An Indigenous Community-Based Approach to Tuberculosis Control in Rural East Sumba, East Nusa Tenggara, Indonesia.

BACKGROUND: Indonesia ranks second globally in tuberculosis (TB) burden, including East Sumba and East Nusa Tenggara. Due to structural barriers and cultural beliefs, case detection is persistently challenging. OBJECTIVE: This study aimed to explore structural and cultural barriers to TB case detection in rural East Sumba and to develop and implement culturally grounded, community-driven strategies to strengthen local TB control efforts. METHODS: A participatory action research approach was conducted from 2017 to 2018 in six rural villages of the Umalulu District, engaging traditional leaders (wunang, ratu), shamans, health cadres, and government stakeholders. Data were collected through focus group discussions, indepth interviews, participant observations, and document reviews, and were analyzed thematically. RESULTS: The study was conducted in three phases between 2017 and 2018 in the Umalulu Sub-district of East Sumba, Indonesia. The first phase identified local understandings of TB and barriers to sputum collection through collaboration with indigenous leaders (wunang, ratu, and shamans) and health workers. The second phase implemented training and community empowerment to engage these leaders as agents of change in TB education, referral, and sputum collection. The third phase reflected on the implementation through interviews, document reviews, and field observations. The findings show that involving indigenous leaders helped bridge biomedical and local health beliefs, increased community awareness of TB symptoms, and strengthened collaboration between health services and communities. However, public spitting and reliance on traditional healing remain barriers to TB prevention. CONCLUSION: This study highlights the importance of culturally grounded, community-driven strategies for strengthening TB control efforts in culturally diverse settings.