project consists of four main components: 1. The first component involves a needs assessment in different local communities at an early stage of the project. This will determine the magnitude of the problem of diabetes and the prevalence of NCD risk factors. Furthermore, people's needs, preferences and potential barriers in attending health promotion activities will be identified. The needs assessment will consist of anthropometric and biological measures, individual and focus group interviews and questionnaires. 20 health workers in each province will be trained for this activity, and at least 1,500 subjects will be included. 2. The second component involves development of local policies on the prevention and control of diabetes. This includes, among other things, a policy on essential medicines to deal with the problem as well as providing information on NCDs risks and prevention in the school curriculum. 3. The third component focuses on capacity building by skills enhancement of health care workers, through training in integrated NCD prevention and management. Furthermore, volunteer community members will receive training in early detection and health promotion and dietary educators / counsellors will be selected from amongst the community members. The training component will be carried out by the Indonesian Society of Endocrinology (PERKINI), and the Indonesian Diabetic Association (PERSADIA). 4. The final component involves the development of so-called integrated health posts and groups for NCD risk factor prevention and control - Posbindu PTM. PTM stands for Penyakit Tidak Menular, which means NCD. These Posbindus are for people living with or at risk of NCDs, and the main focus is on providing early detection, counselling and education. The Posbindus will be facilitated and supported by public health centres in each district. Activities will be carried out by trained cadres at different community settings such as workplaces and household settings. Based on evidence from the pilot project in 2001 each Posbindu is expected to serve 100-200 people. Meetings will be held every month and monitoring and screening tests as well as counselling and education will be offered. The purpose is for everybody, regardless of disease status, to learn about risk factor prevention, the importance of regular medical checkups and for people to exchange experiences.
• Local policy on prevention and control of diabetes and related NCDs developed • 1,500 people participated in community needs assessment • 30 public health nurses/midwives trained in integrated prevention and control of NCDs • 60 health workers trained in integrated prevention and control of NCDs • 30 teams of medical professionals trained in clinical NCD control • 54 cadres of health workers trained in risk factors • 54 counsellors selected and trained as dietary educators • 18 integrated community health posts and groups for people living with or at risk of NCDs established • More than 2,500 people screened, monitored and counselled on risk factors at the community health posts