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Tackling diabetes head-on. A story of public and private sector collaboration in Indonesia

Despite solid economic growth in recent years, Indonesia still faces a series of structural challenges on the road towards poverty alleviation. Overcoming these challenges is essential if Indonesia is to accelerate this process.

Palladium's Indonesia MAMPU team at the Cegah Resiko Tinggi Technical workshop

Palladium and the National Team for the Acceleration of Poverty Reduction (TNP2K) have joined forces to design and drive Indonesia Mampu – a Coalition for Prosperity in Indonesia. Indonesia Mampu will enable systemic change across key education, health, employment and economic growth issues. The first intervention, called Cegah Risiko Tinggi, focuses on preventing the increase of diabetes in Indonesia. In May this year, Palladium and TNP2K hosted a workshop with organisations from the private and public sectors to discuss priority activities for this ambitious initiative.

Indonesia Mampu
Indonesia Mampu exists to develop multi-actor partnership models that have the capability to fund and deliver targeted poverty reduction interventions across the country. All members of these Positive Impact Partnerships share the belief that the country’s complex socio-economic challenges can be effectively addressed by establishing coalitions. The combination of private sector, government, civil society, funder and investor organisations creates a powerful platform to achieve meaningful and enduring impact.

“Poverty reduction programs cannot succeed if executed by the government alone, we need participation from the private sector … I believe we should have a new design for partnerships which also bring value for companies. This is why we are setting this up, it is a process” Pak Bambang Widianto, Deputy for Social Welfare and Poverty Alleviation/Executive and Secretary of TNP2K.

Indonesia Mampu’s partnership framework will focus its development agenda on health, education, employment and economic growth in line with TNP2K’s key priorities. The first intervention, called Cegah Risiko Tinggi, aims to drive systemic change to support the reduction of diabetes in Indonesia.

The challenge of diabetes in Indonesia – a burden to prosperity
Around 10 million people in Indonesia are living with diabetes, 6.2% of the adult population. The figure is expected to grow to 11.8 million by 2030. That’s a growth rate higher than that projected for the population itself! Diabetes in Indonesia has historically shown higher prevalence amongst the poor and lower educated segments of the population. According to the International Diabetes Federation (2016) almost 185,000 Indonesians died from diabetes in 2015, making diabetes and associated complication a leading cause of death in the country alongside heart-related and respiratory diseases.

As of 2013, close to 59% of all diabetes cases went undiagnosed and, of those that were diagnosed, only 1.6% achieved treatment targets. In 2014, diabetes was estimated to have cost the Indonesian health system $1.6 billion a year – more than 40% of the overall government spending on Non-Communicable Diseases (NCDs).

So as is clear, the scale of diabetes in Indonesia makes it a huge barrier to development and economic growth, especially for the poorest in society.

Our solution – Positive Impact Partnerships
Addressing Indonesia’s diabetes challenge requires a different approach. There is a huge opportunity to tackle one of the country’s greatest impediments to health, whilst also driving the growth of a healthy economy. We believe this can be achieved by bringing the government, private sector and civil society organisation’s together in a Positive Impact Partnership.

Positive Impact Partnerships (PIPs) are a new investment and delivery structure being pioneered by Palladium. Multiple partners join forces to collaboratively finance and address social challenges too large for any one of actor to solve alone, and generate economic opportunities. Organisations come together to use their distinct skills and capital to co-create and co-deliver solutions for market failures that currently prevent the creation of enduring economic and social value for all.

Joan Cabezas, Oliver Mathieson, Pak Bambang Widianto, and Ibu Prastuti Soewondo formalise the Positive Impact Partnership.

Cegah Risiko Tinggi – (Prevent High Risk)
The first initiative under Indonesia Mampu is Cegah Risiko Tinggi (CRT) – focusing on preventing diabetes in Indonesia. CRT is a Positive Impact Partnership between the Indonesian government, businesses and private sector organisations, and civil society. CRT aims to strengthen the Ministry of Health’s community-based healthcare approach (Posbindu) by addressing current challenges associated with:

  • Limited geographical reach
  • A general lack of awareness of diabetes and the community-based approach
  • Absence of an integrated approach to screening, diagnostics and patient profiling
  • Lack of follow up and continuous monitoring after a series of screening processes
  • Difficulties in finding and maintaining Posbindu cadres affecting the quantity and quality of registration, screening, data analysis, management and counselling, and education efforts for impact;
  • Poor amalgamation and analysis of data at a central digital repository
  • No integrated impact measurement system across Indonesia

Within CRT Palladium plays the role of convenor and catalyst, providing partnering brokerage services to the coalition through the integration of multiple development pathways to drive greater impact and value creation. CRT will evolve to become a nation-wide and programme initially focused on promotive-preventive outcomes. There is no doubt that this model has huge potential.

“If this program is run well, it will become the new format framework for future partnerships between the private and public sector.” Pak Bambang Widianto, Deputy for Social Welfare and Poverty Alleviation/Executive and Secretary of TNP2K.

Entering phase II – CRT in progress
The recent technical workshop marked the commencement of Phase II of the CRT intervention. The ‘formation’ phase brought all partners together to finalise the proposed initiative design framework (including the action plan and target locations for activities, sub-activities and proof-of-concept pre-pilots) and agree on the preliminary setup of the coalition’s operating model.

This phase is critical for the establishment of successful Positive Impact Partnerships. The workshop confirmed CRT’s vision and was used as a launch platform to agree the partnership’s initiative design model, strategy map, and a potential portfolio of mutually-reinforcing activities and sub-activities. The meeting also provoked interesting discussions amongst partnership members on the funding and capability required to successfully implement and scale-up the programme in Indonesia.

“To achieve the vision of 0% growth in diabetes by 2025, the problem must be fixed at different levels. The awareness, education (patients & doctors), government protocols and follow-up need to be improved.” Laurent Ho-Young, Business Project Manager, Novo Nordisk.

Partnership working groups are now being established to design and implement the intervention framework’s sub-activities through proof-of-concept pre-pilots across selected locations within the scope of the Posbindu model. These working groups will be supported by the partnership’s core team to ensure that a common agenda is maintained, a robust governance structure is put in place, and a common financing and impact measurement framework is agreed and incorporated.

The pre-pilot implementation is scheduled to commence in July 2017, and a launch ceremony with the Vice President of Indonesia scheduled for the coming months.

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