The Importance of Health Prevention to Handling Catastrophic Diseases in North Kalimantan
The Importance of Health Prevention to Handling Catastrophic Diseases in North Kalimantan

The Importance of Health Prevention to Handling Catastrophic Diseases in North Kalimantan

AUTHORS: Diah Ilmi Rizqiana, Fiorentina, Lukman Hapsaro, Nurfitri Azhri

Reviewers: Dinda Ganisawati Javada, Eulis Ardiyanti, Farid Al-Firdaus, Fatimah Azzahra, Mike Damayanti

Indonesia’s Pillar of Health in 2045

In 2045, Indonesia is projected to experience a demographic bonus, with 70% of its population falling within the productive age range of 15-64 years (IndonesiaBaik Article). One of the key objectives for achieving a Golden Indonesia in 2045 is the “Indonesia Sehat” program, which aims to establish a resilient and responsive healthcare system and ensure that the population enjoys long and healthy lives. However, data from Riskesdas 2018 revealed that over 50% of the Indonesian population is afflicted by catastrophic diseases, primarily non-communicable diseases (NCDs). The prevalence of NCDs particularly among individuals aged 45 and above, poses a challenge for Indonesia in managing the demographic bonus anticipated in 2045. To achieve health development targets, including the 2030 Sustainable Development Goals (SDGs) and the Executive Summary of Indonesia’s Vision 2045, proactive health prevention measures are required to reduce the incidence of NCDs.

The Highest Burden of Health Insurance

The high prevalence of NCDs including catastrophic diseases require extensive and costly medical treatment. In Indonesia’s National Health Insurance Program (JKN), diseases categorized as catastrophic include heart disease, kidney failure, cancer, stroke, liver cirrhosis, thalassemia, leukemia, and hemophilia. According to the Media Info BPJS Health Edition 104 report heart disease, in particular, imposes a significant financial burden as the most costly expenditure within JKN services and accounts for the highest expenditure in the state budget from 2016 to 2019. Catastrophic diseases are typically treated at secondary healthcare facilities with higher services fees. From 2016 to 2020, the cost of health services reached IDR 374.86 trillion, with 83.31% attributed to referral services for catastrophic diseases. According to Riskesdas 2018 data, North Kalimantan has the highest prevalence of heart disease and kidney failure. Therefore, it is crucial to implement preventive measures and provide healthcare services that enable early detection of diseases.

NCDs Prevention in North Kalimantan

Meanwhile the high prevalence of catastrophic diseases in North Kalimantan can be attributed to the inadequate implementation of promotive and preventive actions at the Primary Healthcare level. According to the 2021 Indonesian Health Profile, North Kalimantan has approximately 40% of its districts implementing prevention efforts in the form of Integrated Services for NCDs (Pandu PTM) at Primary Healthcare level. Additionally, independent and continuous early detection efforts are conducted under the guidance of Primary Healthcare through Integrated NCDs Development (Posbindu PTM) by home visiting. As of 2021, there were a total of 75,508 Posbindu PTM across the country, with North Kalimantan having the lowest number of 124 Posbindu PTM, reaching only 21.1% implementation rate for Pandu PTM. 

The Study of Policy Implementation of Catastrophic NCDs services from 2015 to 2018 identified several challenges in implementing early detection of NCD risk factors. These challenges include limited budget, inadequate screening facilities, and difficulties in reaching the productive age group. Additionally, addressing infrastructure such as transportation access challenges is crucial. Residents in remote areas, border regions, and those living on outer islands generally face difficulties in accessing quality primary healthcare services (Diskominfo Kaltara). The road construction techniques in North Kalimantan are the most difficult due to the geography which has hilly terrain, unstable ground contours, and protected forest status compared to all Provinces in Kalimantan.

Policy Recommendations

Promotive and Preventive Actions

The government must ensure the full implementation of NCD prevention through Pandu PTM to achieve 100% coverage. It should be conducted at least once a year and focus on assessing smoking behavior, obesity, blood pressure, blood sugar, and cholesterol levels. Furthermore, the government should increase the number of Posbindu PTM in North Kalimantan by establishing additional centers and expanding their reach to remote and underserved areas. Programs like the North Kalimantan Flying Doctor Service should be expanded in coverage before adequate and equitable infrastructure is available to access primary healthcare services. Posbindu PTM can be conducted monthly aiming to reach the entire population aged 15-59 years, focusing on measurements like height, weight, Body Mass Index (BMI) calculation and providing education on NCD risk factors. 

As for addressing transportation access challenges, an agenda for road infrastructure development is already in place, aiming to enhance regional connectivity and provide access to remote areas. Priority is given to the implementation of flexible pavements in densely populated regions with existing settlements and essential public facilities, such as health centers, markets, schools, and government offices. This agenda is expected to support efforts in the prevention of NCDs.

Additional Budget for Promotive and Preventive Actions

In 2023, the Ministry of Health has been allocated a budget of 85 trillion from the 2023 State Budget. The budget is divided into six priorities, aligned with the healthcare transformation efforts. The Transformation of Primary Services is the top priority and receives 7% of the budget, totaling 5.9 trillion. An additional 12.7 trillion is allocated as Non-Physical Special Allocation Funds (DAK) to cover operational costs of Primary Health Care, including funding for essential medicines, consumable medical materials, and enhancing the performance of healthcare workers and cadres. 

For North Kalimantan, 22.1 billion is allocated for Fast Action Team Training at Health Centers (SKN) and Healthy Living Movement (Germas) Literacy. These initiatives are aimed at reducing catastrophic diseases and funded by Ministries/Institutions. Optimizing budget utilization and supervision is crucial to achieve a decline in catastrophic disease cases in North Kalimantan.

Improve Human Resource for Screening 

Primary Healthcare has a crucial role in combating NCDs by actively promoting health check-ups and educating the public. Taking inspiration from India’s ASHA program, competent individuals can assist in community outreach and education. India’s Accredited Social Health Activist (ASHA) are among the six recipients of the WHO Director-General’s Global Health Leaders Award and have been recognised for their outstanding contribution towards protecting and promoting health. By reintroducing Posbindu PTM, screening tests can be conducted in various settings, including government agencies and educational institutions. Furthermore, cadres will bring civic engagement coordinated with a non-governmental organization. This initiative aims to foster routine health check-up habits within the community, leading to early detection of NCDs and improved health outcomes.


The government should consider providing incentives to cadres and establishing a benchmarking system based on ASHA’s training and education model to enhance the effectiveness of Posbindu PTM. Additionally, coordination among organizations, NGOs, Primary Healthcare, schools, and workplaces can reach more people and expand the screening subjects. Increasing budget allocation for early screening programs, pharmaceuticals, medical devices, and implementing the road infrastructure agenda will help expand the screening process. 


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