written by Dr Herdiana H. Basri, M.Kes, M.Epi - National Professional Officer (Malaria)
In September 2021, the Ministries of Health (MOH) of Indonesia and Timor Leste agreed to continue several joint health programmes, including malaria. Following the agreement, an assessment of the malaria situation was conducted in all municipalities and districts of Timor Island. The assessment results will be used as a baseline to develop a joint strategy and roadmap for eliminating malaria on Timor Island.
On the Indonesian side of Timor Island, a team visited all six municipalities and districts from 23 November to 2 December 2021: Kupang municipality, North Central Timor (Timor Tengah Utara/TTU), South Central Timor (Timor Tengah Selatan/TTS), Belu, Malaka, and Kupang districts. The team consisted of officials of the National Malaria Control Programme (NMCP), Provincial Health Office (PHO), East Nusa Tenggara (NTT) government, and WHO.
.jpg?sfvrsn=7f4235e_4)
Fig. 1. Assessment team visiting a patient’s house at North Central Timor district, Indonesia. ©WHO, 2021
The Minister of Health had already certified Kupang municipality as malaria-free in early 2021. Meanwhile, the five districts are categorised as low malaria-endemic districts or having annual parasite incidence (AP) less than 1 per 1,000 population at risk. WHO guidelines require no indigenous malaria cases in three consecutive years before districts can be verified for malaria elimination. Based on this benchmark, two additional districts are currently being verified – Belu and North Central Timor districts. The remaining three districts will be verified in 2024.
.jpg?sfvrsn=462ed6f8_4)
Fig. 2. A laboratory technician is preparing a Giemsa solution for staining blood smear from a suspected malaria case at PHC Wedomu, Belu district, Indonesia. ©WHO, 2021
In addition to the endemicity status of the six districts, the team assessed nine domains at the national and district levels. The nine domains in the malaria elimination audit tool (MEAT) are the national strategy, coordination, policies, and advocacy; stratification; diagnosis; case management; surveillance; focus investigations, microplans and epidemic response; vector control and entomological surveillance; and prevention of re-establishment. One domain, accelerating strategies, is not applicable for Indonesia since no policy is applied under this domain, such as mass drug administration for P. falciparum. The team concluded that the six Indonesian districts of Timor Island should improve their case finding, case investigation, cross notification of malaria cases, and vector surveillance.
NMCP and consultants discussed the assessment result in mid-December 2021 and disseminated the result to multisectoral stakeholders in March 2022. This data, combined with Timor Leste’s assessment data, will be used by both countries to develop a joint strategy and roadmap for eliminating malaria throughout Timor Island.
***