Indonesia is approaching the ‘last mile’ of elimination for several skin-related neglected tropical diseases (skin NTDs): notably, leprosy, yaws and lymphatic filariasis (LF). However, persistent transmission in selected districts highlights systemic weaknesses in surveillance. This paper aimed to analyse the health system, operational and sociocultural barriers to integrated skin NTDs surveillance in Indonesia. A descriptive analysis of the national programmatic review of integrated skin NTDs was conducted in 2024, using a mixed-methods descriptive evaluation based on routine data and thematic analysis. Comparative case studies of the Belitung, Mimika and Sorong Selatan Districts were conducted using routine data, programme reports, and structured observations at primary health centres, district health offices and laboratories. Qualitative insights from programme managers, health workers and communities were thematically analysed. Integrated surveillance was constrained by fragmented governance, inflexible financing, and uneven workforce capacity, alongside operational challenges like delayed detection and geographic inaccessibility. Furthermore, sociocultural factors such as stigma and population mobility, combined with zoonotic LF transmission in Belitung, significantly undermine effectiveness and long-term programmatic sustainability. Despite strong national policy commitment and substantial progress in disease elimination, significant gaps remain between integration frameworks and operational realities at the district level. Accelerating skin NTDs elimination in Indonesia requires context-adapted integration, strengthened digital surveillance, sustained subnational financing, workforce capacity building and, in zoonotic settings, a One Health approach. Addressing these factors is essential for achieving and sustaining elimination in the last mile. Indonesia has achieved substantial progress across major skin NTDs, while also revealing persistent gaps that threaten the sustainability of elimination gains.
Putri et al. (Wed,) studied this question.