WHO’s Indonesia TB stats

How pirate metrics work in a TB elimination campaign

Indonesia’s TB incidents lingered at 133 new cases per 100 thousand population in 2018.

What’s worse, people affected by TB are excluded from their social circles and often their own family, face discrimination in health care, and are even robbed of employment opportunities. It will take longer path to reduce TB incidents in Indonesia due to social stigma of TB patients that eventually affect the performance of Tuberculosis Preventive Treatment (TPT) take-up in Indonesia.

To increase TPT take-up among Indonesians, I’ve been thinking of…

An integrated campaign

People consume content almost every hour; it has become normal for an average Indonesian to spend half their day on the internet. People are now hardwired to switch rapidly between activities, allowing almost no room for fixated attention to a particular medium. This says, a social media-based campaign without ease of access to TPT, or positive news-based publication without access to non-judgmental healthcare practitioners is pointless. There’re 3 steps at the least before I got to map the proposed activities:

Step #1: find the nationwide targeted TPT take-ups in numbers

Let’s see what the National Strategy of TB Care and Prevention in Indonesia aims by 2024:

Target #1: at least 110,356 of kids below 5 y.o who live with lab-confirmed TB patients receive TPT;

Target #2: at least 122,618 of kids between 5 and 14 y.o who live with lab-confirmed TB patients receive TPT;

Target #3: at least 696,197 of people above 15 y.o who live with lab-confirmed TB patients receive TPT;

Target #4: at least 87,858 of people living with HIV/AIDS (PLHIV/AIDS) receive TPT;

Target #5: at least 111,986 of people with risk factors of TB receive TPT.

I’d like to go through each of these targets, but I don’t want to be boring. So, let’s pick target #1 and #2 instead

Step #2: identify the challenges

Once the success indicators are identified, I needed to see possible situations that might’ve gotten in the way. Could there be specific behavior among people not taking TPT at the moment?

An infographic PSA in Bahasa Indonesia on TB Preventive Treatment (TPT) for kids
An infographic PSA in Bahasa Indonesia on TB Preventive Treatment (TPT) for children. Picture courtesy of Ministry of Health of the Republic of Indonesia

Parents and/or guardians are among the first people the campaign has to reach when it comes to campaigning to kids and teenagers. Unfortunately, I haven’t found reliable scientific studies on Indonesian parents’ perception towards TPT, although other studies helped me a lot in identifying people’s perception towards TB itself.

I then listed assumed challenges to TPT take-up among kids and teenagers in Indonesia:

  • Parents*/ guardians are unaware if their family member(s) is a TB suspect
  • Parents/ guardians are aware their family member(s) may catch TB, but it isn’t lab-confirmed
  • Parents/guardians are aware that their family member(s) is lab-confirmed TB patient, but they have 0 awareness of TPT
  • Parents/guardians are aware that their family member(s) is lab-confirmed TB patient and they have minimal awareness of TPT, but never seek medical confirmation
  • Parents/guardians are aware that their family member(s) is lab-confirmed TB patient and they’re fully aware of TPT, but don’t seek TPT
  • Parents/guardians are aware that their family member(s) is lab-confirmed TB patient, fully aware of and are willing to receive TPT but don’t engage in the treatment
  • Parents/guardians refrain from giving TPT

*’parents’: expecting and the currently-parents

The list can go on and on, but I tried to keep it as short and nice as possible

Step #3: define expected outcome(s) of the campaign

Now that I’ve dropped the list of assumed challenges to meeting the 2024 goals, I could figure out desired specific behaviors of the parents and the kids and teenagers themselves:

(P.S. this’d come in handy in numbers)

  • Parents/ guardians living with TB suspects or lab-confirmed TB patients seek medical advice for younger family members
  • Parents/ guardians living with lab-confirmed TB patients who’ve sought and received medical advice on TB take TPT for their younger family member(s)
  • Parents/ guardians living with lab-confirmed TB patients whose younger family member(s) on TPT make monthly visit to a health professional and receive continuing treatment
  • Parents/ guardians living with lab-confirmed TB patients whose younger family member(s) on TPT make immediate visit to a health professional if something unexpected happens
  • Young family members engaged in TPT never miss taking medication within the designated period
  • Young family members engaged in TPT don’t lose weight and even maintain physical health
  • Lab-confirmed TB patients whose family members take TPT continue their TB medication despite unwanted side effects

Again, the list can go on and on, but let’s keep it as short and nice as possible

Step #4: map the proposed activities in AAARR

This is the fun part

Once I knew the nationwide target of TPT take-ups, assumed the challenges to meeting the target, and define desired behavior of the campaign’s audience, I list all of thinkable activities where parents and guardians would be involved in using the pirate framework:

Awareness:

  • New and returning patients, of small and big healthcare, with respiratory issues receive a flyer containing general information on TB and a call-to-action (CTA) to consult with doctors on 11 telemedicine apps, visit designated helpline(s) if their household members catch symptoms of TB or visit the nearest health facilities. The pamphlet is given after payment
  • A flyer containing general information of TPT is given after the payment/ data verification of new TB suspects and returning TB patients at small and big health facilities
  • The poster version of the 2 flyers should be displayed in the waiting room and the payment area
  • The mobile version of the 2 flyers is sent via WhatsApp at every new account registration on 11 telemedicine apps; as for existing accounts, it can be broadcast anytime
  • In less-populated areas, the big-size version of the 2 flyers should be distributed to households within postal service coverage from a health facility (mind you, some parts of Indonesia are geographically challenging)
  • The poster version of the 2 flyers should be displayed on waiting area, canteen’s entrance and toilet’s entrance at schools and outside classrooms
  • Collaborate with popular GPs and maternal health as well as respiratory professionals to create TikTok and Instagram Reels videos on the most common questions on TB and TPT (TikTok and Instagram’re popular among moms)
  • Host customer service training to agents of the designated helplines
  • Collaborate with popular GPs and maternal health as well as respiratory professionals to create tweets on the most common questions on TB and TPT
  • Collaborate with Indonesian online media platforms to increase existing relevant articles’ rank on Google search. The aforementioned CTA and designated helplines should be available on every article and a backlink to an article on TPT
  • Collaborate with online media platforms to create more articles on TPT, and improve their Google search rank
  • Collaborate with HIV counsellors to broadcast the mobile version of the flyers to their social circles and HIV patients
  • Advocate for ending the stigma and for non-judgmental reporting of TB cases to mainstream media

Acquisition:

  • School administrators and teachers all over Indonesia should be able to request a virtual meeting or call with a TB counsellor. The mobile version of the 2 posters should be sent via WhatsApp to those making the call/ in the virtual meeting
  • Collaborate with medical media platforms to host live free consultation on YouTube on TPT. Invitation of the free consultation is broadcast through host platforms’ social media channels
  • Collaborate with medical media platforms to host free seminars on TPT at health facilities of districts and subdistricts with the highest TB incidents across Indonesia. Invitation of each seminar is broadcast through location-based SMS D-5 days and D-5 hours as well as through social media channels of the host healthcare facilities
  • Monitor agent performance on the designated helplines
  • Collaborate with for-profit companies to host seminars and TB testing in detention centers. The 2 flyers are given to participants of the seminars and testing events
  • Request CSR program from mining companies in forms of TB seminars and testing events at mining facilities. The 2 flyers are given to participants of the seminars and testing events
  • Collaborate with social media-popular HR experts to host fireside chats and/or live YouTube sessions on discrimination at work, in which representatives of employment agencies (it’s ‘Disnaker’ in Indonesian) speak. Participants of these activities also get to hear about TPT
  • Collaborate with for-profit companies and social media-popular HR experts to host seminars and TB testing events

Activation:

  • Track lab-confirmed TB patients from all TB testing events and provide TPT for their household members/ people who live with them

Retention:

  • Collaborate with financial advisors and TB counsellors to host free live financial consultation for parents and/or guardians
  • Collaborate with PLHIV/AIDS communities, financial advisors and TB counsellors to host free live financial consultation for parents and/or guardians whose children are on TPT
  • Collaborate with Indonesian medical media platforms to host live free consultation on YouTube on TPT. Invitation of the free consultation is broadcast to parents and guardians via host platforms’ social media channels
  • Collaborate with popular culture media to produce videos on how people taking TPT fight for their health

Referral:

  • Collaborate with Lambe Turah (one of Indonesia’s most-followed celebgram with huge followers of moms) and other social media-based citizen activism channels to generate personal stories about non-judgmental health professionals
  • Collaborate with most-watched and most-followed popular culture media to produce video stories on people who religiously follow TPT

Revenue:

  • This campaign should be not-for-profit, so I wasn’t sure where it’d fit

Step #5: execute and evaluate

Phew, the long lists are now covered! It’s time to throw the real work, track the performance on regular basis and act on the results.

I’m aware there may be other ideas to fit Awareness, Acquisition, Activation, Retention and Referral phase better. If you happen to read this and have any of them, feel free to drop your thoughts!

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I overthink things. https://www.linkedin.com/in/novanarima/

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Aisyah Novanarima

Aisyah Novanarima

I overthink things. https://www.linkedin.com/in/novanarima/

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