UNDP-Backed Initiative Strengthens Indonesia's Health Systems for Malaria Elimination by 2027

January 13, 2025
A microscopist examining blood mass survey results for malaria diagnosis

A microscopist examining blood mass survey results for malaria diagnosis

UNDP Indonesia

Thursday, 14 November 2024 

In the pursuit of a malaria-free Indonesia by 2027, the United Nations Development Programme (UNDP) Indonesia, in collaboration with the Ministry of Health, has launched a key initiative to enhance the nation's surveillance and diagnostic capacity for malaria. The initiative's core element is developing standardized malaria slides to serve as diagnostic tools and training resources for health professionals, especially in community health centers (puskesmas), ensuring accurate malaria detection through microscopic blood sample examination. This strengthens health systems by equipping every healthcare worker with the necessary tools and training for precise diagnoses. The initiative is supported by funding from the Global Fund, contributing to the collective goal of improving public health outcomes in Indonesia. 

The successful implementation of this initiative lies on the importance of collaboration between national and local governments, international organizations, and the healthcare sector. The Ministry of Health of Indonesia and UNDP have worked closely with regional health offices and local puskesmas to design and deliver training programs that are relevant to the specific needs of malaria-endemic communities. 

This collaborative effort extends to the development of standardized malaria slides, with substantial contributions from the Balai Besar Lab Biologi Kesehatan (BBLBK) under the Ministry of Health. The BBLBK team has been instrumental in training and overseeing the detailed process of creating these slides, including blood sample collection, preparation of thick and thin smears, fixation, staining, validation, and homogenization. The introduction of standardized slides addresses critical challenges, optimizing resource utilization and ensuring patients receive accurate and timely care. These slides are intended to serve as diagnostic tools nationwide, enabling all puskesmas, regardless of their location or available resources, to adhere to a uniform diagnostic standard, thereby improving the accuracy and reliability of malaria diagnoses. 

Empowering Locals 

Community health workers play a vital role in this initiative. As frontline professionals directly engaging with affected populations, they ensure the success of malaria elimination efforts, particularly in remote areas where healthcare disparities are pronounced. Their involvement in training and field surveys bridges the gap between local challenges and effective solutions. In the region of Aceh Jaya, healthcare workers are provided with on-the-job training to strengthen their capacity in malaria diagnosis using microscopic test methods. The training consists of both theoretical classroom sessions and practical fieldwork to ensure that staff are equipped to conduct mass blood surveys, identify malaria cases, and make accurate diagnoses

a group of people sitting at a table

Collecting samples from key populations in Aceh Jaya as part of malaria surveillance efforts

UNDP Indonesia

During the one-day classroom training, participants are taught about the different forms and characteristics of the five Plasmodium species, which are responsible for malaria in humans. Special emphasis is placed on the identification of Plasmodium knowlesi (Pk), a species transmitted by the macaque monkey and its vector, the Anopheles mosquito. Healthcare workers are also trained in the process of creating malaria slides, which will later be standardized for diagnostic purposes. 

After the training, participants join field teams for a six-day survey, where they perform mass blood tests on key populations who are at higher risk of contracting malaria, particularly workers who spend time in the forested areas where macaque monkeys live. These populations, including plantation workers, miners, and loggers, are more likely to be exposed to the infected Anopheles mosquito, which can transmit the Pk parasite. 

Through this hands-on experience, healthcare workers not only strengthen their skills in diagnosing malaria but also gain valuable insights into the challenges faced by communities at risk. The involvement of local healthcare workers in such surveys is a critical step in achieving the 2027 malaria elimination goal, as it helps ensure that diagnostic efforts are rooted in the realities of local populations. 

"This initiative is about equity—about empowering every healthcare worker with the tools they need, no matter where they serve," said dr. Zulkarnaini, ZA, Head of the Disease Prevention and Control Section in Aceh Jaya. 

While this initiative is currently focused on Aceh Jaya, its impact is expected to extend nationwide. By standardizing malaria diagnostics at the puskesmas level, the initiative is contributing to the larger goal of eliminating malaria in Indonesia by 2027. This ambitious goal is supported by a national malaria surveillance strategy, which includes the development of tools such as the malaria slide standards, as well as the training of healthcare workers to implement them effectively.

Looking Ahead 

The effort to eliminate malaria by 2027 is not just about reducing the number of cases—it is about improving the overall quality of health systems across Indonesia. By equipping local healthcare workers with the necessary skills and resources, this initiative strengthens the foundation of the country's healthcare infrastructure. The long-term impact will be a more resilient and responsive healthcare system, capable of effectively diagnosing and treating malaria and other infectious diseases. 

As the project progresses, the focus will shift towards expanding the reach of this initiative to other malaria-endemic regions in Indonesia. The success in Aceh Jaya will serve as a model for other areas where malaria remains a public health threat. Expanding the use of standardized malaria slides and further training of healthcare workers will be essential steps in accelerating the country's malaria elimination efforts. Additionally, plans are underway to create a digital ATLAS for Plasmodium, serving as a digital database for original Indonesian Plasmodium images. This initiative is not just about eliminating malaria—it is about creating a stronger, more resilient healthcare system capable of addressing the challenges of today and tomorrow. With the continued dedication of all stakeholders, the goal of a malaria-free Indonesia by 2027 is within reach (*). 

Written by Maya Tamara, 

Edited by Thomas Benmetan.