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  
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) Completed
1.2.2.1.6 Identification coding used among information system, ie., ICD-10 codes, 23 code syndrome in EWARS 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. Completed
1.2.2.1.8 Identification of algorithm to improve the early detection on SKDR website 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 Completed
1.2.2.1.10 Technical consultation based on result needs analysis and surveillance data mapping 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 In Progress
1.2.2.2.2 Gap analysis on FHIR resources with used information systems (P-Care, INA-CBGs, SKDR and HER) In Progress
1.2.2.2.3 Develop interoperability architecture among system with possible options to be implement or trial In Progress
1.2.2.2.4 Developing FHIR Profile for interoperability surveillance information system In Progress
1.2.2.2.5 Developing FHIR server for interoperability trial among systems (P-Care, INA-CBGs and SKDR) In Progress
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) In Progress
1.2.2.3.2 Audience with BPJS Kesehatan   In Progress
1.2.2.3.3 Audience with Province and District Health Office and Health Care Facilities (Primary Health care and Hospital) In Progress
1.2.2.3.4 Kick-off stakeholders meeting for signing data sharing agreement and protocols In Progress
1.2.2.4 Development of SKDR website with MoH  
1.2.2.4.1 Technical Discussion with SKDR website developer In Progress 
1.2.2.4.2 Develop a sample website of data Integration between BPJS data and SKDR In Progress
1.2.2.4.3 Finalization development of SKDR website In Progress
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 for the surveillance for COVID-19 and other priority disease training Completed
1.3.1.1.3 Web-based district surveillance team capacity building training (early detection of cases, epidemiological investigations, processing, data analysis and reporting, dissemination of results; etc.) Completed
1.3.1.1.4 Report and dissemination of results In Progress
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 In Progress
1.3.2.1.2 Trial of the alert respond in epidemiological investigation system based on website or android in South Sulawesi In Progress
1.3.2.1.4 Report and dissemination of results In Progress
1.3.2.2 Evaluation of training and implementation of the system development in Sulawesi Selatan  
1.3.2.2.1 Onsite evaluation of the surveillance training in Sulawesi Selatan In Progress
1.3.2.2.2 Report and dissemination of results In Progress
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 1 April 2021
2.1.1.1.2 Assessment by on site visit 6-9 April 2021
2.1.1.1.3 Completed
2.1.1.2 Strengthening PHEOC capacity in Sulawesi Selatan  
2.1.1.2.1 Workshop to develop PHEOC Steering committee In Progress
2.1.1.2.2 Define Scope of Works of each entity in PHEOC In Progress
2.1.1.2.3 Develop a workshop for PHEOC operational structure In Progress
2.1.1.2.4 Reports and dissemination the results In Progress
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 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 In Progress
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) In Progress
2.3.1.1.3 Development of an integrated system for collecting and reporting data on morbidity and mortality for health workers In Progress
3. Others  
3.1 Writing a Scientific articles  
3.1.1 Gaps assessment in the surveillance system of Indonesia In Progress
3.1.2 The potential usage of National Health Insurance Claim as the complementary data for EWARS in Indonesia Not Started

 

Activity Details 1.1

  1. TOR Finalization and Coordination
    This activity has been conducted by compiling several activities which are later incorporated in the Inspiration Project (Improving Quality of Disease Preparedness, Surveillance and Response in Indonesia). The objectives are to increase the detection, prevention and response Ministry of Health capacity, increase interconnectivity of the capacity to handle natural and non-natural disasters for BNPB and BPBD at provincial and district levels, and increase interoperability data surveillance to districts.
  2. Ethical Clearance Proposal Entry
    Activities conducted to meet requirements for conducting research are submitted to the Ethics Commission of FK KMK UGM
  3. Validate Focus Group Discussion and Indept Interview Question
    Before data collection, activities were carried out to validate the question points to be asked
  4. Develop Interview Guidline
    Preparation of in-depth interview guidelines that refer to validated question points. A guide is useful for guiding data retrieval
  5. Interview Training
    It was conducted online on 28th and 30th November 2020, with instructor as qualitative research expert lecturers at the FKKMK UGM.
  6. Initial Meeting with MoH
    This initial meeting between Inspirasi Project team and the Ministry of Health, was held to provide an explanation of the concepts and research activities.
  7. Interview with Respondent
    Activities have been carried out through zoom application, interviews were conducted with BNPB, Kementrian Kesehatan (P2P), Pusdatin to understand the gaps that occur when natural health disasters
  8. FGD with 5 Provinces
    Focus group discussions were carried out through zoom application, this activity was carried out to BPBD and Dinas Kesehatan Papua, South Sulawesi, Daerah Istimewa Yogyakarta, Nusa Tenggara Timur
  9. Quantitative Data Gathering from MoH and Public Health
    Data sourced from Sistem Kewaspadaan Dini dan Respon (SKDR) from Dirjen Pengendalian Penyakit dan Penyehatan Lingkungan is processed to know completeness and accuracy of reporting.
  10. Develop Data Analysis and Verbatim
    Data collected through in-depth interviews and focus group discussions were analyzed and reported in a systematic format.
  11. Initial Report
    After conducting qualitative and quantitative analysis, for the first a simple report will be carried out regarding gaps that occur in the surveillance and outbreak disaster preparedness systems.

Activity Details 1.2

  1. TOR Finalization and coordination
    An internal coordination between UGM team and Project HOPE.
  2. National academic discussion forum on defining entity working area in surveillance system
    A national disccussion forum that invites all provincial and district health official in Indonesia. The objectives is to have a general exposure of INSPIRASI program from 2020 ~ 2025. Expert from UGM will explain the best practice of public health surveillance from academic perspective and the possibility of Indonesia to achieved those goals. The participants will expected to give an opinion or input towards the program or standards.
  3. Internal meeting UGM – Project HOPE
    An internal meeting discussing the progress and the details for one year period.
  4. Coordination meeting UGM – Project HOPE – CDC
    Coordination meeting with CDC to discuss the details, goals, and program administration.
  5. Coordination meeting CDC – UGM – Project HOPE with PUSDATIN – P2P
    Coordination meeting between UGM, CDC, Project HOPE and MoH (PUSDATIN and P2P) on Scope of service between UGM and MoH. This meeting will finalize the program detail on plan, system mapping, surveillance data interoperability, surveillance staff training and PHEOC development.
  6. Results of assessment on surveillance and PHEOC gaps in Indonesia
    Report the results on identifying surveillance and PHEOC gaps in Indonesia.
  7. Seminar for the PHO and DHO on the usage of surveillance data for early outbreak detection (2 days)
    Online seminar that invites provincial and districts public health officie to discuss the utilization of surveillance data to prevent the outbreak. We will also invites the expert from Taiwan to explain the tracing and monitoring COVID-19 in Taiwan.

Activity Details 1.3

  1. TOR Finalization and coordination
    An internal coordination between UGM team and Project HOPE.
  2. Systems mapping and interoperability architecture development and design
    Meeting with selected stakeholder to conduct system mapping to look at the current interoperability system architecture. The aim of the system mapping is to show the components and boundaries of those components at a specific point in time. The goal of system mapping is to describe the current state of electronic components that are currently used by different stakeholders. The following activities need to be considered: List main stakeholders, List current stakeholder systems, List outputs from each stakeholder system List inputs from each stakeholder system, List processes that link the Inputs and the Outputs, Identify any linkages between stakeholders, Outline the main system components and their boundaries, Review of the system map document, Revise the system map document.
    Interoperability activities will be, List current data exchanges, List desired data exchange needs, Describe data exchange needs as use cases, Prioritize use cases for interoperability Identify possible solutions for interoperability, Design interoperability architecture, Review detailed design document, Revise the detailed design document.
  3. Workshop in the data sharing agreements and protocols in line with the existing system
    Discussing the obstacles and solutions on data sharing between agencies inside the ministry of health. This discussion will be consist participant from the Ministry of Health, Provincial Health Office, and District Level Health Office.
  4. Technical assistance in Jakarta to strengthen the current web-based surveillance data entry platform
    UGM and Project HOPE will conduct the system mapping in Jakarta and discuss with PUSDATIN and P2P to measured the obstacles in recording disease surveillance.
  5. Working together with expert, PUSDATIN and P2P directorate in MoH develop interoperability architecture design)
    Discussion with website vendor / teams at PUSDATIN on indentification database structures on the surveillance website of the Ministry of Health and discussing the possibility of compiling the surveillance aggregate reports on the website that owned by Ministry of Health. http://www.onehealth-size.id/guest , or www.Satudata.kemkes.go.id

D. REGULAR DISCUSSION

Januari Juli
Februari Agustus
Maret September
April Oktober
Mei November
Juni Desember