Reaching the Unreached: On-Demand Solutions for TB Control in Densely Populated Settlements

Tuberculosis (TB) remains one of the deadliest infectious diseases in Indonesia, especially in urban areas such as Jakarta. Population density, poor ventilation, and limited access to health services in densely populated settlements are the main factors in the rapid and difficult-to-control spread of TB. Early detection is key in efforts to break the chain of transmission, but its realization is often hampered by logistical constraints, limited facilities, and low public awareness. 

In this context, the presence of on-demand health workers offers an effective, fast, and adaptive solution. On-demand health workers are medical personnel such as doctors, nurses, or surveillance officers who can provide direct services in the field on demand, often connected to a digital platform. They play an important role in reaching vulnerable communities who have difficulty or are reluctant to access formal health facilities. 

The main benefit of this approach is its ability to conduct active screening directly into people's residential environments. By carrying simple test kits and symptom assessment forms, on-demand health workers can identify individuals with TB symptoms such as chronic cough, fever, and weight loss, and provide direct education. This is especially crucial in densely populated areas, where disease can spread quickly within a single neighborhood or family.

In addition, on-demand health workers also help reduce the stigma that is often attached to TB sufferers. With a more personal and educational approach, they are able to build public trust and encourage more people to get tested without fear or shame. 

Another advantage is the flexibility of time and location. Visit scheduling can be adjusted to the needs of residents, including at night or on weekends. This is very helpful for residents who work all day or have limited mobility. On the other hand, digital technology allows for fast and real-time reporting to community health centers (Puskesmas), so that follow-up such as sputum examinations or referrals can be carried out without delay. 

However, the implementation of this program requires logistical support, intensive training, and cross-sector collaboration—between health offices, RT/RW, and digital service providers—so that the impact is optimal and sustainable. 

Overall, the use of on-demand health workers in early detection of TB in densely populated areas in Jakarta is a promising innovation. Not only does it accelerate case detection, but it also prioritizes a more inclusive and responsive approach to the complex needs of urban communities.