Translating tuberculosis control policy into practice: Planning and budgeting challenges at a primary healthcare center

Mujtahidah  Mujtahidah; Mitha Rahmilah

doi:10.70347/svsthya.v2i4.118

Authors

Mujtahidah Mujtahidah Department of Health Administration, Faculty of Sport and Health Sciences, Universitas Negeri Makassar https://orcid.org/0009-0003-0918-1901
Mitha Rahmilah Department of Health Administration, Faculty of Sport and Health Sciences, Universitas Negeri Makassar

DOI:

https://doi.org/10.70347/svsthya.v2i4.118

Keywords:

Tuberculosis, Primary Health Care, Program Planning, Health Budgeting, Treatment Adherence, Urban Health, Community Engagement, Indonesia

Abstract

Tuberculosis (TB) remains one of the most prevalent communicable diseases in Indonesia, with high morbidity and mortality rates, particularly in urban areas such as Makassar city. This study aimed to examine the planning and budgeting processes of the TB control program at the Tarakan Public Health Center (PHC) in Makassar city. A qualitative descriptive study was conducted via document analysis, direct observations, and in-depth interviews with four key informants (TB program managers, healthcare workers, and community health volunteers involved in TB control). Thematic analysis was used to identify patterns related to program planning, budgeting, implementation, and barriers to program implementation. The TB control program at Tarakan PHC followed national guidelines but faced local challenges, including insufficient early case detection, limited community awareness, and strong social stigma. Budget allocations fluctuate yearly, with IDR 12,800,000 allocated in 2023 and increasing to IDR 25,000,000 in 2024, affecting the program’s sustainability. Patient nonadherence to treatment, often due to perceived recovery, economic hardship, and stigma, was a major barrier. In response, the PHC implemented activities such as active case finding, contact tracing, default tracing, treatment supervision, and preventive therapy, supported by community engagement. Between 2020 and 2024, 226 TB cases were identified. Although national policy supports TB control efforts, local implementation is hindered by behavioral, operational, and financial constraints. Consistent budget allocation, targeted health education, and stronger community involvement are essential for improving treatment outcomes and supporting TB elimination strategies at the primary care level.

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Author Biographies

Mujtahidah Mujtahidah, Department of Health Administration, Faculty of Sport and Health Sciences, Universitas Negeri Makassar

Department of Health Administration, Faculty of Sport and Health Sciences, Universitas Negeri Makassar

Mitha Rahmilah, Department of Health Administration, Faculty of Sport and Health Sciences, Universitas Negeri Makassar

Department of Health Administration, Faculty of Sport and Health Sciences, Universitas Negeri Makassar

References

Setyawan MF, Mertaniasih NM, Utomo B, Soedarsono S, Adnyana IMDM, Eljatin DS, et al. An analysis of the trend of incidences and fatality of pulmonary tuberculosis in East Java from 2015-2020: A lesson from COVID-19. Nat J Comm Med 2023;14:308–15. https://doi.org/10.55489/njcm.140520232903.

World Health Organization. Global tuberculosis report 2022. Geneva: WHO; 2022. https://www.who.int/publications/i/item/9789240061729 (accessed 23 July 2024)

MacNeil A, Glaziou P, Sismanidis C, Maloney S, Floyd K. Global epidemiology of tuberculosis and progress toward meeting global targets—Worldwide, 2018. MMWR Morb Mortal Wkly Rep 2020;69(11):281-5. https://doi.org/10.15585/mmwr.mm6911a2.

Adnyana IMDM, Utomo B, Eljatin DS, Sudaryati NLG. One Health approach and zoonotic diseases in Indonesia: Urgency of implementation and challenges. Narra J 2023;3:e257. https://doi.org/10.52225/narra.v3i3.257.

Marliyati SA, Nur R, Adisasmito W. Determinants of tuberculosis in urban settings in Indonesia: a systematic review. J Public Health Res 2022;11:227990362211287. https://doi.org/10.56338/mppki.v8i2.6860

Kementerian Kesehatan Republik Indonesia. Laporan Kinerja Program Tuberkulosis Nasional 2023. Jakarta: Direktorat Pencegahan dan Pengendalian Penyakit Menular Langsung; 2023. https://www.tbindonesia.or.id/wp-content/uploads/2024/12/Laporan-Program-Penanggulangan-TBC-2023_Final.pdf (accessed 23 July 2024)

Kementerian Kesehatan Republik Indonesia. National Action Plan for Tuberculosis Control 2025–2026. Jakarta: MoH; 2024. https://www.tbindonesia.or.id/wp-content/uploads/2024/02/Revised-NSP-TB-2020-2024-and-interim-plan-2025-2026_final_ttd-1.pdf (accessed 23 July 2024)

Dinas Kesehatan Provinsi Sulawesi Selatan. Laporan Penanggulangan TB 2024. Makassar: 2024. https://apidinkes.sulselprov.go.id/repo/dinkes-RENJA%20DINKES%202024.pdf (accessed 23 July 2024)

Singal, S, Modi, N, Singal, A, Agrawal, H. Investigating the prevalence of tuberculosis in urban slums: a pathological cross-sectional approach. Europ J Cardio Med 2025;15:198-202. https://doi.org/10.5083/ejcm/25-01-3.

Jiang W, Dong D, Febriani E, et al. Policy gaps in addressing market failures and intervention misalignments in tuberculosis control: prospects for improvement in China, India, and Indonesia. Lancet Reg Health West Pac. 2024;46:101045. https://doi.org/10.1016/j.lanwpc.2024.101045.

Adiwinoto RP, Adnyana IMDM, Soedarsono S, Gustam TYP. From Silos to Systems: Reimagining zoonotic neglected tropical disease management through the lens of one health. Svāsthya Trends Gen Med Public Health 2024;1:e61. https://doi.org/10.70347/svsthya.v1i3.61.

Saragih, S., Hafidz, F., Nugroho, A. et al. Estimating the budget impact of a Tuberculosis strategic purchasing pilot study in Medan, Indonesia (2018–2019). Health Econ Rev 2024;14:44. https://doi.org/10.1186/s13561-024-00518-2

Budi U, Widati F, Sulistiawati S, Chow KC, Shifa F, Adnyana IMDM, et al. Does COVID-19 pandemic affect the elimination of tuberculosis? Lessons learned from Indonesia. Afr J Infect Dis 2025;19:1–7. https://doi.org/10.21010/Ajid%20v19i2.1.

Utomo B, Chan CK, Mertaniasih NM, Soedarsono S, Fauziyah S, Sucipto TH, et al. Comparison epidemiology between Tuberculosis and COVID-19 in East Java Province, Indonesia: An analysis of regional surveillance data in 2020. Trop Med Infect Dis 2022;7:83. https://doi.org/10.3390/tropicalmed7060083.

Alema H, Hailemariam S, Misgina K, Weldu M, Gebregergis Y, Mekonen G, et al. Health care seeking delay among pulmonary tuberculosis patients in North West Zone of Tigrai Region, North Ethiopia. BMC Infect Dis 2019;19:3893. https://doi.org/10.1186/s12879-019-3893-7.

García P, Hernández-Córdova G, Pourjavaheri P, Gómez-Paredes H, Sudar S, Bayer A. Knowledge, attitudes and practices related to tuberculosis in pharmacy workers in a cross-sectional survey in El Agustino, Peru. PLoS One 2018;13:e0196648. https://doi.org/10.1371/journal.pone.0196648.

Probandari A, Sanjoto H, Mahanani M, L. A, Widayati S. Being safe, feeling safe, and stigmatizing attitude among primary health care staff in providing multidrug-resistant tuberculosis care in Bantul District, Yogyakarta Province, Indonesia. Hum Resour Health 2019;17:35. https://doi.org/10.1186/s12960-019-0354-8.

Hadi A, Sujoko E, Widasari L, Simamora F. Pengaruh pendekatan edukasi sociocultural terhadap pencegahan TBC di Kabupaten Tapanuli Selatan. Media Publikasi Promosi Kesehatan Indonesia 2023;6:2295–303. https://doi.org/10.56338/mppki.v6i11.4297.

Schmidt B, Engel M, Abdullahi L, Ehrlich R. Effectiveness of control measures to prevent occupational tuberculosis infection in health care workers: a systematic review. BMC Public Health 2018;18:5518. https://doi.org/10.1186/s12889-018-5518-2.

Herman B, Sirichokchatchawan W, Nantasenamat C, Pongpanich S. Artificial intelligence in overcoming rifampicin-resistant screening challenges in Indonesia: a qualitative study on the user experience of CUHAS-ROBUST. J Health Res 2021;36:1018–27. https://doi.org/10.1108/jhr-11-2020-0535.

Zinatsa F, Engelbrecht M, Rensburg A, Kigozi G. Voices from the frontline: barriers and strategies to improve tuberculosis infection control in primary health care facilities in South Africa. BMC Health Serv Res 2018;18:3083. https://doi.org/10.1186/s12913-018-3083-0.

Nazi’at A, Nadatien I. Overview of intensified health efforts in TB control policies at the Siwalankerto Community Health Center. J Sosial Sains 2022;2:1078–85. https://doi.org/10.59188/jurnalsosains.v2i10.493.

Fitriyani L, Irawan T, Wahyuningsih W. Pelatihan pembuatan video kampanye cegah TBC di Desa Purworejo [Eng: Training on making videos to prevent tuberculosis in Purworejo Village]. Sasambo J Comm Service 2023;5:392–9. https://doi.org/10.36312/sasambo.v5i2.1148.

Rosaline M, Herlina S. KAMI-PMO TB (edukasi dan pendampingan pengawas menelan obat TB) dalam pengendalian MDR TB [Eng: KAMI-PMO TB (education and supervision of TB medication intake) in the control of MDR TB]. J Bakti Masyarakat Indonesia 2021;3:947. https://doi.org/10.24912/jbmi.v3i2.9475.

Anandita Y, Krianto T. Penggunaan bahasa daerah dalam komunikasi pendampingan pengobatan pasien tuberkulosis resistan obat [Eng: The use of regional languages in communication when assisting patients with drug-resistant tuberculosis]. Hearty 2022;11:5. https://doi.org/10.32832/hearty.v11i1.7449.

Nurfikri A, Nurhasanah N. Infection control risk assessment of obstetric services in primary clinics in the city and regency of Cirebon. J Kesehat Vok 2022;7:148. https://doi.org/10.22146/jkesvo.72014.