Indonesia Prepares to Face Future Epidemics by Institutionalizing a “One Health” Approach
This post was written by Muhammad Azhar and Nurul Huda, FHI 360. Muhammad Azhar is the Indonesia team lead and Nurul Huda is a program officer for IDDS at FHI 360. ICF leads the IDDS project with a consortium of organizations.
Indonesia is one of Asia’s hotspots for emerging infectious diseases (EIDs) that can jump from animals to humans. Epidemics of zoonotic diseases have become more frequent and spread more quickly than ever, with devastating health, social and economic consequences. In recognition of this growing problem, in 2019, Indonesia issued a presidential instruction, which set in motion a government-wide initiative to better prepare for and respond to potential pandemics.
USAID’s Infectious Disease Detection and Surveillance (IDDS) project is helping the country build a strong, integrated surveillance system, complete with laboratory capacity, information systems and well-trained staff to prevent, detect and quickly respond to outbreaks using the One Health approach. One Health is a collaborative, multisectoral approach that recognizes the health impacts of the connections between humans, animals and their shared environment.
In 2020, IDDS supported the Government of Indonesia to establish the One Health Coordination Working Group, which aims to support the government in handling EIDs through cross-sectoral collaboration and coordination nationally and locally. The working group consists of three subworking groups: the One Health Laboratory Network, Integrated Surveillance and the Zoonosis and EID Information System (SIZE). In 2021, the One Health Coordination Working Group was formally legalized under the Deputy Decree of the Coordinating Minister.
Animal Health, Human Health and the Environment
IDDS also supported the government in developing the Cross-Sectoral Integrated Surveillance Guideline, the Revitalization Four-Way Linking (4WL) Guideline and the National SIZE Roadmap (which became annexes of the Regulation of the Coordinating Minister). In 2022, the pilot implementation of the joint risk assessment (JRA), using the 4WL framework and the Cross-Sectoral Integrated Surveillance Guideline, was carried out at the district level, with a focus on controlling the high number of cases of leptospirosis, a disease that is worsened during the rainy season when water becomes contaminated with Leptospira bacteria. Agricultural workers are at higher risk of contracting the disease, and its prevalence among humans, livestock and ruminants may be severely underestimated in Indonesia.
The pilot included all stakeholders, including human health, animal health and wildlife/environment health professionals from central and local government, as well as international partners: the World Health Organization, Food and Agriculture Organization of the United Nations (FAO) and Australia Indonesia Health Security Partnership. The JRA-4WL revealed a high risk of leptospirosis in Demak district, finding sporadic increases in both human and livestock disease cases. The preliminary findings have been presented to the head of local government, along with several recommendations:
- Strengthen existing programs by adding educational content on leptospirosis prevention
- Improve infrastructure, such as laboratory equipment for detecting processes and reporting tools
- Conduct risk communication, such as socialization, involving local champions and local people
IDDS expects to expand the implementation of the JRA-4WL and Cross-Sectoral Integrated Surveillance to other priority zoonosis and other regions in Indonesia in 2023.
Preventing and Detecting Outbreaks
To increase laboratory capacity to detect new EIDs with epidemic potential, IDDS developed the PREDICT laboratory protocol curriculum in collaboration with the Eijkman Institute for Molecular Biology. The certified training on PREDICT has been successfully carried out at four public health laboratories (Balai Teknik Kesehatan Lingkungan dan Pengendalian Penyakit (BTKLPP) Manado, Ambon, Makassar and Batam). After participating in this training, around 20 public health laboratory officers were certified by the Human Resources Training Center, Ministry of Health. Laboratory test results from the pilot were reported in SIZE to be circulated and responded to by provincial and central levels, showing the improvement of Indonesia’s capacity to prevent and respond to future outbreaks.
Information technology is another key area for preventing and detecting outbreaks of infectious diseases. IDDS supports the government to develop, operationalize and optimize the SIZE information system, which integrates human and animal disease data from across Indonesia. In 2019, SIZE was piloted to detect rabies in four provinces (North Sulawesi, West Kalimantan, Riau and Central Java), supported by the FAO. To accelerate SIZE implementation, IDDS supported the government to conduct training sessions, including One Health training in Karawang, West Java, which will be followed by the upcoming SIZE onsite technical training on priority zoonoses. It will be targeted to four additional provinces (North Sumatera, West Sumatera, Banten and West Nusa Tenggara) that expect to implement SIZE in the future. Meanwhile, the improvement of SIZE to be interoperable and integrated with human, animal and wildlife information systems, as well as to cover more priority zoonoses, is ongoing to ensure that SIZE will be regularly updated and functional in Indonesia.
For more effective responses in Indonesia, we must first understand the epidemiology of zoonotic diseases and track their incidence and prevalence across sectors. Through international collaboration and investments, the government of Indonesia has made substantial progress toward achieving an integrated disease information system, has articulated its vision and roadmap toward integrated surveillance and has taken important steps toward training the health workforce and building capacity for preparedness and response, including within the agricultural sector. With zoonotic diseases an ever-present threat, the vision established at the G20 summit held in Indonesia in November — to redouble efforts to strengthen national health systems and global health governance across sectors — is more important than ever.
This post was written to mark One Health Awareness Month (January). The views expressed here do not necessarily represent those of USAID or the U.S. government.