Although the World Health Organization (WHO) had targeted the elimination of measles and rubella in Southeast Asia by 2023, measles-contain vaccination (MCV) coverage in Indonesia dropped by about 6%. Additionally, vaccine-preventable disease was reported to drop 30% because of the COVID-19 pandemic. Investigators of a study published in Clinical Epidemiology and Global Health developed a community surveillance program to determine the performance of measles-rubella control programs and identify gaps in implementation.
For this study, the investigators implemented a surveillance system in Bantul’s public health center (PHC) that interviewed data managers, doctors, and analysts. Health care professionals in 18 PHCs (66.7%) were interviewed. Data were collected using a semi-structured questionnaire based on WHO surveillance system evaluation guidelines. The questionnaire was divided into 4 parts that covered the following: demographics characteristics; networking; partnership of surveillance structure; and attributes, such as timeliness, completeness, utility, simplicity, acceptability, and flexibility of data quality.
The network and partnership implementation for the measles-rubella program were evaluated, and attributes (eg, timeliness, completeness, utility) were analyzed as part of 4 components of the surveillance and response system. Data were analyzed by scoring each variable within 3 categories: good (>80%), fair (60%-80%), and weak (<60%) system coverage. Network and partnership were defined as the availability of communication flow media information, including the network of health facilities who were willing and able to implement case-based measles surveillance (CBMS) under the PHC.
The CBMS detected and responded to disease outbreaks early. Case-based surveillance reports were updated daily, and aggregate reports were updated weekly. Additionally, a district health office (DHO) officer examined the district and PHC weekly data. Although guidelines defined the standards, each PHC reported cases differently. A total of 5 private health clinics and 27 PHCs participated in the surveillance system and all centers sent suspect lists weekly to the central server via social media.
Key Takeaways
- Gaps in Measles-Rubella Surveillance and Vaccine Coverage in Indonesia: Despite efforts to control measles and rubella, the COVID-19 pandemic led to a significant drop in measles-containing vaccination (MCV) coverage in Indonesia, with private health facilities showing poor participation in surveillance activities. This emphasizes challenges in vaccine implementation and data reporting.
- Surveillance System Weaknesses: The community-based surveillance program revealed weaknesses in data quality, timeliness, and completeness. Only 55.6% of public health centers and 3.7% of private clinics consistently participated in case-based measles surveillance, with private clinics facing difficulties in cooperation and reporting.
- Need for Improved Networking and Partnerships: The study emphasized the need for stronger collaboration between public and private health facilities, particularly in enhancing vaccine coverage and improving the surveillance system. Additionally, the investigators called for increased monitoring, assessment, and private health care participation by 95%, notably in vulnerable areas.
According to the findings, 13 (55.6%) PHCs participated in the CBMS. Only 6 (3.7%) private health care centers participated in CBMS activities, and most private health institutions reported facing difficulties with cooperation (40.7%).
Despite overall good MCV coverage, vaccination in private health care and independent midwives’ clinics have never been supervised, which can contribute to cold-chain problems. In addition, the authors note that laboratory feedback for specimens’ results depended on the availability of Indonesia Health Ministry reagents. In the evaluation year, specimens from each second half year were reported to be delayed for the test because of reagent availability. The system implementation was also reported to be hindered, according to the authors.
The investigators observed that timeliness (50%) and completeness (58.9%) indicators were weak in the data quality indicator, and that only 6 (33.3%) PHCs were consistent in the accuracy of their reporting during 2021 and 2022. Generally, the accuracy of reporting in 2022 was improved (91.9%) than in 2021 (71.4%). Further, approximately 16.7% of health care workers have completed reporting of suspected measles-rubella cases with outbreak forms and weekly reports, even though about 47.4% of data managers had already implemented national measles surveillance guidelines.
Additionally, the investigators observed an overall lack of availability of evidence. All PHCs implemented the measles-rubella surveillance system; however, only 63.2% of respondents could provide evidence during 2021 and 2022. The ability of PHC to implement the update’s case definition with only 11.1% of health facilities in 2021 and 12 (66.7%) in 2022 demonstrates a weakness in the flexibility indicator.
The measles-rubella surveillance system had overall lacked networking, partnerships, and community involvement. Because of this, the investigators noted that the health office is expected to boost private health facility participation, monitoring and assessment. As well as vaccine coverage by at least 95%. This is especially urgent in more vulnerable areas, the investigators noted.
REFERENCE
Gusrina S, Sitaresmi MN, Aryanto S, Wiratama BS. Evaluation of measles-rubella control and prevention program implementation: System and community review. CEGH. 2024;29:101758. doi:10.1016/j.cegh.2024.101758
