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Background
Malaria constitutes a global health priority with an estimated 249 million cases in 2022 from 85 endemic countries. Across the past slightly over a decade, the malaria burden in Indonesia has fluctuated significantly, with 464,764 cases reported in 2010, followed by a decrease to 304,607 cases in 2021, and a sharp spike to 418,546cases in 2023.
Through a robust malaria control effort, Indonesia has managed to ensure that 85% of its population now resides in malaria-free areas and a total of 398 (77%) districts/cities have been accorded malaria elimination certificates as of June 2024.
Despite this progress, over 400,000 malaria cases are still reported annually, primarily from the Papua region. Additionally, Indonesia’s new capital city Nusantara, although currently malaria-free, remains at risk for transmission due to high population movement from surrounding high malaria endemic areas that have yet to achieve elimination.
Roadmap on Malaria Elimination and Prevention of Re-Establishment
To intensify the fight against malaria towards nationwide elimination by 2030, the country’s Ministry of Health launched a Roadmap for Malaria Elimination and Prevention of Re-establishment in Indonesia for the period of 2025-2045. His Excellency, Former President Susilo Bambang Yudhoyono, Special Advisor to APLMA joined Minister of Health, Budi G. Sadikin to officially launch the roadmap on 10 October 2024 in Jakarta.
The roadmap outlines the financial requirements for implementing malaria elimination efforts and preventing its re-establishment. These efforts must be sustainable and cost-effective. Securing funding from central and local governments, along with contributions from the private sector and development partners, is crucial to ensure the success of these initiatives.
Having launched this year, this initiative supports the 2020-2024 National Development Priority and is aligned with the Final Draft of the National Long-Term Development Plan (RPJPN) of 2025-2045, and Regulation of the Minister of Health Number 22 of 2022 on Malaria Elimination.
The roadmap is anchored by a five-pillar framework:
- Pillar 1 - Ensure universal access for prevention, diagnosis and treatment of malaria
- Pillar 2 - Transformation of malaria surveillance into a core intervention
- Pillar 3 - Community empowerment and behaviour change communication to accelerate malaria elimination
- Pillar 4 - Strengthening the health system, health security and leadership to achieve malaria elimination program objectives based upon the principles of equity, human rights and leave no one behind
- Pillar 5 - Health innovation and research
Challenges
Efforts to eliminate malaria in Indonesia face numerous challenges. High endemic regions, especially those in Eastern Indonesia, provide a receptive environment for the disease, and the public often perceives malaria as a common illness, leading to reluctance to seek treatment. Additionally, the high rate of P. vivax infections, especially in low-endemic and malaria-free areas, poses a risk of re-establishing transmission as non-compliance to treatment adherence can cause relapse.
Another significant challenge is the occurrence of simian malaria (P. knowlesi) among highly mobile populations. This increases the risk of re-establishing transmission in both high endemic and malaria-free areas, as well as regions with altered land use. It also poses a threat to specific groups such as miners, remote communities, and forest workers, particularly in hard-to-reach areas, leading to severe cases of the disease.
Specific Interventions in Papua
Cases in Papua have increased over the past five years and in 2023, 86% of the national malaria cases were found in just 14 districts/cities in Papua. The roadmap will guide efforts in Papua through accelerated intervention activities that are targeted at villages with very high malaria transmission (API > 250 per thousand population).
Transmission is predominantly from lowland areas with year-round rainfall, providing conducive environments for mosquito breeding. Weak health infrastructure, poor quality of housing and anthropophilic vector behaviour contribute to high transmission rate in the region.
An integrated and accelerated intervention includes intensifying the role of malaria cadres to cover home visits, enhanced contact tracing, mass drug administration, integrated vector control and administration of preventive drugs for malaria in pregnant women.
The integrated and accelerated interventions include:
- Intensifying the role of malaria cadres to conduct home visits.
- Enhanced contact tracing to break transmission chains, especially in asymptomatic cases.
- Mass drug administration to reduce burden in villages with high transmission.
- Integrated vector control measures to reduce mosquito populations.
- Administration of preventive drugs for malaria in pregnant women.
Collective Approach &Strong Leadership
The roadmap is underpinned by the principles of Whole-of-Government and Whole-of-Society, equity and leave no-one one behind. With support from the Asia Pacific Leaders Malaria Alliance (APLMA), its development draws upon both global and national policies. It engaged key national and international stakeholders to provide direction and clear steps for relevant actors to perform their tasks towards achieving the goal of being malaria free.
Indonesia’s comprehensive approach to malaria elimination positions it as a potential role model for other high-burden countries. By integrating universal access to prevention, diagnosis, and treatment with robust surveillance and community empowerment in the formulation of this roadmap, Indonesia demonstrates a holistic strategy that addresses both immediate and long-term challenges. The country’s focus on strengthening health systems and fostering innovation ensures that interventions are sustainable and adaptable to changing conditions. Additionally, Indonesia’s commitment to equity and human rights, ensuring no one is left behind, is exemplary and is an inclusive strategy. By sharing its experiences, successes, and lessons learned, Indonesia can inspire and guide other nations in their fight against malaria, showcasing the impact of strong leadership and coordinated efforts.
H.E. President Yudhoyono, notably, rallied political leaders in Indonesia and the region to commit support and ensure plan turn into actions. In the fight against malaria, strong and committed leadership provide clear vision and direction, which helps to mobilize resources, inspire stakeholders, and maintain momentum. By demonstrating unwavering support and taking decisive actions, leaders in Indonesia, can turn this ambitious plan into tangible outcome of achieving malaria elimination by 2030.
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