Regions Ignore Massive PCR Tests
The number of polymerase chain reaction (PCR) tests in several regions in Indonesia is still far from the World Health Organization standard.
A man undergoes a polymerase chain reaction (PCR) or swab test at Moh Ridwan Meuraksa Hospital, East Jakarta, Tuesday (16/6/2020). The mobile testing will serve people who have registered through the Covid-19 monitoring app and the results will be sent to their respective mobile phones.
The number of polymerase chain reaction (PCR) tests in several regions in Indonesia is still far from the World Health Organization standard. In fact, there is budget, infrastructure and resources available for the massive PCR testing.
JAKARTA, KOMPAS — Entering nine months of the Covid-19 pandemic, the number of examinations using the PCR method in Indonesia is still one of the lowest in the world. A Kompas investigation in a number of regions found that local governments had ignored the implementation of massive PCR tests to detect cases.
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The World Health Organization (WHO) sets a PCR examination ratio of 1 test per 1,000 population every week. According to data from the Covid-19 Mitigating Task Force as of Dec. 1, 2020, Indonesia was only able to administer about 242,000 tests per week or 90.6 percent of the WHO standard, namely 267,700 tests per week. Inevitably, Indonesia only ranks 160th from 220 countries in terms of the number of tests per population.
In the fourth week of October, PCR testing in Banjarnegara was only 16 percent of the WHO standard or only 151 PCR tests per week from the supposed tests of 928 per week.
In fact, the key to mitigating the Covid-19 pandemic is massive PCR testing, contact tracing and treatment with isolation or 3T. One region with a low PCR test rate is Banjarnegara regency, Central Java. In the fourth week of October, PCR testing in Banjarnegara was only 16 percent of the WHO standard or only 151 PCR tests per week from the supposed tests of 928 per week.
When investigated further, this condition was triggered by a lack of budget for mitigating Covid-19 in the health sector and the commitment of the regional head to seriously handle The pandemic in his territory.
According to date from the Home Ministry, the Banjarnegara Regency Government set the budget reallocation for mitigating Covid-19 at Rp 149.9 billion or around 7.5 percent of the total Regional Budget (APBD). Of this amount, Rp 13.7 billion was used for mitigating the health sector, which was only realized at Rp 7.5 billion by mid-November 2020.
That means that expenditure in the health sector in mitigating Covid-19 in Banjarnegara up to November was only 0.3 percent of the total APBD (Rp 2.01 trillion).
Not a priority
Banjarnegara Regent Budhi Sarwono said massive PCR testing was not a priority in dealing with the pandemic. Only residents who checked themselves to the hospital and were symptomatic would be tested. That was so because massive PCR tests only ate up the budget. "Well, if people on the street are swabbed, they are all negative, money is wasted. How much is one PCR swab? Rp 900,000. Whose money is that, we have to use our brains,” said Budhi when met at his official residence in Banjarnegara, Friday (6/11/2020).
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Health workers take swab samples from residents for the Covid-19 polymerase chain reaction (PCR) test on 8 May 2020 at Kebon Kembang Market in Bogor municipality, West Java. Workers from the Bogor municipal health office collected 175 samples from the market’s traders and employees during the mass Covid-19 testing program.
Even, Budhi did not care if the number of PCR tests in Banjarnegara was still far from WHO standard in mitigating the pandemic. "No problem. Will the money be used to continuously buy the swab tools? We have to innovate, right? Doing the swabs also doesn\'t heal,” said Budhi.
As an illustration, only 200 PCR samples were sent from Banjarnegara were sent to the laboratory of Margono Soekarjo Regional Hospital, Banyumas, from Oct. 26 to Nov. 1, 2020. In fact, the laboratory capacity of Margono Hospital is capable of examining 2,000 samples per day. This laboratory accepted samples from four regencies, namely Banyumas, Cilacap, Purbalingga, and Banjarnegara.
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Depending on the policy Contrasting conditions occurred in Purbalingga. In the last two months, the number of PCR tests in Purbalingga had continuously accelerated until it finally exceeded the WHO standard. In fact, previously, the number of PCR tests in Purbalingga was also one of the lowest in Central Java.
The number of the tests has increased almost 10 times over the previous months.
In June 2020, the number of PCR tests in Purbalingga was only 207 tests a month or an average of 52 tests per week. In fact, it should be 943 tests per week in accordance with the WHO standard. In August, the number of tests was also only 287. The number of PCR tests began to increase at the end of September. In comparison, during Oct. 1-21, the number of PCR tests in Purbalingga reached 1,698 tests or an average of 566 tests per week. The number of the tests has increased almost 10 times over the previous months.
This happened after the leadership of Purbalingga was held by Sarwa Pramana as the acting regent since the end of September. The Regent of Purbalingga, Dyah Hayuning Pratiwi, is on a campaign leave until Dec. 5, 2020 because she is competing again in the regional elections.
Also read: One Indonesia to Combat Covid-19
Once confirmed as the Acting Regent of Purbalingga, Sarwa Pramana, immediately instructed massive PCR testing. The budget for mitigating Covid-19 is focused on the testing, case tracing, and preparing isolation rooms for patients.
For this reason, every 22 community health center (Puskesmas) in Purbalingga is targeted to carry out 56 PCR tests per week in order to meet the WHO standard target of 943 PCR tests per week. Close contact tracing was tightened. Tracing the cases that was previously held through antibody tests was replaced by PCR tests. "The policy I took after I was in this position was carrying out orders from the President, the Home Minister, and also the Governor to carry out testing and treatment according to the WHO standard," said Sarwa.
Firefighters use a hose on Monday (23/3/2020) to clean the Candrabhaga Patriot Stadium complex in Bekasi city, West Java. The West Java provincial administration plans to convert the stadium to provide mass testing for Covid-19.
The budget reallocation for mitigating Covid-19 in the Purbalingga Regional Budget is Rp 52.5 billion, with an allocation for the health sector of Rp 25.6 billion.
Separately, Dyah admitted, at the start of the pandemic until she was on leave for the elections, she did not instruct a massive PCR test. Moreover, said Dyah, she did not make any target on the number of PCR tests because the implementation of massive tests had the consequence that more Covid-19 case would be detected. Purbalingga Regency Government, she said, had to take into account the availability of health facilities.
The low rate of PCR test due to the neglect of the local government also occurred in Bogor regency, West Java. From March to early October, the number of PCR tests in Bogor was only 21,986 tests. In fact, to meet WHO standards, the number of PCR tests in Bogor should be more than 5,900 tests per week.
The secretary of the Bogor Regency Health Office, Achmad Zaenudin, said that there would be waste of budget with the procurement of PCR reagents and tools if the PCR tests and close contact tracing were continued. "For the procurement of PCR tools alone, it costs around Rp 3.5 billion, not to mention the reagents which are disposable. If all residents are examined, how much will the cost be wasted and it will not have any impact," he said.
PCR test samples were taken only if there were people who had indication to have contracted Covid-19. There was no massive PCR test.
In Sampang and Pamekasan, East Java, the budget reallocation for alleviating Covid-19 has been cut during the 2020 Revised APBD. In fact, the number of PCR tests in these two regencies is still very low. The acting head of Pamekasan Regency Health Office, Ahmad Marzuki, said the number of PCR tests in Pamekasan averaged only 10 samples per week. PCR test samples were taken only if there were people who had indication to have contracted Covid-19. There was no massive PCR test.
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The spokesman for the Covid-19 Mitigating Task Force, Wiku Adisasmito, explained that increasing the number of PCR tests in the regions is the responsibility of the local governments. "Right, not all regional heads are proactive," said Wiku.
Wiku Adisasmito, The spokesman for the Covid-19 Mitigating Task Force,.
Director General of Regional Finance Development of the Home Ministry Mochammad Adrian Noevriansyah said the joint decree (SKB) of the Home Affairs Ministry and the Finance Minister regulates the rationalization of regional spending to be directed at reallocating the budget for alleviating Covid-19. If the rationalization is not in accordance with the determined percentage, the central government can delay the transfer of general allocation funds.
According to the former director of WHO Southeast Asia Infectious Disease Protection, Tjandra Yoga Aditama, the massive PCR test does not only diagnose cases, but also maps to cut the transmission of the Covid-19 pandemic in the country. Therefore, massive testing, tracing and isolation are crucial for pandemic control, in addition to implementing strict health protocols.(ILO/NIA/ IRE/BKY/DVD/DKA/BRO/AIN/VIO/TAN)
