The dynamic of non-communicable disease control policy in IndonesiaYodi Christiani A C , Paul Dugdale B , Meredith Tavener A and Julie E. Byles A
A Priority Research Centre for Generational Health and Ageing, Hunter Medical Research Institute (HMRI), University of Newcastle, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia. Email: Meredith.Tavener@newcastle.edu.au; Julie.Byles@newcastle.edu.au
B Centre for Health Stewardship, The Australian National University, Building 131, Canberra, ACT 2601, Australia. Email: email@example.com
C Corresponding author. Email: firstname.lastname@example.org
Australian Health Review 41(2) 207-213 https://doi.org/10.1071/AH15196
Submitted: 17 October 2015 Accepted: 1 April 2016 Published: 23 May 2016
Objective The aim of the present study was to examine non-communicable disease (NCD) policy formation and implementation in Indonesia.
Methods Interviews were conducted with 13 Indonesian health policy workers. The processes and issues relating to NCD policy formation were mapped, exploring the interactions between policy makers, technical/implementation bodies, alliances across various levels and the mobilisation of non-policy actors.
Results Problems in NCD policy formation include insufficient political interest in NCD control, disconnected policies and difficulty in multisectoral coordination. These problems are well illustrated in relation to tobacco control, but also apply to other control efforts. Nevertheless, participants were optimistic that there are plentiful opportunities for improving NCD control policies given growing global attention to NCD, increases in the national health budget and the growing body of Indonesia-relevant NCD-related research.
Conclusion Indonesia’s success in the creation and implementation of NCD policy will be dependent on high-level governmental leadership, including support from the President, the Health Minister and coordinating ministries.
What is known about the topic? The burden of NCD in Indonesia has increased gradually. Nationally, NCD-related mortality accounted for 65% of deaths in 2010. Indonesia is also a country with the highest burden of tobacco smoking in the world. However, the government has not instituted sufficient policy action to tackle NCDs, including tobacco control.
What does this paper add? This paper deepens our understanding of current NCD control policy formation in Indonesia, including the possible underlying reason why Indonesia has weak tobacco control policies. It describes the gaps in the current policies, the actors involved in policy formation, the challenges in policy formation and implementation and potential opportunities for improving NCD control.
What are the implications for practitioners? An effective NCD control program requires strong collaboration, including between government and health professionals. Health professionals can actively engage in policy formation, for example through knowledge production.
Additional keywords: developing countries, policy analysis, policy formation, tobacco control.
References World Health Organization. Global status report on noncommunicable diseases 2014. Geneva: WHO; 2014.
 Watkins D, Olson ZD, Verguet S, Nugent RA, Jamison DT. Cardiovascular disease and impoverishment averted due to a salt reduction policy in South Africa: an extended cost-effectiveness analysis. Health Pol Plan 2015; 1–8.
 O’Flaherty M, Flores-Mateo G, Nnoaham K, Lloyd-Williams F, Capewell S. Potential cardiovascular mortality reductions with stricter food policies in the United Kingdom of Great Britain and Northern Ireland. Bull World Health Organ 2012; 90 522–31.
| Potential cardiovascular mortality reductions with stricter food policies in the United Kingdom of Great Britain and Northern Ireland.CrossRef |
 World Health Organization. Global action plan for prevention and control of noncommunicable diseases 2013–2020. Geneva: WHO; 2013.
 Miranda JJ, Kinra S, Casas JP, Davey Smith G, Ebrahim S. Non-communicable diseases in low- and middle-income countries: context, determinants and health policy. Trop Med Int Health 2008; 13 1225–34.
| Non-communicable diseases in low- and middle-income countries: context, determinants and health policy.CrossRef | 1:STN:280:DC%2BD1cnnsFamsQ%3D%3D&md5=2208eca1c7a73f7b963afb62d71a2abeCAS | 18937743PubMed |
 National Institute of Health and Research Development. 2013 basic health research. Jakarta: National Institute of Health Research and Development, Ministry of Health; 2013.
 Christiani Y, Byles JE, Tavener M, Dugdale P. Assessing socioeconomic inequality of hypertension among women in Indonesia’s major cities. J Hum Hypertens 2015; 29 683–8.
| 1:STN:280:DC%2BC2MrislSlug%3D%3D&md5=85bc93d96808a6b880dc08e8deeca034CAS | 25652531PubMed |
 Institute of Health Metrics and Evaluation. GBD profile: Indonesia. 2013. Available at: http://www.healthdata.org/sites/default/files/files/country_profiles/GBD/ihme_gbd_country_report_indonesia.pdf [verified 4 June 2015].
 Institute of Health Metrics and Evaluation. Global Burden of Disease Study 2013. Results by Location, Cause, and Risk Factor. Seattle: Institute for Health Metrics and Evaluation; 2016.
 Kosen S, Suryati T, Indriyasih E, Abikusno N, Lung TW-C, Clarke P. Changing demand for health services. Health sector review. Jakarta: Kementerian PPN/Bappenas; 2014.
 World Health Organization. WHO report on the global tobacco epidemic, 2013. Geneva: WHO; 2013.
 Framework Convention Alliance. Parties to the WHO FCTC (ratifications and accessions). 2015. Available at: http://www.fctc.org/about-fca/tobacco-control-treaty/latest-ratifications/parties-ratifications-accessions [verified 4 June 2015].
 Achadi A, Soerojo W, Barber S. The relevance and prospects of advancing tobacco control in Indonesia. Health Policy 2005; 72 333–49.
| The relevance and prospects of advancing tobacco control in Indonesia.CrossRef | 15862641PubMed |
 Pablos-Mendez A, Shademani R. Knowledge translation in global health. J Contin Educ Health Prof 2006; 26 81–6.
| Knowledge translation in global health.CrossRef | 16557508PubMed |
 Lang ES, Wyer PC, Haynes RB. Knowledge translation: closing the evidence-to-practice gap. Ann Emerg Med 2007; 49 355–63.
| Knowledge translation: closing the evidence-to-practice gap.CrossRef | 17084943PubMed |
 Latour B. Reassembling the social: an introduction to actor-network-theory. New York: Oxford University Press; 2005
 UN System Task Team on the Post-2015 UN Development Agenda. Health in the post-2015 UN development agenda. May 2012. Available at: http://www.un.org/millenniumgoals/pdf/Think%20Pieces/8_health.pdf [verified 1 August 2015].
 Intergovernmental Negotiating Body of the WHO Framework Convention on Tobacco Control. WHO framework convention on tobacco control, Doc. No. A/FCTC/INB6/5, Mar. 3, 2003. Geneva: World Health Organization; 2003.
 National Institute of Health and Research Development. 2007 basic health research: national report. Jakarta: Ministry of Health Indonesia; 2008.
 Ministry of Health. Decree of Minister of Health No. 40/2013 on road map for tobacco control for health. Jakarta: Ministry of Health Indonesia; 2013.
 Kickbusch I. Health in all policies: where to from here? Health Promot Int 2010; 25 261–4.
| Health in all policies: where to from here?CrossRef | 20702678PubMed |
 Waqa G, Mavoa H, Snowdon W, Moodie M, Schultz J, McCabe M, Kremer P, Swinburn B. Knowledge brokering between researchers and policymakers in Fiji to develop policies to reduce obesity: a process evaluation. Implement Sci 2013; 8 74
| Knowledge brokering between researchers and policymakers in Fiji to develop policies to reduce obesity: a process evaluation.CrossRef | 23816188PubMed |
 Jones AC, Geneau R. Assessing research activity on priority interventions for non-communicable disease prevention in low- and middle-income countries: a bibliometric analysis. Glob Health Action 2012; 5 18847
| Assessing research activity on priority interventions for non-communicable disease prevention in low- and middle-income countries: a bibliometric analysis.CrossRef |
 Rani M, Nusrat S, Hawken LH. A qualitative study of governance of evolving response to non-communicable diseases in low-and middle- income countries: current status, risks and options. BMC Public Health 2012; 12 877
| A qualitative study of governance of evolving response to non-communicable diseases in low-and middle- income countries: current status, risks and options.CrossRef | 23067232PubMed |
 Lim J, Chan MMH, Alsagoff FZ, Ha D. Innovations in non-communicable diseases management in ASEAN: a case series. Glob Health Action 2014; 7 25110
| Innovations in non-communicable diseases management in ASEAN: a case series.CrossRef | 25249061PubMed |
 Levintova M, Novotny T. Noncommunicable disease mortality in the Russian Federation: from legislation to policy. Bull World Health Organ 2004; 82 875–80.
| 15640924PubMed |
 Young D, Borland R, Coghill K. An actor-network theory analysis of policy innovation for smoke-free places: understanding change in complex systems. Am J Public Health 2010; 100 1208–17.
| An actor-network theory analysis of policy innovation for smoke-free places: understanding change in complex systems.CrossRef | 20466949PubMed |
 Echouffo-Tcheugui JB, Kengne AP. Chronic non-communicable diseases in Cameroon: burden, determinants and current policies. Global Health 2011; 7 44
| Chronic non-communicable diseases in Cameroon: burden, determinants and current policies.CrossRef | 22112686PubMed |
 Bosu WK. A comprehensive review of the policy and programmatic response to chronic non-communicable disease in Ghana. Ghana Med J 2012; 46 69–78.
| 1:STN:280:DC%2BC3snis1Cnuw%3D%3D&md5=d423bf79a93f3b3f89aa70a1cbab64a1CAS | 23661820PubMed |
 Barber S, Ahsan A. The tobacco excise system in Indonesia: hindering effective tobacco control for health. J Public Health Policy 2009; 30 208–25.
| The tobacco excise system in Indonesia: hindering effective tobacco control for health.CrossRef | 19597454PubMed |
 Southeast Asia Initiative on Tobacco Tax. Tobacco tax for health, a win–win for all. Bangkok: South East Asia Tobacco Control Alliance; 2014.
 Visaruthong C. Thailand tobacco tax report card: Southeast Asia Initiative on Tobacco Tax (SITT) Resource Center, South East Asia Tobacco Control Alliance (SEATCA), October 2010. Available at: http://www.smoke-free.ca/trade-and-tobacco/Thailand/Thailand%20Tax%20Report%20Card%202010.pdf [verified 12 April 2016].