REVIEW  OF NATIONAL  VECTOR CONTROL  POLICY IN INDONESIA

WINARNO & BANGKIT HUTAJULU

DIRECTORATE OF VBDC DG DC & EH, MOH INDONESIA

• No. of Islands : 17.000• Population : 227, 3 million• Area : 1.100 x 1500 miles sqr• No. of Province : 33• No of District : 430• Life Expectancy : 67 year

PROFILE OF INDONESIA

Top Ten Health Problem Priority:1. Malaria2.Tuberculosis3. HIV AIDS4. DHF5. Filariasis

6. ARI7. Leprosies8. Immunization9. Diarrhea10.Reproductive Health

General information

Population : 227.328.509 people

Population at risk:  107,785,179 (49,6%)

Endemic districts : 310 (70,3%)

No. of malaria cases  has reported : 2.5 million/yr 

Predicted about :  10 millions of cases/years

Low ModerateFree1 dot = 50 Kasus 

1 dot = 250 kasusHigh

0 0‐1 1‐5 5‐49 50‐100 > 100API o/oo

PETA ENDEMISITAS MALARIA TH. 2007

Malaria Klinis, SD Diperiksa, Malaria PositifTn 2000 – 2008 (Jan‐Mei)

0

500,000

1,000,000

1,500,000

2,000,000

2,500,000

3,000,000

3,500,000

2000 2001 2002 2003 2004 2005 2006 2007 2008 (Jan-Mei)Klinis Malaria 3,178,212 2,737,927 2,660,674 2,482,906 2,335,585 2,113,265 2,167,028 1,774,845 543,126

SD Diperiksa 1,880,418 1,604,573 1,440,302 1,224,232 1,109,801 982,828 1,246,324 930,029 355,924Positif Malaria 256993 267,592 273,793 223,074 268,852 315,394 347,597 311,789 93,830

Keterangan :1. An.aconitus 6. An.barbumbrosus            11. An. kochi                   16. An. Maculatus 21. An. subpictus2. An.annularis 7. An. flavirostris  12. An.punctulatus 17. An.minimus 22. An. sinensis3. An.balabacensis 8. An.farauti 13. An.ludlowi          18  An.nigerimus 23. An. umbrosus4. An.barbirostris 9. An.karwari 14.An.letifer        19. An. parangensis      24. An. vagus5. An.bancrofti  10. An.koliensis 15. An.leucosphyrus    20. An. Sundaicus 25. An. tessellatus

1

1

2

3

4

5

6

7

89

10

11

12

13

14

14

1515

16

16

16

17

17

18 19

2020

20

20

21

2121

21

22

22

23

24

24

25

25

PENYEBARAN VEKTOR MALARIA DI INDONESIA 2008•

SUMBER DAYA PENDUKUNG

GF R1 in Tsunami Relief Program for MCP In Aceh and North Sumatera :

GF R1 (5 Provinces), For MCP in Eastern Indonesia= $ 23 JUTA ( termasuk NAD &

Nias)

GF R6 Areas : $ 57 JUTA

VEKTOR DEMAM BERDARAH DENGUE

Incidence Rate (IR) dan Case Fatality Rate (CFR) DHF Menurut Tahun di Indonesia,1968-2008 (30 Juni)

0

20

40

60

8019

68

1970

1972

1974

1976

1978

1980

1982

1984

1986

1988

1990

1992

1994

1996

1998

2000

2002

2004

2006

2008

Tahun

IR d

an C

FR

IR (per 100.000 pddk)CFR(%)

1.01

0.76

71.18

29.36

Peta Insidensi DBD Menurut Provinsi in Indonesia, 2007

<5 5-19 20-50 >50

IR=incidence rate (per 100,000 penduduk)

NADSumut

SumbarRiau

KepriJambi

SumselBabel

BengkuluLampung

BantenDKI Jakarta

JabarJateng

DIYJatim

KalbarKalteng

KalselKaltim

SulutGorontalo

SultengSulbar

SulselSultra

BaliNTB

NTTMaluku

MalutPapua Barat

Papua

0 0,5 1 1,5 2 2,5 3 3,5 4 4,5

Case Fatality Rate (CFR) DBD Menurut Provinsidi Indonesia, 2007

CFR (%)

• Planning of MDA 2007: 98 district in filariasis endemic targeting 30 million pop• Realisation of MDA th 2007: 47 district filariasis endemic, covered 9.576.215 pop

MASS DRUG ADMINISTRATION (MDA) ON 2007

VEKTOR JAPANESE ENCEPHALITIS

Species Lokasi Tahun

1.Cx.tritaeniorhynchus

2.Cx.gelidus

3.Cx.vishnui

4.Cx.annulus

5.Cx.fuscocephalus

6.Cx.bitaeniorhynchus

7.Cx.quinquifasciatus

8.An.annularis

9.An.vagus

10.An.kochi

11.Armigeres subalbatus

Kapuk,Bogor,Lombok,Semarang

Bogor,Kapuk,Lombok

Kapuk, Pontianak

Pontianak

Kapuk, Semarang

Semarang

Semarang

Lombok

Lombok, Semarang

Semarang

Semarang

’72-74,85;75;85;93

’75; 85; 85

’85 ; 85

‘85

’85; 93

’93

’93

’85

’85; 93

’93

’93

STRATEGIC ISSUE ON VECTOR BORNE DISEASES:

1) OUTBREAK (RE/NEW EMERGING DISEASES) : SEASION, POPULATION MOVEMENT, PHISICAL ENVIRONMENT CHANGE

2) ENTRANCE OF  NEW EMERGING DISEASES/VECTOR  BORNE DISEASE (BY  INTER‐NATIONAL TRAFFIC)

3) ROLE OF SECTORAL & COMMUNITY SUPPORT NOT YET  OPTIMUM4) DESENTRALIZATION  LACK OF PROFESSIONAL STAFF  & OTHER 

RESOURCES5) EPIDEMIOLOGICAL MAPPING (ASPECT OF CASES, VECTOR)6) VECTOR CONTROL AS A ONE OF MAIN ACTIVITY FOR VBDC MUST 

BE RATIONAL , EFFECTIVE, SUSTAINABLE, ACHIEVABLE

MAIN ISSUES  FOR VECTOR CONTROL 

• HRD ‐ Medical Entomologist which comprehensive oriented .‐ Technical & Functional Training & Education

• DEVELOPMENT OF INFORMATION SYSTEM‐ Reactivation of Vector  Surveillance in District level.‐ Networking of Surveillance & Vector  control

• PROVIDE OF MATERIAL & SUPPLIES

• PROGRAM INTEGRATED‐ Integrated Vector Surveillance (IVS)‐ Integrated Vector Management (IVM) 

Pesticides used in Public Healthsusceptibility status of target organismssafety to humansimpact on the environment

WHO recommendations

application equipment

method of application

cost

NATIONAL Pesticides Commission

Malaria - Alternative PesticidesBifenthrin 10% WP (0.025 gr/m2)Alpha-cypermethrin 5% WP (0.025 gr/m2)Bendiocarb 80 %WP (0.2 gr/m2)Deltamethrin 5% WP (0.02 gr/m2) Lambdasihalotrin 10% WP (0.025 gr/m2)Etofenprox 20%WP (0.1 gr/m2)

Bacillus thuringiensis H-14 1200 ITU/ltrS Methopren IGR 1.8 % G 72 mg/m2Pyriproxifen 0.5 G 2 g/m2

Permethrin 10% ECDeltametrin 2.5 %

Space Spraying

Malathion 96 % (500 ml/ha) Cyflutrin 50 % EC (75 ml/ha)Cypermetrin 25 % ULV (400 ml/ha)Lamdasihalotrin 25 EC (75 ml/ha)Permetrin S Bioalterin 10/1.5 OS (100 ml/ha)

Temephos 1 % G 10 gr/100 ltrMetoprene 1.3 % G 72 mg/m2Piriproksifen 0.5 G 2 gr/200 ltr

Larvicides

Abate 1%sand granules

ADULTICIDE

DHF Alternatives Pesticides

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

0

200000

400000

600000

800000

1000000

1200000

1400000

1600000

Rmh Disemprot 1360258 1403368 1196334 801962 444353 189261 135460 125760

Kasus dlm API 0.17 0.07 0.08 0.12 0.3 0.52 0.81 0.62

1994/ 1995 1995/ 1996 1996/ 1997 1997/ 1998 1998/ 1999 1999/ 2000 2000/ 2001 2001/ 2002

Number of house sprayed vs Malaria incidence 1994 - 2001

INSECTICIDE USED (IRS) FOR MALARIA 2004-2006

INSECTICIDE USED (SPRAYING) FOR DENGUE/DHF 2005-2006

Lambda cyhalotrine, alpha cypermetrine

etofenprox

carbamat

pyretroid

organophosphate

Partner Support each others

Central ProvinceDistrict/

Municipality

Action gradually, Coordinate,Community involve

ORGANIZATION

PROVINCE

DISTRICTS

CENTRAL

CDC DIVISION

VBDC SECTION / UNIT

CDC DIVISION

VBDC SECTION

MOH

VBDC DIRECTORATE

MINISTRY OF HEALTH

DIRECTORATE GENERAL CDC&EH

VBDC

ROLE FUNCTION COOPERATION

CENTRAL

PROVINCE

DISTRICT

Motor on Vector Control at national , international link and donor.

•Policy & strategy formulated•Guidelines, standard, moduls •Sosialisation•National Campaign•Study operational &application•Asistance & Consult

- Networking natnl, intern’l functional

- Working groups.

Motor on Vector ccontrol in province level

Organize & implement on Vector control at District level

-Networking regi’l / province

- Work groups.• Planning,, Coordination , Organize ,

Actuating, Monitoring & Evaluation

• Implementaion• Supervise, Monev at District level.• Develop infra structure

-Cooperation.

-Work groups.

ROLE : CENTRAL, PROVINCE & DISTRICT/MUNICPLTY

ERA DECENTRALIZATION

•Develop & ajust guideline & modul at province level.

•Evaluate •Sosialisation•Province campaign. •Asistance &Consult

MOH Min Of EnvMin Of Agricltr

NFDCVBDCCenter forLicense & Invest

PHO PFDCProv Agric Off Prov Env Off

Distr Agric Off DHO Distr Env Office

National pesticidesCommission

Provincial PesticideMonitoring Comm

District PesticidesMonitoring Comm

NATIONAL

PROV

DIST

Min Of Agricltr

Governor

District Head

CHALLENGES

• Decentralization impacts on procurement of insecticides.

• Massive used of pesticide in agriculture will impact on vector resistance to public health.

• Weak on vector resistance monitoring.

• Weak of rule and regulation on standardization.

STRATEGIES

1. Capacity building,

2. Collaboration

3. Exchange information

CAPACITY BUILDING

• Assessment on Integrated Vector Management (IVM) activities.

• Develop Minister of Health decree on Vector Control.

• Workshop and TOT on Guidelines Management Public Health Pesticide.

• Standardization public health pesticide monitoring.

• Strengthen monitoring and evaluation on public health pesticide use.

COLLABORATIONINTRA HEALTH SECTOR COLLABORATION:• Integrate Vector control activities as a sub system of health. • Harmonized resources used for integration.• Commitment needed for budget allocation to achieve the integrated 

objectives.• Integrated program approach could be managing properly to 

achieve mutual objectives.INTER‐SECTOR COLLABORATION• Establish the partnership and inter sector collaboration• Mutual objectives, strategy, monitoring and evaluation and 

budgeting. • Identify roles of each partner. • Government policy on partnership and collaboration

EXCHANGE INFORMATIONINTRA HEALTH SECTOR:• Used the network available within ministry of Health to 

share information between Vector Borne Diseases Control, Food and Drug Control, NIHRD, Environmental Health

INTER SECTORS:• Used the existing network to share information between 

Ministry of Health, Ministry of Agriculture, Ministry of Environment, Universities, Pest Control association and other network, WHO, Private sectors.

OTHERS:• Establishing system on information exchange: 

communication network, IEC and others.

ACTION PLAN

• Training public health pesticide management guidelines.

• Standardization public health pesticide & resistance monitoring.

• Development other legal instruments for public health pesticide managements..

• To establish public health pesticide & resistance networking

To Establish Public Health Pesticide & Resistance Networking

PROPOSE A NATIONAL CENTRALIZED REPORTING SYSTEM FOR VECTOR CONTROL 

PESTICIDES IN INDONESIA

WORK PLAN ELECTRONIC REPORTING SYSTEM ACTIVITIES

1. REVIEW AND REVISE OF EXISTING REPORTING SYSTEM TOOLS FOR MALARIA & DHF VECTOR CONTROL PESTICIDES

2. TO DEVELOP SOFTWARE AND HARDWARE OF DATA BASE VECTOR CONTROL PESTICIDES USAGE 

3. STRENGTHENING CAPABILITY OF MANPOWER FOR DATA MANAGEMENT

4. WORKSHOP  SOSIALIZATION & TO DEVELOP AGGREEMENT IN REPORTING SYSTEM PROGRAM

5. IMPLEMENTATION REPORTING SYSTEM BY ELECTRONIC 

TARGET ACTIVITIES

• Target  Area : Start from National level consist  of  33 Provinces ; and extend to all District & Municipality Level

• Target Health Institution : Center Vector Control Data Base, PHO, DHO, Port Health, BTKL

• Target of Intersector Institution: Agricultural, Private sector 

• Scope of Information : Number & history  insectisides  usage, Resistance states, Coverage

RESISTANCE MANAGEMENT 

• Insecticide usage in selected area priority (high endemic, outbreak).

• Monitoring and evaluation during application (operational process, entomological impact, epidemiological outcome)

• Rotation insecticide use periodically.• Detection of resistance status of vectors was done by WHO standard.

• Monitoring resistance status of applied insecticides was done in several locations.

Discriminating concentrations of Insecticides for adult mosquitoes (one hour exposure‐WHO/CDS/CPC/MAL/98.12)

a. Half an hour exposure

b. Four hours exposure

c. Two hour exposure for Anopheles sacharovi

d. 0.1% for anpheles sacharovi

e. Two hour exposure

No Place Species tested insecticide mortality Year

Province/Distric/subdistric (no of test) Control

MALARIA

1 Riau/Batam/Nongsa An.sundaicus Bendiocarb 0,1 % 100% (149) 2002

2 NTT/Kupang An.subpictus Permethrin 0,75% 100%(95) 0% 2003

An.subpictus Lambda cyhalothrin 0,05% 100%(102) 0% 2003

An.subpictus Bendiocarb 0,1% 100%(112) 0% 2003

DENGUE

1 Bengkulu Ae.aegypti Malathion 0,8% 68,59% (83 ) 2002

2 SouthSul/Makassar/kasi-kasi Ae.aegypti Malathion 0,8% 76,53%(115) 4.16% 2002

3 West kalimantan/Pontianak/

west Pontianak Ae.aegypti Malathion 0,8% 87% 4.76% 2002

4 South Sumatera/Palembang/

sekip Ae.aegypti Malathion 0,8% 79.41% 0% 2002

5 Yogyakarta/Yogya city/

Mantri jeron Ae.aegypti Malathion 0,8% 76.59% 0% 2002

6 North Sulawesi/Manado Ae.aegypti Malathion 0,8% 82.50% 0% 2002

7 North Sulawesi/Manado Ae.aegypti Malathion 5 % 100% (104) 0% 2003

(Malaria, 2004)

No.

Province Species tested

insecticide mortality status year

1 West Java

An.aconitus

Lambda cyhalothrin 0,05% 96,1% tolerant 2005

2 West Nusa Tenggara

An.subpictus

Lambda cyhalothrine 0,05% 100% susceptible 2005

An.subpictus Bendiocarb 0,1% 100% susceptible 20053 West

Kalimantan An.nigerimus Etofenprox 0,5% 100% susceptible 2005

An.nigerimusDeltamethrine

0,05% 100% susceptible 2005

(Malaria, 2005)

No.

Province Species tested

insecticide mortality status year

1 North Sulawesi Ae.aegypti Malathion 0,8% 27% resistant 2005

Malathion 5% 100% susceptible 2005

2 DI Yogyakarta Ae.aegypti Malathion 0,8% 100% susceptible 2005

3 West Kalimantan Ae.aegypti Malathion 0,8% 68,67% tolerant 2005

4 East Java Ae.aegypti Malathion 5% 68% tolerant 2005

Malathion 0,8% 100% susceptible 2005

5 Bali Ae.aegypti Malathion 0,8% 71,92% tolerant 2005

Malathion 5% 100% susceptible 2005

6 South Sumatera Ae.aegypti Malathion 0,8% 28% resistant 2005

No Contents Yes No Comments

(1) Provide technical support Yes WHO Technical Assistant to setting data information system; operational study.

(2) Mobilizing financial resources Yes Advocacy and Socialization to all stakeholders; Identification potential partners.

(3) Work w/ other organizations Yes Broadening Involvement of all potential partners and community.

(4) Potential standing recommendation

Yes Mapping of Vector Borne Disases related with climate change. Improvement of community awarrenness to anticipate VBD outbreak related with climate change

(5) Submit proposals Yes WHO technical assistant to develop proposals; Involve of all related sector and program

REQUESTS THE VBDC OF INDONESIA AS STRATEGIC POLICY DISCUSSION RELATED

WITH VECTOR CONTROL PESTICIDES AND CLIMATE CHANGE