Indonesia has achieved a remarkable increase in drug-susceptible tuberculosis (DS-TB) notification in 2022 and 2023 after a significant drop in 2020-/2021 due to COVID. In 2023, the country has notified the highest ever number of patients with DSTB - 821,200 persons (77% of incidents) 1077% increase compared to pre-COVID notifications (tbdiah.org). However, during the same year, almost 100,000 notified patients didn't initiate treatment, or their treatment status is not known due to different reasons.
The DS-TB treatment gap is not a new phenomenon. The magnitude however is evolving, e.g., the gap was 8% in 2021 but became 12% in 2023. Only 79% of patients from private physicians, 82% from private clinics, 89% in government clinics, 87% in private hospitals, 86% in public hospitals, and 92% patients in Puskesmas were enrolled in DS-TB treatment in 2023. People diagnosed with TB who are not treated may develop worsen conditions and continue transmission to their household and close contacts.
Indonesia has strengthened public-private mix strategy in TB program implementation, which enabled referrals between healthcare facilities particularly for those with limited diagnostic tools availability and capacity to provide treatment to nearest DOTS facilities that provide quality and standardized care. Unfortunately, even with successful referral for accurate diagnosis, not all people with TB initiated treatment. The main objectives is are to find out what are the causes for the gaps; why, where and when they are happening.
While improving TB screening, diagnosis and notification are critical steps, ensuring everyone diagnosed receives appropriate and timely treatment is very important. The gap between notification and treatment could arise due to different reasons in service delivery, access and barriers to care, and issues in the health systems including sources, quality and completeness of data. An assessment to better understand the root causes and mitigating them would be urgently needed. Therefore, this assessment aims to examine the process, barriers, and good practices in treatment initiation including the vertical and horizontal referrals between healthcare facilities.
The assessment approach could be streamlined balancing scientific rigor and pragmatic and time needed.
The assessment would use both qualitative and quantitative approaches. These include desk reviews at the beginning of the assessment, development of a data collection tool/questionnaires, plan for data collection including site visits and data analysis.
Description of works and responsibilities of the consultant:
- Work in close collaboration with Public Health Expert to ensure all the tasks for DS-TB enrolment gap assessment are done on time
- Collect, process, and analyze TB data related to DS-TB enrolment gap assessment
- Provide TB data analysis result regarding Desk Review Report
- Provide preliminary and final report on data analysis results (inc. present the result with graph and analytical interpretation, detailed analysis also provided in report)
- Participate in meetings and regular communication with NTP and USAID-BEBAS TB
Qualifications
Required Education:
Bachelor's or master's degree in public health (epidemiology and biostatistics preferred)
Experience:
Relevant experience (at least 3-5 years) in TB control programs, or public health research. Proficiency in data analysis software (e.g., SPSS) and qualitative analysis tools (e.g., NVivo).
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