Category: inspirasi

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

 

 

1.2 Second year activities for Strengthening National Real-Time Surveillance and Reporting System (SKDR)
Below is the workplan and timeline for the 2nd year activities, the activities numbering system is continuing the previous year.

Code	Activity description	2021			2022
		10	11	12	1	2	3	4	5	6	7	8	9
1.3.4	Integrate MoH database between Surveillance and BPJS system
1.3.4.1	Development of data sharing agreements and protocols in line with the existing system from local to national level	x	x
1.3.4.2	Development of data interoperability technical guidelines between MoH and BPJS-K		x	x
1.3.4.3	Finalization of technical Interoperability scenario, data use, and security measure				x
1.3.4.4	Integrate MoH database between Surveillance and BPJS system					x
1.3.4.5	Embedding BPJSK-based surveillance data into current SKDR Dashboard					x	x	x	x	x
1.3.4.6	Security assessment and bug fixes in the live SKDR Dashboard									x	x	x

2.2 Second Year Activities for Strengthening National Surveillance and Reporting Capacity of PHO and DHO staff
Below is the workplan and timeline for the 2nd year activities, the activities numbering system is continuing the previous year.

Code	Activity description	2021			2022
		10	11	12	1	2	3	4	5	6	7	8	9
1.3.3	Strengthening National  Surveillance and Reporting Capacity of PHO and DH staff
1.3.3.1	Development of training module	x	x
1.3.3.2	Curation learning material into online platform	x	x
1.3.3.3	Initiating the onsite SKDR training course materials in the province of Yogyakarta Materi 1 Materi 2 Materi 3			x
1.3.3.4	Evaluation and revision of training material			x	x
1.3.3.5	Online SKDR Surveillance Training in South Sulawesi Province					x

3.2 Second Year Activities for Strengthening PHEOC in South Sulawesi Province
Below is the workplan and timeline for the 2nd year activities, the activities numbering system is continuing the previous year.

Code	Activity description	2021			2022
		10	11	12	1	2	3	4	5	6	7	8	9
2.1	Capacity to activate emergency operations
2.1.1	Established or strengthen provincial PHEOC in South Sulawesi
2.1.1.3	Development of PHEOC e-learning content	x
2.1.1.4	Development of Health Office Public Health Emergency Plan		x	x	x
2.1.1.5	Integration and strengthening of PHEOC in Public Health Emergency Plan					x	x
2.1.2	Capacity building of Province PHEOC staff to improve accurate and timely
2.1.2.3	Small / large outbreak case simulation through table top exercise							x	x	x
2.1.2.4	Dissemination and Evaluation of PHEOC exercise to Crisis Centre										x

4.2 Second Year Activity fo Development of National Covid-19 Surveillance for Health Care Worker
Below is the workplan and timeline for the 2nd year activities, the activities numbering system is continuing the previous year.

Code	Activity description	2021			2022
		10	11	12	1	2	3	4	5	6	7	8	9
2.2	Development of surveillance for health care worker morbidity and mortality for COVID – 19
2.3.1	Development of an integrated system for collecting and reporting data on morbidity and mortality for health workers
2.3.1.2	Development of technical document for COVID-19 Morbidity and Mortality Surveillance System for Health Workers	x	x
2.3.1.3	Development of the healthcare worker surveillance application system in MoH			x	x	x	x	x
2.3.1.4	Dissemination of the healthcare worker surveillance system to Professional Organization							x	x

5.2 Second Year Activity for Scientific Contribution through Publications
Below is the workplan and timeline for the 2nd year activities, the activities numbering system is continuing the previous year.

Code	Activity description	2021			2022
		10	11	12	1	2	3	4	5	6	7	8	9
3.1	Writing a Scientific articles
3.1.2	Technical article on BPJSK administrative database for surveillance activity in Indonesia							x	x	x
3.1.3	Policy brief on …… jurnal public health review										x	x	x

 

 

 

Kerangka Acuan Kegiatan (KAK)

Pelatihan Penggunaan Aplikasi Sistem Kewaspadaan Dini dan Respon (SKDR)
bagi Petugas Surveilans di Dinas Kesehatan Kabupaten/ Kota

A. Latar belakang

Kejadian Luar Biasa (KLB) masih menjadi masalah kesehatan masyarakat karena kejadian ini dapat menyebabkan kesakitan dan kematian yang tinggi. KLB juga memiliki dampak pada aspek ekonomi, sosial, dan psikologis, serta dapat menyebar luas lintas kabupaten/ kota, provinsi, bahkan internasional. Sampai saat ini, Indonesia memiliki beberapa penyakit potensial KLB seperti malaria, demam dengue, leptospirosis, diare, kolera, difteri, antraks, rabies, campak, pertusis, maupun ancaman penyakit – penyakit new emerging dan re-emerging. Penyakit-penyakit tersebut jika tidak dipantau dan dikendalikan akan mengancam kesehatan masyarakat Indonesia dan menyebabkan KLB yang lebih besar.

Kementerian Kesehatan Republik Indonesia bekerja sama dengan World Health Organization (WHO) dan Central of Disease Control (CDC) membangun sistem yang digunakan untuk deteksi dini dan respon terhadap penyakit potensial KLB. Sistem ini dikenal dengan Early Warning Alert and Response System (EWARS) atau Sistem Kewaspadaan Dini dan Respons (SKDR). SKDR diimplementasikan di Indonesia sejak tahun 2009 melalui Subdit Surveilans dan Respon KLB Direktorat Surveilans Epidemiologi, Imunisasi dan Kesehatan Matra (Ditjen P2PL) Kementerian Kesehatan RI. Prinsip utama SKDR adalah pendeteksian ancaman indikasi KLB penyakit menular yang dilaporkan setiap minggu, yang akan menampilkan alert atau sinyal peringatan dini jika terjadi peningkatan kasus penyakit melebihi nilai ambang batas pada suatu wilayah. Selain data mingguan, di dalam sistem SKDR terdapat Surveilans berbasis Kejadian atau yang disebut Event-based Surveillance (EBS). EBS merupakan laporan kejadian kesehatan masyarakat yang dilaporkan segera dalam 24 jam yang berpotensi menimbulkan kedaruratan kesehatan masyarakat dengan menggunakan sumber data dari media, masyarakat, dan tenaga kesehatan.

Pada akhir tahun 2015 Kementerian Kesehatan Republik Indonesia (RI) mengembangkan SKDR berbasis website untuk mempermudah pengolahan dan pelaporan data. Berbagai pembaharuan dan penambahan menu diterapkan pada website SKDR untuk meningkatkan kualitas pelaporan dan mempermudah pemantauan oleh petugas di Dinas Kesehatan Provinsi maupun Kabupaten/ Kota.

Sampai saat ini tingkat target ketepatan dan kelengkapan pelaporan SKDR serta verifikasi alert belum optimal. Salah satu penyebabnya adalah dari aspek sumber daya manusia kesehatan (SDMK), baik kuantitas maupun kualitasnya. Untuk meningkatkan kapasitas SDMK, diperlukan pelatihan yang dapat meningkatkan kompetensi petugas pelaksana SKDR di Dinas Kesehatan Kabupaten/ Kota yang lebih sistemik dan sistematis.

B. Tujuan

Secara umum pelatihan ini bertujuan agar petugas surveilans dalam melaksanakan kewaspadaan dini dan respon terhadap penyakit menular yang berpotensi KLB/ wabah menggunakan aplikasi SKDR di Dinas Kesehatan Kabupaten/ Kota. Secara khusus bertujuan untuk meningkatkan pengetahuan dan kemampuan petugas surveilans tentang:

1. Mengoperasionalkan aplikasi Sistem Kewaspadaan Dini dan Respon (SKDR)
2. Melakukan monitoring pengisian laporan mingguan dalam aplikasi SKDR
3. Melakukan surveilans berbasis kejadian (Event Based Surveillance – EBS)
4. Melakukan manajemen data dalam aplikasi SKDR
5. Membuat perencanaan respon terhadap informasi dari SKDR

C. Waktu

Pelatihan akan diselenggarakan secara luring selama tiga hari pada tanggal 11-13 (selasa-kamis) Januari tahun 2022 di Yogyakarta.

D. Peserta

Peserta berjumlah maksimal 30 orang dalam satu kelas. Kriteria peserta sebagai berikut:

1. Petugas surveilans atau jabatan fungsional epidemiologi di Dinas Kesehatan Kabupaten/Kota;
2. Diutamakan telah mengikuti pelatihan fundamental epidemiologi yang diselenggarakan secara full online melalui Simple-IT BBPK Ciloto https://link.kemkes.go.id/agendapelatihan
3. Diutamakan ASN

E. Fasilitator

Subdirektorat Surveilans dan Karantina Kesehatan, Dit. Surveilans dan Karantina Kesehatan

• Lia Septiana SKM, M.Kes
• Edy Purwanto, SKM, M.Kes
• Eka Muhiriyah, S.Pd, MKM

Pusat Kebijakan dan Manajemen Kesehatan (PKMK) FKKMK UGM:

• Dr. dr. Hanevi Djasri, MARS, FISQua
• dr. Likke Prawidya Putri, MPH
• Eva Tirtabayu Hasri S.Kep., MPH
• dr. Bernadeta Rachela A

Centre of Disease Control (CDC):

• drg. Catharina Yekti Praptiningsih, M.Epid
• Amalya, SKM, MSc.PH

World Health Organization (WHO):

• Ubadillah, S.Si
• dr. Endang Widuri Wulandari, M.Epid

Balai Besar Pelatihan Kesehatan (BBPK) Ciloto:

• Wawan Wahyudin, S.Si, Apt.MM

Master of Training

• Abdul Kadar,SKM.,M.Kes

F. Jadual

Berikut jadual pelatihan selama tiga hari.

Hari	Jam	Materi	JPL		Fasilitator
			T	P
I	07.00 – 08.00	Registrasi			Panitia
	08.00 – 08.30	Pre Test			Panitia
	08.30 – 09.00	Pembukaan			drh. Endang Burni Prasetyowati, M.Kes
	09.00 – 09.15	Break
	09.15– 10.45	BLC		2	Abdul Kadar,SKM.,M.Kes
	10.45 – 11.30	Kebijakan Penyelenggaraan Sistem Kewaspadaan Dini dan Kejadian Luar Biasa (KLB) materi	1		dr. Likke Prawidya Putri, MPH
	11.30 – 12.15	Konsep Umum Sistem Kewaspadaan Dini dan Respon materi	1		dr. Likke Prawidya Putri, MPH
	12.15 – 13.15	ISHOMA
	13.15 – 17.00	Operasionalisasi Aplikasi SKDR materi	2		dr. Endang Widuri Wulandari, M.Epid
	14.45 – 17.00	Operasionalisasi Aplikasi SKDR materi		3	Ubadillah, S.Si
II	07.30 – 08.00	Refleksi			Abdul Kadar,SKM.,M.Kes
	08.00 – 10.15	Monitoring pengisian laporan mingguan dalam aplikasi SKDR materi	1	2	Lia Septiana SKM, M.Kes
	10.15 – 10.30	Break
	10.30 – 12.00	Surveilans berbasis kejadian (EBS) materi	1	1	Edy Purwanto, SKM, M.Kes
	12.00 – 13.00	ISHOMA
	13.00 – 14.30	Surveilans berbasis kejadian (EBS) materi		2	Edy Purwanto, SKM, M.Kes
	14.30 – 15.15	Manajemen data dalam aplikasi SKDR	1		SKK
	15.15 – 15.30	Break
	15.30 – 17.45	Manajemen data dalam aplikasi SKDR	1	2	SKK
III	07.30 – 08.00	Refleksi			Abdul Kadar,SKM.,M.Kes
	08.00 – 08.45	Manajemen data dalam aplikasi SKDR		1	SKK
	08.45 – 09.30	Respon terhadap informasi dari SKDR	1		SKK
	09.30 – 09.45	Break
	09.45 – 11.15	Respon terhadap informasi dari SKDR materi		2	Eka Muhiriyah, S.Pd, MKM
	11.15 – 12.00	Komunikasi dan Advokasi materi	1		Wawan Wahyudin, S.Si, Apt.MM
	12.00 – 13.00	ISHOMA
	13.00 – 13.45	Komunikasi dan Advokasi		1	Wawan Wahyudin, S.Si, Apt.MM
	13.45 – 15.15	Anti Korupsi	2		Bapelkes
	15.15 -15.30	Break
	15.30 – 17.00	Rencana Tindak Lanjut materi		2	Dr. dr. Hanevi Djasri, MARS, FISQua
	17.00 – 17.30	Post Tes & Evaluasi Penyelenggaraan			Panitia
	17.30 – selesai	Penutupan			Kepala Dinas Kesehatan Provinsi/ Kabupaten/ Kota, atau Ketua Penyelenggara