Community-driven strategies and policies for drug-resistant tuberculosis control in Banyumas Regency, Indonesia: A comprehensive 2023 analysis.

BACKGROUND: Central Java, Indonesia, struggles with low drug-resistant tuberculosis (DR-TB) case detection (33%) and treatment rates (25%), far below the 60% target. Despite policies, including Minister of Health Regulation No. 67/2016 and Presidential Regulation No. 67/2021, along with the National TB Strategy for Tuberculosis Control 2020-2024 have been implemented, targets remain unmet due to weak community involvement. This study analyzed TB policy implementation in high-prevalence Banyumas Regency, focusing on cadres and community organizations.

DESIGN AND METHODS: This qualitative study employed the Van Meter and Van Horn framework to assess policy implementation. Key stakeholders involved informants from Puskesmas (community health centers), TB cadres, TB program holders at the Regency Health Office, and the Mentari Sehat Indonesia Foundation. Data collection involved in-depth interviews with these informants, as well as policy documents, guidelines, and reports from agencies or institutions. Triangulation methods were used to enhance the validity of the findings.

RESULTS: Implementers understood policy standards, supported by consistent communication among Health Offices, community health workers, local organizations, and village leaders. Positive attitudes were reflected in joint commitments and Regional Action Plans. Cadres and communities actively supported case-finding, treatment, education, socioeconomic aid, and stigma reduction.

CONCLUSIONS: Policies lack sufficient local budget allocation. Weak motivation of TB cadres, lack of commitment among regional organizations, and persistent stigma in the community are evident. The Global Fund aids DR-TB control through grants and patient support to ensure treatment adherence. However, sustained impact requires government attention to policy, human resources, infrastructure, and complementary resources to achieve synergy.