Tight budgets and bureaucracy hamper efforts to fight Tuberculosis in Indonesia

This story by Arpan Rachman originally appeared on Global Voices on October 31, 2025.

Laeli Rezki is a 20-year-old woman and a tuberculosis (TB) survivor in the Sudiang urban suburb in Makassar, Indonesia. Nowadays, she is fully recovered and busy helping her mother sell food out of their home.

Rezki worked for over a year at a food processing factory before leaving her job in August 2025. Her healthcare providers suspect she contracted TB from a coworker at her workplace. TB spreads through the air through the bacteria Mycobacterium tuberculosis when an infected person coughs, sneezes, or talks. It most often attacks the lungs and causes chest pains, difficulty breathing, and a persistent cough. If left untreated, TB can be lethal.

Even while sick, Rezki worked continuously. She said:

The second-highest TB rate in the world

After visiting a clinic, Rezki was referred for outpatient treatment at Dr. Tadjuddin Chalid Hospital in Makassar. Treatment for TB can be a long and strenuous process, typically taking between six and nine months to treat.

She had to take three drugs every eight hours for about six months. She used alarms on her phone to stick to a strict food and medicine schedule during the treatment process. She was especially fortunate in that her mother was willing to accompany her as a Drug Ingestion Supervisor, someone who volunteers to help and supervise patients in taking their medications regularly until they recover. 

Her mother followed the doctor’s advice to keep a safe distance at home, wear masks, and maintain her own health. By the end of June 2025, after six months of treatment, Rezki is now healthy. Much of the treatment was covered by insurance, leaving Rezki to pay IDR 35,000 (USD 2.10) per month from her own premium as a member of the independent Health Social Security Agency.

Indonesia ranks second in the world for tuberculosis cases, following India. According to the World Health Organization’s Global Tuberculosis Report 2024, 87 percent of TB cases in 2023 were found in 30 high-burden countries. Indonesia is one of the top five, with 1,090,000 cases and around 125,000 deaths last year. This means about 14 people die from TB every hour in Indonesia.

See Also: On the Path to a New TB Vaccine?

The Ministry of Health stated in 2022 that there were an estimated 969,000 new TB cases in Indonesia, of which 25 percent were undetected and unreported. Of the 75 percent of cases, 24 percent did not complete treatment. South Sulawesi Province reported 10,715 TB cases between January and May 2025, with Makassar City recording the highest number at 3,483.

TB is the world’s deadliest infection, according to the World Health Organization. Though it is treatable and preventable, it remains one of the world’s most dangerous diseases and still kills upward of 1 million people each year. One of the best ways to prevent TB outbreaks is through vaccination, aggressive testing, community monitoring, and contact tracing. Many health clinics set targets for TB identification and tracing as part of their prevention and tracking efforts.

Currently, the most common TB vaccine is the BCG vaccine, which was first deployed in 1921 and mainly protects children against severe TB, but its protection fades as people get older. Professor Erlina Burhan from the University of Indonesia shared that researchers are testing the M72/AS01E vaccine on more than 20,000 people in several countries, including Indonesia. These phase 3 clinical trials are important for understanding how well the vaccine works and how safe it is for large groups. If the trials are successful, the vaccine could be available by 2028 or 2029 and may help in the fight against TB. Along with vaccination, people can take other steps to prevent TB, such as wearing masks, improving ventilation, finding and treating latent infections early, eating nutritious food, maintaining cleanliness, and not smoking.

X-rays and sputum test

Dr. Andi Mariani, who leads Disease Control at the Makassar City Health Office, shared that by October 2025, the office had found 7,000 new TB cases — 86 percent of their tracing goals for the year. Health workers are hopeful about fulfilling the 2025 target because they are working hard to collect data, find cases, and provide treatment. They also check people who do not show symptoms if those individuals agree to have X-rays, sputum tests, or both as part of their efforts to identify early cases.

Mariani said:

TB rates in Indonesia are monitored through the Tuberculosis Information System (SITB), a digital platform for recording and managing TB cases. SITB integrates TB control data from health facilities such as community health centers (Puskesmas) — public clinics serving local residents — and hospitals. Importantly, it is accessible both online and offline, which supports case tracking, treatment management, and program reporting. Furthermore, SITB connects to the Ministry of Health and can share information with other health systems.

Mariani explained that many people with TB still face stigma and discrimination, which makes the disease a sensitive topic and hinders its eradication. She hopes that by finding and treating more TB cases, the number of cases will go down. If everyone who is detected receives treatment until they are cured, there will be little or no further transmission, or at least much fewer than if cases go undetected.

Funding TB prevention

Dr. Henry Diatmo, Executive Director of the Stop TB Partnership Indonesia, said that most of the funding for Indonesia's tuberculosis program in 2023 will come from Global Fund grants (64 percent), with the State Budget providing 21 percent and other partners contributing 7 percent.

See Also: Cash and Counselling Slash Unsuccessful TB Outcomes by Half

However, the government is now tightening its budget, which could affect efforts to fight TB. Funding cuts affect meetings, operational coordination, and non-essential activities. Support for community activities, like cadres, is no longer included in the government budget.

Diatmo said:

At the same time, President Donald Trump stopped USAID funding, further shrinking the available resources. USAID provided Indonesia with USD 91,000 between 2006 and 2024 for its TB program. The Global Fund to Fight AIDS, Tuberculosis, and Malaria has also cut USD 1.4 billion for disease prevention efforts due to funding constraints.

Diatmo suggests that Indonesia should not depend solely on foreign donors. He recommends that the government identify priority programs for state budget funding using a data-centric approach.

Budget bureaucracy

Beyond the Health Office, the Makassar City Government established a Multi-Sector Forum (FMS) for TB Elimination in 2022 as a pentahelix formation. The FMS received a grant of IDR 3.5 billion (USD 210,000) from the Makassar City Government in 2023. In addition, IDR 7.65 billion (USD 460,000) is available in 153 urban suburbs in Makassar (each suburb received IDR 50 million, or USD 3,000) for TB outreach and screening. According to a Lae Lae Urban Suburb staff officer, a TB outreach event was held once at the Ujung Pandang District office in 2023.

Sierli Natar, a member of the FMS and a public servant of the Makassar City Health Office, said:

The draft 2023 FMS Annual Report, seen by the author, describes efforts such as training trainers to help eliminate TB in urban suburbs, providing supplementary food to 80 TB patients for 3 months, helping TB-affected communities build skills, and offering peer support training for TB survivors. FMS has since paused its work and halted any new activities.

Natar explained that FMS activities have been paused because of a leadership change in the Makassar City Government. Indira Yusuf Ismail previously led FMS, but after she lost the 2024 election and Munafri Arifuddin became mayor, the program was suspended. Still, this does not mean that stopping the FMS program caused an increase in infections.

(SY)

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