Streamlining Pandemic Warnings in Indonesia – CodeBlue

By Iwan Ariawan, University of Indonesia

JAKARTA, April 6 – Indonesia is home to more than a quarter of a million people, spread across an archipelago made up of thousands of islands. This geographical reality is a double-edged sword.

On the one hand, it is very difficult to guarantee every citizen equal access to health services.

On the other hand, during an epidemic, the government can prevent the disease from spreading throughout the archipelago – if it has the right early warning system.

Three elements are essential for a well-functioning pandemic warning system: the timely recording and reporting of symptoms; accurate diagnoses, supported by rapid case investigation and confirmation; and an effective disease screening system.

Indonesia has several early warning systems. The Early Warning and Response System (EWARS) tracks 23 types of infectious diseases, such as pneumonia and influenza-like illnesses, which can become outbreaks or epidemics.

He gets his data every week puskesmas (community health center). To detect the increase in cases, EWARS relies on a disease diagnosis and response algorithm and an outbreak response algorithm.

However, a weekly report cannot quickly flag outbreaks, so in 2020 the Ministry of Health added an event-based surveillance feature to detect significant cases and report them to the government for response. immediate.

However, EWARS did not detect Covid-19 as early as it should have. Another drawback is that EWARS is not fully linked to the hospital and laboratory information system.

Indonesia has many health information systems at central and sub-national levels. In 2021, research firm Reconstra undertook an internet search mapping that identified at least 155 systems at the central level.

The Ministry of Health has identified hundreds of systems, including at least 77 at puskesmas hospital level and 55 at hospital level.

To further complicate the picture, Indonesia’s decentralized governance system allows regions to modify health systems to better meet local needs.

This vast, fragmented health information system imposes an enormous workload on health workers in clinics and program managers in subnational offices. Data entry staff are scarce in Indonesia, so health staff often have to enter data as part of their job.

Most health workers and program managers have multiple tasks, from service delivery such as immunization to administrative tasks such as budget paperwork to program implementation. Previous reviews have highlighted an urgent need for administrative staff trained specifically for the health information system.

Although there is no process to provide feedback on the timeliness and accuracy of recording and reporting, the overwhelming tasks of health workers and management staff seem to affect the timeliness and accuracy of the data entry process.

Data validation and verification are also suboptimal, as program managers have many other tasks to perform. Varied approaches to data entry also create challenges.

For example, periodic disease prevalence is tracked by a three-year baseline health survey, but the measles and rubella vaccination campaign used separate daily reports via SMS.

In this context, the development of a new pandemic alert system will face many challenges. The new system will require political buy-in, appropriate infrastructure and human resource capacity development. At transition, there should be no period during which monitoring ceases.

On the other hand, it will take years of effort, as well as huge resources and full support from all programs, to integrate existing systems or make them interoperable.

The new system must connect the most important pieces of the puzzle: examining patients, treating patients and monitoring the spread of the disease. The government can assign responsibility for each item.

For example, health workers can focus on disease management and epidemiologists can help the research system. To ease the burden on the government system, some processes can be completed in collaboration with other parties – for example, mass vaccinations can be performed by doctors or health workers who do not work in government institutions.

Indonesia’s economic growth over the past decade has spurred urbanization, subnational connectivity, and population mobility, all of which increase the potential for future epidemics.

Before the pandemic, Indonesia was setting up the largest single-payer health insurance scheme in the world, eventually achieving near-universal health coverage. In recent decades, the country has also increased average life expectancy, reduced infant mortality, and launched better family planning initiatives that have halved the fertility rate.

Covid-19 could threaten some of these achievements. As the country recovers, Indonesia needs to allocate resources to building a better warning system for future pandemics.

Iwan Ariawan is a senior lecturer and researcher at the Center for Public Health Research, University of Indonesia. His work focuses on statistical modelling, survey design and analysis.

Article published with the kind permission of 360info.

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