A. INTRODUCTION

Based on the Ministry of Health act no 45 2014, Public health surveillance is a systematic activity and continous analysis of disease or health conditions that could affect the disease transmission. It is necessary to provide early warning for the potential outbreak event and measure to control it effectively and efficiently. Disease surveillance is regulated in Ministry of Health act no 1479 2003. Currently, 23 disease symptom had been regularly monitored using SKDR (Sistem Kewaspadaan Dini dan Respon ~ Early Warning Alert and Respons System (EWARS)) through routine message from 10232 primary health care (Puskesmas) in 34 provinces of Indonesia. Fast and accurate information could become a foundation the have a strategic regulation in national or provincial level.

Data interoperability were still an issue in Indonesia. This is due to the difficulties of the technical aspect, such as different application used in province, district or puskesmas. These application has different database or naming, that create a difficulties in combining together. Many puskesmas also still did not have a dedicated person who were specifically assigned to manage the disease surveillance.

International Health Regulation (IHR) had been proved able to counter the spread of H1N1 pandemic in 2009. Indonesia had also fully adopted IHR in 2014. The IHR external evaluation in 2017, mention that Indonesia capable to manage the future pandemic since we already have the regulation. However in 2020 during the COVID-19 pandemic, there still a hole in the Indonesia health system that cause an increase in number of COVID-19 patient.

For the first year activity, INSPIRASI will measure the gaps of Indonesia surveillance system and the preparedness to prevent the potential outbreak event. Together with the Ministry of Health we will improve the province / districts surveillance capacity to identify and respons to public health threat.

B. OBJECTIVES

1. Identify Gaps in Indonesia Surveillance System, range from early detection procedures, surveillance registration, case reporting, analysis and dissemination of feedback on surveillance results to the public
2. Assess the ability of PHEOC at the provincial level in dealing with an epidemic or pandemic
3. Assess the routine immunization coverage activities by comparing service data for 2018 - 2020.
4. The implementation of national academic discussions and work area distribution on infectious disease surveillance in Indonesia.
5. Disseminate the results of gap study on disease surveillance in Indonesia.
6. Training for province and districts surveillance and utilization of data surveillance for early outbreak detection.
7. Conducting interoperability data surveillance improvement with PUSDATIN and MoH.

C. ACTIVITY TIMELINE

	Activity Description	Status at Time
Strategi 1.	Strengthen Real-Time Surveillance and Reporting
Objective 1.1	Accurate assessment of indicator and event-based surveillace and reporting systems to detect public health threats
1.1.1	Identify gaps in MOH surveillance response to public health threat
1.1.1.1	Development of the interview guidelines
1.1.1.1.1	Validate Focus Group Discussion and Indepth Interview question	Completed
1.1.1.1.2	Develop interview guideline	Completed
1.1.1.1.3	Interviewer training	Completed
1.1.1.2	Conduct Interview and data analysis
1.1.1.2.1	Initial meeting with MoH	Completed
1.1.1.2.2	Interview and FGD with respondents	Completed
1.1.1.2.3	Quantitative data gathering from MoH and Public Report	Completed
1.1.1.2.4	Develop data analysis and verbatim	Completed
1.1.1.2.5	Results of assessment on surveillance & PHEOC gaps in Indonesia	Completed
Objective 1.2	Improve interoperable, interconnected, electronic real-time
1.2.1	Improve surveillance coordination and report on gaps in surveillance
1.2.1.1	Kick off seminar and meeting
1.2.1.1.1	Seminar for improving the quality of disease surveillance during a pandemic	14 Februari 2021
1.2.1.1.2	Meeting Coordination with MoH (P2P and Pusdatin) in Jakarta	12, 13, 14 Januari 2021
1.2.2	Integrate MOH data source from disease surveillance using web portal
1.2.2.1	Map and define data standards between the health information systems and SKDR Metadata Data Sampel BPJS Kesehatan 2017-2018 API PCare dan VClaim Mapping_icd10_SKDR 23 Penyakit SKDR Mapping data element and data value Mapping FHIR Resource data element Surveillance Mapping Clinical Documentation
1.2.2.1.1	Discussion with DIY Province Health Office	10 Februari 2021
1.2.2.1.2	Discussion with BPJS Kesehatan	4 Maret 2021
1.2.2.1.3	Discussion with MoH (Pusdatin, Yankes, P2P/ Surveilance Unit, P2JK)	1 Maret 2021
1.2.2.1.4	Discussion with representative hospital and primary health care	3 Maret 2021 dan 9 Maret 2021
1.2.2.1.5	Data mapping based on the previous discussion (SKDR, P-Care and INA-CBGs database) [report ada di bagian 1.2.2.1]	Completed
1.2.2.1.6	Identification coding used among information system, ie., ICD-10 codes, 23 code syndrome in EWARS [report ada di bagian 1.2.2.1]	Completed
1.2.2.1.7	Identification of program languange from each information systems and databases, and Identification of opportunities and challenges to build data communication (bridging) among information systems. [report ada di bagian 1.2.2.1]	Completed
1.2.2.1.8	Identification of algorithm to improve the early detection on SKDR website [report ada di bagian 1.2.2.1]	Completed
1.2.2.1.9	Identification of data sharing needs among information system to strengthening the Indonesia's surveillance system, and to develop data sharing agreement [report ada di bagian 1.2.2.1]	Completed
1.2.2.1.10	Technical consultation based on result needs analysis and surveillance data mapping [report ada di bagian 1.2.2.1]	Completed
1.2.2.2	Development of interoperability architecture
1.2.2.2.1	Identification of short-term, mid-term and long-term roadmap to build bridging mechanism among information system with several consideration, includes personal data protection	Completed
1.2.2.2.2	Gap analysis on FHIR resources with used information systems (P-Care, INA-CBGs, SKDR and HER)	Completed
1.2.2.2.3	Develop interoperability architecture among system with possible options to be implement or trial	Completed
1.2.2.2.4	Developing FHIR Profile for interoperability surveillance information system	Completed
1.2.2.2.5	Developing FHIR server for interoperability trial among systems (P-Care, INA-CBGs and SKDR)	Completed
1.2.2.3	Development of data sharing agreements and protocols in line with the existing system from local to national level
1.2.2.3.1	Audience with MoH (Pusdatin, Yankes, P2P/ Surveilance Unit, P2JK)	Completed
1.2.2.3.2	Audience with BPJS Kesehatan	Completed
1.2.2.3.3	Audience with Province and District Health Office and Health Care Facilities (Primary Health care and Hospital)	Completed
1.2.2.3.4	Kick-off stakeholders meeting for signing data sharing agreement and protocols Draft_PKS BPJS K dan P2P Pertukaran  Data untuk SKDR PKS Kemenkes - BPJS Kesehatan Notulensi Pertemuan Teknis  Tatalaksana Implementasi Penguatan SKDR	Completed
1.2.2.4	Development of SKDR website with MoH
1.2.2.4.1	Technical Discussion with SKDR website developer	Completed
1.2.2.4.2	Develop a sample website of data Integration between BPJS data and SKDR	Completed
1.2.2.4.3	Finalization development of SKDR website	Completed
Objective 1.3	Increase capacity of Indicator based surveillance and event system
1.3.1	Conduct training of staff on COVID-19 and other priority disease data analysis and data communication
1.3.1.1	Strengthen capacity of Province and District Health Office on the Surveillance for COVID-19 and other priority disease
1.3.1.1.1	Finalize the modules and curriculum of Surveillance for COVID-19 training Fundamental epidemiology Fundamental epidemiology training curricula Curricula development for Early Warning and Response (SKDR) Training for surveillance staff in District Health Office Draft Curiculla off Early Warning and Response (SKDR) Training for surveillance staff in District Health Office	Completed
1.3.1.1.3	Web-based accredited training for Early Warning and Response (SKDR) Training for surveillance staff in District Health Office	Completed
1.3.1.1.4	Report and dissemination of results	Completed
1.3.2	HR Capacity Building in data analysis (national and sub-national)
1.3.2.1	Development of interactive dashboard to improve alert and response of SKDR (Android or web based)
1.3.2.1.1	Development of an interactive dashboard to support the alert system in the SKDR	Completed
1.3.2.2	Evaluation of training and implementation of the system development in Sulawesi Selatan
1.3.2.2.2	Report and dissemination of results	Completed
2.	Strengthen Real-Time Surveillance and Reporting
2.1	Capacity to activate emergency operations
2.1.1	Established or strengthen provincial PHEOC in South Sulawesi
2.1.1.1	Executives Summary Review Public Health Emergency Operation Center Provinsi Sulawesi Selatan, Kota Makassar dan Kabupaten Maros
2.1.1.1.1	Preparation of assessment instruments PHEOC Sulsel Review Instrument	1 April 2021
2.1.1.1.2	Assessment by on site visit	6-9 April 2021
2.1.1.1.3	Laporan Naratif Review Public Health Emergency Operation Center Provinsi Sulawesi Selatan Laporan Naratif Review Public Health Emergency Operation Center Kota Makassar Laporan Naratif Review Public Health Emergency Operation Center Kab. Maros	Completed
2.1.1.2	Peningkatan Kapasitas PHEOC Daerah Provinsi Sulawesi Selatan, Kota Makassar dan Kabupaten Maros
2.1.1.2.1	Workshop to develop PHEOC Steering committee	Completed
2.1.1.2.2	Define Scope of Works of each entity in PHEOC	Completed
2.1.1.2.3	Develop a workshop for PHEOC operational structure	Completed
2.1.1.2.4	Reports and dissemination the results	Completed
2.1.2	Capacity building of Province PHEOC staff to improve accurate and timely
2.1.2.1	PHEOC Training (web learning)	Completed
2.1.2.1.1	Preparation of curriculum, modules, and training methods (Workshop emergency management system; Logistics during emergency; Workforce mobilization and coordination; etc)	Completed
2.1.2.1.2	Finalize curriculum, modules and training methods	Completed
2.1.2.1.3	Web based PHEOC training	2,3,8, dan 10 Juni 2021
2.1.2.2	Evaluation of competency improvement and preparation of further plans in developing PHEOC capacity
2.1.2.2.1	Evaluation by on site visit	Completed
2.1.2.2.2	Reports and dissemination of evaluation results Surat Undangan Diseminasi Pengembangan PHEOC - Pusat Krisis Diseminasi Pengembangan dan Pelatihan PHEOC di Sulawesi Selatan sebagai best practice Provinsi Lain Pengorganisasian PHEOC PHEOC Models in Indonesia Policy brief management pengorganisasian daerah pada kedaruratan kesehatan masyarakat (KKM)	Completed
2.3.1	Development of surveillance for health care worker morbidity and mortality for COVID - 19
2.3.1.1	Development of surveillance for health care worker morbidity and mortality for COVID - 19
2.3.1.1.1	Discussions with the IDI Mitigation Team and MoH	Completed
2.3.1.1.2	Discussions with the Indonesian Dentists Association (PDGI), the Indonesian National Nurses Association (PPNI), the Indonesian Midwives Association (IBI), the Indonesian Medical Laboratory Technological Expert Association (PATELKI), and the Indonesian Pharmacists Association (IAI) regarding the health personnel surveillance system (collection, processing, analysis, reporting, dissemination of results) Sistem Surveilans dan Respon Terkait Morbiditas dan Mortalitas Covid-19 pada Tenaga Kesehatan	Completed
2.3.1.1.3	Development of an integrated system for collecting and reporting data on morbidity and mortality for health workers	Completed
3.	Others
3.1	Writing a Scientific articles
3.1.1	Gaps assessment in the surveillance system of Indonesia	Completed
3.1.2	The potential usage of National Health Insurance Claim as the complementary data for EWARS in Indonesia	Not Started