Malaria control is one of the longest running health programmes at the Indonesian Ministry of Health (MoH). However, despite many achievements in malaria eradication, Indonesia is still one of nine malaria-endemic countries in the South-East Asia region, and accounts for 21% of the regions reported cases and 16% of malaria deaths.
The malaria programmes in Indonesia have gone through several iterations over the years. The formal efforts to eradicate malaria in Indonesia began through the introduction of the Malaria Eradication Command (KOPEM). Launched on 12 November 1959 – a date that is now celebrated annually as National Health Day – even this first programme was based on WHO recommendations. Since then, the Malaria Eradication Command evolved into the Malaria Control Program, then the Roll Back Malaria Program, and now to the current Malaria Elimination Program.
In the early days, the main malaria intervention was larvae source management (LSM) and the preferred method for identifying malaria patients was through mass blood survey (MBS). The primary geographic focus during this period was limited to Java Island.
During the eradication and control phase between 1947 and 1968, the Government of Indonesia, with support from WHO and other partners, routinely conducted indoor residual spraying using dichlorodiphenyltrichloroethane (DDT), MBS and LSM throughout Java Island, and in the provinces of Bali and Lampung. Based on research conducted in Indonesia on DDT concerns and chloroquine resistance, the practice of indoor residual spraying with DDT was stopped in 1968. In 2004, malaria treatment protocol transitioned to Artemisinin Combined Therapy (ACT).
Caption: An entomologist participates in a training at BBPPVRP Salatiga on monitoring insecticide resistance through support from WHO. Credit: WHO/Herdiana/2019
Today, the malaria programme is incorporated into the health system, and is no longer viewed as a stand-alone programme. Thus, almost all interventions can be integrated with other health programmes, such as screening pregnant women and providing them with malaria prevention strategies during their first antenatal care visits. Current main interventions include long lasting insecticide-treated nets (LLINs), laboratory diagnosis using microscope/rapid diagnostic test (RDT), ACT-based treatment, community-based case management, and vector control.
More than 27 million LLINs have been distributed since 2004, as part of a massive campaign to reduce malaria within high and moderate endemic areas such as some parts of Sumatera, Kalimantan, and Sulawesi Islands.
Further WHO technical and financial support towards Indonesia’s malaria agenda over the years has helped generate evidences, strengthen malaria case management, increase quality assurance of diagnosis, surveillance and information systems, as well as formulate national strategic plans and policies. WHO has supported Indonesia to adapt and adopt WHO global norms and standards based upon local situations, and build the skills and capacity of national and local level workforce. Indonesia’s strategy on sub-national elimination from district to province and regional islands has been acknowledged by the WHO Global Malaria Programme and incorporated into the WHO framework for malaria elimination guideline.
Caption: Long lasting insecticide-treated nets (LLINs) hang over the bed to protect against mosquito bites, in turn preventing malaria transmission from mosquito to human. Credit: WHO/Herdiana/2019
The detailed history of malaria programme evolution in Indonesia has shown particularly positive progress in the last ten years. Recently, WHO estimated the number of people with malaria infections decreased from 1.7 million in 2008 to 1 million in 2018. This decline also corresponds to a shrinkage of areas with malaria transmission: today over 55% of districts in Indonesia are free from local transmission with 75% of the Indonesian population living in these areas. According to the National Malaria Program Report 2018, 91% of malaria cases in the country are reported from only three provinces: Papua, West Papua and East Nusa Tenggara.
Since November 2018, WHO has been providing technical assistance to nine districts in four provinces of Java Island that have persistent local transmission of malaria. Support is provided to review preparedness and achievements towards indicators of certification of malaria elimination, facilitate the adaptation of a reliable workplan to achieve elimination in the next one to three years, strengthen programme management and the information system, and advocate for local commitment and resource mobilization. As a result of this support, two districts in West Java Province have succeeded in the certification assessment of malaria elimination by the MoH, and one district (Purworejo) in Central Java Province has reported no indigenous cases since January 2019. Upon request by the MoH, WHO support will expand to all provinces in Java - Bali Region, and 26 districts in Sumatera, Kalimantan, and Sulawesi that have experienced malaria elimination stagnation over the past five years.
However, the positive progress achieved to-date across country is now seemingly threatened by the mounting consequences of the unfolding COVID-19 pandemic. From January to March 2020, a total of 266 956 suspected cases of malaria were tested by microscopy/RDT, resulting in the detection of a total 23 632 positive cases. Compared with the same period last year, where 677 536 suspected cases were tested and 64 753 positive cases were confirmed, these numbers appear incredibly low.
Almost all malaria activities planned in Indonesia for 2020 have been postponed due to the COVID-19 pandemic. Activities such as active case finding through outreach approaches or house-to-house visits by community health workers, distribution of LLINs, training, case and foci investigation, and migration surveillance are all crucial to effectively detect, treat, and reduce malaria cases.
Throughout the pandemic, WHO remains committed to continue supporting the MoH response to COVID-19 while also advocating to maintain essential health services, including malaria programmes. In recognition of the potential impact COVID-19 may have on existing health programmes such as malaria, the MoH has released a new protocol of continuing malaria services and have modified the malaria treatment protocol for cases where there may be co-infection with COVID-19.
This World Malaria Day, Indonesia is highlighting the theme “Zero malaria starts with me: Malaria-free, a national achievement” with the history of malaria elimination and the current situation in mind. The development of the 2020-2024 Malaria National Strategic Plan, the 2030 Roadmap for Malaria Elimination, and the Prevention of Re-Introduction Plan are all underway as Indonesia continues to move towards becoming a malaria-free country, and despite present challenges, the Moh and WHO are continuing to work towards the accomplishment of total malaria elimination by 2030.
- Indonesia Malaria profile
- World malaria report 2019
- All materials associated with the “Zero malaria starts with me” campaign can be found on the 2020 World Malaria Day campaign website
- For more detailed information about WHO’s work in support of malaria control and elimination around the world, please refer to the Global Malaria Programme’s website