Achieving universal social protection for people with tuberculosis.

As we mark World TB Day 2024, we take this opportunity to reflect on the 2023 UN General Assembly High-Level Meeting (HLM) on the fight against tuberculosis-a milestone in the commitment towards a more coordinated, comprehensive approach to end tuberculosis globally. The UN HLM declaration on the fight against tuberculosis includes a specific pledge that all people with tuberculosis should receive a social benefits package to mitigate financial hardship. However, it is not known how this specific pledge will be realised and through which concrete actions. The use of the term financial hardship instead of WHO's key End TB Strategy indicator of catastrophic costs might prove challenging for robust evaluation of both the socioeconomic impact of tuberculosis and the effectiveness of socioeconomic support strategies to mitigate this impact. Moreover, in contrast to the financial pledges made for biomedical interventions, there was an absence of explicit investment in social protection. Such investments are imperative to facilitate successful expansion of social protection to meet the needs of people with tuberculosis and their households. Successful expansion of social protection is also dependent on political commitment and protected budgets from relevant stakeholders, including across government ministries. These strategies will help to ensure that the commitments on social protection made in the UN HLM declaration are turned into tangible actions with measurable effects.

Taxing sugar sweetened beverages in Indonesia: Projections of demand change and fiscal revenue.

The global trend of diets high in sugar sweetened beverages (SSB) is associated with a high risk of obesity and non-communicable diseases (NCDs). To reduce SSB consumption on a population level, SSB taxes have become a popular policy solution. In Indonesia, although the prevalence of obesity has doubled in the past decade (11.7% in 2010 to 21.8% in 2018), SSB taxes have not yet been implemented. Utilizing the 2021 Indonesian household socioeconomic survey (SUSENAS), this study estimated price elasticities and projected the plausible effects of implementing an SSB tax on consumers' demand for SSBs and the associated government revenue using the Quadratic Almost Ideal Demand System (QUAIDS) model. Five SSB groups were studied: 1) manufactured liquid milk; 2) sweetened condense milk; 3) instant coffee; 4) tea drinks and fizzy drinks with CO2; 5) fruit juices, "health" drinks, and energy drinks. The overall results showed that the non-milk SSB groups were price elastic. Probing deeper into the substitutions for SSB across categories, we found both substitutionary and complementary effects. Our analysis revealed that increasing SSB prices by 20% would reduce the demand for SSBs on average by 17.5% (14.3%-18.6% for each SSB group) and generate additional state revenue up to IDR 3,628.3 billion per year (approximately US$ 238.5 million or 0.2% of total tax revenue in 2022). Considering the health and economic impacts of high consumption of SSBs, this study provides empirical evidence that imposing taxes on SSBs could be an effective measure to reduce public consumption and to generate tax revenue for financing health programs that address obesity and NCDs in Indonesia.

The advocacy coalition of sugar-sweetened beverage taxes in Indonesia.

The Ministry of Finance of Indonesia has put sugar-sweetened beverages (SSBs) taxation on its agenda since 2020 to address the need for health financing, as outlined in the National Medium-Term Development Plan for 2020-2024. However, the adoption process of this fiscal policy has been slow. This study aims to generate insights into the actors involved in the discourse of SSB tax adoption in Indonesia to inform their advocacy and communication efforts using the Advocacy Coalition Framework and Discourse Network Analysis. The analysis was conducted using data extracted from 1733 statements collected from 200 online web domains and subdomains, divided into three timeframes of the policy process. The analysis identified actors supporting and opposing the adoption of SSB tax. The discourse network also identified key advocacy coalitions and organisations in the discussion on SSB tax adoption in Indonesia. The results indicate that there are diverse network patterns in each timeframe and reveal the process and focus of the policy change. The Ministry of Finance had the most significant influence on the discourse, with actors from civil society organisations and universities involved in the process of policy change through evidence-based policy recommendations. Meanwhile, economic actors contributed to the debate on the potential harm of tax adoption to the industry. These findings can inform the policy process and ensure the successful adoption of the SSB tax in Indonesia.

Seroprevalence of antibodies against SARS-Cov-2 in the high impacted sub-district in Jakarta, Indonesia.

BACKGROUND: Understanding the actual prevalence of COVID-19 transmission in the community is vital for strategic responses to the pandemic. This study aims to estimate the actual infection of COVID-19 through a seroprevalence survey and to predict infection fatality rate (IFR) in Tanjung Priok, the hardest-hit sub-district by the COVID-19 in Jakarta, Indonesia. METHODS: We conducted a venous blood sampling (phlebotomy) to 3,196 individuals in Tanjung Priok between Nov 23, 2020, and Feb 19, 2021 to detect their antibodies against SARS-CoV-2. Using an enumerator-administered questionnaire, we collected data on the respondents' demographic characteristics, COVID-19 test history, COVID-19 symptoms in the last 14 days, comorbidities, and protective behaviours during the last month. We employed descriptive analysis to estimate the seroprevalence and IFR. FINDINGS: The prevalence of Antibody against SARS-CoV-2 was 28.52% (95% CI 25.44-31.81%), with the result being higher in females than males (OR 1.20; 95% CI 1.02-1.42). By the end of the data collection (February 9, 2021), the cumulative cases of COVID-19 in Tanjung Priok were reported to be experienced by 9,861 people (2.4%). Those aged 45-65 were more likely to be seropositive than 15-19 years old (OR 1.42; 95% CI 1.05-1.92). Nearly one third (31%) of the subjects who developed at least one COVID-19 symptom in the last 14 days of the data collection were seropositive. The estimated IFR was 0.08% (95% CI 0.07-0.09), with a higher figure recorded in males (0.09; 95% CI 0.08-0.10) than females (0.07; 95% CI 0.06-0.08), and oldest age group (45-65) (0.21; 95% CI 0.18-0.23) than other younger groups. CONCLUSION: An under-reporting issue was found between the estimated COVID-19 seroprevalence and the reported cumulative cases in Tanjung Priok. More efforts are required to amplify epidemiological surveillance by the provincial and local governments.

Socioeconomic and Behavioral Correlates of COVID-19 Infections among Hospital Workers in the Greater Jakarta Area, Indonesia: A Cross-Sectional Study.

(1) Background: because of close contacts with COVID-19 patients, hospital workers are among the highest risk groups for infection. This study examined the socioeconomic and behavioral correlates of COVID-19 infection among hospital workers in Indonesia, the country hardest-hit by the disease in the Southeast Asia region. (2) Methods: we conducted a cross-sectional study, which collected data from 1397 hospital staff from eight hospitals in the Greater Jakarta area during April-July 2020. The data was collected using an online self-administered questionnaire and Reverse Transcription-Polymerase Chain Reaction (RT-PCR) tests. We employed descriptive statistics and adjusted and unadjusted logistic regressions to analyze the data of hospital workers as well as the subgroups of healthcare and non-healthcare workers. (3) Results: from a total of 1397 hospital staff in the study, 22 (1.6%) were infected. In terms of correlates, being a healthcare worker (adjusted odds ratio (AOR) = 8.31, 95% CI 1.27-54.54) and having a household size of more than five (AOR = 4.09, 1.02-16.43) were significantly associated with a higher risk of infection. On the other hand, those with middle- and upper-expenditure levels were shown to have a lower risk of infection (AOR = 0.06, 0.01-0.66). Behavioral factors associated with COVID-19 infection among healthcare and non-healthcare workers included knowledge of standard personal protective equipment (PPE) (AOR = 0.08, 0.01-0.54) and application of the six-step handwashing technique (AOR = 0.32, 0.12-0.83). (4) Conclusion: among hospital staff, correlates of COVID-19 infection included being a healthcare worker, household size, expenditure level, knowledge and use of PPE, and application of appropriate hand washing techniques.