Cost of Prevention Dengue Hemorrhagic Fever in Gianyar, Bali
Putu Ayu Indrayathi
1
, Ni Luh Widiantari
1
, Rini Noviyani
2
1
School of Public Health, Medical Faculty of Udayana University, Denpasar, Indonesia
2
Pharmacy Department, Udayana University, Denpasar, Indonesia
pa_indrayathi@unud.ac.id
Keywords: Dengue fever, Cost of prevention, Health Department Gianyar.
Abstract: Dengue Hemorrhagic Fever (DHF) is a disease caused by Aedes aegypti mosquito bites. In 2016, Gianyar
District is one district in Bali has become area with highest dengue fever case in Bali. Up to now there is no
complete data and publication of the costs incurred by the government. The purpose of this study is to
determine the cost of prevention and control program of dengue disease in Gianyar District Health Office as
a baseline data to determine the economic burden due to DHF. This research is descriptive research with
mixed methods approach using secondary data and interview technique .Study found that fund spent by
Departement of Health Gianyar District amounted to 91% for vector control, the cost incurred for
communication, information, and education was 8,5% and the lowest cost was surveillance of 0,7% of total
cost of prevention in Gianyar Regency. This is calculated as IDR 2.203.172.875,00 in 2016. The most
widely applied cost for vector control is for fogging purposes which reached 96,3% of total DBD vector
control with the cost of the three largest activities were for officer fee, ULV, and fogging insecticide. The
highest level of expenditure was on prevention and control is fogging. This activity is the most widely used
alternative of DHF control although it is realized that fogging is not effective to prevent DHF. This study
suggests that more effective innovation prevention and control programs are needed, and to obtain
maximum results further research can be done using a broader perspective to calculate the total cost of
prevention of DHF.
1 INTRODUCTION
Dengue Haemorrhagic Fever (DHF) is one of the
infectious diseases transmitted by mosquito bites
that are found in many tropical and subtropical
regions around the world (Guzman, 2010). Globally
in 2012, based on morbidity and economic impact
for a country especially in developing country DHF
has become more important to be handled than
Malaria (Dubler and Duane, 2012; Senanayake and
Manouri, 2014).According to Senanayake (2014),
knowing the economic impact of DHF can be useful
for formulating policies ranging from prevention
program planning and further research priorities
(Senanayake and Manouri, 2014). Kongsin et.al
(2010), also stated that considering the costs
incurred as a result of the handling of vectors as well
as humans such as fogging, program
implementation, health promotion activities, and
DHF surveillance will be very useful in public
health
(Kongsin et al, 2010).
In Asia especially in Indonesia, estimation of the
cost of prevention are difficult to ascertain. This is
because the DHF case information is less clear due
to incomplete reporting of some cases that occur
5
.In
2016, incidence rate of DHF per month in Bali
province is 486,2 per 100.000 population, this
number increased compared to 2015 with dengue IR
269 per 100.000 population (Dinas Kesehatan
Provinsi Bali, 2016). The economic burden occur
due to DHF has become the responsibility of each
local government. Puskesmas plays pivotal point in
handling prevention and control of DHF budget. An
integrated information on the economic costs of
vector control and other extras costs include plague
management costs are not available for policy maker
(Baly et al, 2011). Therefore, it is important to
conduct a research of cost-prevention analysis of
dengue haemorrhagic disease because DHF is one of
the causes of many deaths in Gianyar District. This
study was conducted to complement the limited
empirical evidence in relation to the estimated cost
310
Indrayathi, P., Widiantari, N. and Noviyani, R.
Cost of Prevention Dengue Hemorrhagic Fever in Gianyar, Bali.
In Proceedings of the 4th Annual Meeting of the Indonesian Health Economics Association (INAHEA 2017), pages 310-313
ISBN: 978-989-758-335-3
Copyright © 2018 by SCITEPRESS – Science and Technology Publications, Lda. All rights reserved
of dengue disease, as local data collection will
provide more accurate information.
2 METHODS
This study is a cross sectional study with mixed
methods sequential explanatory design. Based on the
characteristics of sequential explanatory
combination method, the first phase of the study
using quantitative methods and in the second stage
using qualitative methods. Thus a combination of
research was conducted to answer the formulation of
quantitative problems in order to complete each
other. The method is used because lack of data
available on how well vector, surveillance and IEC
controls. This research had been approved by the
ethical commission with ethical clearance number
762/UN.14.2/KEP/2017 from Research Ethical
Commission Udayana University Medicine Faculty/
Sanglah Hospital, Denpasar. This research was
conducted at Gianyar Regency starting from March
until April 2017. The study use primary and
secondary data. Quantitative data is gained from
secondary data from Department of Health (DOH)
Gianyar and qualitative data is gained form in-depth
interview. Sample is chosen purposively with five
informants and use triangulation technique to
validate data.
3 RESULTS
3.1 Cost of Vector Control in 2016
Based on interview with staff from DOH Gianyar,
study found that there are three activities undertaken
by DOH Gianyar Regency to control DHF vector in
2016 namely Environmental Management,
Abatization, and Fogging
Table 1: Cost and Percentage of Vector Control of Dengue
Disease in DOH Gianyar 2016
Control of Dengue Vectors Year 2016
Activity
IDR
%
Environmental
Management
13.550.000,00
0,68
Abatization
60.000.000,00
3,0
Fogging
1.925.020.000,00
96,3
Total
1.998.570.000,00
100
From Table.1 can be seen that total cost incurred
by DOH Gianyar for vector control is Rp.
1.998.570.00,00 with the highest percentage for
fogging activity that is equal to 96,3%
3.2 Cost of Communication, Information
and Education 2016
This study found that DOH Gianyar and some
related agencies spent Rp. 188.218.000,00 to
develop posters, brochures, leaflets, brochures,
booklets, messages for health education purposes,
partnering with cross-sector agencies, radio
broadcasts, print media, potential partners consisting
of non-governmental organizations as a means of
promoting the danger of DHF.
3.3 Cost of Surveillance Program 2016
Data on surveillance costs are obtained from
secondary data. While the flow and surveillance
system of Dengue Haemorrhagic Fever in DOH
Gianyar obtained from in-depth interview.
"... there is supervision, official travel, ... there
for the web every week is made. There is STP
(integrated surveillance of puskesmas), the same
format from the center under the ministry is
distributed to the puskesmas ... by name by case
... integrated report ... "(R.02)
Table 2: Cost of Surveillance at DOH Gianyar 2016
Activity
IDR
%
Buying Goods
1.400.875,00
9
Meeting
2.304.000,00
14
Supervision
12.680.000,00
77
Total
16.384.875,00
100
The cost of surveillance is fully utilized by the
DOH Gianyar Regency, there is no fund given to the
Puskesmas because community health center has
become is a public service agencies primary health
care policy(BLUD) institution. The public service
agencies primary health care policy has been
implemented to all primary health care in Gianyar
district since 2010 (Indrayathi et al, 2014).
3.4 Cost of Prevention of Dengue
Hemorrhagic Fever (DBD) in DOH
Gianyar 2016
Based on in-depth interview and secondary data
available in DOH Gianyar, this study found that cost
of prevention of DHF is Rp. 2.203.172,875. Detail is
as follow:
Cost of Prevention Dengue Hemorrhagic Fever in Gianyar, Bali
311
Table 3. Cost of Prevention of DHF in DOH Gianyar 2016
DHF Prevention and Control Program DBD Year 2016
Activity
%
Vector control
91%
Communication,
Information and
Education
8,5%
Surveillance
0,7%
Total
100%
Based on table.3, it can be seen that the most
fund is for vector control as much as Rp.
1.998.570.000,00 or about 91% of the funds for the
P2DBD program at the DOH Gianyar Regency.
Followed by communication, information and
education, and surveillance with Rp188.218.000,00,
and Rp 16.384.875,00 respectively.
4 DISCUSSIONS
DHF is the most important vector-borne disease in
terms of disease and economic burdens. The
government has invested substantially for dengue
prevention program. This is because Dengue creates
a real economic burden for society. Cost of
prevention is a disease prevention activity that uses
the resources needed to perform various intensive
activities undertaken by the parties concerned to
prevent and control the disease. DHF prevention and
control activities are surveillance, periodic larvae in
houses, larvacide use in water storage containers,
peripheral insecticide spraying against adult
mosquitoes (fogging), health education/ promotion
related to disease prevention
9
.Based on the
secondary data collection, it can be concluded that
the large cost incurred by the DOH Gianyar in 2016
for P2DBD (DHF Prevention and Control) activities
is Rp. 2.203.172.875,00. These costs are spent on
vector control consisting of environmental
management, abatization, and fogging.
Environmental management activities consist of
PSN (Mosquito Nest Eradication) and PJB (Periodic
larva monitoring) by Jumantik cadres in the working
area of DOHGianyar.The cost incurred for Jumantik
incentives in 2016 is Rp. 13.550.000,00 or equal to
0.68% of the total cost incurred for vector control in
2016. The incentive given to Jumantik is given by
the Gianyar District Health Office directly without
going through the puskesmas. Based on DOH
Gianyar District report, the activity that absorbed
most of APBD funds managed by DOH Gianyar
Regency is fogging which is 96,32% from total cost
of DBD vector control. As can be seen from table.1
that the cost is high enough for the fogging activity.
This is because fogging is an activity that is
routinely done every year and is realized to spend
high cost with low effectiveness in preventing
dengue disease. But fogging is still done to prevent
and control the vector of dengue fever which aims to
kill infective adult mosquitoes quickly and break the
chain of dengue virus spread carried by
mosquitoes
10
. This fogging activity is not only an
alternative to vector control in Indonesia but also in
Cambodia which costs 500,000 USD every year.
While Thailand spent 4.87 million USD each year
for the fogging activities. The fees vary depending
on the policies of each country in the P2DBD
9
However, there are several concerns about the
use of insecticides in dengue prevention, namely the
development of mosquito resistance, environmental
risks, and the transient variable efficacy of
peridomesticarea spraying
11
. According to WHO,
education programs / programs to the public about
prevention and control of DHF more effectively can
raise awareness about the importance of prevention
and control activities to be done independently by
community rather than fogging
12
.The DOH Gianyar
also conduct health promotion activities to prevent
DHF.
There are several health promotion activities
undertaken by the DOH namely advocacy, business
development, and community empowerment. The
activities not only targeting community groups but
also for policy advocacy and foster relationships
with partners in the process of disseminating
information to the community about DHF .By
raising public awareness through education activities
against the dangers of dengue fever and doing
activities of prevention and control of dengue fever
is the choice to avoid this infectious disease
11
.
However, the fund provide for health promotion
through communication, information and education
program in Gianyar District not as much as fund for
fogging activity. This approach may be driven by
public expectations of government reaction to
dengue outbreaks in the district area rather than
higher expectations of proactive actions to prevent
dengue outbreaks.
There are several limitations to this study. The
cost of prevention perspective is limited to the
public sector only especially from DOH Gianyar
District perspective. The study did not include the
cost of dengue vector activities paid for by private
corporations (e.g., fogging activities surrounding
hotels, factories, and warehouses) and private
INAHEA 2017 - 4th Annual Meeting of the Indonesian Health Economics Association
312
households (e.g., fogging conducted in elite
residential area) also not included community
mosquito prevention activities conducted by non
governmental organizations (NGO). Most cost data
for communication, information and educational are
borne from interview since the DOH Gianyar office
does not the written document.
5 CONCLUSIONS
The cost of prevention borne due to DHF is
Rp2.203.172.875,00. In 2016, spending for Dengue
Prevention and Control activity at the DOH Gianyar
Regency is the highest fund compared to other
diseases. Fogging is the most costly alternative
option from year to year that costs the most from
other preventive activities from supporting
equipment, human resources and chemicals used.
Although fogging is not effective to prevent dengue
fever, fogging activities are still done to kill
infective adult mosquitoes to prevent rapid
transmission but also driven by public expectations
of government reaction to dengue outbreaks. The
cost has increased notably over time, primarily due
to price inflation and the increasing prevalence of
DHF.Data on DHF costs in Gianyar will help
indicate how much money could potentially be
reallocated to other control approaches as they
become available. DHF disease creates a real
economic burden for society. The community in
Gianyar area has been reliant on a government
funding for prevention and control program.
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