Strengthening government’s response to COVID-19 in Indonesia: a modified Delphi study of medical and health academics

The Indonesian government has issued various policies to control COVID-19. However, COVID-19 new cases continued to increase and there remains uncertainties as to the future trajectory. We aimed to investigate how do medical and health academics view the Indonesian government’s handling of the COVID-19 and which area of health systems that need to be prioritized to improve government’s response to COVID-19. We conducted a modified Delphi study adapting the COVID-19 assessment score card (COVID-SCORE) as the measurement criteria. We invited medical and health academics from ten universities across Indonesia to take part in the Delphi study. In the first round, participants were presented with 20 statements of COVID-SCORE and asked to rate their agreement with each statement using five-point Likert scale. All participants who have completed the first cycle were invited to participate in the second cycle in which they had the opportunity to revise their answer based on results of previous cycle and to rank a priority of actions to improve government response. We achieved consensus for 5 statements, majority agreements for 13 statements and no consensus for 2 statements. The prioritization suggested that top priorities for improving government’s response to COVID-19 in Indonesia, according to medical and health academics, encompass: (1) The authorities communicate clearly and consistently about COVID-19 and provide public health grounds for their decisions; (2) Everyone can get a free, reliable COVID-19 test quickly and receive the results promptly; (3) Contact tracing is implemented for positive cases; (4) Public health experts, government officials, and academic researchers agree on COVID-19 nomenclature and clearly explain the reasons for public health measures; and (5) Government communications target the entire diverse population. Ultimately, our study highlights the importance of strengthening health system functions during the pandemic and to improve health system resilience for dealing with future public health emergencies.

A four-step process for building sustainable access to diagnosis and treatment of Chagas disease

The vast majority of people with Chagas disease (CD) are undiagnosed and untreated. Improving access to diagnosis and treatment for CD involves confronting a wide range of barriers. This report discusses a collaborative approach to eliminate barriers and increase the availability of CD testing and treatment. Potential areas for intervention are selected based on burden of disease, support of local champions, and commitment from national and local authorities. A 4D approach (diagnose, design, deliver, and demonstrate impact) is then implemented. The diagnose step involves gathering key stakeholders at a seminar to collaboratively identify important barriers and propose solutions. The design step creates a specific plan to act upon the seminar’s conclusions with consensus on core indicators. The deliver step entails implementing the plan at pilot locations, while simultaneously strengthening health system capacity for CD testing and treatment. Lastly, the demonstrate impact step compares baseline data with annual post-implementation data to measure progress. In Colombia, this approach has helped simplify testing procedures and increase CD testing and treatment access in pilot communities, though challenges remain. The 4D approach represents one of several pathways toward ensuring that the best therapeutic and diagnostic products reach people affected by neglected tropical diseases.

FUTURE OF HEALTH POLICY & SYSTEMS RESEARCH: TRANSITIONING FROM MILLENNIUM DEVELOPMENTAL GOALS TO SUSTAINABLE DEVELOPMENTAL GOALS FOR IMPROVING HEALTH

The importance of health policy and systems research (HPSR) for strengthening health systems is widely recognized. However, availability and uptake of research evidence for health systems to formulate evidence informed policies is challenging. The transition from Millennium Development Goals to Sustainable Development Goals (SDG) represents a new global promise to health by encompassing a broader range of economic, environmental, and social pillars of sustainable development. The adoption of the 2030 agenda offers an exciting opportunity for strengthening health system governance. The integration of HPSR is essential for the fulfillment of SDGs through the collaboration of multiple sectors and policy coherence. Various innovative strategies have been recognized to build strong partnerships between researchers, policy-makers, and academicians to highlight the role of HPSR in realizing and achieving SDGs. Multilateral and bilateral organizations working in the field of HPSR can play a facilitatory role to inform the development of healthcare reforms through strategic engagement among a variety of stakeholders.