A strategy for the improvement of diseases surveillance

infrastructure in Indonesia

Agung Fatwanto

Sunan Kalijaga

Content

Sunan Kalijaga

• Background• Research Strategy• Improvement Strategy

Overview

Sunan Kalijaga

(Wikipedia, 2010)

Background

Sunan Kalijaga(Wikipedia, 2010)

Background

Sunan Kalijaga

• Population: 238 millions (CSB, 2010)• 17,504 islands (MIA, 2004), about 6,000 of

which are inhabited (IMF, 2006)• Around 8,548 community health center (CHC)

where 20% of them are not assigned with doctor (Republika, 4-Oct-10)

• 1,523 hospitals (MoH, 2010)

Background

Sunan Kalijaga

Securing public health need:A diseases surveillance infrastructureIn order to detect outbreak:

– earlier– more sensitive (highlight potential increase)– accurate– nation-wide– with communicable result

Background

Sunan Kalijaga

(Sedyaningsih, 2006)

Background

Sunan Kalijaga

Current system (Sedyaningsih, 2006):EWORS (Early Warning Outbreak Recognition System)• Developed by the National Institute of Health

Research and Development (MoH) in collaboration with US NAMRU 2

• Implemented in 9 cities: 13 hospitals + 2 CHC• Form: paper-based data gathering +

web-based electronic data entry

Background

Sunan Kalijaga

(Sedyaningsih, 2006)

Background

Sunan Kalijaga

(Sedyaningsih, 2006)

Background

Sunan Kalijaga

(Sedyaningsih, 2006)

Background

Sunan Kalijaga

(Sedyaningsih, 2006)

Background

Sunan Kalijaga

(Sedyaningsih, 2006)

Background

Sunan Kalijaga

(Sedyaningsih, 2006)

Background

Sunan Kalijaga

(Sedyaningsih, 2006)

Background

Sunan Kalijaga

Substantial Drawbacks:• Timing problem: due to the use of semi-

manual data entry process• Coverage problem: only implemented in 9

cities (13 hospitals + 2 CHC)• Dissemination problem: lack of dissemination

to the responsible parties

Background

Sunan Kalijaga

Proposed project:Improving the existing diseases surveillance

infrastructureGoal:Formulate a strategy to improve the diseases

surveillance infrastructure for resource-limited context

Research Strategy

Sunan Kalijaga

Q1: Participatory research and designDo they suitable for the Indonesian context?

Sociological theories:Culture, Polity, Economy(Habermas 81, Giddens 84, Bourdieu 86)

Research Strategy

Sunan Kalijaga

Cultural Setting:Very diverse: - more than 300 ethnic groups (with many foreign influences)- 742 spoken languages and dialects (with their own alphabet/character)- various religions/beliefs (6 are acknowledged by the state)- different level of modernity

Characters of the majority:Communal, Introvert, Responsive, Tend to be dogmatic, Religious, Mystic,

Superstitious, Strong oral tradition, Hypocrite, Flexible, Friendly, Adaptive

Research Strategy

Sunan Kalijaga

Political Setting :Democratic (in progress)Unitary state (most power is concentrated in central government, limited

autonomy given to district)Presidential system: with a council of ministers, who are not required to be

elected members of the legislature.Division of power: executive, legislative, and judicative.

Executive: central, province, district.Legislative: central (people’s representative council & regional representative council), province (provincial people’s representative council), district (district-level people’s representative council).Judicative: state court, high court, supreme court.

Research Strategy

Sunan Kalijaga

Economic Setting:Mixed economy system (played by both public and private sectors)Economic sectors (WB, 2006):- Revenue: industry (47.6%), services (37.1%), agriculture (15.3%).- Labour: agriculture (44.3%), services (36.9%), industry (18.8%).GDP per capita (IMF, 2006): US$ 2,329GDP PPP (IMF, 2006): US$ 4,157GDP growth (UN, 2008): 6%Very diverse level of income (big economic gap):

unemployment rate (2009): 7.7%, below poverty line (WB,2006): 17.8%

Research Strategy

Sunan Kalijaga

Participatory research and design:- Scandinavian style?

close to labor movement, design entire system (the work supported by the system)

- Pacific-rim style?broader stakeholders, more circumscribed (individual features)

- Combination?Harmony vs Conflicts

Research Strategy

Sunan Kalijaga

Level of analysis:

Application

System

Infrastructure

Research Strategy

Sunan Kalijaga

Participatory research and design:- Application level

directly-involved stakeholders: users (union/worker), management

- System levelusers, management/executive

- Infrastructure levelusers, management/executive, other influential entities (legislative, NGO, chamber of commerce, media, etc)

Improvement Strategy

Sunan Kalijaga

Q2: Does an adoption of the core concept of computer-supported collaborative work may improve the diseases surveillance system which is currently in place?

Improvement Strategy

Sunan Kalijaga

Incorporating 3 aspects of CSCW:- Incentive Structure

reward and punishment scheme motivation

- Workflowstandardized operating procedures, standardized forms

- Awareness current awareness (paper-based) electronic

Improvement Strategy

Sunan Kalijaga

At 4 levels of analysis perspective:- Institutional (MoH)- Organizational (Hospital, District/Provincial

Health Office)- Group (Group of paramedics)- Individual

Improvement Strategy

Sunan Kalijaga

Combining 2 types of diseases surveillance:- Structured

authoritative content, symptom/syndrome-based report

- Unstructureduser-generated content: blog, media, social network

Improvement Strategy

Sunan Kalijaga

Q3: Does mobile-based platform a good alternative to scale-up the current infrastructure?

Improvement Strategy

Sunan Kalijaga

Celluler users (ATSI, 2010): 80%

In 2015 it is predicted to be 107% (ATSI, 2010)

Improvement Strategy

Sunan Kalijaga

(Facebook, 2010)

Improvement Strategy

Sunan Kalijaga

(Wikipedia, 2011)

Improvement Strategy

Sunan Kalijaga

Action:- Design and develop a prototype of mobile-

based application for surveillance system- Social experiment with it (pilot project)