Building a robust health shield: Strengthening Indonesia's surveillance for emergency preparedness

A robust surveillance system is the linchpin of health emergency preparedness, as it allows us to swiftly detect and obtain valuable information for informed decision-making. However, the COVID-19 pandemic showed that Indonesia had inadequate surveillance capacity to address major health crises. Indonesia's surveillance system also faces challenges due to the diverse nature of over 40 national-level systems, each with its own unique data collection and processing methods. Meanwhile, more than 10,000 health facilities, laboratories and port health offices in the nation produced surveillance data, but comprehensive analysis at the subnational level remains a challenge. This highlights the need to develop a comprehensive transition plan, improve detection capabilities, evaluate the systems, and bridge the gap in data analysis and utilization skills.

Recognizing the limitations revealed during the pandemic, the MoH and WHO in 2023 developed a transition plan to reinforce and improve Indonesia's surveillance capabilities. Involving experts from diverse fields in its development, this plan ensures a One Health approach and more collaborative response to future pandemics. Implemented since the end of 2023, the transition plan is expected to enhance detection and risk assessment, monitor the pathogen's epidemiological characteristics, and inform interventions for human health.

To improve detection capabilities, WHO assisted the Ministry of Health (MoH) to conduct 18 batches of trainings about the National Early Warning and Response System (EWARS) in 2023. These trainings enabled surveillance officers from various community health centre (puskesmas), District Health Offices and public health laboratories to utilize EWARS, which allows the users to do early detection, early notification and data sharing. WHO and MoH also evaluated EWARS by discussing insights from various outbreak responses and introducing advanced techniques like media monitoring through Epidemic Intelligence from Open Source (EIOS). The MoH emphasized the importance of improving the capacity of staff to deliver quality responses and encouraged collaboration among various sectors.

“We need to advance to the next level. We already have a good timeliness and completeness. Now, we need to improve the quality of the alert response to stop the transmission at the source,” said Dr Triya Dinihari, Head of Surveillance Working Group of MoH, during the opening remarks.

Meanwhile, to ensure the 40 systems are efficient and able to address emerging challenges, Indonesia needs to have the human capitals capable to regularly evaluate the systems. WHO contributed by providing training in surveillance evaluation in the 10th National Scientific Conference on Epidemiology, in Makassar, South Sulawesi, from 9 to 12 October 2023. In the training, WHO highlighted guidelines that emphasize a broader perspective on implementation. 

Addressing the crucial need for data analysis and utilization, the MoH worked with WHO, the Indonesian Epidemiology Association, and the Field Epidemiology Training Program (FETP) to develop a practical handbook for simple surveillance data analysis and effective communication. Developed in June 2023, the handbook will be used by surveillance officers across Indonesia. This initiative was followed by a two-day hands-on training for MoH officials in July 2023. The initiative received positive feedback from participants, highlighting its significance in enhancing Indonesia's preparedness and response capacity.

According to Sabrina, Soekarno-Hatta Port Health Officer who participated in the training, surveillance officers are no stranger to data analysis, but they need to work on communicating the data to the policy makers and the public. “It is our homework to provide data visualization with powerful interpretation. This training answers to this need,” she said. 

Implementation of transition plans, EWARS evaluation and trainings, surveillance systems evaluations, and enhanced data analysis and utilization will not only improve response timeliness and effectiveness, but also fortify Indonesia's resilience against diseases and emerging health threats.

Indonesia's commitment to strengthening its surveillance systems sets the stage for continued improvement. WHO will continue to support the MoH in conducting EWARS trainings for surveillance managers and finalizing surveillance data handbook, which is slated for publication in 2024 and will be used in future trainings. Ongoing collaboration with relevant ministries and partners, combined with the promotion of collaborative surveillance, ensures the nation is better prepared for future pandemics.

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This activity is generously supported by the governments of Germany and Australia.