dr.Caca_Pemanfataan Dana Grant GF Komponen TBC.pptx

Global Fund TBC

1. Pemanfaatan Dana Grant GF ATM Komponen TBC Tahun 2024- 2026

2. Outline Situasi TB Indonesia Overview Grant GF TB 2024- 2026 Modular dan Intervensi Grant GF TB2024- 2026 Area Prioritas Grant GF TB2024- 2026 Performance Framework Grant GF TB 2024- 2026 Budget Summary & Co- financing Grant GF TB 2024- 2026 Harapan kepada Stakeholders

3. Situasi TB di Indonesia

4. SITUASI GLOBAL TB Global TB Report 2022: Indonesia salah satu dari 8 negara yang berkontribusi terhadap 2/3 beban TB di dunia Insidensi TB di Indonesia tertinggi ke- 2 di dunia Negara Estimasi % terhadap beban TB dunia India 2.950.000 28% Indonesia 969.000 9,2% China 780.000 7,4% Filipina 741.000 7,0% Pakistan 611.000 5,8% Nigeria 467.000 4,4% Banglades 375.000 3,6% Demokratik Republic Kongo 305.000 2,9% Delapan Negara dengan Beban TB Tertinggi di Dunia di Tahun 2021

5. Dukungan Global Fund untuk Penanggulangan TB PR TB MOH PR TB Komunitas Beneficiaries Dukungan GF mencakup pencegahan dan penanggulangan TB di pelayanan kesehatan & komunitas Dukungan enabler Penguatan komunitas DPPM Diagnostik dan lab Pelayanan pasien PMDT Presumptive or active TB case Obat dan logistic Community right and gender Penjangkauan pasien Penguatan HRH GF Komponen TB

6. Capaian Indikator Program TB Data source: 2000- 2021: Global TB Report 2022 : final data per 13 March 2023 2023* : data from SITB per 3 Juli 2023 845,000 824,000 969,000 969,000 969,000 568,987 393,323 443,235 724,309 359,455 2019 2023* 2020 2021 Estimated TB Burden 2022 Notified TB Cases Case- finding Gap 48% 46% 75% 22% 67% Keberhasilan Pengobatan TB Pemberian TPT bagi kontak serumah Tahun Capaian Target 2019 83% 90% 2020 83% 90% 2021 86% 90% 2022 86% 90% 2023* 82% 90% *data s.d. Juli 2023 Tahun Capaian Target 2020 0,18% 11% 2021 0,28% 29% 2022 1,32% 48% 2023* 4,0% 58% *data s.d. Juli 2023 Capaian notifikasi kasus TBC mencapai 75% di tahun 2022 Per Juni 2023 capaian notifikasi kasus TBC tercatat 22% dari estimasi kasus Tren capaian Treatment Success rate meningkat namun belum mencapai target Capaian TPT meningkat dari tahun ke tahun, namun masih jauh dari target yang disepakati

7. Overview Grant GF TB 2024- 2026 Modular dan Intervensi Grant GF TB 2024- 2026

8. Overview Grant GF TB 2024-2026 (1) Goal To reduce TB incidence rate per 100,000 population from 354 in 2021 to 300 in 2026 To reduce TB mortality rate per 100,000 population from 52 in 2021 to 26 in 2026 Objective To increase TB treatment coverage of new and relapse TB cases from 70% in 2022 to 90% for 2024 onwards To improve TB quality of service by increasing treatment success rate of all forms TB cases to 90% from 2024 and beyond To increase RR- TB and/or MDR- TB Treatment coverage from 42% in 2022 to 75% by 2026 To improve TB quality of service by increasing treatment success rate of RR- TB and/or MDR- TB cases to 80% by 2026 To remove TB stigma in community settings Proposal Funding Request TB disusun dengan pendekatan Tailored to NSP

9. Overview Grant GF TB 2024-2026 (2) PRs PR MOH TB PR Konsorsium Penabulu STPI (PR PB STPI) Performance Framework Impact indicator : 4 indikator Outcome indicator : 6 indikator Coverage indicator : PR MOH TB: 20 indikator PR PB STPI: 5 indikator Intervention Area PR MOH TB : 514 kab/kota, fokus di 359 kab/kota PR PB STPI: Y1: 190 kab/kota and Y2 and Y3: 229 kab/kota Modular yang diajukan 13 modul (7 TB modul, 5 RSSH modul, dan program management) Budget summary Allocation + Matching Fund: US$ 156,009,397 PR TB MOH: US$ 123,180,397 PR PB STPI : US$ 32,829,000

10. Modular Grant TB 2024- 2026 Modular TB TB diagnosis, treatment, and care TB/DR TB Prevention Collaboration with other provider and sectors Key and Vulnerable population TB/DR TB DR TB diagnosis, treatment, and care TB/HIV Removing human rights and gender- related barriers to TB service 10 RSSH disease specific: Community Systems Strengthening Health products management systems Human resources for health, including community health workers Laboratory systems Monitoring and Evaluation Systems Program management

11. Modular dan Intervensi - 1 No Modul, Intervention PR TB MOH PR PB STPI PR TB MOH % thd Total PR PB STPI % thd Total 1 Collaboration with other providers and sectors 6,743,192 5.5% 1,210,729 3.7% a Collaboration with other programs/sectors 64,835 0.1% 1,079,475 3.3% b Community- based TB/DR- TB care - 131,254 0.4% c Private provider engagement in TB/DR- TB care 6,678,358 5.4% - 2 Drug-resistant (DR)- TB diagnosis, treatment and care 59,200,805 48.1% 5,657,681 17.2% a DR- TB diagnosis/drug susceptibility testing (DST) 27,690,239 22.5% - b DR- TB treatment, care and support 31,510,565 25.6% 5,657,681 17.2% 3 Key and vulnerable populations (KVP) – TB/DR- TB 4,977,416 4.0% - a KVP - Children and adolescents 734,166 0.6% - b KVP - Others 2,361,795 1.9% - c KVP - People in prisons/jails/detention centers 1,881,455 1.5% - 4 Program management 21,819,997 17.7% 12,403,133 37.8% a Coordination and management of national disease control programs 433,525 0.4% - b Grant management 21,386,472 17.4% 12,403,133 37.8%

12. Modular dan Intervensi - 2 PR TB MOH PR PB STPI No Modul, Intervention PR TB MOH % thd Total PR PB STPI % thd Total 5 Removing human rights and gender related barriers to TB services - 0% 610,249 1.9% a Community mobilization and advocacy, including support to TB survivor- led groups - 0% 174,734 0.5% b Eliminating TB- related stigma and discrimination - 0% 208,322 0.6% c Ensuring people-centered and rights- based law enforcement practices - 0% 14,062 0.0% d Increasing access to justice (TB) - 0% 154,106 0.5% e Monitoring and reforming policies, regulations and laws - 0% 32,605 0.1% f Reducing TB-related gender discrimination, harmful gender norms and violence - 0% 26,419 0.1%

13. Modular and Intervention - 3 PR TB MOH PR PB STPI No Modul, Intervention PR TB MOH % thd Total PR PB STPI % thd Total 6 RSSH/PP: Human resources for health (HRH) and quality of care 936,504 0.8% 1,799,222 5.5% a RSSH/PP: Community health workers: Integrated supportive supervision - 5,506 0.0% b RSSH/PP: Education and production of new health workers (excluding community health workers) 321,896 0.3% 27,766 0.1% c RSSH/PP: HRH planning, management and governance including for community health workers (CHWs) 114,970 0.1% 25,752 0.1% d RSSH/PP: In- service training (excluding community health workers) 479,704 0.4% - e RSSH/PP: Integrated supportive supervision for health workers (excluding CHWs) - 1,740,198 5.3% f RSSH/PP: Quality improvement and capacity building for quality of care 19,933 0.0% - 7 RSSH: Community systems strengthening - 443,622 1.4% a Capacity building and leadership development - 162,016 0.5% b Community engagement, linkages and coordination - 166,331 0.5% c Community- led monitoring - 100,773 0.3% d Community- led research and advocacy - 14,503 0.0%

14. Modular and Intervention - 4 No Modul, Intervention PR TB MOH PR PB STPI PR TB MOH % thd Total PR PB STPI % thd Total 8 RSSH: Health products management systems 281,925 0.2% - a Policy, strategy, governance 29,115 0.0% - b Regulatory/quality assurance support 100,642 0.1% - c Storage and distribution capacity, design & operations 152,168 0.1% - 10 RSSH: Monitoring and evaluation systems 5,325,489 4.3% 1,720,339 5.2% a Analyses, evaluations, reviews and data use 2,052,580 1.7% 661,753 2.0% b Data quality 2,120,944 1.7% 19,814 0.1% c Operational Research 406,957 0.3% - d Routine reporting 745,007 0.6% 1,038,771 3.2% 11 TB diagnosis, treatment and care 16,432,737 13.3% 634,873 1.9% a TB screening and diagnosis 10,589,980 8.6% - b TB treatment, care and support 5,842,757 4.7% 634,873 12 TB/DR- TB Prevention 5,370,310 4.4% 7,422,365 22.6% a Infection prevention and control (IPC) 846,642 0.7% 85,336 0.3% b Preventive treatment 3,757,360 3.1% - c Screening/testing for TB infection 766,308 0.6% 7,337,029 22.3% 13 TB/HIV 2,092,024 1.7% 924,449 2.8% a TB/HIV - Collaborative interventions 269,014 0.2% b TB/HIV - Prevention 679,870 0.6% c TB/HIV - Screening, testing and diagnosis 747,996 0.6% d TB/HIV - Treatment and care 395,143 0.3% e TB/HIV - Community care delivery 924,449 2.8% TOTAL 123,180,397 100% 32,829,000 100%

15. Area Prioritas & Performance Framework Grant GF TB 2024- 2026

16. Area Prioritas Area prioritas tematik : DR TB : 240 kabupaten/kota DPPM 161 kab/kota (80 kab/kota di allocation dan 81 kab/kota di PAAR) Screening TB DM: 161 districts Percepatan TPT : 359 districts ACF: 193 districts (kab/kota di 8 provinsi akselerasi eliminasi TB) Kolaborasi TB HIV: 359 districts Area intervensi PR Kemenkes seluruh kab/kota di Indonesia dengan Wilayah Prioritas 359 kab/kota mereprsentasikan 91% estimasi kasus TB Area intervensi PR PB STPI 190 kab/kota di tahun ke- 1 , ekspansi ke 229 kab/kota di tahun ke- 2 dan ke- 3 mereprsentasikan 78% estimasi kasus TB

17. PERFORMANCE FRAMEWORK IMPACT INDICATOR OUTCOME INDICATOR 4 Indikator 6 Indikator COVERAGE INDICATOR PR Kemenkes: 20 indikator PR PB STPI: 5 indikator 3 indikator 2 indikator 17 indikator Dievaluasi di akhir 2026 Dievaluasi setiap tahun Dievaluasi setiap semester RATING PR TB SR Provinsi 1 SR Pusat 3 IU Pusat IU Kabupaten SR Provinsi 1 SR Pusat 190 SSR

18. Performance Framework- Impact Indicator Impact Indicator Number Standard Indicator Baseline #N Baseline #D Baseline Year 2024 Target #N Target #D 2025 Target #N Target #D 2026 Target #N Target #D Comments 1 TB I-2 TB incidence rate per 100,000 population 354 2021 406 348 300 Based on the modelling of TB Global Plan 2023- 2030 by STP Global team, the post Covid- 19 TB incidence in Indonesia will increase until 2023 then will start to decline in 2024 2 TB I-3⁽ᴹ⁾ TB mortality rate per 100,000 population 52 2021 38 31 26 Based on the modelling, inline with the increase of TB Incidence 3 TB I-4⁽ᴹ⁾ RR- TB and/or MDR- TB prevalence among new TB patients: Proportion of new TB patients with RR- TB and/or MDR- TB 2.2% 2021 2.2% 2.2% 2.2% Modelling, considering historical trend, TB post covid incidence and 2.2% DR- TB proportion among new TB patients and 25% among retreatment cases. 4 TB/HIV I-1 TB/HIV mortality rate per 100,000 population 2.4 2021 2.8 2.4 2.0 Modelling based on the latest rate and dynamic of TB mortality after pandemic.

19. Performance Framework- Outcome Indicator PR TB MOH Outcome Indicator Number Standard Indicator Baseline #N Baseline #D Baseline % Baseline Year 2024 2025 2026 Target #N Target #D Target % Target #N Target #D Target % Target #N Target #D Target % 1 TB O- 5⁽ᴹ⁾ TB treatment coverage: Percentage of patients with new and relapse TB that were notified and treated among the estimated number of incident TB in the same year (all forms of TB - bacteriologically confirmed plus clinically diagnosed 708,658 66.85% 2022 824,942 72.00% 794,336 80.08% 783,931 90.79% 1,060,000 1,145,821 991,954 863,427 2 TB O- 2a Treatment success rate of all forms of TB - bacteriologically confirmed plus clinically diagnosed, new and relapse 338,738 86.58% 2022 691,535 90.00% 742,448 90.00% 714,902 90.00% 391,245 768,372 824,942 794,336 3 TB O- 6 Treatment coverage of RR- TB and/or MDR- TB: Percentage of notified people with bacteriologically confirmed, drug resistant RR- TB and/or MDR-TB as a proportion of all estimated people with RR- TB and/or MDR- TB 12,531 40.82% 2022 17,213 53.35% 17,821 63.81% 18,455 75.91% 30,699 32,262 27,930 24,311 4 TB O- 4⁽ᴹ⁾ Treatment success rate of RR- TB and/or MDR-TB: Percentage of patients with RR and/or MDR-TB successfully treated 2,365 50.97% 2020 12,025 65.00% 14,783 75.00% 13,770 80.00% 4,640 18,500 19,710 17,213 5 TB O other- 1 Percentage of notified female TB cases among estimate incidence females TB cases 300,227 80.99% 2022 350,621 90.00% 303,538 90.00% 264,209 90.00% 370,707 389,579 337,264 293,565 6 RSSH O- 3 On- shelf availability: Percentage of facilities with tracer health products for the three diseases - HIV, TB, malaria (as applicable) available on the day of the visit or day of reporting 5,572 55.53% 2022 11,554 90.00% 11,554 90.00% 11,554 90.00% 10,034 12,838 12,838 12,838

20. Performance Framework- Outcome Indicator PR PB STPI Outcome Indicator Number Standard Indicator Baseline #N Baseline #D Baseline % Baseline Year 2024 2025 2026 Target #N Target #D Target % Target #N Target #D Target % Target #N Target #D Target % 1 TB O- 5⁽ᴹ⁾ TB treatment coverage: Percentage of patients with new and relapse TB that were notified and treated among the estimated number of incident TB in the same year (all forms of TB - bacteriologically confirmed plus clinically diagnosed 708,658 66.85% 2022 824,942 72.00% 794,336 80.08% 783,931 90.79% 1,060,000 1,145,821 991,954 863,427 2 TB O- 2a Treatment success rate of all forms of TB - bacteriologically confirmed plus clinically diagnosed, new and relapse 338,738 86.58% 2022 691,535 90.00% 742,448 90.00% 714,902 90.00% 391,245 768,372 824,942 794,336 3 TB O- 6 Treatment coverage of RR- TB and/or MDR-TB: Percentage of notified people with bacteriologically confirmed, drug resistant RR- TB and/or MDR-TB as a proportion of all estimated people with RR- TB and/or MDR- TB 12,531 40.82% 2022 17,213 53.35% 17,821 63.81% 18,455 75.91% 30,699 32,262 27,930 24,311 4 TB O- 4⁽ᴹ⁾ Treatment success rate of RR- TB and/or MDR-TB: Percentage of patients with RR and/or MDR- TB successfully treated 2,365 50.97% 2020 12,025 65.00% 14,783 75.00% 13,770 80.00% 4,640 18,500 19,710 17,213 5 TB O- 9 Percentage of people diagnosed with TB who report stigma in community settings that inhibited them from seeking and accessing TB services 163 12.7% 2021 6.37% 1,280 6 TB O other- 1 Percentage of notified female TB cases among estimate incidence females TB cases 300,227 80.99% 2022 350,621 90.00% 303,538 90.00% 264,209 90.00% 370,707 389,579 337,264 293,565

21. Beberapa Kegiatan Baru di Grant 2024- 2026 PR TB Kemenkes Active Case Finding dengan CXR di Puskesmas Ekspansi inisiasi pengobatan TB RO di Puskesmas Pilot pengobatan TB dengan durasi lebih pendek Implementasi programatik regimen BPaL/M untuk pasien TB RO Pengembangan kegiatan PPM Diagnostik: Inisiasi TB LF- LAM testing pada PLHIV, scale up non sputum laboratory test to detect childhood TB ( including stool ) Pengembangan kapasitas WGS untuk surveilans DR TB ( Develop the technical manual for WGS TB Examination) Surveilans DR TB berdasarkan data rutin DST Koordinasi rutin dengan Dit Gizi KIA dan Kemendikbud untuk penguatan skrining TB Penguatan dan pengembangan Pemantauan Mutu Eksternal (PME) Tuberculosis molecular laboratory (TCM dan LPA) PR PB STPI Skrining CXR dikoordinasikan komunitas Sasaran TPT seluruh kontak rumah tangga Dukungan transport suspect TB untuk melakukan pemeriksaan Mengembangkan platform pelatihan CHW berbasis web Bridging SITB- SITK dua arah Pendampingan pasien TB RO, termasuk pasien yang didiagnosis di Puskesmas GX site Pelacakan pasien TB RO yang belum memulai pengobatan, absen dalam pengobatan, dan LTFU ( TB Army )

22. Budget Summary & Co- financing Grant GF TB 2024- 2026

23. Budget Summary Allocation+Matching Fund: US$ 156,009,398 PR TB Kemenkes : US$ 123,180,397 (79%) PR Konsorsium (PB STPI) : US$ 32,829,000 (21%) TOTAL : US$ 156,009,397 Matching fund ( Find and treat the missing people with DS- TB dan DR- TB): PR TB MOH: US$ 3,747,242 dan PR PB STPI: US$ 455,227 Secara keseluruhan Grant GF TB 2024- 2025 lebih sedikit dari Grant 2021- 2023 Sebagian (41%) budget di PR TB MOH digunakan untuk pembelian health product dan sebagian lainnya (59%) untuk pelaksanaan kegiatan Sebagian besar anggaran (41%) dialokasikan untuk modul DR TB diagnosis Treatment and Care Y1 Y2 Y3 TOTAL PR MOH TB 58,902,566 41,973,604 22,304,227 123,180,397 PR PB STPI 10,974,046 10,928,042 10,926,912 32,829,000 TOTAL 69,876,612 52,901,647 33,231,139 156,009,397 - 100,000,000 80,000,000 60,000,000 40,000,000 20,000,000 180,000,000 160,000,000 140,000,000 120,000,000 Distribusi Budget GF TB 2024- 2026 PR MOH TB PR PB STPI TOTAL 48% budget PR Kemenkes dialokasikan di Y1 Distribusi budget PR Konsorsium 33% tiap tahun GF menilai performa finansial setiap semester PR TB MOH PR PB STPI HP/Non HP Y1- Y3 % thd Total TY1- Y3 % thd Total HP 50,183,666 41% 80,267 0.2% Non HP 72,996,731 59% 32,748,733 99.8% TOTAL 123,180,397 100% 32,829,000 100.0%

24. Harapan kepada Stakeholders

25. Harapan kepada Stakeholder - 1 PR dan SR agar mengimplementasikan hibah GF dengan optimal untuk mencapai tujuan: Programatik , sebagaimana tertuang dalam Performance Framework Finansial , sebagaimana work plan dan diimplementasikan dengan akuntabel PR perlu meningkatkan monitoring dan evaluasi , baik programatik maupun keuangan diantaranya dengan terus melakukan umpan balik secara rutin Kementerian Kesehatan dan Pemerintah Daerah agar mengupayakan capaian komitmen co financing pendanaan penanggulangan TB. Pendanaan domestik, baik APBN dan sumber lainnya sangat penting untuk sustainabilitas program, perlu diadvokasi terus menerus agar dapat mencapai komitmen co financing Indonesia untuk program TB.

26. Harapan kepada Stakeholder- 2 PR Kemenkes dan PR Konsorsium agar memperkuat koordinasi baik di tingkat pusat maupun daerah dalam pelaksanaan hibah GF Kementerian Kesehatan perlu bekerja sama dengan BPJS untuk advokasi skema pembiayaan strategis untuk Program TB Mitra Pembangunan diharapkan dapat mendukung Program TB Nasional dengan dukungan yang menitikberatkan inovasi sehingga dapat memberikan daya ungkit dalam pencapaian program. Perlu dipastikan agar dukungan program TB yang diberikan sejalan ( align ) dengan Strategi Nasional Penanggulangan TBC dan tidak tumpang tindih satu dengan yang lainnya

27. TERIMA KASIH