Sub-District Surveillance Response System Development:

A Linkage Between University, Health Providers and

Community to Face Global and Local Health Challenge

Sunjaya DK, Herawati DMD, Sirlan FUniversitas Padjadjaran - Indonesia

International Conference on Sustainability ScienceBangkok 23-24 November 2009

Content

Context and problems

Sub district SRS Development

Result

Discussion

Conclusion

Context and Problem

Indonesia :16 000 islands226 million popHDI : 109/ 179LE : 70.1

Under developped villageSource : PHO West Java

Province of West Java :•26 Districts•5683 villages•Population : 43 million•Poor : 26 %

Jakarta BandungDistrictSumedang

Sub districtJatinangor

Kab. Karawang

Kota Bandung

Kab. Ciamis

Kab. Tasikmalaya

Kab. Cirebon

Kab.Bogor

Kab. Sukabumi

Kab. Cianjur

Kab. Bandung

Kab. Garut

Kab. Kuningan

Kab. Majalengka

Kab. Sumedang

Kab. IndramayuKab. Subang

Kab. Purwakarta

Kab. Bekasi

Kota Bogor

Kota Sukabumi

Kota Cirebon

Kota Bekasi

Kota Depok

Kota Cimahi

Kota Tasikmalaya

Kota Banjar

EndemisEndemis malariamalaria

CASE DETECTION RATE CASE DETECTION RATE DiDi PROPINSI JAWA BARATPROPINSI JAWA BARAT

TahunTahun 20032003

Kab. Karawang= 35,8

Kota Bandung

Kab. Ciamis= 36,2Kab. Tasikmalaya

= 36,2

Kab. Cirebon= 34,4

Kab.Bogor= 40,09

Kab. Sukabumi= 20,4

Kab. Cianjur= 21,1

Kab. Bandung= 31,5

Kab. Garut= 30,9

Kab. Kuningan= 32,2

Kab. Majalengka= 53,1

Kab. Sumedang= 35,8

Kab. Indramayu= 27.7

Kab. Subang= 32,1

Kab. Purwakarta= 11,5

Kab. Bekasi= 24,6

Kota Bogor= 48,3

Kota Sukabumi= 57,5

Kota Cirebon= 56,8

Kota Bekasi= 25,1

Kota Depok= 59,3

Kota Cimahi

Kota TasikmalayaKota Banjar

< 15 %

16 - 25 %

36 -50 %

> 50 %

26- 35 %

Target = 50 %Target = 50 %

AREA MAP SITUASI IR DBD AREA MAP SITUASI IR DBD didi PROPINSI JAWA BARAT PROPINSI JAWA BARAT TAHUN 200TAHUN 20033

Kab. Karawang

Kota Bandung

Kab. Ciamis

Kab. Tasikmalaya

Kab. Cirebon

Kab.Bogor

Kab. Sukabumi

Kab. Cianjur

Kab. Bandung

Kab. Garut

Kab. Kuningan

Kab. Majalengka

Kab. Sumedang

Kab. IndramayuKab. Subang

Kab. Purwakarta

Kab. Bekasi

Kota Bogor

Kota Sukabumi

Kota Cirebon

Kota Bekasi

Kota Depok

Kota Cimahi

Kota TasikmalayaKota Banjar

>10/100.000

5-10/100.000

< 5/10.000

PETA KASUS HIV(+) / AIDS DI PROVINSI JAWA BARAT, TAHUN 1989 - 2007

Kab. Karawang(62 HIV (+) & 8 AIDS)

Kab Bandung (15 HIV & 35 AIDS)

Kab. Ciamis (21 HIV (+) & 2 AIDS)

Kab. Tasikmalaya (112 HIV (+) & 0 AIDS)

Kab. Cirebon (127 HIV (+) &0 AIDS)

Kab.Bogor (21 HIV (+) & 12 AIDS)

Kab. Sukabumi (5 HIV (+) & 5 AIDS) Kab. Cianjur

(52 HIV (+) & 8 AIDS)

Kota Bandung (491 HIV (+) & 628 AIDS)

Kab. Garut (6 HIV (+) & 15 AIDS)

Kab. Kuningan (7 HIV (+) & 4 AIDS)

Kab. Majalengka(9 HIV (+) & 1 AIDS)

Kab. Sumedang (8 HIV (+) & 9 AIDS)

Kab. Indramayu(33 HIV (+) & 7 AIDS )

Kab. Subang(23 HIV (+) & 14 AIDS)

Kab. Purwakarta(6 HIV (+) & 5 AIDS)

Kab. Bekasi(102 HIV (+) & 8 AIDS)

Kota Bogor(47 HIV (+) & 54 AIDS)

Kota Sukabumi(44 HIV (+) & 31 AIDS)

Kota Cirebon(8 HIV (+) & 6 AIDS)

Kota Bekasi(143 HIV (+) & 158 AIDS)

Kota Depok(58 HIV (+) & 3 AIDS)

Kota Cimahi(1 HIV (+) & 10 AIDS)

Kota Tasikmalaya(16 HIV (+) & 16 AIDS)

Kota Banjar(1 HIV (+) & 0 AIDS)

Sumber: Sub Dinas Penyehatan Lingkungan

> 10050 - 10025 - 49< 25

JABAR :HIV : 1587AIDS : 1611

PETA KASUS AVIAN INFLUENZADI PROVINSI JAWA BARAT, TAHUN 2005-2006

Kab. Karawang

Kota Bandung

Kab. Ciamis

Kab. Tasikmalaya

Kab. Cirebon

Kab.Bogor

Kab. Sukabumi

Kab. Cianjur

Kab. Bandung

Kab. Garut

Kab. Kuningan

Kab. Majalengka

Kab. Sumedang

Kab. Indramayu

Kab. Subang

Kab. Purwakarta

Kab. Bekasi

Kota Bogor

Kota Sukabumi

Kota Cirebon

Kota Bekasi

Kota Depok

Kota Cimahi

Kota TasikmalayaKota Banjar

Sumber: Sub Dinas Penyehatan Lingkungan

Tahun 2006Suspect/Mati: 96/11

CFR: 11,5%Konfirm/Mati : 22/19

CFR: 86,4 %

PREVALENCE RATE KUSTADI PROVINSI JAWA BARAT, TAHUN 2005

Kab. Karawang(1,13%)

Kota Bandung(0.02%)

Kab. Ciamis(0.2%)

Kab. Tasikmalaya(0.44%)

Kab. Cirebon(1.77%)

Kab.Bogor(0.5%)

Kab. Sukabumi(0.13%) Kab. Cianjur

(0.13%)

Kab. Bandung(0.08%)

Kab. Garut(0.07%)

Kab. Kuningan(0.55%)

Kab. Majalengka(1.61%)

Kab. Sumedang(0.27%)

Kab. Indramayu(1.27%)

Kab. S.ubang(1.83%)

Kab. Purwakarta(0.49%)

Kab. Bekasi(1,18%)

Kota Bogor(0,2%)

Kota Sukabumi(0.04%)

Kota Cirebon(0.83%)

Kota Bekasi(1.1%)

Kota Depok(0.06%)

Kota Cimahi

Kota Tasikmalaya Kota Banjar

PR < 1/10.000

PR > 1/10.000

Sumber: Sub Dinas Penyehatan Lingkungan

DAERAH ANTHRAX DAN LEPTOSPIROSISDI PROVINSI JAWA BARAT, TAHUN 2002-2006

Kab. Karawang

Kota Bandung

Kab. Ciamis

Kab. Tasikmalaya

Kab. Cirebon

Kab.Bogor

Kab. Sukabumi

Kab. Cianjur

Kab. Bandung

Kab. Garut

Kab. Kuningan

Kab. Majalengka

Kab. Sumedang

Kab. Indramayu

Kab. Subang

Kab. Purwakarta

Kab. Bekasi

Kota Bogor

Kota Sukabumi

Kota Cirebon

Kota Bekasi

Kota Depok

Kota Cimahi

Kota TasikmalayaKota Banjar

Sumber: Sub Dinas Penyehatan Lingkungan

DAERAH TERTULAR RABIES DI PROVINSI JAWA BARAT, TAHUN 2003-2006

Kab. Karawang

Kota Bandung

Kab. Ciamis

Kab. Tasikmalaya

Kab. Cirebon

Kab.Bogor

Kab. Sukabumi

Kab. Cianjur

Kab. Bandung

Kab. Garut

Kab. Kuningan

Kab. Majalengka

Kab. Sumedang

Kab. Indramayu

Kab. Subang

Kab. Purwakarta

Kab. Bekasi

Kota Bogor

Kota Sukabumi

Kota Cirebon

Kota Bekasi

Kota Depok

Kota Cimahi

Kota TasikmalayaKota Banjar

Sumber: Sub Dinas Penyehatan Lingkungan

TBCMALARIA

DHF Avian FluHIV/AIDS

Leprae

ANTHRAX & LEPTOSPIROSIS RABIE

S

5

Environment :Physical

Social

Development

Behaviour

Health Status :Mortality, Morbidity

Health System

3488

2352

3654 3572

28562657

2957

35103648

1323 1406 1419

754

321

903726 678 626 644 672 763

1143

0

500

1000

1500

2000

2500

3000

3500

4000

1999 2000 2001 2002 2003 2004 2005 2006 2007

kematian bbl kematian ibu ( bkkbn ) kematian ibu ( dinkes )Infant Maternal (FPB) Maternal (PHO)

Number of infant and Maternal DeathWest Java Province

Source : PHO West Java

Problem of information system missing data; missing vital statistics

Challenge :

new emerging diseases

local and traditional health problems

disparity

poverty

lack of appropriate health system

combination of complexity needs

systemic change to protect and

empower community.

PrimaryHealthCenter

DistrictGovt

Univ.Medical

Fac.

Sub-districtGovt.

Community

PrivateSectors

VillageGovt

Villagemidwifes

Health cadres

CentralGovt

Do they awareDo they careDo they know ?

NGO

Sub-district Jatinangor

Univ.Medical

Fac.

12 villagesPop : 81 thousand

Surveillance-response system (SRS) development

in a sub-district as a pilot project diseases & risk factors

providing new approach of surveillance system involving community, local government and private health provider and link to academic society

strengthen existing public health efforts

Initiated by medical faculty, cooperated with Local Government & Primary Health Center (PHC)

Objectives

To empower local community and

advocate stakeholders facing global and

local health challenge

To solve community health problem by

identify risk factors and other

determinants of health

Intervention to prevent the increasing of

disease and outbreak.

Steps Program design Survey Modules/ SRS guidance

development Training ICT media development Socialization and advocacy Intervention

System Development Training

Cadres Village midwifes School teachers Health providers :

Government Private

ICT development PHC Training Health mapping Web based media

Training health cadres

Training and involving villagemidwife

Training and involving teachersProfessor ophtalmologist involved

Training and involving governmenthealth providers

Involving private health providers Involving chief of villages

Involving chief of subdistricts Involving community

ProgramDesign

Assessment& mapping

Systemdevelopment

Risk Factors &Diseases

Intervention

Research

Student & Lecturer research & SRS

ResearchResearch

Research Research

Role of Medical Faculty/ University

Results.

A survey was accomplished to get health system

baseline data. It involved lecturer, undergraduate

and postgraduate students.

Internet-based health mapping was developed for

exposing diseases and risk factors.

Modules were developed for SRS training.

Training was executed for health cadres, village

midwifes, school’s teachers.

ICT training was carried out for PHC worker.

PrimaryHealthCenter

DistrictHeathOffice

Univ.Medical

Fac.

Sub-districtGovt.

Community

HealthFacilities(Private)Village

Villagemidwifes

Health cadres

Model SRS

Authority and health provider were endorsed to joint the network.

Community through trained people detects disease cases and risk factors and reports them to PHC using sms gateway, internet and or traditional media.

District and sub-district authority gain information easier and at real time through internet therefore response could be done.

Academic society can get information and do intervention or research needed.

Sub distrioct govt

Village govt

PHC

Med Faculty

Public internet cafeCadresCommunityHealth providersNGO

Cases of diarrhea reportedby cadres using sms gateway

Intervention for health determinant

Discussion SRS in sub-district area is a media for every

health’s stakeholders to identify community

health problems and its determinants.

Academic society

touch directly to the real health problem.

involving students, lecturers, researchers and

use every finding as new knowledge and

manage it as well.

Through this media they can help health

provider and authority in decision making

to overcome health problems

Linkage between community, local

government, private health provider and

academic society synergize efforts and

responses to cope the health challenges.

Some risks factors and environmental problems were identified

Need more risks factors and diseases intervention activities/ program by stakeholders

Program evaluation SRS could be extend for district

and West Java Province next year program

Scaling up : whole of the district 3 districts at north coast involving other faculties : Agriculture,

Veteriner, Antropology, Agric.Technology, etc

Integrated Food , Health and Energy Program : 2010 -2012 Funded by Ministry of Education,

University, Provincial Government, District Government

Conclussion : Problems: How to raise the sustainability

issues to the surface Solution: Create a system (SRS) as media to

communicate between stakeholders Endorse stakeholders to participate: Local

government, public and private health providers, community, cadres, teachers, academia

Role of academia: mediation, advocacy, facilitation, system development, research & knowledge,

Orchestration and responsibility for human future