Post on 19-Jan-2016
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