Study of Successful Malaria Eliminate Program at Teluk Bintuni District

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Indonesia targets malaria elimination in 2030 and in the Ministry of Health's Strategic Plan In 2015-2019 malaria elimination is one of the targeted diseases to reduce the illness rate from 2 per thousand population to 1 per 1,000 population. The target of malaria elimination in Indonesia in 2019 from the 2012 results of 212 increased to 300 Regencies / Cities (RI Ministry of Health, 2015). Malaria morbidity in an area is determined by Annual Parasite Incidence (API) per year. API is the number of malaria-positive cases per 1,000 residents in one year. National API trends in 2011 (API, 175) to 2015 (API 0.85) continued to decline which can be seen in the graph of the Malaria API trend in Indonesia in 2011 - 2015.

Malaria prevention efforts have been carried out since 1959 which was marked by the launching of the malaria eradication program known as the 'Malaria Extermination Command' (KOPEM) by President Soekarno. In 2000 the communist movement was known as the Movement to Fight Back Malaria or 'Gurgling Malaria' which was followed by various sectors with the slogan 'Let's Fight Malaria'. Furthermore, malaria control in Indonesia enters the phase of malaria elimination as stipulated in the Decree of the Minister of Health of the Republic of Indonesia Number 293 / MENKES / SK / IV / 2009 which aims to create healthy living communities, which are gradually free from malaria transmission until 2030 (RI Ministry of Health, 2013).

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Research in Bali Province by Roosihermiatie and Rukmini (2013), about the analysis of the implementation of malaria elimination policies in Bali Province, showed the success of the API decline. This success is based on an understanding of the malaria elimination policy regarding the procedures for implementing malaria elimination in Bali Province and the Regulation of the Regent of Karangasem No. 2 of 2010 concerning the elimination of Malaria in Karangasem Regency is sufficient in accordance with the central strategy. Funding for malaria elimination policies in Bali Province and Karangasem Regency still relies on funds from the APBD. The role of the regional government to support the malaria elimination policy is quite good, local government support in the form of policy / regulatory support, budgeting and socialization activities. Bintuni Bay Regency has declared malaria elimination in West Papua Province in 2020 which can be seen in Figure 1.3 in 2009 - July 2018.

The elimination phase is expected to be achieved by 2020 malaria cases become zero, there are only imported cases or cases from outside the Bintuni Bay Regency area considering the location of the Bintuni Bay Regency which is the gateway to West Papua Province so that population mobility is quite high, and this means difficult to control the entry of malaria cases from outside the Bintuni Bay Regency. Furthermore, at the maintenance stage, if for two years until 2026 local cases remain zero and if there are cases of malaria, these cases originating from outside the area must be quickly detected and carried out so that treatment is not contagious to the residents of Bintuni Bay Regency.

Based on preliminary studies from interviews with the Head of the Bintuni Bay District Health Office, the efforts of the Bintuni Bay government in suppressing malaria cases by making the EDAT program (early diagnostic accurate treatment) invite the participation of the community to actively participate in malaria elimination programs in the area as health cadres or health volunteers who are trained to be able to provide early treatment for malaria, in addition to diagnosing malaria in patients, they are also given provisions in terms of drug administration, prevention and reviving community movements. In addition, some programs are aimed at eliminating malaria with planning management carried out by Bintuni Bay District in malaria elimination.

Based on this, the researchers were interested in conducting research under the title of Study of the Success of the Malaria Elimination Program in the Bintuni Bay Regency of West Papua Province.

Materials and method

2.1. Type of Research

This type of research is qualitative descriptive research. Syaodih (2008) states that descriptive research is the most basic form of research. Aimed at natural or human engineering conditions. According to Syaodih (2008) in Pongtiku, et al (2016) that qualitative research is a study aimed at describing and analyzing phenomena, events, social activities, attitudes, beliefs, perceptions, and thoughts of individuals individually and in groups '. This type of research is qualitative with a case study approach, which is a method of research conducted with the aim of describing the problem that occurs to conclude the image objectively (Swarjana, 2013). Focus on research to understand the factors that influence the success of the Malaria Elimination Program in Bintuni Bay District.

2.2. Place and Time of Research

  1. 1. Place

This research was conducted at the Bintuni Bay District Health Office.

  1. 2. Time of research

The time of study took place in October 2018.

2.3. Informant

The informants in this study were all policymakers at the Bintuni Bay District Health Office as key informants related to malaria elimination efforts totaling 17 people plus 9 people from community representatives.

The selection of informants is done by using a purposive sampling technique, namely taking selected informants is seen to be more clear about malaria elimination (Saryono and Anggraeni, 2010), and can be trusted to be a good source of data and able to express opinions properly and correctly (Notoadmodjo, 2012)The key informants in this study were the Head of Bintuni Bay District Health Office 1 person, Head of Health Problems Control Division 1 person, Head of Section for Eradication of Communicable Diseases 1 person, Responsible for the Control and Eradication of Malaria 1 person, Head of Community Health Center in 13 work areas of Teluk Bintuni Regency as many as 13 people. Thus the number of informants was 17 people and as many as 9 people from representatives in the Puskesmas working area.

The adequate number of health workers and the knowledge of health workers is the ability of health workers to understand, diagnose and provide the right dose of treatment for people with malaria. The indicators that were assessed were the ability of health workers to diagnose and provide treatment doses quickly and precisely and counseling patients to improve compliance with malaria patients. If health workers understand, diagnose and provide appropriate treatment doses of patients with malaria (Hamzah, 2008).

In accordance with Permenkes No. 370 of 2014 regarding the standard microscopes D-III analyst, this was also referred to by the Decree of the Regent No. 11 of 2010 that the level of education of microscopists and malaria-level personnel was at least D-III. The decision that the quality and quantity of the distribution of health workers to control malaria has not reached the target until 2018, with a lot of energy shortages and of course the number of energy needs for 2020 is difficult to achieve according to the target.

The results of the study are in line with those conducted by Rahmawati (2012), that evaluating malaria elasticity in the city of NTT for aspects of personnel/staff management of malaria is still very minimal (2 people) even though the tasks and workload are quite large. In addition, Entomologists have not yet been in the puskesmas, even though Entomologist has an important role in efforts to break the chain of malaria transmission. Malaria eradication management staff consists of health workers and cadres who have participated in training at the level of Ternate City, North Maluku, and regional provinces (Eastern Indonesia), then according to the parameters of evaluating the implementation of malaria eradication programs in Ternate City, the personnel/workforce aspects are assessed included in the bad category because the number of Ternate City DKK technical staff, Puskesmas, cadres and other agencies is not enough to implement a malaria eradication program, the number of personnel involved in malaria control cannot cover all target areas (not spread evenly) and all DKK City technical personnel Ternate, Puskesmas, cadres and other agencies are workers who do not have the appropriate educational background and all evaluate environmental management.

Attempts to achieve malaria elimination are many obstacles encountered in various places in the world such as in achieving malaria elimination in Ethiopia according to (Woyessa, 2013) a decrease in malaria incidence observed in the past 3-4 years has not achieved the goal of malaria elimination due to individual awareness of environmental health risks reduce the occurrence of malaria infections. In Russia, technical problems occur in the final stages of the elimination program, namely difficulties in identifying patients and the absence of a very effective method for detecting malaria parasites and requiring the use of different treatment regimens and antimalarial drugs. Uncontrolled population migration is very important in the spread of infection in malaria-free areas. The urgent solution is to improve existing methods and develop new ones for infection detection and treatment and antimalarial policy packages.

In Indonesia, the Government issued a Decree of the Minister of Health Number 293 of 2009 concerning the Elimination of malaria in an effort to support the malaria elimination program. But as is the case in the Bintuni Bay District In an effort to achieve malaria elimination there are many obstacles that are encountered where there is a shortage of health workers and malaria experts. The lack of trained human resources and personnel is a major challenge to carrying out the malaria elimination planned for 2025.

Thus, the quality and quantity of the distribution of malaria control health workers in Bintuni Bay District has not been implemented properly and it is very likely that the target achievement cannot reach the target set by 2020.

4.2. Continuity of Logistics

The results showed that the sustainability of logistics in Bintuni Bay Regency was calculated in 2018 that the use of medicines and consumables was generally sufficient, with the most use of anti-malaria drugs being Arterakin (ACT) of 10,269 packages, except for those using injection parameters who experienced stock vacancies. While tools and consumables are available. The vacancy is not constrained because it runs out in the allotted time so the logistical combination in Bintuni Bay Regency is adequate. This shows the seriousness of the Bintuni Bay Regency Government in eliminating malaria by strengthening health services in combating malaria.

The results of the study are different from Rahmawati (2012) in Ternate City. For logistics, it is still considered to be lacking, this is due to limited funds. Two-wheeled vehicles at the Ternate City Health Office are limited enough to hamper operational activities considering that two-wheeled vehicles are very useful for use in areas that are quite difficult to reach using four-wheeled vehicles. The absence of computers at the puskesmas makes staff use more personal laptops in malaria eradication work, so the aspects of facilities and infrastructure are considered included in the medium category because the facilities used in implementing the program consist of program operational vehicles, spraying vehicles, spraying machines, laboratory materials, insecticides and equipment needed for malaria eradication are available, insufficient and in good condition.

According to the Indonesian Ministry of Health (2011), the Ministry of Health serves logistics in the form of drugs, reagents, medical devices, and insecticides. To support the quality of services, the logistics mechanism needs to be present. This matrix also considers the number and quality of personnel who will regulate the entry and exit of goods, maintain the quality of goods, and control the presence or absence of puskesmas / pustu / policies areas that run out of drugs or other items. In addition to the power factor, it is also necessary to have a warehouse that is feasible and meets the requirements for storing goods consisting of 2 parts, namely the drug warehouse and insecticide warehouse.

Statement from the main informant (Iu1), that: the efforts made, namely planning logistics based on reports from service facilities, then we predict in what year will the use of logistics be increased by ten to twenty percent, and include buffer stocks that must be prepared by the service. This is also stated by supporting information (IP1) that 'efforts in the procurement of logistics that have been carried out, namely through timely and correct reports for tools and reagents, are still dependent on the health department to procure it'The Bintuni Bay Regency Government based on Regent Regulation No. 11 of 2010 has been well implemented, by improving health services in treating the community by providing adequate logistics.

4.3 Cross-Sector Coordination

The results of the study found that cross-sectoral coordination in malaria eradication was done by collaborating with the Coordination Meeting on malaria control, a technical meeting on malaria control and a meeting to revise the malaria control plan held every 4 years. The purpose of the implementation is to examine the results of cross-sectoral cooperation activities and the arrangement of the next quarter's work plan Cross-sector-specific objectives are discussed and are resolved jointly across sectors and the obstacles faced. New cross-sectoral work mechanisms/plans are formulated for future work plans (Bustami, 2011).

Cross-sector activities when linked to malaria elimination policies, activities are related to vector control efforts, environmental health management and health promotion. Malaria transmission can be minimized by controlling Anopheles Sp mosquitoes as malaria-transmitting mosquitoes. Some vector control efforts that can be carried out in the malaria program are larviciding (the controlling action of Anopheles larvae chemically using insecticides), biological controls (using larvae-eating fish), environmental management and others. Control of adult mosquitoes is done by spraying the walls of the house with insecticides (IRS / Indoors Residual Spraying) or using an insecticide-treated mosquito net. But it needs to be emphasized that vector control needs to be REESAA (rational, effective, efficient, sustainable, effective and affordable) given Indonesia's vast geographical conditions and diverse bionomic vectors so that mapping of breeding places and mosquito behavior is very important (Pusdatin Kemenkes RI, 2011). For this reason, the role of the government, all stakeholders and the community is needed in controlling malaria vectors.

The results of this study were not different from those of Roosihermiatie and Rukmini (2012) regarding malaria elimination policies in Bali Province, that cross-sectoral coordination was still lacking, even the cross-sectoral coordinators did not know the malaria elimination policy from the Governor of Bali. Cross-sectoral coordination in Teluk Bintuni Regency from informant interviews (Iu4), that 'cross-sectors are still needed by comrades from other sectors to also participate in coordinating efforts to control malaria. This shows that cross-sector coordination in Bintuni Bay District shows a lack of commitment from policymakers in the Bintuni Bay Regency. This is also supported by the statement of all supporting informants that: Cross-Program coordination is carried out by Malaria Integration activities, both immunization and MCH, namely for KIA Skiing Malaria activities for pregnant women and distribution of bed nets and for immunization for providing mosquito nets for those who finish measles immunization, across sectors do PLA activities

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