IMPLEMENTING
THE NATIONAL STRATEGIC PLAN FOR
AVIAN INFLUENZA
(INSPAI)
Project Funded by The European Union
CRIS no. ASIE/2007/145-079
11 December 2007 to 12 December 2011
FINAL REPORT
616.9
Ind
p
Penerbit
KEMENTERIAN KESEHATAN REPUBLIK INDONESIA
TAHUN 2010
WORLD HEALTH ORGANIZATION
INDONESIA COUNTRY OFFICE
JUNE 2012
TABLE OF CONTENTS
1
Table of Contents…………………………………………………………………………...…………
Acronyms and Abbreviations………………………………………………………………..............
EXECUTIVE SUMMARY……………………………………………………………………………...
2
3
CHAPTER ONE: SUMMARY OF THE ACTION
Background……………………………………………………………………………………………. 6
Summary of the Action………………………………………………………………………………... 9
CHAPTER TWO: PROJECT PERFORMANCE
Strengthening Case Management…………...………………………………………………………….
Strengthening Disease Surveillance……………………………………………………………………
Promote Healthier Food Market and Risk/Outbreak Communication…………………………............
Improved Understanding of H5N1……………………………………………………………...............
10
33
51
58
PROJECT MANAGEMENT
Administration, Finance and Procurement…………………………………………………………….
Human Resources……………………………………………………………………………………...
Planning, Monitoring and Reporting…………………………………………………………..............
Visibility Action……………………………………………………………………………………….
Constraints and Challenges……………………………………………………………………………
Deviation from Description of Action...................................................................................................
69
70
70
74
74
75
CONCLUSION…………………………………………………………………………………………….. 76
ANNEXES
1
Work Break Down Structure & Achievement Toward the Logical Framework
2
Avian Influenza Referral Hospitals
3
Medical Equipment and Ambulance Distribution
4
Infection Prevention Control (IPC) and Healthcare Association Infections (HAIs) Surveillance
Trainings Monitoring and Posters.
5
Avian Influenza (AI) Case Management Trainings
6
Laboratory Network
7
Influenza Like Illness (ILI) and Severe Acute Respiratory Infection (SARI) Sentinels
8
Laboratory Trainings
9
FETP Students, Field Supervisors, List of Thesis of FETP students
10 Field Epidemiology Assistant Trainings and Surveillance Trainings
11 Healthy Food Market (HFM) Trainings, HFM IEC and HFM Procurement
12 List of Research Methodology Training
13 List of Research Proposals
14 Financial Report
15 Project Personnel (WHO)
16 Key Project Stakeholders
17 Visibility Action
18 UNOPS Isolation Room Development Report
1
ACRONYMS AND ABBREVIATIONS
AI
AusAID
BSL3
CRRT
DC-EH
EID
EU
EWARS
FAO
FETP
GIS
GISN
GoI
GSM
HAI
HQ
HVAC
H5N1
HFM
HVAC
IAA
IEA
IEC
IHR
ILI
INSPAI
IPC
LIMS
Komnas FBPI
MoA
MoF
MOH
NIC
NGO
NIHRD
OIE
PDSR
PIDU
PPE
PSC
PTIC
SEARO
SARI
SOP
RRT
TEPHINET
TORs
ToT
UNOPS
WP
WHO
Avian Influenza
Australian Agency for International Development
Bio-Safety Level 3 Laboratory
Continuous Renal Replacement Therapy
Disease Control and Environmental Health Directorate General of Ministry of
Health of the Republic of Indonesia
Emerging Infectious Diseases
European Union
Early Warning Alert and Response System
Food and Agriculture Organization
Field Epidemiology Training Programme
Geographic Information System
Global Influenza Surveillance Network
Government of Indonesia
Global Management System
Healthcare Associated Infection
Headquarter
Heating Ventilating Air Conditioner
Highly pathogenic AI A virus expressing the hemagglutinin type 5 and the
neuraminidase type 2 protein variants of the influenza virus family
Healthy Food Markets
Heating Ventilating Air Conditioning
The Interagency Agreement
International Epidemiology Association
Information, Education, and Communication
International Health Regulations of the World Health Organization
Influenza Like Illness
Implementing the National Strategic Plan for AI
Infection Prevention and Control
Laboratory Information Management System
Indonesia National Committee for AI and Pandemic Preparedness
Ministry of Agriculture
Ministry of Finance
Ministry of Health
National Influenza Centre
Non-Governmental Organization
National Institute of Health Research and Development
World Organization for Animal Health
Participatory Diseases Surveillance and Response
Physical Infrastructure Design Unit
Personal Protective Equipment
Project Steering Committee
Project Technical Implementation Committee
WHO South East Asia Regional Office
Severe Acute Respiratory Infection
Standard Operating Procedure
Rapid Response Team
Training Program in Epidemiology and Public Health Intervention Network
Terms of References
Training of Trainers
United Nation Office Project Services
Work Plan
World Health Organization
2
EXECUTIVE SUMMARY
This is a consolidated report of the “Implementation of the National Strategic Plan for Avian Influenza
(INSPAI)” project, funded by European Union (EU). The report highlights achievements towards project
logical framework, covering all years period implementation from 11 December 2007 to 12 December
2011.
The EU funded the INSPAI project through World Health Organization (WHO) to support Government of
Indonesia in responding to Avian Influenza (AI). The project aimed to improve the accessibility and quality
of health services for the community, has largely achieved its stated objectives and succeeded in disbursing
its budget with significant results covering the four key strategic objectives of core public health:
(1) Strengthen disease management including infection prevention and control.
(2) Strengthen disease surveillance.
(3) Promoting health through healthy food markets and health promotion.
(4) Improved understanding of H5N1 infection through research.
The country capacity building in those core public health areas also strengthens country capacity in
responding to other emerging infectious diseases such as H1N1. The Ministry of Health (MoH)
implemented activities in close collaboration with WHO and the United Nation Office for Project Services
(UNOPS).
The following is an overview of achievements of results.
The developed negative pressure isolation rooms at 10 hospitals serve as a demonstration for preventive
measures to limit the spread of viruses, prevent cross contamination and protect health
personnel from contracting disease. The ten hospitals are Persahabatan hospital Jakarta, Gatot Subroto army
hospital Jakarta, Tangerang hospital Banten, Kandau hospital Manado and Gunung Jati hospital Cirebon,
Sulianti Saroso hospital Jakarta, Soetomo hospital Surabaya, Moewardi hospital Solo, Abdoel Moeloek
hospital Lampung, Ulin hospital Banjarmasin.
Furthermore, to improve the healthcare facility in supporting AI case management, 90 three-position beds
and mattress, 180 strechers, PPE packages, 52 suction pumps, 15 infusion pumps, 15 syringe pumps and 22
ambulances were procured and delivered to AI referral hospitals. Trainings and manuals were provided to
ensure optimal use of isolation room and equipments.
Infection Prevention Control (IPC) and AI case management guidelines were developed , printed and
distributed to hospitals. More than 600 healthcare workers in hospitals were trained in infection prevention
and control and around two hundred healthcare workers were trained in AI case management.
In addition, to improve healthcare workers on AI early detection and treatment, training in AI early
detection and treatment were conducted for approximately 8.500 front line primary healthcare workers
from health centres and private clinics in seven high risk provinces (Riau, DKI Jakarta, DI Yogyakarta,
South Sulawesi, North Sumatera, Bengkulu and West Kalimantan).
In laboratory capacity building, development of Laboratory Information Management System (LIMS) has
improved the National Influenza Centre (NIC) capacity in managing specimens. Around 300 laboratory
staffs from 45 laboratories received training in PCR diagnosis, biosafety and biosecurity, valuable in
improving laboratory diagnosis capacity. The quality control program served as a monitoring tool to
measure the quality of emerging diseases laboratories as well as strengthened laboratory networking.
Furthermore, procurement of supplies and equipments for laboratory to support performing diagnostic
testing improved the infrastructure of laboratories.
3
Responding to the threat of zoonosis diseases, The National Committee on Zoonosis and Communicable
Diseases Control has been established through a presidential decree no 30/2011, replacing the National
Committee for Avian Influenza (KOMNAS). The efforts in the past in establishing national and provincial
influenza coordination committee through INSPAI funding and other donor supports have contributed in
building the national and provincial capacity to establish the Zoonosis Committee.
In terms of pandemic preparedness, Indonesia supported by various donor agencies developed pandemic
response guidelines and conducted epicenter simulations in Bali and Makasar. The pandemic preparedness
and response effort emphasizes significant roles of multisectoral entities and also communities.
In building the work force in epidemiology, a total of 73 trainees from all over Indonesia completed Field
Epidemiology Training Programme (FETP) at University of Indonesia (UI) and University of Gadjah Mada
(UGM). The graduates are assigned back to their duty stations and apply their knowledge and skills to
improve surveillance at their work place.
Close collaboration among MoH, universities, FETP secretariat, officials at the field placement sites and
field supervisors contributed to the success of FETP. The revitalized curricula allocated 70% field work and
30 % academic study, thus the students more exposed to the field experience. Review of curicula and
continous quality improvement were carried out to improve the program. Furthermore, FETP Indonesia is
active internationally through participation in various global event, and epidemiology networking such as
TEPHINET and the International Epidemiology Association. The commitment of the Ministry of Health to
FETP gives a solid foundation to this training program for the sustainability of the program.
To strengthen the surveillance system, a total of 180 public healthcare workers were trained in field
epidemiology assistance (PAEL) short course . In addition, collaboration with animal health sector is also
strengthened through Rapid Response Team (RRT) trainings. Up to date, around 500 public health
workers in eleven provinces were trained in RRT, using INSPAI project fund, while RRT in other
provinces were supported by other donor funding. This brings a total of 1669 healthcare workers from 345
districts of 29 provinces that were trained using multiple donor funding.
To reduce transmission infection in traditional market, the Healthy Food Market (HFM) pilots in 10 sites
serve as a demonstration for future replication to other markets. The HFM raised awareness of market
communities and stakeholders through Participatory Hygiene and Sanitation Transformation (PHAST) ,
market cleaning training (promoting basic hygiene and sanitation practices including cleaning and
disinfection as part of diseases control in wet market), establishment of land radio as a food borne diseases
risk promotion tools, distribution of Information, Education and Communication (IEC) materials and
improvement of basic hygiene infrastructure in the market. 4916 workers from district/ municipality local
authorities and market communities from 10 markets participated in the HFM trainings. 30,000 flyers,
10,000 booklets, 5,000 pocket books, 1,000 posters and 240 sign boards and 14 Audio Public Service
Announcement (PSAs) were distributed to market communities at the pilot sites.
Advocacy to local government for sustainability of healthy food market program gained positive responses
from the market community, local government as well as central level and private sectors. The positive
responses are expressed in the publication of HFM program in local newspaper and commitment from
stakeholders to support the HFM program. For example, Ministry of Trade has allocated fund to support
daily operation and to sustain project initiatives in most of the pilot sites, local government has been
supporting HFM at the pilot sites and partnership with different entities have been established.
Raising awareness has been done through Communication Behaviour Impact (COMBI) implementation in
Central Java and distribution of IEC materials including 1000 VCD and manual instructional on community
empowerment in preventing AI and Influenza pandemic for healthcare workers in 33 provinces.
12 research projects funded by INSPAI have improved understanding of virology, epidemiology and
clinical spectrum of avian influenza. The research results were presented and disseminated during the
international event, TEPHINET conference, November 2011 in Bali.
4
The Directorate Vector Borne and Diseases Control (VBDC), MoH RI has successfully facilitated
coordination among key stakeholders during implementation of the project. Project Steering Committee
(PSC) and Project Technical Implementation Committee (PTIC) mechanism enhanced the management
experience of the Government of Indonesia in managing inter sectors activities as well as harmonizing AI
control efforts funded by various funding sources. All key stakeholders were actively involved in planning,
implementation, monitoring and evaluation of the INSPAI program, thus they had good ownership spirit of
the program.
The one-year extension recommended by the Mid Term Evaluation has allowed optimal implementation of
the project. In addition, Results orientated monitoring mision in 2009, 2010 verification mission in 2010
and the final evaluation of the project in November 2011 have given useful feedback recommendations for
possible future ways forward.
Overall, the project has been completed according to the approved work plan and contributed in
strengthening overall human health system capacity to deal with human cases of avian influenza as well as
raising community awareness to minimize the potential spread of AI virus and increase country capacity in
responding to potential pandemic emerging diseases.
Key Achievements
 10 negative pressure isolation rooms developed.
 Procurement of 90 three-position beds and mattress, 180 stretchers, 52 suction pumps, 15
infusion pumps, 15 syringe pumps and 22 ambulances and PPE packages for AI referral hospitals.
 Infection Prevention Control (IPC) and AI case management guidelines produced.
 IPC training for more than 600 hospital healthcare workers.
 AI case management training for around two hundred healthcare workers.
 Training in AI early detection and treatment for approximately 8.500 primary healthcare workers
from health centres and private clinics in seven high risk provinces (Riau, DKI Jakarta, DI
Yogyakarta, South Sulawesi, North Sumatera, Bengkulu and West Kalimantan).
 Development of Laboratory Information Management System (LIMS) at NIHRD.
 Training of PCR laboratory diagnostic, biosafety and biosecurity for around 300 laboratory staffs.
 Laboratory quality control program for 44 laboratory network supported.
 Advocacy meetings for establishment of PICC at 8 prioritized provinces (DKI Jakarta, West Java,
Central Java, East java, North Sumatera, Riau island, Lampung and East Nusa Tenggara).
 Establishment of revitalized FETP at University of Indonesia and University of Gadjah Mada
with 73 graduates.
 Field Epidemiology Assistance short course for 180 public healthcare workers.
 Rapid Response Team (RRT) training for around 500 public health workers in eleven provinces.
 10 Healthy Food Market (HFM) pilots established.
 HFM training for 4916 district/ municipality local authorities and market communities from 10
markets.
 COMBI implementation in Central Java.
 1000 VCD and manual instructional on community empowerment in preventing AI and Influenza
pandemic for healthcare workers.
 12 research projects on virology, epidemiology and clinical spectrum of avian influenza.
5
CHAPTER ONE: SUMMARY OF THE ACTION
2.1 Background
Avian Influenza reminds a challenge in Indonesia. As of June 2012, Ministry of Health has confirmed 190
cases of which 158 were fatal (case fatality rate: 83%). All confirmed cases were reported from provinces
in the Java, Sumatra, Sulawesi, Bali and Nusa Tenggara Barat islands.
The spread of cases over time indicates continues exposure of humans to the virus in Indonesia. While the
numbers of cases have fallen each year since 2006, the fatality remains high.
83% of cases were fatal since the start of the outbreak. In 2005/2006, the case fatality ratio was 77%. In
2007, 2008, 2009, 2010, 2011 the case fatality ratio was 88%, 83%, 90% , 78%, 88% respectively. In 2012,
up to date, with seven cases, the CFR is 100%.
Map showing location of officially reported human cases of avian influenza A/(H5N1) is shown below :
The peak of H5N1 in Indonesia appears to have been in early 2006 before intense effort of government of
Indonesia to control H5N1 began. Although the epidemic curve of H5N1 cases at this point does not
suggest a rising rate of infection, there still is a probability of mutation in the virus and there is concern that
without complete eradication of this disease in human and bird, the possibility of a mutation, which makes
the virus more easily transmittable, could occur at any time.
On average, a larger number of cases are detected in January than the other months of the year. It suggests a
seasonality effect, since January falls within the peak months (December – February) of the wet season in
many parts of Indonesia.
To date, most human cases have been sporadic single cases or parts of small family clusters. There were 14
clusters of avian influenza infection in Indonesia, but relatively few of these occurred after 2006, and none
occurred in 2010 and only one was detected in 2011. The majority of cases were not employed in poultry
related occupations.
6
Inconclusive, 25,
13%
Slaughtered sick
birds, 14, 7%
Visited wet market,
11, 6%
H5N1-positive
poultry at home, 2,
1%
Handled sick/dead
poultry, 29, 15%
Poultry deaths in
home, 26, 14%
Healthy poultry in
environment, 32,
17%
Handled poultry
faeces, 1, 1%
Poultry deaths in
environment, 41,
22%
Data Source: MoH ; Current as of 23 April 2012
Handled poultry
products, 4, 2%
H5N1-positive
poultry in
environment, 3, 2%
From investigations, it was found that
38 % of cases had direct exposure which
were exposed to H5N1 confirmed
animals or animal by products and had
recent poultry deaths within home.
These include slaughtered sick birds,
handled sick / dead poultry, handled
poultry product/ fesses, etc. 48 % of
cases were due to indirect exposure,
which refers to cases where there were
recent poultry deaths in the case’s
environment or where there were any
poultry in the environment or visited wet
market. The role of contaminated
environment in the transmission and
propagation of H5N1 in human and
animals needs to be more clearly
defined.
AI cases are predominantly disease of young adults and adolescents. The average age is approximately 20
years and the distribution of cases is relatively equal in males and females.
Some improvements of community awareness and knowledge about AI at community level have been noted
in some provinces, such as Bali, however a qualitative study on AI in 2008-2009 revealed that in most part
of Indonesia, there is still lack of knowledge and awareness about AI at community level. The traditional or
customary ways of life in Indonesia have brought about a wide range of AI related risk behaviour. Chicken
and birds play important roles in social and cultural activities. The traditional backyard and open range
poultry raising as well as placing poultry cages in close proximity to homes facilitates the spread of illness.
Lack of compliance to standard control measure such as applying personal protective equipments when
handling poultry and improper handling sick and dead poultry gives rise to the risk of H5N1 avian
influenza infection. Recent studies suggest that there is also contamination in live bird markets particularly
in certain provinces (West Java, Banten, DKI Jakarta). The risk factors include slaughtering birds in the
market and no zoning that segregate poultry related workflow areas in the market.
The majority of cases first present to primary healthcare (private clinics/doctors, midwives’, private
hospitals or government health care centres). Early symptoms of H5N1 are not specific and thus busy
primary healthcare physicians would find it extremely difficult to predict which of their patients with
influenza like illness is going to turn out to have highly pathogenic H5N1 in few days.
Most patients present to local hospitals after few days of illness and there is often a further delay in
transferring patient to the tertiary care facility. Furthermore, the cases present to hospital at an advanced
stage of illness, where case management was less likely to impact on clinical outcome.
The continuous circulation of H5N1 virus in Indonesia is having potential serious implications for health,
economics and food security as well as could trigger a human pandemic. In order to minimize morbidity,
mortality, and economic loss, as well as to reduce the threat of the pandemic, Indonesia has taken efforts to
strengthen its capacity in disease surveillance, case management, risk communication and appropriate
responses and strengthen integrated inter sectoral approach to battling H5N1 . Notification under the
obligation of International Health Regulation (2005) is taking place.
7
In December 2005, the Government of Indonesia (GOI) adopted the National Strategic Plan for Controlling
AI. The plan includes 10 strategies to control AI based on recommendations from the WHO, the Food and
Agriculture Organization (FAO) and the World Organization for Animal Health (OIE). The strategies are:
(1) Controlling of AI H5N1 in animals;
(2) Management of human cases of avian influenza;
(3) Protection of high risk groups from infection;
(4) Epidemiological surveillance for animals and humans
(5)Restructuring the poultry industry;
(6) Risk communication, information and public awareness;
(7) Strengthening relevant laws;
(8) Capacity building;
(9) Action research;
(10)Monitoring and evaluation.
The European Union (EU) funded WHO for Implementation of the National Strategic Plan for AI (INSPAI)
project to address the needs of Indonesia in controlling AI and preparing the country for influenza
pandemic. The MoH is key partner in the implementation of the National Strategic Plan. There are four key
strategic objectives covering:
 Strengthen diseases management
 Strengthen disease surveillance
 Promoting health through healthy food markets and health promotion
 Improved understanding of H5N1 infection through essential research.
The capacity building in those four key strategic objectives also strengthens the country capacity in
responding to other pandemic potential emerging disease.
8
The Summary of the project is as follow:
Duration of the project:
Objectives:
December 2007 to December 2011
Overall objective(s):
Improvement in the accessibility and quality of health services for the
community through supporting the GoI in its efforts to implement the
health related aspects of prevention and control of AI (AI), specifically
H5N1 and pandemic preparedness nationwide.
Specific objective:
Strengthened mechanisms and capacity to reduce human exposure to the
virus thereby reducing morbidity; improved case management of patients,
thereby reducing mortality.
Partner(s)
MOH, National Committee for Avian and Pandemic Influenza (Komnas
FBPI).
Target group(s)
Designated referral hospitals and laboratories in Indonesia, High risk
groups, such as health care workers, people attending wet markets, and
people who handle poultry and/or poultry products. Community
populations at risk for infection with H5N1, where high density of humans
coincide with high densities of poultry and other AI risk factors. Research
scientists and public health professionals.
Final beneficiaries
Population of Indonesia, neighbouring countries, and the world in terms of
controlling the virus transmission in humans, and possibly pre-empting or
slowing the course of a pandemic.
Expected results
1. Strengthened case management
2. Strengthened disease surveillance
3. Healthy Food Markets and effective risk/outbreak communication
4. Improved understanding of H5N1
Total eligible cost of the Action
EUR 13,500,000
Amount requested from the
Contracting Authority
EUR 13,500,000
% of total eligible cost of
Action
100%
9
CHAPTER TWO: PROJECT PERFORMANCE
3.1 Project Performance –Achievements during the period of 11 December 2007 to 12 December 2011
The following provides detailed information on progress towards results according to each activity
component for all years period implementation (11 December 2007- 12 December 2011). The summary of
achievement during reporting period toward the Objective Verifiable Indicators (OVIS) of logical
framework is attached in Annex 1.
RESULT I: STRENGTHENING CASE MANAGEMENT
Activity 1.1 – Enhanced Infrastructure at AI Referral Hospitals
The negative pressure isolation rooms at 10 hospitals serve as demonstration and centre of
excellence for preventive measure in AI case management in Indonesia.
180 Stretchers, 90 three-position beds and mattresses, 52 Suction pumps, 15 Syringe
pumps, 15 Infusion pumps, 22 ambulances, and PPE delivered to AI referral hospitals
equipped the referral hospitals for better AI case management.
1.1.1 WHO Technical Assistance and Travels
Technical officers provided technical assistance to the MoH and UNOPS for assessment and monitoring of
isolation room development and facilitated coordination among key stakeholders. International isolation
room experts from the University of Hong Kong (Prof. Yu Go Li and Mr. Yuen Pak Leung) delivered
technical assistance during isolation room development.
1.1.2 Isolation Room
A well-ventilated isolation room is an effective infection prevention control measure to prevent
contamination and further transmission of AI and other pandemic potential emerging infectious diseases
particularly for airborne transmitted diseases.
It is well known that in well-ventilated isolation room, contaminated air can be rapidly decayed thus
reducing the infective droplets in the room air and further exposure to healthy individuals. The utilization of
mechanical ventilation is selected to warrant the necessary controls to achieve adequate ventilation rates
and controlled direction of airflow. These includes maintain the air change per hour (ACH) > 12,
differential pressure between spaces and monitor the performance of high efficiency particulate air (HEPA)
filtration of room air before it is re-circulated or disposed.
As part of INSPAI project, to support AI case management and infection control, Ministry or Health (MoH)
and WHO in collaboration with UNOPS has successfully developed isolation room facilities with negative
pressure. These sites are located in AI endemic and high-risk location, dense poultry population as well as
poultry traffic line. The 10 sites are Persahabatan hospital Jakarta, Gatot Subroto army hospital Jakarta,
Tangerang hospital Banten, Prof Dr Kandau hospital Manado and Gunung Jati hospital Cirebon, Sulianti
Saroso hospital Jakarta, Dr Soetomo hospital Surabaya, Dr Moewardi hospital Solo, Abdoel Moeloek
hospital Lampung and Ulin hospital Banjarmasin.
10
The MoH selected 10 hospitals based on the high AI prevalence, health facility accessibly for community,
availability of trained human resources in AI case management, critical care and infection control, adequate
infrastructure capacity to support AI case management and hospital management commitment to ensure
proper operational and maintenance for isolation room for its sustainable function.
This complex project involved construction work and installation of Heating Ventilating Air Conditioning
(HVAC) system. A negative pressure room includes a ventilation system designed so that air flows from the
corridors, or any adjacent area, into the negative pressure room, ensuring that contaminated air cannot
escape from the negative pressure room to other parts of the facility. This protects healthcare workers as
well as patient and surrounding environment from infection by cross contamination.
Both technical and operational trainings were conducted to
ensure the optimal use of isolation room. The technical training
was attended by doctors and nurses in the hospital AI team
covering the subjects of update on AI case management,
infection control, pandemic preparedness, and utilization of the
facility through onsite simulation on patient flow. The
operational training was attended by hospital maintenance staffs
and nurses covering the introduction of the system,
troubleshooting, replacement of spare parts and other
maintenance facility.
Commissioning and testing were also conducted on site in each hospital to
ensure that the isolation room meets the WHO standard requirement.
Furthermore, twelve months defect liability period has been applied up to
12 December 2013 to ensure the quality of isolation room developed and
enable contractors to rectify any defects found during the
period. Retention monies of contractor will be kept by
UNOPS as securities during this period and will be
returned to the contractor when appropriate. During
the liability period, UNOPS quality inspector visits all
sites to evaluate the quality of isolation room and delivers
guidance and refresher on the operational and
maintenance of isolation room.
The picture showstechnical expert from Hong Kong participating during testing and
Commissioning at Persahabatan hospital Jakarta.
The symbolic hand over of the ten isolation
rooms was conducted on 12 December 2011
together with the inauguration of the isolation
room facility in Tangerang hospital by the
honorable Minister of Health Republic of
Indonesia. All Directors or representatives
from the ten hospitals attended the ceremonial
hand over.
The Ministry of Health handing over the isolation room to Director of Tangerang hospital.
European Union delegation representative and WHO Indonesia attended the hand over ceremony.
11
The symbolic hand over attracted much media
coverage as the ten isolation rooms donated to
MoH are the first of its kind in Indonesia.
Following the hand over, UNOPS provided the
necessary documentations such as testing and
commissioning report, as-built drawing, SOP and
maintenance manual to the hospitals.
A simulation was conducted at the Tangerang
hospital isolation room, prior to the symbolic hand
over.
The hospitals have now all accepted the developed isolation rooms. Hospital management has allocated
budget for the operational and maintenance of the isolation room and to ensure the optimal use of the
facility.
For optimal use of isolation room, the Directorate General of Medical Care, MoH RI released circular letter
distributed to all referral hospitals. The circular stated that the isolation room and medical equipments
dedicated for AI cases should be used for AI patients or any emerging infectious diseases as priority,
however, for optimal use of the facility, whenever there is no AI case being treated in the facility, the
isolation room and medical equipments can be used for patient treatment of any other infectious diseases.
Below pictures shows isolation rooms at 10 hospitals :
Persahabatan hospital, Jakarta
RSPAD hospital, Jakarta
12
Tangerang hospital, Banten
RSPI Sulianti Saroso hospital, Jakarta
Kandau hospital, Manado North Sulawesi
Gunung Jati hospital, Cirebon West Java
13
Soetomo hospital, Surabaya East Java
Ulin hospital, Banjarmasin South Kalimantan
Moewardi hospital, Solo Central Java
Abdoel Moeloekhospital, Lampung
14
1.1.3 WHO Technical Assistance and Travel for Medical Equipment Delivery
Technical officer and logistic units provided assistance to the MOH for the procurement and delivery of
essential medical equipments to AI referral hospitals. Technical assistance was also delivered during onsite
training and monitoring of medical equipments and ambulances.
1.1.4 Medical Equipments and Ambulances
During the project, WHO delivered 180 Stretchers for 99 AI
referral hospitals, 90 three-position beds and mattresses for 50 AI
referral hospitals, 52 Suction pumps for 30 AI referral hospitals,
and 15 Syringe pumps, 15 Infusion pumps, 22 ambulances and
PPE packages. Detailed distribution list of medical equipments
is attached in Annex 3.
To ensure the optimum use of the equipments, WHO in
collaboration with MoH conducted monitoring of medical
equipments at AI referral hospitals. Most medical equipment is
located in the isolation rooms, but some of the medical equipment
is located in the other wards/ ICU. Hospitals have registered the
donated equipment to the hospital inventory list for further
utilization and maintenance.
Upon delivery of ambulances, function
testing and training for the use of
ambulance and its supporting medical
equipments was conducted on-site,
attended by doctors, nurses and hospital
technicians. The onsite trainings were
completed in August 2011.
The supporting medical equipments in
the ambulances includes: portable
ventilator, suction pump, patient monitor,
O2, trauma kit and ambu-bag, suction
pump, stretcher, resuscitation kit, first aid
kit, oxygen system, UV lamp etc. During
the testing, it was reported that all
vehicles and medical equipments were
properly functioning and currently in use.
Overall, since 2006, 100 AI hospitals have received various medical equipment donations from INSPAI
project, other donors or the national budget. The equipments have contributed significantly to the case
management of AI patients in the referral hospitals.
15
Activity 1.2 – Develop, Revise and Disseminate AI Infection Control and Case
Management Guidelines
Development and distribution of AI case management and Infection Prevention
Control guidelines were essential as guidance for good quality standardized care in
AI case management and control measure to prevent spread of diseases. Furthermore,
development of hospital pandemic preparedness guideline has contributed in
preparing Indonesia for a pandemic.
1.2.1 Technical Assistance and Travel
Technical officers provided assistance to MoH, Directorate General of Medical Care on the infection
control and AI case management for healthcare workers.
1.2.2. Infection Prevention & Control (IPC) Guidelines
The national infection prevention and control guidelines are the
adaptation of the WHO interim IPC guidelines of epidemic and
pandemic prone acute respiratory diseases in health care setting
developed in June 2007. MoH has taken several steps preceding to the
nationwide utilization of the guidelines including translation and fieldtesting in 2008 to the three piloted hospitals namely Dr. Achmad
Mochtar Hospital in West Sumatera; Dr. Oen Hospital in Central Java,
and A.M Perikesit Hospital in East Kalimantan. Indonesia was part of
the ten countries included in the pilot testing of this interim guideline
by WHO.
Following to the successful field testing, MoH launched the adapted IPC technical and managerial
guidelines to be used by the hospitals with the support of WHO, Indonesian Society for Infection Control
(INASIC) and other professional organizations. These guidelines were endorsed by the Minister of Health
decrees as the legal basis of the utilization as reference documents at national level. 2000 copies of IPC
managerial and 2000 copies of IPC technical guidelines were printed and distributed to hospitals, provincial
health officers, district health officers, and health centers. The technical guideline covers the principles of
IPC, standard precautions, hand hygiene, PPE, disinfectant, waste management, the facts of communicable
diseases, safe processing of equipment and preparedness on emerging infectious diseases, while the
managerial guideline covers management and administration aspects of IPC practice in hospital. In addition,
5000 copies of cough etiquette posters and 5000 copies of hand washing posters were printed to support the
training.
616.9
Ind
p
In the infection control program, surveillance of healthcare associated
infections (HAIs) is a key component to show data related to the
incidence of HAIs in the facility. By doing so, hospital can also
measure the achievements of the IPC program implementation by
looking to the trend of morbidity and mortality due to HAIs. It can also
early detect disease outbreaks within the hospitals including AI or other
new emerging infectious diseases. Responding to the need, MoH with
the support of WHO, Indonesian Society of Infection Control
(INASIC) and professional organizations, developed a national guideline for HAIs surveillance
in the hospital through a series of workshops in 2009 until 2011.
Penerbit
ESIA
REPUBLIK INDON
N KESEHATAN
KEMENTERIA
TAHUN 2010
16
The guideline covers the objectives of IPC surveillance, methods, case definition of HAIs and surveillance
management to enable IPC doctors and nurses to conduct routine facility based surveillance on HAIs to
develop evidence based policy for the hospital administrators and MoH. In 2011, 1000 copies of the HAIs
surveillance guideline and 1000 copies of the pocket book version were printed and distributed to hospitals.
To strengthen the implementation of IPC in hospitals, MoH conducted a national meeting on IPC in 15-17
December 2008 attended by 109 participants from 62 hospitals, medical professional organizations,
Indonesia National Infection Control Association, MoH and a representative from the Coordinating
Ministry of Social Welfare. The primary objectives of the meeting were to share the national policies,
advocate better implementation in the hospitals and update the knowledge of participants on IPC issues.
Some significant progresses in IPC program and healthcare-associated infections (HAIs) surveillance in
hospital have been achieved but the implementation remains a challenge in Indonesia. The high compliance
of IPC practices by healthcare workers supported by the availability of complete and timely data on HAIs
are essential to prevent and timely identify and respond to an outbreak within a hospital or other health
facilities.
1.2.3. AI Case Management Guidelines
The significant reduction of AI cases during the last five years is in contrast with the constantly high case
fatality rate (CFR > 80%) observed in Indonesia. MoH developed AI case management guidelines in 2006
and updated the guideline through series of workshops during 2009. The Minister of Health endorsed the
updated guidelines in 2010.
The guidelines cover the case definition and diagnosis of AI, case management in the
pre-referral hospitals, case management in the AI referral hospitals, critical care,
nursing care, infection prevention and control aspect of AI case management,
referral, administrative arrangements, and post treatment rehabilitation.
5000 copies of AI case management guidelines were printed and distributed to 100
AI referral hospitals, 33 provincial health offices, 465 district health offices and 1528
public and private hospitals in Indonesia.
Adoption of the guideline by hospitals is expected to improve AI case management starting from the early
recognition of cases, immediate deployment of the protocols in the guideline both for non-critical and
critical patients at the secondary or tertiary facility level.
1.2.4. Hospital Pandemic Preparedness Guidelines
During a pandemic, it is essential for the hospital to continue its operation; therefore, it is important for
hospitals to be prepared for the effects of a pandemic as these situations can affect the functioning of
hospitals in many ways. Therefore, MoH developed hospital pandemic preparedness guidelines in 2010 in
collaboration with medical doctors and experts from main AI referral hospitals, medical professional
associations and WHO.
The guidelines cover hospital operations during pandemic including human resource surge capacity,
infrastructure surge capacity, logistic supply, policy setting, command and control, clinical management,
infection control during pandemic and risk communication.
17
.
Activity 1.3 – Training of Health Care Staff in AI
More than 600 healthcare workers were trained in IPCs and HAIs surveillance,
around 200 healthcare workers were trained in AI case management and around
8500 primary healthcare workers were trained in AI early detection to improve the
capacity of healthcare work force in managing AI cases as well as putting
appropriate control measures in preventing further transmission.
IPC is a major consideration for patient and healthcare workers’ safety and prevent the diseases
transmission. It is also one of the pillars of International Health Regulations (2005). Considering the
strategic importance of IPC, the Ministry of Health has put IPC programme as one of the targets in the five
years strategic planning for the health sector. MoH has put significant efforts to develop policies for IPC
implementation, as well as trainings according to guidelines.
1.3.1. Technical Assistance and Travel for IPC and Case Management Training
Technical officer provided assistance for IPC and case management trainings during the planning and
implementation phases of the activities.
1.3.2. Infection Prevention & Control (IPC) Training
The emergence of new infectious diseases such as SARS, AI and H1N1 pandemic has been a warning for
global health security. Together with the emergence of multi-resistant microorganisms often found in
health facility settings particularly in hospitals. These agents can cross transmit from patients to health care
workers and vice versa in a vicious cycle. Infection control in hospitals and health care facilities is an
essential program to prevent and minimize the transmission of the agents among patients, health care
workers, visitors and surrounding communities.
Responding to above challenges, MoH with the support of various agencies and donors has been conducting
on-going activities to improve the preventive measures and resilience of hospitals and other health facilities
against the potential threats.
The MoH conducted series of IPC trainings targeting healthcare workers focusing on doctors and nurses in
hospitals to improve knowledge and skills of healthcare workers in implementing the IPC program. The
training module covered the basic principles of IPC, HAIs surveillance, hospital waste management, PPE
utilization and pandemic preparedness components. This training used adult learning method consisting
variety of methods including deployment of skill stations and field visits to hospital for onsite practice.
Since Dec 2007- Dec 2011, the INSPAI project supported 18 batches of IPC trainings covering 529
healthcare workers from 100 AI referral hospitals and non-referral hospitals. In addition to the training, a
workshop on IPC improvement was conducted on 31 March – 2 April 2009 in Mataram, West Nusa
Tenggara, attended by 52 participants from 12 hospitals. List of IPC trainings is attached in Annex 4.
MoH actively participated in the International IPC events to update the knowledge, skill and learn IPC
global best practices, as well as to enhance IPC networking, such as :
 8th East Asia IPC Conference in Japan, November 2009.
 27th annual meeting of the European society for pediatric infectious diseases in Brussels, Belgium,
June 2009.
 Infection Prevention and Control African Network (IPCAN)
 International Federation of Infection Control (IFIC) conference in Cape Town, August-September
2010 and IFIC conference in Venice Italy 12-15 October 2011.
18
During the conferences, Indonesian delegates were involved in various discussions and met with delegates
from other countries to share experiences and lesson learned. As a result, some program adjustments have
been made following the activity such as the development of the HAIs surveillance guideline and
adjustment in IPC training curricula.
In addition, MoH supporting by other funding sent delegates to attend training of trainers on infection
control for respiratory diseases in Laos in 2010, IPC training in Hong Kong in 2010 and Asia Pacific
Society of Infection Control (APSIC) Congress in Melbourne in 2011. The congress brought together
international and regional experts to present and discuss the latest evidence based advancement in infection
control.
1.3.3. Hospital Infection Prevention & Control Surveillance Training
MoH developed the HAIs surveillance training modules
through workshops and editorial meetings in June 2010.
The training module covered national policy on HAIs
surveillance, role and responsibility of infection control
nurse, specimen handling, surveillance management,
hospital outbreak, reporting of incident, which includes:
hospital acquired pneumonia, ventilator associated
pneumonia, surgical site infection, intravenous catheter
related infection, urinary tract infection, septicemia and
other HAIs. Upon completion of the training, the
participants developed follow up action to implement
surveillance at their hospitals. The module also
completed with several relevant case studies.
Following the development of training module, MoH
conducted a Training of Trainer (TOT) in Batam, Riau Islands on 19-23 December 2010, attended by 26
participants from 20 hospitals. The TOT aimed to produce regional trainers and increase capacity of
regional IPC centers to conduct HAIs surveillance training within their regions in the future using their own
resources.
As the follow up, MoH conducted two batches of IPC surveillance training in Surabaya, East Java Province
on 26-30 December 2010 attended by 80 participants from 41 hospitals. The surveillance training aimed to
enable participants in conducting routine surveillance on HAIs incident in the hospitals and provide regular
reports to the hospital decision makers to further develop evidence based policy. List of HAIs surveillance
trainings is attached in Annex 4.
1.3.4. Monitoring and Evaluation
IPC program has been a national policy for more than two decades, but the implementation is still a
challenge. More intense efforts have been initiated since the inception of INSPAI project and have resulted
in significant progress. To monitor the program implementation, MoH established annual monitoring and
evaluation mechanism to measure progress of IPC implementation in hospitals. MoH developed monitoring
tools in October 2009 to assure standardize results.
In 2009-10, MOH conducted monitoring to 20 IPC hospitals. The monitoring visit found some
improvement in IPC implementation at visited hospitals. These include establishment of IPC committee and
improvement in knowledge and changes in the behaviour of healthcare workers toward IPC practices at the
observed hospitals. However, inadequate support from hospital management and lack of full time IPC
nurses in many hospitals are still key challenges.
19
The implementation of IPC in the hospital does not merely relies on the availability of the standardized
guidelines and trained personnel, it also heavily rely on the support from the hospital management to
provide guidance, support and also sufficient allocation of resources (operational fund, logistics, human
resources, etc). Addressing this issue, MoH conducted IPC national meeting of hospital manager in
Bandung, West Java Province on 15 – 16 December 2010, attended by 59 participants from 30 hospitals.
The meeting discussed the achievements, challenges, lesson learned in the implementation of IPC program.
The meeting also evaluated the IPC program strategy to reduce the infection rate in the hospitals and
produce efficiency that will be useful to hospital and patients. For sustainability, the meeting also discussed
IPC as one of the areas of focus for hospital accreditation. The MoH has indicated that by 2014, all
hospitals must obtain the accreditation from Hospital Accreditation Committee otherwise; the hospital’s
license will be suspended of rejected.
As part of monitoring and program evaluation, during 19-26 May 2011, Dr Geeta Mehta, the WHO SEARO
Infection control and patient safety focal point, assessed the IPC national program. The assessment aimed to
conduct a rapid ‘situation analysis’ to define current infectious disease threats in Indonesia and to undertake
a review of infection control infrastructure at national level and in selected hospitals. During the
assessment, Dr Geeta conducted discussion with MoH, Indonesia Society for Infection control (INASIC)
and visited district hospital (Pasar Rebo Hospital Jakarta) and National Cardiovascular Centre Hospital. The
assessment focused on WHO IPC core components covering:
(1) Organization of the IPC programme
(2) Technical guidelines
(3) Human resources
(4) Surveillance of Hospital Associated Infection
(5) Microbiological support
(6) Monitoring and evaluation
(7) Environment
(8) Links with public health and other services
The assessment revealed considerable progress had been made by the MoH in putting in place the essential
components of IPC although further efforts are still needed to improve and scale up the intervention to all
public and private hospitals in Indonesia. The assessment identified key challenges in IPC, which are:
complex and fragmented health structure, decentralization, as well as disconnect in skill development with
the function of the staff at healthcare facility level due to frequent transfer of staff. These factors can
hamper the implementation of IPC in hospitals.
The key recommendations from the assessment are:
 Strengthen coordination and collaboration among different departments in health sectors.
 Establishment of IPC committee at healthcare facility level, strengthen coordination with clinical
departments and empowerment of infection control team to identify HAI and improve IPC
implementation at healthcare facilities.
 Standardize the surveillance of HAIs and empower the infection control team to be able to identify,
analyse and respond to HAIs.
 Ensure the availability of PPEs and other supplies in the hospital.
 Improve waste management at hospital
 Deploy a Microbiologist in secondary and tertiary hospitals
 Improve pre-professional IPC education and training by establishing post professional diploma in
IPC.
MoH conducted IPC regular meeting to improve collaboration among IPC stakeholders involving MoH,
hospital authorities, professional organizations such as doctor associations, nurse associations and IPC
association, which play very significant role in developing IPC program. The meeting discussed and
provided technical advice for implementation of IPC national strategies and direction for the IPC program.
The meeting served as a medium to review and evaluate IPC implementation in Indonesia as well as
strengthen IPC network.
20
1.3.5. AI Case Management Training
Capacity of the healthcare workers is important to improve AI case management in hospitals particularly in
100 AI referral hospitals. As AI is considered as a new emerging disease, many aspects of the case
management are also still developing. MoH conducted series of AI case management trainings focusing on
the 100 AI referral hospitals with the support from various donors. The training intended to ensure that
healthcare workers particularly medical doctors and nurses are qualified and updated with the new
treatment protocols.
MoH conducted a workshop on case management and pandemic preparedness for Indonesian military
hospitals funded by the INSPAI project on 8-10 November 2008, attended by 32 military doctors and
nurses. The workshop was organized by Gatot Subroto hospital, an Indonesian military hospital that also
serves as one of the national AI referral hospitals. During the workshop, hospital pandemic simulation
exercise was conducted involving 250 health department personnel from 12 provincial military offices and
from 74 districts.
Critical care is essential in AI case management as many of AI cases fall into a severe condition that needs
critical care. The recognition of Systemic Inflammatory Response Syndrome (SIRS) is a critical step in the
management of critically ill patients, and is rapidly progressive with high fatality rate. It is essential to
invest in training and equipping the tertiary hospitals in developing countries to ensure the hospitals can
provide proper care and can potentially result in good outcomes even in some individuals who present late.
For this purpose, WHO sent a delegation to participate in critical care management training at the Cochin
University Hospital in Paris, France in 2009. Cochin hospital is one of the centres of excellence in France
for managing critical illness patients particularly with acute respiratory distress syndrome (ARDS). This
activity is jointly supported by WHO Indonesia and the Regional Emerging Disease Centre based in
Singapore. Twelve Intensive Care Unit (ICU) physicians and nurses from six hospitals (one physician and
one nurse per hospital) participated in the training. Follow-up actions of the training have been conducted
including development of an action plan to improve critical case management, compiling training materials,
summarizing form assessment of ICU management from all AI referral hospitals, infectious diseases
clinical trials network, procurement of medical equipments and on hands training on critical care medical
equipment. List of critical care training participants is attached in Annex 5.
To improve coordination of AI referral hospitals in AI case management, MoH conducted a national
meeting on May 24th – 26th 2010 in Bandung. The meeting enhanced networking among AI referral
hospitals and central level (MoH) for influenza pandemic preparedness. The meeting also served as medium
to build commitment of hospital management to improve capacity of AI case management, and to
disseminate latest clinical knowledge and update national policy on AI case management.
MoH also conducted two batches of provincial workshops in West Sumatera and East Kalimantan in
responding to the mass poultry deaths in those areas. The workshop in West Sumatera was conducted on 89 August 2011, attended by 20 participants from the provincial office, six hospitals including two AI
referral hospitals and five primary healthcare centres in the province. The workshop in East Kalimantan
was conducted on 19-20 August 2011, attended by 21 participants from the provincial office, eight
hospitals including three AI referral hospitals and six primary healthcare centres in the province. The two
days workshop with tailor made curriculum was intended to improve the local capacity in early detect cases,
provide treatment according to the national protocol and conduct referral.
Responding to the constantly reported of human AI cases in Western Java, MoH conducted a three days AI
case management training attended by 19 participants from 12 AI referral hospitals in Lampung, DKI
Jakarta, West Java and Banten provinces on 15-16 September 2011. In addition, 214 healthcare workers
were attended AI case management training in Bali on 8-10 December 2011. The training aimed to refresh
and update knowledge of participants in AI case management according to the revised AI case management
guideline. List of AI case management training is attached in Annex 5.
21
Complementary to the training, by the support of other funding, in 2009-2010, MoH distributed oseltamivir
to high-risk provinces. This to ensure that oseltamivir is widely distributed and easily accessible for primary
and secondary healthcare providers to rapid evacuate the patient to tertiary facilities that are able to treat the
patients for better outcome.
1.3.6. AI Early Detection and Case Management for Primary Health Care (PHC) Workers
Early detection and recognition is critical, as it has been recognized from global review cases of H5N1 that
delays in treatment with antiviral agents resulted in higher mortality. Early treatment is important in
achieving clinical success. Nevertheless, based on the data of confirmed human AI cases in Indonesia, more
than half of the patients presented at primary healthcare centers (PHCs) and private practitioners/clinics.
Most of the AI cases were misdiagnosed and just recognized several days after the onset when mostly
already in severe condition. Antiviral (Oseltamivir, Zanamivir) should be given within 48 hours after the
onset for better outcome. The delay of the diagnostic and the antiviral administration has led to the high
case fatality rate (CFR) of the AI patients in Indonesia with the average above 80%.
Considering this situation, MoH and WHO in 2008 and 2009 conducted socialization and training for AI
early detection and case management for primary healthcare workers in public and private facilities in three
provinces namely Riau (Funded by INSPAI), West Java and East Java (other funding). Preceding the roll
out training, MoH conducted ToT involving provinces and district health officers. INSPAI funded ToT in
Riau provinces on 11-14 June 2008, attended by 31 participants, followed by 25 batch of roll out training
covering 735 participants.
In 2010 and 2011, MoH expanded the AI socialization for primary
healthcare workers to oher six provinces, namely: North Sumatera,
Bengkulu, DKI Jakarta, DI Yogyakarta, West Kalimantan and South
Sulawesi. Preceding the socialization roll out, MoH conducted ten
batches of training of trainers (ToT)
covering 293 participants from provincial
and district health offices, hospitals,
universities, etc. Later the participants
became local facilitators during the scale
up activities. The scale up of socialization
The picture describes
activity covered 7.861 health care workers
active learning
in the six provinces. This brings a total of
method of AI
8.596 healthcare workers trained in
socialization roll out
AI early detection, funded by INSPAI. The
highest proportion of the trainees are
nurses (31.2%) followed by doctors (28.2%), midwives (21.7%) and surveillance officers (18.8%)
respectively.
To support the activities, approximately 6000 material kits including AI reference book, flow diagram on
case diagnosis, posters, leaflets and other materials were procured and distributed to participants.
The training materials were delivered to participants through interactive discussion, presentations,
experience sharing, microteaching and a case-study exercise. The training material covered epidemiology of
AI, national strategy on AI control, operational activity by PHC and private clinic to control AI, early
detection and prompt treatment, referral system, response, reporting and pandemic preparedness plan.
At the end of socialization session, the participants developed action plan to be implemented in their
working area and MoH encouraged the trainees actively involved in disseminating the knowledge within
their peer groups.
22
Summary of AI early detection socialization for primary healthcare workers during 2008-2011
Province
DKI
Bengkulu
West Kalimantan
No. of
Participant
1350
899
1230
Batch
Doctor
Nurse
Midwives
45
30
42
878
173
153
189
285
604
216
238
270
Surveillance officer
and others
68
193
203
South Sulawesi
1800
60
423
684
391
302
DI Yogyakarta
932
31
295
324
267
46
North Sumatera
1650
55
294
365
324
667
Riau
Total
735
8,596
25
288
217
2,433
131
2,582
237
1,943
150
1,629
The evaluation of roll out socialization in November 2011 revealed that upon the socialization, there was
improvement of knowledge and skills of the trainees focusing on diagnosis, treatment, referral, reporting
and response. The initiative improved confidence of healthcare workers in putting AI as working diagnosis
of patients presenting with ILI syndrome who have risk factors and referring the patient to the AI referral
hospitals. However, capacity of PHCs in responding to the AI cases found to be varied. It was documented
that the involvement of the private facilities can improve the coverage although its involvement is still
limited.
The key recommendations of the evaluation are:
(1) Refresher activities to maintain the knowledge and preparedness,
(2) Improve public and private partnerships,
(3) Better case documentation at primary healthcare centre and district health office,
(4) Optimizing the role of district focal point to provide routine supervision to primary facility,
(5) Improve coordination within units in the other stakeholders such as veterinary office and
(6) Securing local funding for the continuity of the activities.
Activity 1.4 – Provision of Personal Protective Equipments (PPEs)
355 PPE packages were distributed to AI referral hospitals to support the implementation
of infection prevention control.
The INSPAI project delivered 355 PPE packages to the AI referral
hospitals. The first shipment was done in 2010 to deliver 239 PPE
packages to 100 AI referral hospitals in 2010. Furthermore, in
2011, 116 packages of MoH PPE buffer stock were delivered to
53 AI referral hospitals. The packages consist of single use gloves,
gown, protective goggle, N95 mask, surgical mask, rubber boot,
alcohol rub disinfectant single use plastic apron, disposable bag
for bio hazardous waste. The purpose of the distribution is to
support the implementation of proper infection control program in
the hospitals with particular emphasis to manage Avian Influenza
patients.
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Activity 1.5 – Vaccination of Health Care Workers with Seasonal Human Influenza
Vaccine
-
-
4,799 doses of seasonal influenza vaccines were administrated to Central,
Provincial, District Surveillance officers involved in the investigation, healthcare
workers in AI referral hospitals, and laboratory staffs.
Pandemic Influenza Vaccine deployment plan has been developed as part of country
pandemic preparedness.
Various efforts have been conducted to improve country capacity to produce H5N1
vaccine.
Vaccination is one of activities to prepare for an influenza pandemic. With the availability of pandemic
vaccine, immunization becomes one of the key strategies to control outbreak. In 2009, 4,799 doses of
seasonal influenza vaccines were administered to Central, Provincial, District Surveillance officers involved
in the investigation, healthcare workers in AI referral hospitals, and laboratory staffs. However, considering
no significant impact due to limited resources with the large priority groups, vaccination for healthcare
workers under INSPAI project was not continued in 2010 onward.
Consultations on pandemic vaccine have been done with cross-sectors division within MoH (Sub
Directorate Immunization MoH and Directorate Transmittable Diseases) and Technical Working Group of
Influenza Vaccination. Technical assistance has been provided in timely manner in developing pandemic
vaccination plan, which is incorporated in the national pandemic plan. These include identifying the priority
list of vaccination target during pandemic.
To update progress on the influenza and pandemic vaccine, two NIHRD staffs attended World Vaccine
Congress Asia 2011 on June 20-24 2011, Grand Hyatt, Singapore. It was a five days event bringing together
over 400 vaccines executives to discuss partnerships, latest innovations, public healthcare policies,
manufacturing solutions and regulatory developments as well as pandemic preparedness and control.
A road map on developing vaccines for communicable diseases such as dengue fever, avian influenza and
malaria was developed. To improve the national capacity in pandemic preparedness, pandemic influenza
vaccine deployment plan was developed. The plan served as the core strategic document for the use of a
safe effective vaccine to respond to the pandemic and protect the most essential and critical population
groups. The vaccine deployment and implementation plan involves intense planning, coordination and
communication among many sectors at all levels. Directorate General of Diseases Control and
Environmental Health (DG DC & EH) MoH RI will coordinate the activity in the country and Director of
Immunization and Quarantine will be focal person that is responsible for planning, procurement and
distribution of vaccine and ancillary items, and supervise the implementation activities. Head of the
provincial Health Office and District/ Municipality Health Office are responsible for all activities in their
own region.
The priorities vaccine beneficiaries during pandemic has been set according to recommendation of
pandemic preparedness expert team and technical advisory group on immunization of Indonesia in line with
SAGE (Strategic Advisory Group of Experts on Immunization). These include all front line health work
force in public and private sectors which estimated around 600,000 across the country, essential staff
engaged in critical services (administrative health staffs, government personnel, members of parliament,
police, armed force, National disaster Management Agency, Red Cross personnel), which estimated are
1,997,775 across the country. Other priorities group includes pregnant women, children and young adults
and adults with underlining medical condition with the ultimate goal to protect the entire population when
vaccines are locally produced.
A vaccine research consortium was formed involving Biopharma, Ministry of Research and Technology,
Ejikman institution, the agency for the assessment and application of technology, Ministry of Health,
university of Indonesia and other institutions. The consortium has been conducting research on AI vaccine.
24
A prototype of bird flu vaccine has been produced. It is expected that at the end of 2013, Biopharma will be
able to start production of avian influenza vaccine.
WHO member states reached agreement on a pandemic influenza preparedness (PIP) framework for the
sharing of influenza viruses and access to vaccines and other benefits in April 2011. The framework
addresses a troubling controversy—should low- and middle-income countries share influenza virus
specimens with WHO without assurances that benefits derived from sharing will be equitably distributed.
The PIP framework aimed to improve pandemic influenza preparedness and response and strengthen the
protection againts the pandemic influenza by improving and strengthening the WHO global influenza
surveillance and response system (WHO GISRS), with the objective of a fair, equitable, efficient,
effective system for on an equal footing for sharing of H5N1 and other influenza viruses with human
pandemic potential and access to vaccines and sharing of other benefits.
Activity 1.6 – Capacity Building for a Laboratory Network
“Laboratory Information System (LIMS) implemented in NIHRD has improved the
performance of the National Influenza Centre. Furthermore, Laboratory trainings in
PCR and biosafety for around 300 Laboratories staffs and a quality control program
have strengthened the 44 laboratory network in diagnosing emerging infectious
diseases”
Health laboratory services are integral component of the health system. Efficiency and effectiveness of both
clinical and public health functions including surveillance, diagnosis, prevention, treatment, research and
health promotion are affected by reliable laboratory services. Given the growing importance of health
laboratories and emphasis on evidence-based medical and public health practices, it is imperative that health
laboratories are strengthened to provide critical inputs in making informed decisions.
1.6.1 Technical Assistance
WHO National Expert provided consistent technical assistance to MoH on laboratory activities to improve
the capacity of laboratory network, Laboratory Information System (LIMS) and to support establishment of
NIHRD to be a WHO Collaborating Centre (WHO CC).
1.6.2 Develop Road Map on Emerging Infectious Diseases (EID) for Laboratories
Emerging infectious diseases are remain threat to Indonesia, particularly those caused by viruses such as
H5N1, H1N1, Dengue Hemorrhagic Fever, Chikungunya, Japanese Encephalitis and others. Laboratory is
essential in responding to H5N1 and other emerging infectious diseases. In order to strengthen laboratory
capacity and networking in respond to the emerging diseases, Ministry of Health released a Ministerial
Decree no 658/MENKES /PER/VIII/2009 on new emerging and re emerging diseases laboratory network.
This network is a collaboration of DC-EH and NIHRD and operationally conducted by Center of Biomedic
and Basic Health Technology, MoH RI. The network is designated to conduct early diagnostic and identify
the etiology of pandemic potential new emerging and re emerging infectious diseases as public health
emergency of international concern. The laboratory network also supports influenza Like Illness (ILI)
sentinels. The network consists of national referral laboratory (NIHRD) and sub national diagnostic
laboratories at provincial/ district level (public health laboratories/ hospital laboratories/ university
laboratories).
The 44 AI referral laboratories which was previously designated as AI diagnostic referral laboratory for AI
are now included in the new emerging and re emerging diseases laboratory network. (List is attached as
Annex 6). In addition, other laboratories which handled biological and clinical specimen material and meet
the standard requirement as stated in the decree can be included in the network. It is expected that in future
25
development, at least one surveillance and emerging infectious diseases laboratory will be established in
every province as sub national laboratory.
The laboratory network should have an established SOP on laboratory procedure, biosafety and biosecurity,
adequate human resources, adequate infrastructure and laboratory equipment to support laboratory
diagnostic including PCR/ DNA sequencing. The national referral laboratory should meet the international
certification of external quality assurance scheme, while the laboratory network at provincial / district level
should meet the national standard quality certification.
The national referral laboratory is mandated to provide guidelines, standard diagnostic testing confirmation
testing, deliver technical assistance in developing capacity of laboratory network, conduct quality control,
facilitate availability of reagents and equipment to the laboratory network. It also conducts virus
characterization and research.
The diagnostic laboratory at provincial / district level is mandated to conduct H5N1 testing within 24 hours
and send the result as well as specimen to the national referral laboratory for confirmation.
In developing capacity of new emerging and re merging laboratory network, NIHRD, funded by the
national budget has developed laboratory road map to analyze and identify potential and constraints of
laboratories to be included in the network, in order to develop strategies and planning to improve the
capacity of those laboratories to be able to properly functional as new emerging and re emerging laboratory
network. The road map covers the strategies to improve capacity of human resource, infrastructure, logistic,
laboratory management, and laboratory information system, laboratory financing for sustainability
improvement, and improving laboratory capacities to support outbreak investigation.
In addition, to foster development of research laboratories which have the capability in emerging infectious
diseases diagnostic, Centre of Biomedical and Basic Health Technology NIHRD, responsible to improve
biomedical and health technology research and laboratory management, conducted assessment at nine
potential laboratories using INSPAI project fund. The laboratories are :
1.
2.
3.
4.
5.
6.
7.
8.
9.
Banda Aceh health research laboratory
Baturaja zoonosis research laboratory, South Sumatera
Ciamis zoonosis research laboratory, West Java
Banjarnegara zoonosis research laboratory, Central Java
Salatiga reservoir and vector borne research laboratory, Central Java
Tanah Bambu zoonosis research laboratory, South Kalimantan
Waibubak zoonosis research laboratory, East Nusa Tenggara
Donggala zoonosis research laboratory, South Sulawesi
Papua biomedical research laboratory, Jayapura.
Throughout assessment, NIHRD identified potentials and constraints of these laboratories, and developed a
plan to improve the capacity of those laboratories in research and emerging infectious diseases diagnosis.
Since 1975, NIHRD has been designated as National Influenza Centre (NIC) as part of influenza global
network with terms of reference that include monitoring circulation of influenza viruses and detection of
novel strains with pandemic potential. The global network comprises five World Health Organization
(WHO) Collaborating Centers (WHO CCs), four Essential Regulatory Laboratories and 134 institutions in
104 WHO Member States, which are recognized by WHO as National Influenza Centers (NICs)
In addition to the central role, strengthening provincial/ district laboratories is essential. To describe
epidemiology of influenza among ILI outpatient and to monitor virology characteristic, seasonality and
geographical influenza activities in Indonesia to enable early detection of new strain of influenza virus,
NIHRD established an ILI surveillance laboratory network.
In 2011, the network consisted of national referral laboratory (NIHRD) and five regional laboratories at
University of Indonesia Jakarta, University of Diponegoro Semarang, University Udayana Bali, and
University Hasannudin Makasar and Public Health Laboratory Palembang. These five ILI laboratories
coordinate with ILI surveillance sentinels at 20 health centres in 20 provinces. ILI health centre sentinels
26
monitor ILI patient presenting to the health centres and sent the specimen (throat and nasal swab) to the
laboratory network. The specimens were taken from patient presenting with ILI symptoms.
In addition, Severe Acute Respiratory Infection (SARI) surveillance is a problem in Indonesia. SARI is an
acute infection process in the lung tissue (alveoli or interstitial tissue) which manifest in several symptoms,
such as fever, difficulty in breathing, and chest X-ray shows acute lung infiltrate. SARI surveillance is
essential for early case detection and for the antigenic and genetic evaluation of the etiology (viral,
bacterial), such as new variants or subtypes of influenza virus, including any strains with pandemic
potential.
Responding to the challenge, NIHRD established surveillance system of epidemiology, virology, and
bacteriology of SARI in Indonesia through SARI sentinels to characterize the epidemiology of SARI,
determine the proportion of confirmed influenza cases among patients of SARI, as well as other selected
respiratory bacteria and viruses and to determine the proportion of SARI-associated deaths among all
hospitalized deaths and patients. The hospitals sent the sample to NIHRD to perform laboratory diagnostic.
In 2011, the NIHRD strengthened SARI sentinels at 10 provinces (Banten, South Sulawesi, DKI
Jakarta,West Java, Central Java, Bali, West Nusa Tenggara, Papua, West Sumatera, and West Kalimantan).
The map above describes the geographical distribution of ILI health centre sentinels, ILI laboratory
sentinels and SARI hospitals sentinels in Indonesia in 2011. List of ILI and SARI sentinels is in Annex 7.
WHO Collaborating Centre (WHO CC)
Indonesia is one of a very few countries in the world in which avian influenza H5N1 is endemically
circulating in animal populations, and one of even fewer countries which continue to regularly report
sporadic human cases. Indonesia is therefore has taken efforts to make a potentially significant contribution
to improve the understanding of such infections and to strengthening the global response to the threat posed.
Indeed, at present, WHO requires greater levels of collaboration in the field of influenza at the humananimal interface to clarify and better understand the cultural and other processes that facilitate humans
becoming exposed and infected with animal influenza viruses and the differences in virus virulence in
different settings and parts of the world. Indonesia is well placed to collaborate in strengthening WHO’s
assessment and response activities through improved linkages between the laboratory, animal,
environmental, epidemiological and clinical sectors. Therefore, Indonesia and WHO agreed to propose
Indonesia to be a WHO Collaboration Centre on Influenza at the human-animal interface covering areas of
surveillance, laboratory capacities and research. The centre will focus on human-animal interface of the H5
avian influenza.
27
As a follow up, on 18 March 2011, NIHRD held a meeting on designation of WHO CC-Influenza focusing
on human and animal interface. The meeting outlined steps and key activities for the NIC to become a
WHO Collaborating Centre for Influenza.
1.6.3 Training of Laboratory Technicians
Laboratory Biosafety & Biosecurity Training
Biosafety and biosecurity implementation is essential to minimize risks of infections through safe and
secure practices in laboratory and transport environments, appropriate protective equipment, engineering
and administrative controls in the handling of pathogenic organisms, to protect workers, environment and
community from exposure, infection, and subsequent development of disease.
The Center for Biomedic and Basic Health Technology - NIHRD, as a national referral health laboratory for
investigation and research of communicable diseases, has a role in the development of biosafety and
biosecurity aspects of public health and hospital laboratories under the Ministry of Health. Therefore, the
NIHRD has taken efforts in standardizing biosafety and biosecurity of laboratories in Indonesia through
development of biosafety biosecurity guidelines, training modules and trainings.
Users and all laboratories staff are required to complete orientation courses prior to start working at their
laboratories. They need to have abilities to determine the hazards they may be exposed to during the course
of their work. The orientation includes health and safety, radiation safety, biosafety, laboratory safety, and
task specific training for specific job. Furthermore, Biosafety Officers (BSO) with sufficient knowledge and
experience along with a good microbiological technique practice and a bio-risk management system are
also needed to ensure that biosafety and biosecurity are addressed and managed properly at bio-risk
facilities.
Funded by INSPAI project, NIHRD conducted two batches of five days biosafety and biosecurity trainings
for 55 laboratory technicians, laboratory managers and researchers.
Lectures, interactive discussions, role model, case
study, laboratory practices, video sessions and also
an evaluation game were used. The training is
accredited by Board for Development and
Empowerment of Human Resources for Health,
MoH RI, so that upon completion of the training,
the participants gained credits which contribute to
their career development.
The picture on the left depicted safe
pipet technique as part of laboratory
procedure according to biosecurity
and biosafety, and the picture below
describes hands on laboratory PPE as
part of biosecurity and biosafety.
As part of the training package, the trainees visited BSL 3 NIHRD laboratory and Institute of Human
Virology and Cancer Biology (IHVCB) of University of Indonesia. Upon completion of the training, pre
and post test evaluation showed improved knowledge of participants. The trainees were expected to
implement the training materials in daily working and disseminate the knowledge within their peer groups.
28
The training materials covered :
1. Laboratory biosafety principal and practice
2. Laboratory associated infection
3. Biosafety committee and biosafety officer
4. Aerosol risk in laboratory
5. Biological safety cabinet
6. Microorganism classification based on
hazard risk group
7. Risk analysis of laboratory microbiology
8. Decontamination, sterilization
9. Personal Protective Equipment (PPE) for
laboratory staffs
10. Laboratory waste management
11. Chemical waste management
12. Infectious sample transportation management
13. Biosecurity
PPE BSL 3 Laboratory
PPE BSL 2 Laboratory
At the end of the training, the trainees developed follow up action plan to implement biosafety and
biosecurity at their laboratory institutions. The participants were also equipped with the modules and
handouts to be used in their offices.
As follow up action, to continue the improvement, NIHRD conducted a monitoring program to monitor the
effect of training at work place. The monitoring result shows that there has been improvement in knowledge
and skill of laboratory personnel in PCR diagnosis and biosafety. However, the high turn over of laboratory
staffs remains a challenge. Therefore, refresher trainings is still needed.
Laboratory Information and Management System (LIMS) Software
Following the training of LIMS in December 2010, NIHRD has been implementing LIMS to facilitate the
researchers, laboratory workers and officials in monitoring condition of specimens, result of examinations,
planning and decision making on specimen management in all laboratories for biomedical and
pharmaceutical research. The LIMS implementation at NIHRD has proven useful to improve the
management of specimens in NIHRD laboratories.
PCR Refresher Training for Laboratory Staffs
Laboratory examination for influenza diagnosis to detect A/H5N1’s and A/H1N1‘s RNA from the swab
specimens are performed by RT-PCR technique gel based and Real-time RT-PCR. Since Indonesia is a
vast archipelago country, improving capacity of laboratory network is essential to enable access for rapid
diagnosis response to identify H5N1 infection, H1N1 infection and other emerging diseases. Therefore,
NIHRD has been organizing PCR trainings for AI laboratory networks. Furthermore, high turn over of
laboratory staffs also made the PCR refresher training important to maintain quality of laboratory
diagnostic. Seven batches of laboratory PCR diagnostic trainings were held for 213 laboratory technicians.
List of laboratory PCR trainings is attached in Annex 8.
The training aimed to improve capacity of diagnostic laboratories in identifying and conducting differential
diagnostic test for influenza cases and to achieve high standard and adequate capacity to support the
national influenza pandemic preparedness program.
29
The training focused on updated laboratory procedures to rapid
influenza detection in clinical samples in a hands-on manner
through a combination of lectures and laboratory sessions. Specific
techniques include principles of PCR techniques, sample
collection, transport, storage and processing, template preparation,
data analysis, personal and laboratory safety. The training provided
overview of influenza viruses and various diagnostic
methodologies and basic laboratory quality system. The training
not only covered the performing assays, but also covered
troubleshooting and development. The pre and post test of the
training showed that there were improvement in trainees
knowledge on PCR techniques upon completion of the training.
Conventional Electrophoresis PCR
NIHRD has taken efforts to ensure sustainability of laboratory diagnostic capacity building using national
budget or other donor funding. Furthermore, through EU join action in supporting WHO, adopted in April
2008, the EU might continue supporting high risk countries including Indonesia, through WHO to improve
biosafety-biosecurity. A country consultation visit from biosecurity experts – WHO HQ was done during
27-30 June 2011, to assess the needs in improving biosafety and biosecurity in Indonesia.
Quality Control Program for AI Laboratory Network
Following the training, in order to monitor laboratories quality and capability in performing AI diagnosis,
NIHRD has been conducting quality control program for laboratory network. The 1st panel quality control
program was conducted during 2009-10. The NIHRD provided quality control test (reagents, primer and
samples) for AI laboratory network in Indonesia. Inactive influenza viruses (Influenza A/H1N1 seasonal,
A/H3N2 and RG A/H5N1) are used as samples. The virus isolates were extracted to obtain the RNA and
tested by both real-time RT-PCR and conventional RT-PCR. The isolates, primer and reagents were
distributed to laboratory network using the quality control test package provided by NIHRD. The results
were reported to NIHRD for evaluation.
Overall, there was improvement made during the 2nd quality control panel in 2011, compared with the
previous quality control panel result in 2010.
Five laboratories performed excellent result in 2010 and 2011 quality control panel. The five laboratories
are Sanglah hospital laboratory, University of Udayana laboratory, Hasan Sadikin laboratory, Bandung
public health laboratory, Persahabatan hospital laboratory.
The 1st panel quality control
program during 2009-2010, found
that from 41 laboratories that
received the samples, only 11
laboratories (27 %) performed
excellent result (quality control test
100% correct) , 9 laboratories
(22%) performed good result
(quality control test score 80-99%
correct), while the others still need
to be improved.
30
The eleven laboratories that achieved an excellent result are :
1. Sanglah hospital laboratory, Bali
2.Udayana University Laboratory, Bali
3. Hasan sadikin hospital laboratory, Bandung
4. BBLK (Public health laboratory) Bandung
5. Otorita hospital laboratory, Batam
6. Persahabatan hospital laboratory, Jakarta
7. Mataram hospital laboratory,West Nusa Tenggara,
8. BLK (Public health Laboratory) Palembang
9. Ulin hospital laboratory, Banjarmasin
10.University of Indonesia Laboratory, Jakarta
11.M. Hoesin hospital laboratory, Palembang.
The nine laboratories that achieved a good result are :
6. Sulianti Saroso hospital laboratory, Jakarta
1. BBLK (public health laboratory), Makasar
7. BLK (provincial laboratory) Bali
2. BLK ( provincial laboratory) Yogyakarta
8. BTKL (public health laboratory) Yogyakarta
3. University of Hasanuddin laboratory, Makasar
4. University of Diponegoro laboratory, Semarang 9. BBLK (public health laboratory) Jakarta.
5. Karyadi hospital, Semarang
During 2011, the NIHRD run a 2nd panel quality control program. The NIHRD provided quality control test
(reagents, primer and samples) for AI laboratory network in Indonesia.
There was some improvement in the 2nd panel quality control program. From 42 laboratories received the
samples, 11 laboratories (26 %) performed excellent result (quality control test 100%) , 13 laboratories
(31%) performed good result (quality control test 80-99 %), while the others are still need to be improved.
The eleven laboratories that achieved an excellent result are :
1. Sanglah hospital laboratory, Bali
7. R.S. Dr. Sardjito laboratory, Yogyakarta
2. Udayana University Laboratory, Bali
8. Provincial Public Health Laboratory Jakarta
3. Hasan sadikin hospital laboratory, Bandung 9. Provincial Public Health Laboratory Surabaya
4. BBLK (Public health laboratory) Bandung 10. Public Health Laboratory (BBTKL) CDC Jakarta
5. Persahabatan hospital laboratory, Jakarta
11. Public Health Laboratory (BBTKL) CDC Yogyakarta
6. Public Health laboratory Denpasar, Bali
The thirteen laboratories that achieved a good result are :
8.
1. Dr. Sutomo Laboratory, Surabaya
9.
2. Public Health Laboratory Medan
10.
3. Hassanudin university laboratory, Makassar
11.
4. Adam Malik hospital laboratory, Medan
12.
5. Otorita Batam hospital laboratory, Batam
13.
6. Dr.M. Husen hospital laboratory, Palembang
7. Wahidin Sudirohusodo hospital laboratory
Yogyakarta Public Health Laboratory
Surabaya Environmental Laboratory
Mataram hospital laboratory
Pekanbaru provincial laboratory
Syaiful Awar hospital laboratory, Malang
Makasar provincial laboratory
Following the quality control result, NIHRD delivered technical assistance and conducted monitoring visit
to other laboratories, which did not perform well in influenza diagnosis. The main constraints found in the
field included high turn over of laboratory technicians, lack of knowledge in laboratory diagnosis test and
lack of laboratory infrastructure to support proper lab diagnostic such as biosafety cabinet not available.
1.6.4 International Trainings and Seminars
To improve the international networking and collaboration as well as to update knowledge on laboratory
technique, Indonesia participated in various international conferences..
Two staffs from NIHRD attended the International Meeting on Emerging Disease and Surveillance in
Vienna, Austria on 4-7 February 2011. The meeting discussed H1N1 pandemic, biosecurity in one health
approach, antibiotic resistance, update on emerging diseases surveillance, emerging infection prevention at
healthcare setting, etc. The meeting was one of the global programs in monitoring emerging infectious
diseases. Indonesia existence in the workshop strengthened networking of NIHRD with international
society. Furthermore, as follow up action, the delegates shared update knowledge and program on
emerging diseases and surveillance to be applied in Indonesia.
31
On 21-25 March 2011, two staffs of NIHRD attended Bi-regional workshop on laboratory based
surveillance of antimicrobial resistance in Chennai, India. The workshop aimed to assist countries in
developing their laboratory capacity for efficient surveillance of emergence and spread of antimicrobial
resistance. The workshop reviewed status of laboratory based surveillance of antimicrobial resistance in
Asia Pasific. WHO oriented and trained the participants on WHO recommended laboratory techniques for
determination of antimicrobial resistance and WHO-net5 application (WHO software for antimicrobial
resistance and data analyses). At the end of the workshop, countries delegates developed follow up actions
at country level for establishment of a national surveillance system for monitoring drug resistance.
As a follow up action, Indonesia Microbiology Association in collaboration with MoH and WHO held a
national symposium on antimicrobial resistance during 1-3 July 2011. As part of the symposium, a WHOnet5 workshop was delivered for laboratory staffs from hospitals. Furthermore, in combating antimicrobial
resistance, WHO in collaboration with MoH also held a national seminar on antimicrobial resistance during
world health day commemoration on 7 April 2011. The seminar aimed to raise awareness to contain
antimicrobial resistance.
To strengthen country capacity in biosafety and biosecurity, two staffs from NIHRD attended regional
biosafety course on 25-29 April 2011 in Bangkok. The course emphasized biosafety implementation and
biorisk analysis. As follow up action, NIHRD delegates shared the update knowledge from the course to
enrich biosafety training material for laboratory network in Indonesia.
As part of Asia pacific region countries, Indonesia also actively participated in strengthening health
laboratory services in Asia Pacific. Head Centre of Biomedical and Basic Health Technology, NIHRD
attended informal consultation meeting on development of Asia Pacific Laboratory Action Plan (20112015) for emerging infectious diseases. The meeting was held in Manila, on 19-20 May 2011.
The strategies developed in the meeting include:
1.Establishment of national framework for laboratory.
2.Sustainable financial of laboratory services.
3.Laboratory services capacity building (Physical infrastructure, human resource, procurement and
supply, laboratory network, specimen transportation, information and communication).
4.Assure the quality of health laboratory services.
5.Promote the rational use of laboratory services.
6.Improve laboratory safety (biosecurity, biosafety, occupational heath safety and waste management).
7.Support research and ethics in laboratory settings.
To update information and enrich knowledge on emerging diseases, two NIHRD staffs attended Fifth
Meeting of National Influenza Centers in the South-East Asia and Western Pacific Regions. The meeting
was held in Vientiane, Lao PDR on 7-10 June 2011. The meeting provided a forum for sharing experiences
and knowledge on influenza, a disease which remains a global concern. Participants of the meeting
developed a five-year plan (2011- 2015) on national influenza surveillance, enabling a harmonized regional
approach to data collection, collation, analysis and dissemination. Delegates also set a prioritized regionspecific research agenda to fill knowledge gaps and strengthen pandemic preparedness, reduce disease
burden and inform future policy for seasonal influenza prevention.
1.6.5 Purchase Laboratory Supplies & Equipment
To support laboratory network function in performing laboratory diagnostic for AI and other emerging
infectious diseases, WHO supported procurement of essential reagents and laboratory equipments. These
include one PCR unit for M Djamil hospital Padang, one real time PCR unit, three PCR thermal cyclers,
three medical refrigerators, and two biosafety cabinets for NIHRD, computers and software to support
LIMS implementataion, and reagents. WHO also supported the procurement of reagents for laboratory
network quality control program. For optimal and long term use of laboratory equipment, NIHRD has
committed to ensure operational cost and maintenance of laboratory equipment.
32
RESULT 2: STRENGTHENING DISEASE SURVEILLANCE
Activity 2.1 – Establish 33 Provincial Influenza Coordination Committees (PICC)
INSPAI supported advocacy meetings for establishment of PICC at 8 prioritized provinces
(DKI Jakarta, West Java, Central Java, East java, North Sumatera, Riau island, Lampung
and East Nusa Tenggara).
The efforts in establishing national and provincial influenza coordination committee
through INSPAI funding and other donor support contributed in building the national and
provincial capacity to establish the Zoonosis Committee.
2.1 Establish Provincial Influenza Coordination Committees (PICC).
Deliver technical assistance to establish PICC
Technical officer provided assistance to Indonesia National Committee on AI Control and Pandemic
Influenza Preparedness (KOMNAS FBPI) to encourage local government particularly provincial authority
to establish provincial influenza coordination committee (PICC) as a coordinating body for prevention and
controlling AI (H5N1) and reactivate provincial committee established as well as find out solution over
constraint on this local committee establishment.
Conduct advocacy and coordination meeting on the needs of PICC
During October-November 2009, INSPAI supported advocacy meetings and workshops for raising
awareness on AI control and the importance of establishment and activation of local committees (PICC) to
strengthen multi-sectoral coordination among institution concerned in responding to AI in 8 prioritized
provinces (DKI Jakarta, West Java, Central Java, East java, North Sumatera, Riau island, Lampung and
East Nusa Tenggara)
The workshops discussed the importance of local committee, prevention and control of AI, zoonosis
diseases and other major communicable diseases and promoting multi sector coordination for better
management of AI control activities. Participants acknowledge that the existence of local committee as
coordinating board at province and district level was required to meet better achievement in battling disease
outbreak and pandemic. Thereby team of KOMNAS encouraged participants to plan an establishment of the
committee and find out solution to maintain local committees for AI and other zoonotic diseases.
In addition team of KOMNAS FBPI together with local committee worked to identify problems,
constraints, and barriers during the establishment and implementation of local committee. Participants in
the workshop were representatives of regional working groups, local commitees, regional management
unit, health authority, livestock office, district surveillance officer, AI referral hospital, farmer association
and NGOs.
Subsequent activity was a regional seminar organized by regional working groups for AI which is intending
to increase capacity of local committee :
Region I : Pekanbaru (Covering Sumatera Island)
Region 2 : Yogyakarta (Covering Java, Bali, West Nusa Tenggara and East Nusa Tenggara)
Region 3 : Pontianak (Covering Kalimantan)
Region 4 : Makassar (Covering Sulawesi, Papua, Maluku)
Provincial influenza Coordination Committees (PICC) were established in 17 provinces. In 2010,
KOMNAS FBPI was no longer in operational, therefore the PICCs were not established in all 33 provinces.
33
Beside AI, Indonesia also facing many zoonotic diseases that in certain circumstances can potentially
become epidemic or pandemic. The threat of zoonoses in Indonesia and the world tends to increase, with
negative implications for social, economic and security aspects as well as the welfare of the people.
Accelerating zoonotic control requires comprehensive and integrated measures from various sectors to
engage quick operational steps under a nationally integrated command and control system. These include
central government, local government, business, professional organizations, non-governmental
organizations, universities, international institutions and all levels of society as well as relevant parties.
In responding to the challenges, the government established a National Committee on Zoonosis and
Communicable Diseases Control, an inter-ministerial framework to ensure adequate allocation of the
resources and support to combat AI.
The National Committee on Zoonosis and Communicable Diseases Control replaces the now defunct
National Commission for Bird Flu Control and Pandemic Influenza Preparedness (KOMNAS) which only
monitored avian influenza. The Zoonosis Committee monitors a wider range of infectious diseases; include
anthrax, rabies, influenza and other kinds of animal-borne diseases.
A Presidential Decree no 30/2011 on National Committee for Zoonotic Control has been released. The
decree stated the formation, roles and responsibilities of National Commitee for Zoonotic Control as well as
Provincial and District Committees for Zoonotic Control. The decree also mentioned the policy direction,
strategy and implementation of zoonotic control.
The efforts in the past in establishing national and provincial influenza coordination committee through
INSPAI funding and other donor support have contributed in building the national and provincial capacity
to establish Zoonosis Committees.
The National Commission for Zoonotic Control is chaired by the Coordinating Minister for People’s
Welfare with vice chair consisting of Minister of Home Affairs, Minister of Agriculture and Minister of
Health. The Committee is directly responsible to the President and will act as the zoonotic control centre in
the case of extraordinary events/ outbreaks and pandemic due to zoonoses. The National Commission for
Zoonotic Control is tasked with coordinating and synchronizing the formulation of national policies and
programs implementation and supervision for zoonotic control activities at national level and deliver
guidance and technical assistance for implementation of zoonotic control at provincial and district level.
The Provincial Commissions for Zoonotic Control are to be established and chaired by Governor, while
District/ City Commissions for Zoonotic control are to be established and chaired by Head of District/
Major. Provincial and district commissions for zoonosis are tasked with coordinating and synchronizing
the policy, implementation of programs and monitoring of zoonotic control in the respective province,
district/ city, in line with the national policy and program for zoonotic control.
The national and regional policy for zoonotic control is guided by the medium and long term national
development plan. The strategies are carried out by prioritizing the prevention of human transmission
through :
1. Increasing zoonotic control efforts at source of infection.
2. Strengthening cross- sectoral coordination to develop comprehensive zoonotic control system.
3. Integrated planning and accelerated control through surveillance, identification, prevention, case
management, and transmission control, resolution of extraordinary events/outbreaks, as well as
destruction of zoonosis sources in animals if required.
4. Reinforcing the protection of areas that are still free of new zoonotic infections
5. Improving resource capacity that includes human resources, logistics, and implementation
guidelines, technical procedures for control, zoonotic control institutions and budgets.
6. Strengthening research and development in the field of Zoonosis.
7. Empowering communities by engaging businesses, universities, non-governmental organizations,
professional organizations, and other parties.
34
Activity 2.2 – Build Capacity in Field Epidemiology
‐
‐
‐
73 graduates of the Field Epidemiology Training programme (FETP) in UI and
UGM strengthen public health workforce in conducting surveillance and
responding to outbreak.
The commitment from the Ministry of Health to FETP gives a solid foundation to
the programme for the foreseeable future.
Moreover, the existence of FETP Indonesia is well known through active
participation in the International epidemiology network, such as TEPHINET.
Actual progress towards the results during the reporting period
The Field Epidemiology Training Program (FETP) is important sector that contributes in strengthening
public health workforce capacity to meet the core requirements of the International Health Regulations
(IHR). The programme aims to build capacity in public health epidemiology for disease surveillance,
disease programme management and outbreak response by training personnel in applied epidemiology.
Field epidemiology expertise is an essential component for a successful EID program. The emphasis of
FETPs on intervention epidemiology and outbreak response increases the human resources available to
detect and respond to public health events of international concern. Trainees are unique in that they
prioritize “learning by doing” in which trainees complete formalized coursework along with field projects
in public health offices.
The Indonesian Field Epidemiology Training Program (FETP) started in 1982 as a two-year full-time nondegree programme conducted by the Directorate General of Disease Control and Environmental Health of
the Ministry of Health. The first innovation, implemented in 1990, consisted of collaboration between the
Directorate General of Disease Control and Environmental Health and two universities to award a master’s
degree. However, due to lack of funding, the training was university based with lack of field experience and
over time, however, the field aspects of the program had been diluted.
In 2007, an assessment and evaluation of FETP in Indonesia was carried out as baseline to identify needs in
improving the quality of FETP in Indonesia. The 2007 assessment identified several issues that needed
attention to enhance the quality of FETP outputs.
The recommendations included to update curricula, increase trainee access to learning aids such as textbook
and internet, ensure high quality teaching method and field placements that provide a positive learning
environment and a challenging set of field projects as well as enhancing supportive structures that benefit
FETP graduates career development.
Responding to the needs, with support form various donors, such as European Union, JICA and Ausaid,
since 2007, the Government of Indonesia in collaboration with WHO and universities initiated efforts to
revitalize FETP in Indonesia. A national advocacy and consensus-building workshop was held in March
2008 to develop a strategy to scale up the Indonesian FETP and to agree on a work plan. A Decree was
released by MoH Secretary- General to revitalize the FETP, to accept Indonesian public health workers, to
establish a steering committee and a secretariat for the oversight of implementation. Memorandums of
Understanding were signed between the Ministry of Health and the two universities currently offering
FETP; University of Indonesia and University of Gadjah Madah, to state the responsibilities of MOH and
the responsibilities of the universities regarding the program.
35
The Indonesian Epidemiology Network (JEN) and Indonesian Epidemiology Association (PAEI) were
engaged and consulted during the development and revitalization of FETP Indonesia in 2008. The two
institutions approached the MOH to add a functional stream for epidemiologists working in government,
and to clearly define the standards for epidemiologists in the public health workforce. These were useful
advocacy measures to increase the visibility and to highlight the importance of well-trained epidemiologists
in the public service.
WHO has been delivering technical and financial support for FETP in Indonesia. INSPAI project supported
FETP student expenditures which include tuition cost, field placement and students lodging. Other supports
included operational of FETP secretariat, monitoring and evaluation as well as to expand FETP networking
and to improve the learning quality.
2.2.1 Deliver Technical Assistance for FETP.
An international epidemiologist funded by another donor delivered technical assistance for planning,
implementation and evaluation of FETP. Short-term consultants delivered technical assistance in the
continuous quality improvement (CQI) of FETP Indonesia. In addition, with the International network,
FETP experts through TEPHINET have also delivered inputs to improve the FETP in Indonesia.
2.2.2 Support for Universities on Academic Components of FETP & Student Scholarships.
Seventy three students (37 in UI and 36 in UGM) funded by European Union completed FETP at UI and
UGM. First batch FETP students (10 in UI and 9 in UGM) graduated in June 2011, while the second batch
FETP students (14 in UI and 15 in UGM) graduated in December 2011. The third batch FETP students (13
students in UI and 12 students in UGM) completed their third semesters funded by EU, continued with
support from the government budget for the final semester. The third batch students finished their FETP
by mid 2012. List of FETP students is attached as Annex 9.
In addition, two students were funded by JICA and one student self-funded in the 2nd batch. One
international student joined the cohort at UGM in November 2008 from Timor-Leste which was funded by
the Canadian International Development Agency (CIDA). This cross-country collaboration is useful for
future public health networking and will be encouraged for future cohorts.
The universities in collaboration with MoH, WHO and other key stakeholders reviewed the FETP curricula
and increased the relevancy of the programme to the Indonesia context by inclusion of learning materials
relevant to Indonesia needs as well as aligning the curricula with international standards. The revised
curricula emphasize field experience of students, which allocate 30% of study time to class activities and
70% to field work at the student placement site. This model enhances field experience of FETP students.
During the academic lectures at University, the
lecturers delivered materials in the class with
interactive discussion. The materials included
biostatistics, epidemiology analysis, surveillance
epidemiology, public health, field laboratory and bio
safety, surveillance, outbreak investigation, research
methodology, communication, advocacy and field
epidemiology application. Then the student applied the
knowledge to complete the field project at field
placement sites. The students also conducted field visit
to laboratory as shown in the picture on the left.
At the beginning of each semester (2 months), the students attended academic lectures at the university and
then continued with the field placement (4 months).
36
2.2.3 Support for Field Placements of FETP Students
During field projects, FETP students applied epidemiology principles in the field. The field project was
integrated with health programs within the student placement site such as district, provincial health office or
public health laboratory.
During field assignment, the FETP students
analyzed priority health problems within their
field site and delivered recommendations for
intervention. The students also actively were
involved in any outbreak investigations. This
approach has contributed to improve health
program implementation at this grass root
level.
The picture on the right describes field activity
of FETP students during filariasis screening
and home visit monitoring to filariasis patient
in Pasuruan, Gadingrejo district, East Java
In completing the fieldwork, field supervisors delivered technical input and consultation to the students.
The supervisors were recruited to oversee the student progress and deliver technical inputs during the
placement period. The supervisors are public health practitioners at students’ placement sites.
List of FETP field supervisors are attached in Annex 9.
Upon completion of academic university based program and six field projects, the students developed thesis
at their final academic semester to gain an academic degree and professional qualification.
FETP students actively involved in
various field activates such as mesles
outbreak investigation in Pasuruan,
investigation of outbreak during merapi
eruption disaster in Central Java,
investigation of environmental risk factor
of malaria in Kebumen district Central
Java and rabies control effort in Bali and
Poso. The FETP students and MoH also
conducted epidemiological study on
anthrax and paralysis which occurred in
Boyolali district, Central Java in May
2011.
The picture on the left describes FETP
students’ contribution during field
placements.
Upon completion of the program, FETP graduates continue their function in their duty station as
epidemiologists and contribute to tackle health problems including avian influenza and other emerging
infectious diseases.
37
2.2.4 Maintain Support for FETP Secretariat
FETP secretariat has been operational at sub division Surveillance-Outbreak Directorate Immunization
Surveillance and Quarantine DG DC & EH to support FETP revitalization in Indonesia. The secretariat staffs
consist of FETP Director, FETP field supervisor coordinator and administrative assistant.
FETP Director is responsible to deliver strategic direction for FETP implementation and sustainability,
facilitate coordination among key stakeholders and enhance international collaboration. FETP supervisor
coordinator is responsible to coordinate student supervisory program, develop and review systematic FETP
field supervisory program planning, monitoring, evaluation, and develop epidemiological study and outbreak
investigation methodology for FETP students. FETP supervisor coordinator also arranges field supervisor
for the students, while FETP secretary is responsible to support administrative issues and coordination
among stakeholders for smooth implementation of the program.
The Secretariat facilitated recruitment and geographic distribution of students/graduates to areas of need.
The secretariat also facilitated advocacy for sustainability of FETP in Indonesia and enhance national and
international network. Upon completion of INSPAI project, WHO funded by AusAid will keep supporting
the secretariat toward integration of FETP into government structure.
2.2.5 Procurement of Supplies & Equipment for FETP
To support FETP students, 100 mobile modems were procured for students and
supervisors. 300 copies of field supervisor handbooks were distributed and
1,000 copies of the Field Epidemiology book by Michel Gregg translated into
Indonesian were printed and distributed. FETP quarterly bulletin “Segitiga” has
been published since April 2009. Sixty copies of communicable diseases manual
and principal and practice of public health surveillance book were purchased in
2009 for FETP students.
An FETP Indonesia website (www.penyakitmenular.info/fetp) was developed
and launched in August 2009. An FETP brochure as advocacy media were
printed and distributed.
WHO also supported the procurement for Tephinet conference held in Bali,
November 2011. These included brochure, leaflet, conference abstract book,
conference bag, banner, certificates and name tag for participants, etc.
Two FETP vehicles which were procured in 2010 are in use for FETP operational including outbreak
investigation. The government has allocated budget for operation and maintenance.
2.2.6 Monitoring, Evaluation and Sustainability of FETP Including International Collaboration
Monitoring & Evaluation
Coordination among FETP secretariat, MoH, WHO, field supervisors, universities and the institution of the
student placement sites (DHO/PHO/public health laboratory) were strengthened through regular
coordination and consultation meetings. During coordination meetings, the universities reported regarding
the students’ progress, constraints, challenges and possible solution.
MoH initiated the first supervisor workshop in November 2008 in Yogyakarta, where all 24-field supervisors
for the first year of FETP were gathered and were informed about their roles and responsibilities. This was
followed by serial field supervisor workshops which took place in Yogyakarta on 21-22 July 2009, Bandung
on 10-12 June 2009, Surabaya on 18-21 August 2009, and 23-25 June 2011 in Mataram.
38
The workshops improved capacity and updated knowledge and skill of supervisors, discussed student’s
progress, challenges and any concerns as well as mainstreamed comprehensive FETP field placement
program among field supervisors. The workshop also built a commitment and ownership of the field
supervisor to participate actively in FETP revitalization.
To review the students’ activities during field placement period and to strengthen national networking
among epidemiologists, MoH organized Eastern FETP Regional meetings in Batam during 24-26 May 2010
and Western FETP regional meeting in Bali during 9-11 June 2010. The meetings highlighted the need of
financial support to allow students and supervisors to conduct outbreak investigation or epidemiological
study outside their district to enhance students’ experience. Current curricula, FETP students were placed in
a district and therefore the students’ experiences were limited only to the placement at districts.
Continuous Quality Improvement (CQI) Evaluation
Continuous quality improvement of FETP Indonesia should be done to improve, sustain and maintain the
highest quality standard. MoH in collaboration with WHO evaluated progress against the Continuous
Quality Improvement (CQI) standards developed by TEPHINET (an International FETP network). CQI is a
systematic reiterative review of inputs, processes, outputs and outcomes of training programs to improve the
performance with a goal of protecting and improving the health of a population.
The areas, indicators and TEPHINET recommendations for CQI of field based training programs in applied
epidemiology and public health includes :
 Input: curricula, human resource, material resource, financial resource, trainee recruitment, monitoring
and evaluation, certification and career path for the graduates.
 Process: class work, teaching method, field work, technical supervision, evaluation of trainees and staffs.
 Output : graduates, presentation at scientific conference, publication, service output (investigation,
research, surveillance, policy and recommendations)
 Outcome: strengthened health work force, improvement of surveillance system, policy recommendations
implemented, existence in the international network.
 Impact: improvement in health status of a target population resulting from implementation of a
recommendation from the training program.
During 12-20 July 2011, International consultants (dr. Kamalini lokuge, dr. Somsak Wattanasri, dr. Alden
Henderson) along with WHO Indonesia representative undertook CQI evaluation and participated in the
field visit to University of Gadjah Mada and University of Indonesia. The team assessed CQI indicators and
identified the improvement toward CQI assessment result 2007 to identify gaps. The international
consultants and assessment team from MoH conducted field visit to the placement site at West Kalimantan
and Surabaya. An evaluation workshop was conducted during 16-17 July 2011.
The picture on the right describes
interactive discussion during field visit at
field placement in West Kalimantan.
The picture on the left describes interactive
The picture on the left describes discussion
during field visit at UGM, Yogyakarta.
39
Main recommendation raised from the evaluation includes :
–
Change selection criteria for incoming students. The selection criteria for incoming students are
made by the admission policies of UGM and UI. The criteria are based upon grades and graduate
aptitude tests. Potential students from under served areas generally have lower grade point
averages and admission test scores. These areas generally have the greatest public health needs. To
increase the epidemiology capacity in under served areas, the consultants suggested that the
selection criteria for admission to the university FETP training to allow people with weaker
academic credentials to enroll into the program. Increasing the number of students from under
served areas will also increase the number of epidemiologists in these areas since graduates usually
return to their pre-FETP work place. UGM and UI FETP programs should be part of the selection
process.
–
Involve the laboratory in the student’s outbreak investigations and projects. As the disease
surveillance system of Indonesia changes from syndromic reporting to diseases that are confirmed
by diagnostic laboratory tests, the consultants recommended integration of the laboratory into field
projects and outbreaks. The laboratory can play an essential part of an outbreak investigation and
field project. Students must understand the strengths and limitations of the laboratory and the
diagnostic tests and can gain this experience by working with laboratory staff on outbreaks and
projects.
–
Strengthen field supervision. Field supervisors and mentors are the strength of every FETP
because they play a direct role in developing confident and competent epidemiologists. In addition,
just as students need training to become epidemiologists, PHO and DHO staffs that serve as field
supervisor need ongoing guidance on how to be effective field supervisors. Field supervisor’s
performance should be evaluated.
–
Evaluate students’ reports and field placements. One way to measure quality and impact of the
field placement is by examining the student’s reports on outbreak investigations and field projects.
These projects not only document the student’s progress and competency, they also are a reflection
of the quality of the field supervision. An independent consultant should conduct these reviews.
–
Advocacy for the FETP. The Indonesian FETP is a success story and serves as a model for other
FETPs that want to grant degrees as well as how to improve recruitment and ensure sustainability
of funding. Advocacy should be at the PHO and DHO level to help recruit students as well as
recruit field placements; at the national level within the health sector and also outside public health
agencies such as agriculture, local government. In addition FETP programs and other
epidemiologists need to know about the revitalization and success of the Indonesia FETP.
Overall, the structure of coordination based at academic institutions and field placement primarily at
PHO/DHO sites has achieved the objectives of the program. Administrative coordination through the
secretariat supported the implementation and maintenance of the processes required to achieve this, and
considerable progress has been made in developing a sustainable and robust program structure. Many of the
issues identified related to a lack of formal and systematic technical support and evaluation across the
program as a whole.
National and International Collaboration & Networking
Aiming to promote the role of epidemiology for public health action and advocate its application for
national program development to address health problem in Indonesia, FETP secretariat in
collaboration with Universities, MoH and WHO organized a National Scientific Conference on
Epidemiology on 1-3 December 2010 in Yogyakarta. 94 abstracts from FETP students all over Indonesia
were presented. International participants also joined the conference (FETP Thailand, Australia, Japan
Philiphine and SAFETYNET). The scientific conference was a valuable experience in FETP revitalization. It
enhanced experience sharing among FETP students and public health practitioners as well as an advocacy to
the media about revitalization of FETP in Indonesia.
40
In strengthening international networking, FETP Indonesia also is a member of the International
Epidemiology Association (IEA), a global professional organization of epidemiologists who work on a broad
range of substantive and methodological areas in epidemiology and public health. It fosters the international
links, provide platform for international health research studies and publishes the respected international
journal of epidemiology. It has a major role in education, career development and particularly supports
younger professionals from developing countries.
FETP Indonesia is actively involved in various international occasions on public health and epidemiology.
The existence of FETP Indonesia in the international forum has increased the visibility of FETP Indonesia
internationally. Abstracts from FETP Indonesia were accepted and presented at the international forums.
In November 2008, five officials from Indonesia attended the TEPHINET Global conference in Kuala
Lumpur. The participants were Dr Nyoman Kandun (MoH), Dr Hari Santoso (MoH), Dr Dibio Pramono
(UGM), Dr Lukman Tarigan (UI) and Ms Gina Samaan (WHO). The joint MoH-WHO participation was
important to view the process of conferences in FETP and to initiate international networking.
International collaboration on FETP was
strengthened through FETP directors meeting in
Lyon on 8-10 July 2009 attended by Indonesia
FETP Director. The meeting brought together 70
participants from 40 countries that work in the area
of training and response to epidemics. The meeting
discussed training programmes that bridge the
epidemiology and laboratory field and future
collaboration.
Furthermore, a delegation of 12 persons attended the TEPHINET conference on 1-5 November 2009 in
South Korea. The conference was specifically designed to enable participation, quality enhancements and
opportunities for various program stakeholders. The delegation from Indonesia consisted of five students
whose papers accepted by the conference organizers for presentation. Two university program directors from
UI and UGM participated in special curricula discussion forums organized by the Global Network of FETP.
Three senior officials from MoH and FETP Secretariat participated in the special sessions to assist steer
future collaborations with other FETPs globally, and two field supervisors supervised students and observed
the different sessions held during the conference.
As part of WHO support for enhancing FETP curricula and teaching method, two lecturers: Drg. Theodola
B. Rahayujati from UGM and Dr. Tri Miko Wahyono from UI completed course block master program of
applied epidemiology (MAE Australia FETP), National University of Australia, Canberra, 7-25 September
2009. The knowledge gained from the field visit has been adapted and applied to improve the curricula of
FETP in Indonesia.
In strengthening national and international collaboration on public health network, I Made Winarta, one of
the FETP students attended the 42nd Asia Pacific Academic Consortium for Public Health in Bali during 2427 November 2010. During the conference, discussion focused in Global Health and Emerging Health
including avian influenza and other emerging infectious diseases.
In view of the importance to strengthen the international collaboration and networking on FETP , Indonesia
actively participates in TEPHINET which is an international professional network of field epidemiology
training programs (FETPs) located in 48 countries around the world. TEPHINET aims to strengthen
international public health capacity by training field epidemiologists through an applied apprenticeship
program.
41
Indonesia sent five delegates to attend the 6th TEPHINET Global Scientific Conference that was held in
South Africa on 13-17 December 2010. The delegates were dr I Nyoman Kandun (FETP Secretariat), Dwi
Oktavia (UI FETP Student), dr Yudhi Pramono , Ratna Budi Hapsari (Staff of Sub Directorate Outbreak,
MoH) and HM Akib (Health Human Resource Development and Empowerment Board, MoH). During the
conference, Indonesia received the official certificate of membership from TEPHINET, dated 12 December
2010.
The 6th TEPHINET conference agenda
covered the International Health Regulations
(IHR) and one health approach to reduce risk
of infectious diseases and to improve health
globally.
During the conference there were many
presentations and best practices experience
sharing in epidemiology, surveillance and
interventions of communicable and non
communicable diseases.
The picture shows that during the Tephinet conference, Indonesia FETP student presented her field work
project “Risk Factor of Cholera Outbreak in Ciamis District“
During the conference, Dr. I Nyoman Kandun as Chairman of Indonesia FETP Association also joined the
programme directors meeting. The meeting highlighted five priority areas of strategic planning to enhance
FETP. The priority areas are (1) Assure the quality of training programme (2) Accreditation of FETP and
certification of FETP graduates (3) Build a global community of field epidemiologist and laboratory
personnel (4) Facilitate information sharing and knowledge development (5) Build organizational capacity
and sustainability at global, regional and program level.
Three FETP students presented paper during the IEA World Congress of Epidemiology in Edinburg
Scotland on 7-11 August 2011. The papers were entitled :
1. Risk Factors for an Outbreak of Chikungunya Fever in West Borneo,Indonesia,2010 (Frans Sitepu)
2. Malaria Infection in Pregnant Woman as Risk Factor of the Incidence of Low Birth Weight at District of
Bangka Belitung Indonesia in 2010 (I Made Winarta)
3. Predictors of Malaria in Populations Aged 15 Years and Above in Indonesia, 2010. (Tubianto Anang Z)
The main theme of the congress was changing populations, changing diseases: epidemiology for tomorrow
world. The congress discussed research across many disciplines contributing to the science and practice of
epidemiology and its applications in public health and medicine.
In addition, Director of Immunization, Surveillance, Quarantine and Matra Health, D.G. DC-EH MoH also
participated in the congress to strengthen FETP network and to share the experience of best practices and
lesson learn of FETP Indonesia revitalization in the international forum. Through the conference, the
participants learned about the latest developments and findings in world epidemiology, learn about new
skills, and develop partnerships.
42
On 8-11 November 2011, Indonesia successfully hosted
the TEPHINET’s 6th Bi-Regional Scientific Conference
in Nusa Dua, Bali. The conference held in collaboration
of MOH, WHO, Indonesia Epidemiology Association,
South Asia Field Epidemiology and Technology Network
(SAFETYNET) TEPHINET, Epidemic Intelligence
Programme Malaysia (EIP), various donors and other
stakeholders. 30 members of the scientific committees
from various agencies developed the scientific program
and 63 national and international reviewers received the
abstracts received by the committee.
The program was announced internationally through conference website http://tephinet.fetpindonesia.org/
EU-AUSAID-UNICEF joint funding supported 73 FETP students, supervisors,
MoH officials to participate in the conferece, as well as supported flyers,
conference books, conference kits, and banners.
The theme of the conference was “Global Surveillance Networking for Global
Health”. Surveillance is an important foundation for public health action and
it is the emphasis of the daily work of field epidemiologist. Recognizing that
the world is increasingly interconnected and that diseases know no borders,
through the conference, global surveillance networking for global health was
explored.
The conference provided opportunity to scientists from epidemiology-related disciplines to share their work
and views, as well as the application of latest technologies for surveillance and public health action and
exchange information and views about public health issues and applied epidemiology.
Seven parallel workshops were held as pre conference event on 8 November 2011.
 Avian influenza control and pandemic preparedness.
The workshop disseminated lesson learned of government efforts in implementing the national
strategic plan for avian influenza, focusing in case management, surveillance, healthy food market
and risk communication and improved understanding of H5N1by disseminated 12 research projects
funded by EU. The workshop attracted more than 80 participants.
Mr. Peter Maher (Head of development cooperation of EU to Indonesia), Dr. Graham Tallis (DSE-WHO Indonesia
Team Leader) and Dr. Rita Kusriastuti,MPH (Director Vector Borne and Disseases Control MoH RI) delivered remark
during the opening of the AI control and pandemic preparedness workshop. The picture above also described active
discussion during the INSPAI workshop.
43
Other workshops were :
 Bridging the disciplines to improve rapid response integrated laboratory and epidemiology training.
The workshop provided overview of the South East Asia regional lab/ epidemiology training
toolkits, to prepare trainers to deliver the course to field epidemiologist, public health schools,
laboratory personnel and other members of rapid response teams in the country.
 Workshop on community needs assessment for non communicable diseases.
Through this workshop, participants learned how to use a tool to assess their community, including
community institutions/ organizations, healthcare, schools and worksites.
 Building skills to improve field epidemiology supervision
The workshop aimed to develop curricula for supervisors as a guide to supervise the trainees.
 Data management with epidemiology data
The course provided participants with an introduction to the basic functions of epidemiology data.
 Diseases response : getting the policy right
The course highlighted effective diseases control depends on supportive diseases control policy and
strategy. The courses used rapid case studies developed by the participants to examine barriers to
effective outbreak response and the importance of weak policy as a barrier to response.
 Field Epidemiology Program director meeting: opportunities to strengthen international
collaboration.
The meeting as a media for experience sharing, best practices and achievements of newly-developed
field epidemiology training (conventional FETP and modified FETP).
Following the pre conference workshop, the Minister of Health RI formally opened the conference, followed
by remark from director of TEPHINET, Prof Dionisio Jose Herrera.
The three days conference covered topics on
international health regulation, global surveillance,
zoonosis, vector borne and diseases control, influenza
pandemic, food and water borne diseases, surveillance
and outbreak, non communicable diseases control,
disaster and epidemiology, epidemiology and health
system policy, hospital based epidemiology, social
epidemiology, maternal and child
health, environmental epidemiology,
nutritional epidemiology, respiratory
diseases, IT application in
epidemiology, and human
animal interface.
The Minister of Health
Opened the 6th
Biregional TEPHINET
Scientific Conference
This forum served as opportunity for students of field epidemiology programs to present their work and win
recognition for their efforts. A total of 679 global participants from 30 countries participated in this event.
120 abstracts of 383 abstracts from 19 countries submitted to the committee presented in the conference.
A total of 26 oral presentations and 14 poster presentations were selected; and 2nd best oral presentation was
awarded to an Indonesian participant.
44
Experts on epidemiology from many countries
and organizations gathered together to share
knowledge and experiences to the participants.
The students actively engaged with each topic
and discussed challenges in epidemiology.
A video conference on the impact of epidemic
on travel and trade were conducted during the
conference. The video conference involving
CDC Atlanta, Seattle, Philippine, Australia,
Malaysia, Chinese Taipei, and Chile.
The conference was completed with the international night where the participants from each country
performed their cultural performance. Six best oral presentations and four best poster presentations received
awards at the closing ceremony.
Potential Sustainability of FETP
Establishing and sustaining FETP is a challenge because they are a resource-intensive training model.
Indonesia’s recent revitalization of its FETP provides innovative solutions for countries that wish to
establish or review their own programmes. Although revitalization of Indonesia’s FETP is still in its early
stages, it has already led to achievements.
The investment in students, curricula and field projects has strengthened the quality of student outputs.
Students are now considered as an integral part of efforts to investigate outbreaks of national importance
such as avian influenza H5N1, pandemic influenza A H1N1 and large outbreaks of diarrheal diseases.
The students also participated in the response to natural disasters such as earthquakes and floods. The recent
success of revitalization was also reflected by the success of Indonesian students at international
conferences.
The field extensive experience during FETP improved the capacity of graduated students who continue their
assignment as public health workforce in their duty station. They contribute to improve the quality
management of disease surveillance systems, outbreak response, disease program development and
implementation.
MoH policy support on the FETP revitalization has been expressed in development of a national decree
which was issued by the Ministry of Health that identified FETP as a national strategy for health workforce
development. The aim of training the epidemiologists was made explicit and minimum professional
standards were set. These standards include a master’s degree qualification and three years of experience in
disease surveillance and outbreak response. Memorandum of understanding were signed between the
Ministry of Health and the universities regarding roles, budgets and responsibilities within the FETP.
A meeting with eight schools of public health and provincial health officers took place in Yogyakarta on 2930 July 2009 to discuss the need of epidemiologist in the country and standard curricula for professional
epidemiologist training. The meeting was funded by the Coordinating Minister for Social Welfare.
Continuous advocacy to GoI has been done to ensure that the program remains sustainable and to build
FETP as part of the national education programme for which FETP will be funded with government’s
regular budget. The Health Human Resource Development and Empowerment Board, MoH which is
responsible to improve the capacity of human resource including the funding of Master degree Program
agreed to allocate budget for FETP on step wise basis until the program is fully funded by the Indonesian
government budget. The MoH committed to fund the 4th semester of FETP students at UI and UGM and the
4th batch of FETP students at UI and UGM.
45
Strategic plans to maintain the sustainability of FETP have been formulated. These includes :





Embed the FETP program in to the organizational structure of the Ministry of Health.
Develop network of partners that contributes to accountability, advocacy and technical assistance for
FETP, including SAFETYNET, TEPHINET, etc.
Develop a national FETP secretariat, which can track the progress of FETP alumni to determine
whether the program has successfully generated long-term public health practitioner’s career. The
secretariat can also keep a list of well-trained professionals that can be used for surge capacity needs.
Ensure a competitive and long-term public health career track for FETP graduates.
Promote the program to provincial and district health offices so that they can support and fund
students through their regular budget. These are envisaged as the long-term funding basis for the
program.
Furthermore, an Indonesia epidemiology road map 2010-2014 was developed in collaboration with the
Indonesia Epidemiology Association. The road map has been translated in to a yearly action plan, which
covers advocacy to emphasize the importance of epidemiology in health, capacity building in epidemiology,
standardize epidemiology training, and developing networking in epidemiology.
Considering the large number of FETP graduates that the country would need due to extensive geographic
territory and population size with more than 238 million population across 17,000 islands, MoH and FETP
secretariat have been exploring the possibility and potential to expand FETP program to other universities in
order to achieve the MoH vision which is to ensure that at least one FETP graduate is available in every
province and district level to strengthen public health capacity. Several universities expressed interest in
having FETP in their universities.
Overall, FETP is essential for public health work force development in responding to health problem in
Indonesia. Trainees of FETPs are a set of core competencies that are vital to the practice of public health,
while providing a valuable public health service to countries and regions. FETP students return to their
institution, continue their function, and apply the knowledge they gained from FETP in daily work to
improve health of the people.
Sustaining and maintaining the highest possible quality of FETP in Indonesia is essential to the credibility of
a program and ensures that it is responsive to the needs of the country and is able to make the greatest
contribution to public health. Sustainability planning is critical to ensure that the FETP does not get diluted
as experienced in previous decades after external funding dissipated.
Activity 2.3 Build Capacity in Disease Surveillance and AI Rapid Response
The INSPAI supported Rapid Response Team (RRT) trainings for around 500 public health
care workers in eleven provinces, field epidemiology assistants training for 180
healthcare workers, and workshops on surveillance and epidemiology for 179 health
managers.
Diseases surveillance epidemiology is an essential tool in health management to provide data and
epidemiological information to support health programme management running efficiently.
Epidemiological information with quality, timely and accurate is very useful as evidence based approach on
decision making process in health development. Improving country capacity in event-based surveillance as
well as indicator-based surveillance is essential as required by IHR. Strengthening surveillance capacity
particularly at district and provincial level are expected to provide better data for evidence based
intervention in facing health problem and health policy development. Lack of surveillance knowledge and
skills was recognized as a constraint to deliver qualified surveillance performance at all level. MoH has
taken initiatives to improve the performance of surveillance system.
46
2.3.1 Technical Assistance in Disease Surveillance & AI Rapid Response
An International consultant , a data manager (funded by other donor), and a national surveillance officer
provided technical assistance related to the strengthening effort on AI surveillance and response, pandemic
mitigation measures and alertness of other major epidemic prone diseases.
2.3.2 Training in Disease Surveillance & AI Response
Rapid Response Team
Rapid Response Teams (RRT) have been established in all 33 provinces, and 345 districts of the total 492
districts/cities. The RRTs are teams which respond to AI threats in the field. The team consists of human
health sector (medical doctor, epidemiologist, laboratory officer, program control officer) and animal health
sector members.
INSPAI supported RRT trainings in eleven provinces, covering 518 District Surveillance Officers .
The provinces are Aceh, Riau island, East Kalimantan, Bengkulu, North Sulawesi, Southeast Sulawesi,
Central Sulawesi, West Kalimantan, North Maluku, West Nusatenggara, Bangka Belitung Island. In
addition, 62 Provincial Surveillance Officers were trained in 2 batches of RRT regional training in Makasar
and West Nusatenggara. This brings the total to 1669 health workers from 345 districts of 29 provinces that
were trained on RRT, using multiple donors funding such as EU, CIDA, USAID and AudAID. Various
activities in strengthening surveillance system have been synergized and harmonized to avoid duplication.
List of RRT training is attached in Annex 10.
The RRT training aimed to strengthen coordination and collaboration between health programmes and
sectors involves in AI prevention and control, enhance knowledge and skills of provincial and district health
officers in AI epidemiological investigation, improve capacity of provincial and district health officers in
outbreak detection as well as prevention and control.
The training materials included integrated surveillance and
investigation on AI outbreak, virology surveillance, AI risk factor
surveillance, sentinel surveillance on ILI, outbreak case detection,
case management and rapid response, collection, handling, storage
and transport of specimen, risk communication outbreak and
universal precaution. The training was delivered in five days, using
adult learning process through active trainee participatory in
lectures, working group assignment, demonstration, simulation,
case study and field practice.
The picture on the left describes hands on practice for sample
collection during the training.
Through the training, district RRTs are able to conduct field investigation, identify source of infection,
recognize epidemiological signals as well as raising awareness of district RRTs to promote AI prevention
and control to community and healthcare workers as multiplier effect of training. The knowledge and skill
delivered in the training can be applied to other zoonosis diseases and broader for other particular outbreak
prone diseases in line with strengthening surveillance and outbreak response program at trainees’ working
place.
In the spirit of one world one health vision, the District Surveillance Officers of human health sector
coordinate closely with the Participatory District Surveillance and Response (PDSR) officers of the animal
health sector to identify public health threat, conduct comprehensive investigation and mounting the
response actions to Avian Influenza and other communicable diseases. The RRTs and PDSRs are also
proven as valuable assets in handling other public health threat, such as rabies outbreak and legionella
outbreak in Bali.
47
Field Epidemiologist Assistant Short Courses
It has been identified in the Indonesia epidemiology road map that to cope with the public health challenges
for the country, around 2000 epidemiology officers are needed. This is equivalent to one epidemiology
officer per district/ city, one per each hospital and two per province. To fulfil the needs in responding to
public health challenge, MoH has made some efforts. A one-month short course for field epidemiology
assistants was designed and the training modules were developed. MoH, using INSPAI fund, held six
batches of Field Epidemiology Assistant short course:
Batch
1
2
3
4
5
6
Time and venue of trainings
Trainees
11 July-11 August 2010, Makasar South Sulawesi 30 trainees
11 July- 11 August 2010, Cilandak DKI Jakarta
30 trainees
11 July- 11 August 2010, Bogor West Java
30 trainees
15 March-13 April 2011, Ciloto West Java
30 trainees
15 March-13 April 2011, Ciloto West Java
30 trainees
20 March-18 April 2011, Makasar South Sulawesi 30 trainees
TOTAL
180 trainees
List of Field Epidemiology Assistant Short Course participants is attached in Annex 10.
The course aimed to strengthen capacity on public health surveillance workforce, particularly those who are
working in the area of communicable diseases surveillance and response at sub national level.
The participants were selected from provincial health offices, district health offices, public health
laboratories, port health offices and hospitals, which will function as epidemiology and surveillance officers
at their duty stations.
The updated short course materials covered basic epidemiology in surveillance system, investigation and
outbreak response, management of data surveillance epidemiology (Epi Info, GIS software),
communication and advocacy. During the courses, 24 % of materials were delivered through lecture and
interactive discussion, while 76% of the course consists of group exercises, simulations, hands on practice
and practicing in the field.
The Scheme of the Field Epidemiology Assistance Short Course
48
In addition, during September-October 2011 in Ciloto West Java, MoH conducted another batch of field
epidemiology assistant short course for 30 trainees using other donor fund. Given the importance of this
training course to build human resource capacity in epidemiology, MoH will continue the course in the
incoming years funded by the national budget or other donor funding. Following the courses, MoH
conducted the training evaluation to assess the training process and the application of the training material
at the work place.
Other efforts in strengthening the surveillance system that funded by other donors/ join funding:
Workshop on Usefulness of Surveillance Epidemiology (PENTALOKA)
To promote the use of surveillance epidemiology as integral part of health information system for effective
evidence based intervention, in 2010, MoH with WHO technical assistance, funded by AUSAID conducted
workshop on usefulness of surveillance epidemiology for health managers from provincial and district
health offices, port health offices and hospitals.
The workshop targeted health managers in districts and provinces. The commitment and roles of health
managers at all levels are required to support surveillance function. The workshop delivered introduction of
the epidemiological aspects of health development, surveillance information as evidence health policy and
program planning, use of surveillance information in recognizing health related events and to manage
surveillance system. During the workshop, various topics were discussed; these included national
surveillance system road map and national surveillance system strategy, early warning system for outbreak,
international health regulation as well as epidemiology management.
Early Warning Alert and Response System
As stated in the IHR 2005 that countries need to have ability to detect and respond to public health
emergencies of international concern. To ensure robust national, regional and global health security, an
effective early warning and responds should be an integral part of an existing public health surveillance
system. Therefore, Indonesia has initiated to implement Early Warning Alert and Respond System
(EWARS) in six provinces, namely Lampung, Bali, North Sulawesi, West Kalimantan, South Sulawesi and
Central Java. In the long run, MoH is targeting EWARS implementation in 33 provinces.
Through the EWARS framework implementation, which consists of information and data collection,
identification of outbreak signals, event verification and confirmation, mounting public health response and
communication, it should allow the early detection and respond to the outbreak and any public health
emergency of international concern. Support has been provided from the development of application,
guidelines, standard operating procedures (SOPs), training modules, roll over EWARS implementation to
provinces, monitoring, and evaluation of its functioning. In 2011, INSPAI supported printing cost for
diseases diagnosis algorithm and epidemiology investigation form to support EWARS. The need to
strengthen coordination with provincial laboratory to support the EWARS implementation and outbreak
investigation has been identified and MoH is addressing this issue.
Ministry of Health Outbreak Command Post
Outbreak command post has been operational at D.G. DC & EH MoH to complement diseases surveillance
for emerging and re-emerging infectious diseases. It is a coordination centre that operate twenty four hours/
day and seven days/week to monitor media reporting, taking up rumours from various sources for further
verification, prepare briefings, to share information and to participate in technical discussions and decisionmaking processes.
The command post has been functional as epidemic intelligence to collect information, identify signal,
verify rumours and reporting confirmed significant public health event to DG DC & EH MoH for mounting
public health respond. The SOP for command post has been developed. Comprehensive weekly bulletin
has been developed with the inclusion of weekly reporting of vaccine preventable diseases, EWARS and
report of event based surveillance. The outbreak information from the command Post as well as others
technical units is uploaded on the web that has been established under Sub-directorate of Surveillance and
Outbreak Investigation supervision. http://www.infopenyakit.org .
49
District Surveillance Officer (DSO) and Field Investigation
District Surveillance Officer (DSO) is essential in early detection and responds to outbreak. DSOs are
tasked to implement indicator-based surveillance for routine data collection and actively involve in the
event based surveillance to detect, identify signal, conduct field investigation, and verify rumours and
response to public health threat.
A reporting system using SMS gateway has been implemented to accelerate information flow and response.
The system uses sms format sent by DSOs which received by computer server at Directorate Diseases
Control and Environmental Health, MoH.
To improve capacity of surveillance at grass root level, MoH conducted refresher trainings for DSOs. 334
persons from 10 high-risk provinces were trained using multiple donor funding. The provinces are Bali,
East Java, Central Java, Yogyakarta, West Java, Jakarta, Banten, Lampung, North Sumatera and South
Sulawesi. WHO, funded by USAID also supported operational cost and sample shipments for DSOs in 10
provinces to identify, verify and respond to the outbreak.
To improve the performance of DSOs in the 10 provinces, during September-October 2011, funded by
INSPAI, MoH organized six batches workshop on emerging infectious diseases control and response in
Bogor West Java :
Batches
Time
Participants from provinces :
# of trainees
1
20-23 September 2011
DKI Jakarta, Lampung, Banten
30
2
27-30 September 2011
West Java and Yogyakarta
33
3
4-7 October 2011
Central Java
36
4
11-14 October 2011
East Java
39
5
18-21 October 2011
South Sulawesi, Bali
35
6
25-28 October 2011
North Sumatera
29
Total 202
The workshop-strengthened surveillance networking at all levels and served as media to review and
improve the performance of District Surveillance Officers (DSOs). The workshop emphasized the role of
district surveillance officers in surveillance and outbreak response, policy and strategy of national
surveillance and outbreak response, concept of event based surveillance, sms gateway and simulation as
reporting media for outbreak, and principles of outbreak investigation.
Capacity building at point of entry (PoE)
Avian influenza is a disease of international public health concern because it has the potential to cause
human influenza pandemic. GoI has taken efforts in strengthening public health core capacities to
implement International Health Regulation (IHR) 2005 at various related government sectors at all levels
including port health.
The national guideline on core capacities at point of entry has been developed. Funded by other donor,
IHR trainings for 30 port health officers from 20 port health offices were conducted on 24 June-9 August
2010 in Ciloto . The material covered in the IHR (2005) training:
‐ Overview of IHR (2005)
‐ Epidemiologic surveillance
‐ Effective communication
‐ Sanitation and environmental health impact
‐ Port health office management
‐ Pandemic preparedness.
‐ Quarantine containment
‐ Risk of bioterrorism
‐ Supervision of drugs, food, cosmetic, and additive materials at point of entry
‐ Vector borne and animal diseases transmission at the port, airport and land border cross country
The training consisted of 30% in-class theory, 53% assignment and 17% field practice. The government
has allocated some funding for IHR training in Indonesia from the national budget 2012. Therefore, MoH is
planning to adopt WHO IHR on the job training and design the IHR implementation on the job training
which is suitable to Indonesia context.
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RESULT 3: PROMOTE HEALTIER FOOD MARKETS (HFM) AND EFFECTIVE HEALTH PROMOTION
Activity 3.1 – Healthy Food Market (HFM)
HFM program at 10 pilot sites served as model to develop understanding of risks of AI
transmission, its containment and control in traditional market through: (i) Strengthening
government capacity on HFM model intervention in Indonesia; (ii) Improving market
community awareness and preparedness using Participatory Hygiene And Sanitation
Transformation (PHAST) approach; (iii) Reforming market’s basic hygiene and sanitation
facilities and practices; (iv) Building market capacity to regularize cleaning and
disinfection of wet-market compartment, and (iv) In-house audio-communication along
with dissemination of Information Education, and Communication (IEC) materials for
minimizing health hazards. Around nearly 5000 trained personnel including vendor,
market community, managers and stakeholders in provincials and districts level in 10 pilot
sites are cadres to convey the message of HFM program in their communities. MoH
commitment in replicating HFM in selected provinces has been obtained as an initial step
for the larger coverage of HFM in the country.
3.1.1 Deliver Technical Assistance for HFM
A HFM National Officer and a Food Safety National Officer provided technical assistance for the
implementation of HFM at the pilot sites. A Communication Officer provided technical assistance on risk
communication for raising public awareness on preventing and controlling the spread of AI and other
emerging infectious diseases. The International Environmental Health Adviser (funded by WHO internal
budget) provided overall strategic guidance for the implementation of the HFM activities. In addition,
a Project Secretary supported the team during the implementation of the project.
1.1.2 Coordination, Meetings, and Monitoring
A coordination meeting between MOH and WHO was conducted on 17 February 2011 in Jakarta. The
meeting produced detailed HFM plan for delegation of three HFM activities to the local implementing team
at the district/municipal level. At the meeting, it was decided that district authorities with supervision from
the central level would directly conduct the implementation of HFM at ten pilot sites. The meeting agreed
that WHO and MoH would conduct field visit to each of the ten pilot sites to socialize and monitor the
HFM activities and encourage the local authorities to incorporate HFM activities component into their local
budget. The HFM activities include:
 Behavioural Change Towards Hygienic Practices Through Improvements Upon Facilities And
Conditions In the Food Market.
 Participatory Risk Management using Hygiene and Sanitation Transformation (PHAST) in
Pilot Market Community.
 Promoting basic hygiene and sanitation practices including cleaning and disinfection as a part
of disease control in wet markets- a joint collaboration programme between WHO and FAO.
As a follow-up to this meeting, the coordination and socialization with local implementing team took place
at 10 pilot sites during January- March 2011. During coordination meetings, WHO and MOH met with
relevant stakeholders from line offices, such as from Trade office, market management, Local Development
Planning Agency, Public Works, Water office, and Cleaning office. In a separate session, WHO and MOH
also met with the district health office team and market facilitators.
51
In Payakumbuh, WHO and MOH met with the
Mayor, and Danamon Foundation, while in
Sragen, WHO and MoH met with Danamon
Foundation. Danamon was running a pilot
project of healthy market in the same locations.
At the meeting, WHO/MOH initiative was
synchronized with the Danamon’s.
Concept paper on the three activities were
developed, the local health office as the
executing agency was required to modify them
to suit the local context and submit them to
WHO for financing. WHO explained the
administrative procedures required and provided
the health office with the supporting documents
and template proposal. Funding for the activities
will be channelled directly to the health office.
During monitoring visit, WHO and MOH also visited the market and the planned location of construction
sites. WHO also visited the community radio land in the market and had discussion with the radio facilitator
and radio manager.
3.1.3 Capacity Building and Training
Under capacity building and training, two types of activity took place in the
period of January – December 2011. The first one was the completion of
PHAST (Participatory Hygiene and Sanitation Transformation) training in 10
Pilot sites from 1st March to 30th December 2011.
The objectives of the trainings were to enable all wet market vendors to
enhance knowledge and understanding of food safety risks, transmission of foodborne diseases, and high risk behaviour and to develop a community plan for
healthier market and healthier behaviour for improved hygiene and sanitation in
the market, targeting for minimized food borne diseases. Total participant of the
PHAST in 10 markets were 3.830 including the market vendors, cleaning staff
and market managers. List of participants and details of training is attached in
Annex 11.
The second type of training was the market cleaning
training. The full title of the activity was Promoting
Basic Hygiene and Sanitation Practices including
Cleaning and Disinfection as a Part of Disease Control
in Wet Market. In the training session, the basic food
safety concept also introduced to the vendors to give the
background why cleaning and disinfectant is very crucial
part to minimize the AI and other diseases transmission.
The training was a joint WHO-FAO collaboration.
WHO was invited to a market cleaning training organised by FAO in poultry market on 19-20 January
2011. Although it was designed specifically for poultry zones, the module and curriculum was very much
matched with the needs of HFM pilots. Ideas for collaboration and partnership was quickly discussed and
approved. The cleaning and disinfection activity was replicated in the pilot areas and expanded to cover
non-poultry producers.
52
The primary objectives of the training include:
1. Promoting clean and hygienic behaviour of the market
community in the pilot areas.
2. Developing skills and practices of market community in using
tools and equipments for hygiene and sanitation promotion
including safer foods.
3. Developing local work programme for cleaning and disinfection
that can be done regularly by vendors following a demonstration
in pilot market on cleaning and disinfection with specific
success indicators for each market.
The joint collaboration of WHO/FAO training provided the HFM pilot markets with practical knowledge
(and SOPs) on cleaning and disinfection as well as food safety.
Concept of biosecurity and risk assessment was introduced to the local stakeholders including
representatives of vendors at the pilot markets through training in the period of 2009/2010. However, the
new training helped them to put in practice what they have learned before. At the end of the training, the
participants developed their own market’s work programme.
In 2011, ten locations have received training on market cleaning with total 329 participants including
market manager received training in cleaning, disinfection, and food safety. List of participants is attached
in Annex 11.
3.1.4 Improvement of HFM Facility and Procurement
The improvement of HFM facility has objective to support the
realization of behaviour change of traders, managers and visitors to
perform clean, healthy and hygienic practices by improving
quantity and quality of the basic physical facilities of water and
sanitation for healthy food market. In 2011, all 10 pilot market
have finished the activity. List of physical improvement is attached
in Annex 11.
Procurement for food safety kit and sanitation facilities has been
completed. All supplies now have been distributed and used in all ten
pilot market. List of supplies provided to each HFM location and the
quantity is attached in Annex 11
BEFORE
AFTER
AFTER
53
3.1.5 Raise public awareness on preventing and controlling the spread of AI risk communication
Under Raising public awareness, Radio land were installed in the
ten sites. The radio lands have been operational in the ten
locations starting from February 2011. Local ceremony for
launching of the radio land took place in each location supported
by the local government and the radio community. The radio is on
air everyday during market hours. Promotion on market cleaning
and safety were conducted everyday. Process of monitoring and
evaluation were completed in the ten locations.
In 2010, WHO also printed all
the IEC materials and distributed partially at the various trainings. In
2011 the IEC materials were distributed to the local health office for
further distribution at the market and the stakeholders.
Positive respond were expressed in the publication of HFM program
in local newspaper and commitment from stakeholders to support the
HFM program. Media publication on healthy food market appeared
in local newspapers are shown in the picture.
The Knowledge Attitude and Practice (KAP) was done in December
2011 to evaluate the effectiveness of HFM program and the impact of
AI related to behaviour changes. The assessments targeted the vendors, consumers and related stakeholders.
In general, the results of KAP are as follows:
1. Both consumers and vendors agreed that the markets has been changed to a positive condition related to
cleanliness, zoning, availability of hand washing facility, toilet facility and waste management after
HFM program introduced in their markets.
2. Both consumers and vendors felt that the existence of Radio Land is important as they could get
information from Radio Land including HFM, health topic, social, religious and other general news.
3. Majority of the vendors in 10 pilot markets agreed that they have implemented and followed up the
actions that have been agreed during the PHAST training.
4. The knowledge of both vendors and consumers on the AI transmission and prevention action were good
In summary, impacts of the local intervention under this project can be highlighted as follows:
1.Market based health hygiene and sanitation concerns are raised in public scale on daily basis using
community radio in each of the market.
2. In some of the markets, (central and local) government has taken effort to bring limited funds to support
daily operation and sustain the project initiative, ie :
a. Central government through Ministry of Trade (channeled through Trade and Market Service) in the
form of "Dana Alokasi Khusus (special allocation fund)- DAK". Most of the pilots have this assistance
(such as Payakumbuh, Sragen, Gianyar, Bontang etc.).
b. Central government through Agricultural sector channelled funding through local agricultural service
for construction of Special stall for Fish and Meat Vendor section (e.g. in Metro Lampung).
c. Contribution provided by other public works sector which has been channeled through local public
works service in the form of provision of bins for solid waste, construction of wastewater treatment
plant as part as Water and Sanitation Program (Sanimas) (e.g. Gunung Kidul)
d. Some pilots (Bontang, Payakumbuh, Metro, Mataram) have been supported by local special funds
(allocation for HFM Task Force establishment) to do a comparative study and learning by visiting good
traditional/modern markets in Jakarta and Sragen.
e. In Bontang, the mayor has been trying to replicate the radio initiative to the other two existing markets.
f. In Payakumbuh, the mayor has tried to include HFM activities to be complemented by the city’s budget.
g. In Pekalongan and Malang, one market has been prepared for the next HFM in their city with local
government budget.
54
Overall, the healthy food market program has improved community knowledge and awareness to prevent
the spread of AI and commitment of key stakeholders at community level to reduce AI transmission. This
contributes in reducing human exposures to the virus, thereby reducing morbidity.
Activity 3.2 – Health Promotion
Production and distribution of 1000 VCDs and manual instructional on community
empowerment in preventing AI and Influenza pandemic served as an effective active
learning media for healthcare staffs to mobilize community active participatory in AI
control. Moreover, COMBI implementation in Central Java mobilized available resources in
the community to achieve a condition which individual and community are able to practice
sustainable healthy life behavior including preventing spread of emerging diseases.
Provide Technical Assistance on Health Promotion
Technical officer delivered assistance to the Centre for Health Promotion (CHP), MoH on development of
AI risk communication materials and health promotion activities. A short-term consultant was also
appointed to assist MOH in developing VCD instructional on AI community empowerment. An
International consultant was hired to deliver technical assistance in evaluating effectiveness, efficiency and
impact prospect of risk communication efforts in emerging diseases community empowerment and deliver
recommendations of best practices for risk communication implementation.
Develop health promotion content, materials and method appropriate to the Indonesia context
As part of the implementation of the National Strategic Plan for AI and Pandemic Preparedness, Centre of
Health Promotion (CHP) organized various activities to raise community awareness for preventing the
spread of the diseases. These activities include dissemination of information through various community
leaders and NGOs, production of visual media (VCD) on community empowerment in preventing AI and
Influenza pandemic, Public Service Announcements (PSAs) broadcasting and printing of risk
communication materials.
Following the production of three visual media in VCDs (Video Compact Disc) on community
empowerment in preventing AI and Influenza pandemic, the CHP-MoH developed VCD instructional
manual as a guidance for the viewers.
The VCD manual describes and explains the detailed contents and the importance of the 20-30 minutes
visualized materials on VCD. The Manual elaborates guideline to be used by the chief of health centre in
using the three videos on AI prevention at three different settings:
– The first video shows activities of health centre staffs to empower community in AI prevention,
whenever AI cases in birds have been found in the neighbouring sub-district.
– The second video shows activities of health centre staffs to empower community in AI prevention,
whenever AI suspect cases have been detected at health centre.
– The third video shows activities of health centre staffs to empower community in AI prevention,
whenever a confirmed AI patient has been detected.
Several workshops to review draft of VCD manual instructional were conducted during end of 2010. CHP
conducted pre-testing of the manual using the three videos at four province, i.e., at South Sulawesi Province
(13 - 17 December 2010), at Central Java Province (20 -24 December 2010), at Banten province (3 to 7
January 2011) and at South Sumatra Province (10 to 14 January 2011). The field-testing was followed by
several meetings and the finalization workshop was conducted on 20 June 2011 in Jakarta.
55
The manual serves as the tool for active learning of
the health centre staffs, including the field staffs
such as village midwives and nurses who are
working and posted at the village level. The training
manual facilitates the application of active training
methods such as brainstorming, group discussion,
role playing and even field practice in the closest
neighbourhood to the health centre, such as in
practicing data collection for Community Self
Survey (CSS).
1,000 VCDs along with the VCD manual instructional were distributed to central, provincial and district
health officers. The VCDs serves as an active learning tool for healthcare workers to mobilize community
participation in AI control.
The VCD instructional and manual consist of (1) Practical guideline for health officers on the community
empowerment in preventing AI and Influenza Pandemic (2) Village communities’ participation in AI
prevention action (3) Village communities’ participation in preventing the spread of AI.
Communication for Behaviour Impact (COMBI)
The main challenge to promote healthy behaviour including preventing spread of emerging infectious
diseases is lack of capacity to mobilize resources required to ensure every individual and community
adopting and practicing healthy behaviour including preventing spread of AI consistently. Many activities
of communication and health education were conducted to improve individual and community knowledge
and awareness in practicing the expected healthy behaviour; however, it remains a challenge. Individual and
community participation is essential to the communication process of behaviour change.
Responding to the challenge, MoH intended to strengthen COMBI implementation in Indonesia. COMBI is
an approach of mobilizing available resources in the community to encourage healthy behaviour including
preventing spread of emerging diseases. This effort intends to achieve a condition which individual and
community able to practice sustainable healthy life behaviour.
In April 2010, MoH conducted ToT on COMBI and a COMBI national core team was formed. To follow
up COMBI implementation, following the recommendation of PSC, CHP MoH implemented COMBI in
Central Java funded by join funding EU and WHO-HQ. An orientation workshop were held to gain
commitment of provincial authorities and related stakeholders to support COMBI implementation.
The activity started with baseline data collection covering 800 respondents from four implementation
districts in Central Java and four control districts in Yogyakarta during Dec 2011. Prior to baseline survey,
developing schedule of works and research permission was initiated. Trainings for 16 enumerators were
held, questionnaires construction and field preparation including pilot test for questionnaires was conducted
in Pekalongan City.
The baseline survey revealed that less than half of respondents in the implementation areas intended to
report the sudden death poultry to local authority. 50 % of the respondents in the implementation areas
claimed they would do nothing when they saw sick or dead poultry whilst people in the same criteria of
control group would bury them directly (83.7%).
The baseline survey also indicated although most of the respondents understood that AI is transmitted by
contact with sick/infected chicken/bird, however the respondents’ knowledge of AI symptoms in human
and poultry is still limited. The FGD participants revealed that most of them did not practicing AI
prevention. They only cleaned the chick cages once or twice a week. Only few of them practicing
preventive behavior since they thought it was ineffective and requiring more time. In term of health seeking
behavior, the vast majority of respondents knew they should go to nearest health center; however only less
56
than 20% of respondents come to visit health facilities right after they have flu-like-illness symptoms. Of
those who went to health facilities, almost all delayed until 24hrs.
Health office and animal office indeed have already provided information related to AI, but perhaps it was
not covered all the community members. They delivered the health messages to specific targeted groups
(schools, religious meetings) but maybe some group of community who did not belong to any association
was left behind. The skill of each community leader was also different. Health cadre and village midwife
were able to deliver health messages precisely, but the local authorities (RT/RW/Lurah) were not able to
transform the information. The findings from the baseline survey were used as basis for the COMBI
strategies implementation in Central Java.
Since the EU project ended in December
2011, other donor has taken up the follow
up of COMBI activities in early 2012.
Five strategies and approaches have been
initiated in the COMBI implementation:
(1) Administrative mobilization /public
relation and advocacy which involve several
sectors at provincial level, 16 districts, health
facilities; (2) Community mobilization such as
neighborhood meeting, village community
development meeting, also massive number of
poster and other BCC media (3) Advertising and promotion which is involve radio spot at local radio
station, newspaper.; (4) Personal selling (Interpersonal communication) such as school health promotion
program and school ambassadors:
(5) Build some spot point of service promotion.
During COMBI implementation phase, the community involved actively in developing behaviour theme
logo, media promotion, community mobilization strategies, promotion and evaluation. Central Java
Government also involved students’ participations in COMBI.
Competition for COMBI logo and
posters with key messages was
launched.
The picture describes Central Java
Governor awarded trophies to the
winners of COMBI logo
competition, participated by Central
java high school students.
Monitoring and evaluation strategies as essential components of successful of COMBI were developed to
measure program effectiveness, identify problem groups, gather lessons learned, and improve overall
performance. It served as an advocacy tool to raise awareness of the severity of a situation among those in
a position to change policy, commit resources, and increase or continue support of the efforts.
The COMBI monitoring evaluated impact of COMBI implementation in health seek behavior and
community participation in AI control as well as to monitor the process of COMBI implementation with
compose of measuring media exposure intensity to the people and examine how well activities are being
carried out according to parameters such as reach, quality and participant satisfaction and to assess the
levels of stakeholders participation such as health officers, community leaders, and student ambassadors.
57
RESULT 4: IMPROVED UNDERSTANDING OF H5N1
Activity 4.1 – Study of Disease Ecology & Transmission
Activity 4.2 – Study of Clinical Spectrum & Management of the Diseases
Activity 4.3 – Study of Molecular Genetic & Antigenic Features of the Virus
12 research projects on AI contributed in improving understanding on diseases ecology
and transmission, clinical spectrum & management of the diseases and molecular genetic
and antigenetic features of the virus.
Training on epidemiology, biostatistics and research methodology improved knowledge
and skills of researchers to produce qualified researches.
4.1 Technical Assistance
The WHO National Expert provided technical assistance on the commencement of research projects and
improving the capacity of researchers on the research methodology.
4.2 Capacity building
Training on Epidemiology, Bio statistic & Research Methodology
Epidemiology and biostatistics are the key methodology in public health sciences, which are useful for an
analysis and evaluation of public health issues that policy-makers can decide objectively, based on
knowledge or evidence for proper intervention action.
National Institutes of Health Research and Development (NIHRD) is a key research institution under the
Ministry of Health (MoH) and it is in-charge to coordinate and implement health research in its research
centres as well as in collaboration with other institutions.
NIHRD needs more qualified local researchers to conduct research mainly in areas such as infectious
diseases, cohort studies of non-communicable diseases and large nationwide surveys such as Basic Health
Research, Health Facility Research, and the Specific Research on Environment and Social Determinant of
Health. Therefore, investment in qualified human resource for research is essential.
Following the success of basic level training on epidemiology, biostatistics and research methodology in
2010, NIHRD conducted intermediate level training on epidemiology, biostatistics and research on 11-15
April 2011 in Bogor. Twenty six participants from NIHRD, research centres and universities attended the
training. List of training participant is attached in Annex 12. The materials delivered using adult learning
method process, the combination between lecture, interactive discussion, and simulation and computer
hands on practice using SPSS. The materials covered: (1) Validity, reliability and information bias, (2)
Multivariate linier regression analysis, (3) Logistic regression analysis (4) Confounding, (4) Presentation of
quantitative data, (5) Survey and rapid survey, (6) Research reporting and Building learning commitment.
Upon completion of the training, the post evaluation showed that there is improvement on the trainees’
knowledge to apply research.
58
International collaboration
In order to enhance research in Indonesia, NIHRD initiated national and international networking in
research development. As follow up of public health research agenda for Influenza in New Delhi 2010,
NIHRD prioritized public health research, including research on influenza. Furthermore NIHRD has been
designated to be WHO CC-influenza focusing on human-animal interface.
4.3 Research Proposals
Research on clinical aspects, virology and epidemiology of H5N1 virus in Indonesia are very much needed
to understand the ecology and variability in pathogenesis and transmission to human, as well as
identification of high-risk practices. Since 2009, there were 12 research proposals funded by INSPAI.
There are four research proposals on diseases ecology and transmission, three proposals on clinical
management, and five proposals on molecular / genetics. The proposals selected by the panel are attached
in Annex 13. Overall, the research projects were completed and the result of research projects were
presented and disseminated in the international forum during the bi-regional conference TEPHINET on 811 November 2011 in Bali.
The research projects also represent a good collaboration among human and animal health sector, central
level government (MoA,MoH including NIHRD), universities, local authorities, veterinary laboratory,
provincial , district livestock offices , provincial and district health offices and provincial laboratories.
4.3.1 Research of Disease Ecology & Transmission
A total of four-research projects on diseases ecology and transmission were funded by INSPAI project
4.3.1.1. Epidemiological Study on Highly Pathogenic Avian Influenza (HPAI) of H5N1 in Chicken
and Duck Farms in the Disease Endemic and Enzootic Area of Riau Province, Indonesia
The Highly Pathogenic Avian Influenza (HPAI) H5N1 in Riau Province has been already a disease of
public health importance with the significant increasing of cases/ deaths in human. In the last few years AI
cases in human and bird have been spread in all of eleven (11) districts/ municipalicities in Riau Province.
The latest cases in humans and birds in Riau were reported in Pekanbaru City, Siak District, Dumai City
and Kampar District. In 2011, there were nine confirmed AI cases with Case Fatality Rate (CFR) 77 %.
To improve understanding of H5N1 virus in Riau as
evidence based for effective intervention, NIHRD
in collaboratorin with universities and local
laboratories conducted an epidemiological study on
H5N1 in chicken and duck farms in four hgh risk
RIAU PROVINCE districts (Kampar, Dumai, Siak and Pekanbaru).
The study determined H5N1 prevalence
serologically and genetically in farm workers and
captive bird species as well as in the water/ soil
samples in the high-risk districts in Riau province.
Map of Riau Province highlights the four study
locations (Kampar, Dumai, Siak and Pekanbaru)
The research team collected 243 human blood sera
with 243 completed questionnaires, 129 birds
(chickens, ducks, goose and doves) blood sera, and
138 cloaca swabs, 29 water samples (drainages,
ditches, wells and containers), and 45 soil samples
(animal shelter, gardens and backyard) in the four
high risk provinces.
59
Field sample collections and laboratory examinations were performed in collaboration with:
1. Health Office of Province and Districts/ Cities;
2. Livestock Services Office of Province and Districts/ Cities;
3. Laboratory of Health and Environment of Riau Province in Pekanbaru;
4. Virology Laboratory of Veterinary Faculty of IPB in Bogor;
5. Virology & Biotechnology Lab of Veterinary Investigation Diseases Centre in Baso, Bukit Tinggi,
West Sumatera.
6. Mammalogy and Reservoir of Diseases Laboratory of the Center for Biomedics and Basic Health
Technologies of NIHRD, MoH in Jakarta.
7. Virology Laboratory of the Center for Biomedics and Basic Health Technologies of NIHRD in Jakarta.
The collected sera were transported to NIHRD
virology laboratory, while the environmental samples
(water and soil) were transported to Bogor
Agriculture Institute (Balitvet) for laboratory testing.
The research team then analysed the questioner data
using SPSS.
The result of laboratory examinations revealed that
human blood sera samples were antibody positive to
AI (H5), 5.3 % in Kampar and 3.3 % in Siak, 0.04 %
blood sera of birds were serologically positive to AI
(H5) but no antigen were detected genetically.
Positive water samples were found in Siak (25 %) and
Kampar (50 %).
It was concluded that AI were spread out in humans and their environments in Kampar and Siak and among
birds in Siak and Dumai. Furthermore, in Siak District the virus was found transmitted from birds and their
environments to human. It was apparent that the human behaviour and the environment were having quite
high risk to the disease transmission.
This kind of study should be continued to provide data/ informations useful for development of policies and
guidelines to influenza prevention and control and pandemic influenza preparedness and response.
4.3.1.2 Spatial Epidemiological Analysis of Human Avian Influenza (H5N1) Using Molecular
Approach, Remote Sensing and Geographical Information System (GIS) in Seven Provinces
Vector Borne Disease Research Unit Donggala, Central
Sulawesi, NIHRD completed the study. The study provided
epidemiological basic data and detail maps of avian
influenza virus H5N1 distribution among human and poultry
in seven high risk provinces (North Sumatera, West Java,
Banten, Central Java, Yogyakarta, East Java and Jakarta)
using molecular approaches, remote sensing and Geographic
Information System (GIS). Molecular analysis was applied
to create a phylogenetic analysis, the route of H5N1
transmission and to identify mutation of H5N1 viruses from
human and selected poultry in Indonesia.
The map describes distribution of human H5N1 cases, distribution of poultry H5N1 cases, details
environmental conditions in transmission foci area and the distribution of wild birds in transmission foci
area. This integrated data is very useful for avian influenza surveillance and intervention effort.
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The result of the research produced a comprehensive spatial distribution mapping of avian influenza H5N1
in the high-risk areas, which described the relationship between molecular characteristic and mode of H5N1
virus distribution enabling to understand the spatial dynamics and the route of disease distribution.
4.3.1.3 Spatial Epidemiological Analysis of Human Avian Influenza (H5N1) Using Molecular
Approach, Remote Sensing and Geographical Information System (GIS) in Six Provinces
Following the success of spatial epidemiology analysis research during the first round research grant call
(2009-2010), the second phase of spatial epidemiology analysis was initiated at the end of 2010 and
completed in 2011, covering six high risk provinces : West Sumatera, Riau, South Sumatera, Lampung,
Bali, South Sulawesi.
The spatial epidemiological analysis of human avian influenza provided comprehensive epidemiological
information that can be easy to understand by all level of avian influenza program managers and program
officers.
Using the Arc pad software combined with PDA and Global Pointing System (GPS), the research team
collected data on epidemiological human H5N1 cases through direct interview with family members and
direct observation of environmental condition.
The team also collected secondary data of H5N1 human
cases from PHO, DHO and the MoH. Molecular data of
highly pathogenic AI, particularly hemagglutinin gene
segment in confirmed positive human cases of HPAI
H5N1 were obtained from the six provinces. In addition,
epidemiological and coordinate data of HPAI H5N1
poultry outbreak in Indonesia (from 506 locations in
2011, 1208 locations in 2010 and 1502 locations in
2009) was provided by FAO.
Following data collection, the team analyzed the
data for the application in the digital map
(imagiary map and satellite image map).
The above picture describes coordinate data
collection and environmental observation in the
area of AI cases detected, while the map on the
right shows the pattern of local transmission of
HPAI H5N1 generated from the map
application.
The data has been used to accelerate situation analysis of AI transmission for appropriate response. This
informative data can be used as part of early warning system and basic data of avian influenza surveillance
to the MoH and MoA. The team also produced online template for H5N1 avian influenza surveillance map
in Indonesia that can be accessed by MoH, MoA, WHO and FAO. The map can be updated anytime if new
cases of H5N1 (in both of human and poultry) are found.
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4.3.1.4 Chicken Ration Fortification with Lactic Acid Bacteria to Prevent H5N1 Infection in Poultry
This operational research was conducted by Yogyakarta State University in collaboration with Veterinary
Research Institute Bogor (Balitvet).
The research aimed to define new methodes for protecting
poultry from AI infection by using Lactic Acid Bacteria (LAB)
as poultry fortification to increase the immunity of the poultry.
The research team conducted laboratory analysis by examining
lymphocyte, interferon, phagositocyt, and Ig G from chicken
preparation treated with LAB and challenged by H5N1 avian
inluenza.
The result showed that using single LAB to prevent the
poultry from infection of H5N1 is not effective.
The combination of LAB will be able to increase the
immunity of the poultry and to prevent infection of
H5N1, so that it will increase lymphocyte B,phagositocyt cells and also immunoglobulin G of the poultry.
4.3.2 Research of Clinical Spectrum & Management of the Diseases
A total of three-research projects on clinical spectrum and management of the diseases were funded by
INSPAI project.
4.3.2.1 Avian Influenza Preparedness at the Referral Hospitals in Indonesia
Public Health Faculty University of Indonesia completed the study. The research was designed as cross
sectional study by using quantitative and qualitative approach through data collection, interview and
questionnaire covering 14 hospitals within eight provinces (Banten, West Java, Bengkulu, North Sumatera,
East Kalimantan, West Kalimantan, South Sulawesi, and West Nusatenggara).
From the study, it was found that from the 14 AI referral hospitals surveyed for pandemic preparedness,
78.6% hospitals are prepared in term of human resource capacity and only 42.8% hospitals are prepared
financially with financial support from hospital management and local government. Only 35.7% hospitals
prepared in terms of infrastructure (having isolation room facility and medical equipments for AI case
management) and 57.14% hospitals have SOP on pandemic preparedness and have conducted a simulation
or treated avian influenza patients. Overall, from the 14 hospitals above, 50 % of hospitals are prepared for
pandemic preparedness in term of human resources, methods, finance, and infrastructure.
During pandemic, it is essential to keep hospital functioning. Therefore, capacity building to improve
hospital pandemic preparedness is essential. Advocacy to local government and hospital management to
raise awareness to improve capacity building for hospital pandemic preparedness is important. Hospitals
should be able to develop pandemic preparedness contingency plan to be activated during pandemic.
4.3.2.2 Identification of Other Microbial Infection Among Suspected Avian influenza Specimens
From Negative Influenza H5, H1 and H3
Center for Biomedical and Basic Health Technology, NIHRD coordinated the research. The main objective
of this research was to identify other respiratory bacteria and viruses from suspect AI specimens and
determine pattern of highest respiratory pathogen as well as the association between the pattern of
respiratory pathogen, clinical manifestation and the demographic data from suspect AI cases.
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The research team used 61 samples from lower respiratory tract specimens of suspected AI negative
Influenza H5, H1, H3 and confirmed AI specimens, collected in 2007-2009. 45 (74%) samples had
complete clinical data. The research team performed laboratory test with multiplex beads array assay to
detect gene targets of pathogen. The target of pathogens was 18 species of viral and 8 species of bacteria.
The 18 species of viral : RSV type A & B, Influenza A&B virus, Parainfluenza virus (1,2,3,4), Human
metapneumoviruses A&B, Coxsackievirus/Echovirus, Rhinovirus, Adenovirus (ADVB, ADVE),
Coronaviruses (NL63, HKUI,229E, OC43) and Bocavirus. The 8 species of bacteria covering Mycoplasma
pneumonia, Chlamydia pneumonia, , Legionella pneumophila, Streptococcus pneumonia, Neisseria
meningitidis, Haemophilus influenzae (1,2,3).
In this study it was found that bacteria was the important cause of suspected Avian Influenza specimens of
non H5N1, contributing 60% of the total identified microbia. Streptococcus pneumonia & Haemophilus
influenza 1 were the most common pathogen.
The result showed that out
of the 61 sample, 4 (6,6%)
had an established viral and
6 (10%) had an established
bacterial aetiology. One
pathogen was demonstrated
in 8 (13%) samples and
1(2%) had mixed pathogen.
The identified virus were
Adenoviruses B (5%) and
Rhinoviruses (1,7%), and
the bacteria found in the
specimen were
Streptococcus pneumonia
(5 %), Haemophilus
influenza 1 (5 %). The most prevalent single pathogen was Adenovirus B ( 5%) while the most prevalent
mixed pathogen was Streptococcus pneumonia and Haemophilus influenza 1 species (2%). Viral infection
was found in children aged 1 to 14 years and in adult aged 25 year while bacterial infection was found in
children aged 1 to 7 years and in adult aged 25 to 46 years. All of cases had been treated with antibiotics;
only 1 case had antiviral tamiflu.
The study is useful as evidence based information to improve strategy in case management of respiratory
infections and to decide treatment that is suitable for the patient and prevent oseltamivir resistance.
4.3.2.3 A Community Response to Avian Influenza - Bali- Lombok
University of Udayana-Bali in collaboration with University of Mataram-Lombok West Nusa Tenggara
with technical assistance from University of Sydney Australia completed the study to evaluate the
influence of government policies, programs and activities on community responses to AI over the last five
years.
Structured interview with 402 village households were carried out, covering two sites in Bali ie. Manggis
subdistrict-Karangasem and Negara sub district Jembrana, while in Lombok, interview with 400 village
households were carried out between August and September 2010 in Pujut sub-district a non-infected area
in Central Lombok, and Pringgasela sub-district an infected area in East Lombok district. In addition to the
survey, data were also collected through in-depth interviews and Focus Group Discussions (FGDs)
involving key informants and participants from district and village levels who represent various
stakeholders such as livestock and animal health, public health, and community leaders, both formal and
informal.
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The study focused in sector 3 and sector 4 of poultry industry. Sector 3 is a small-scale commercial
operators that account for the largest number of poultry and have variable, usually low to minimal levels of
biosecurity with live birds and products bought and sold through markets. Sector 4 includes the free-ranging
village poultry producers and keepers and metropolitan backyard poultry producers and keepers where
biosecurity is minimal or absent and birds and products are consumed locally or traded through live bird
markets to meet short term cash needs.
Diagram findings of the study of AI activities in different levels and the knowledge of the community on AI
in Bali and Lombok is shown below.
The study revealed that there are positive responses in the surveyed community in Bali in responding to
HPAI. The community knows the signs and symptoms of AI sick poultry, the transmision route,
prevention and control effort. The community also knows to report sick poultry to the local authorities for
further actions.
Results from the FGD showed that the community is
also active in controlling the sumggling of birds
along the beaches of western part of Bali, from East
Java. It is due to the fact that awareness program,
health education, extension, biosecurity and other
activities in regards to prevention and controlling AI
were regularly conducted in every village at least one
time in a month.
The picture describes surveyor-conducted interview
to respondent at Karangasem District.
Village officers together with cultural officers (desa adat) worked together with other government programs
to disseminate information regarding HPAI. The effective methods carried out were (i) community meeting;
(ii) leaflets or printed materials or banners; (iii) demonstration; (iv) example of safe – act from bupati
(mayor) : how to spray safely, do vaccination correctly; (v) through radio and interactive talk; (vi) cultural
approach. At the community level there are some committees or teams established as a results of a positive
community awareness, such as desa tanggap flu burung (AI alert village), village cader, animal quarantine
cadre, etc.
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On the basis of these findings, the study recommended (i) all of the preparedness which had been
established to prevent and controlling the HPAI in Bali, should be maintained continuously for its
sustainability; (ii) the existing community positive responses should be improved for a better
readiness/preparedness, by periodical boostering on the matter; (iii) law enforcement is a must in
eradicating the smuggling birds into Bali; (iv) in balancing the demands and the supply of birds in Bali, it is
suggested to increase productivity of the domestic poultry industry in Bali. Moreover, the lesson learn and
best practices of community mobilization efforts success in Bali can be adapted to other provinces.
In contrary, the study result in Lombok revealed low and limited community responses to the HPAI –
especially those involved in kampong chicken production or Sector 4. Due to their limited knowledge of the
HPAI and the “absence” of HPAI cases (in Pujut), they do not demonstrate strong and positive attitudes and
perceptions about HPAI.
The study revealed that the community has limited
knowledge on all aspects of Avian Influenza, such as
the symptoms, the way how it is transmitted (bird to
birds, and birds to human trnasmission), what to do to
prevent and control AI, and recomended biosecurity
practices.
According to most respondents, AI only takes place
on other islands and not in Lombok. These attitudes
and perceptions had been supported by the fact that
very limited programs and activities were conducted at the village and community level by the govermment
agencies, even though, in fact, there had been, more generally, many programs and activities carried out at
provincial, district and subdistrict level. Most village households claimed that television programs had been
the most dominant source of information for HPAI. Limited response of community to the HPAI was found
in Lombok.
The community also has negative attitudes and unfavourable perceptions of AI as they considered that it is
safe to consume sick birds, no such ilnesses have been experienced due to the practices (eating sick birds).
This study also confirmed for unfavourable practices of the community, both in sectors 3 and sector 4 and
most importantly in sector 4. Farmers and villagers do not apply recomended biosecurity measures to
prevent their birds from infections such as AI. Most respondents in sector 4 did not vaccinate their birds,
coumsume sick birds, do not clean regularly their cages and pen, do not use mask and hand glove in
handling sick birds, do not apply disinfectant for cleaning the bird pen.
These limited responses (lack of knowledge, negative attitudes and perceptions, poor management
practices) have been due to the facts that very limited activities, programs and policies were conducted by
the govermment agencies, especially at the village levels.
The flow of AI related information has been smooth at the higher levels (from National to provincial, to
districts and subdistrict level), but from subdistricts to village level and from village leaders to ordinary
community have been very low and limited. Numbers of media such as brochures, posters, leaflets, booklets
and others were repported insuficient at the village level. The use of these media have limited impacts on
peoples’ knowledge, attitudes, perceptions, and practices.
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Consistent to this, the study confirmed that most village households learned AI mostly from the national
television program – from the news program. There is a significant difference in responses between the
community in sector 3 and sector 4. The sector 3 community seems to have more positive responses
compared to those in sector 4. This could be understood as those involved in sector 3 have strong profit
oriented and interest while in sector 4, they mostly just do rearing kampong chicken and duck as additional
income and activities. This study also found the absence of collective responses at the community level.
There is no groups/committees /associations established at the community level as part collective efforts to
address AI issues and concerns.
On the basis of these findings, this study recomended (i) more effective communication is required
especially at the lower level – village level communication, in addition to mass media communication, (ii)
there is a need to form groups/associations/network of sector 4 farms to effectively promote effective
behavioural changes at the community level and to articulate their concerns and interest to the government,
and (iii) an operational research is needed to develop “the best approach or model” in disseminating
information on HPAI, especially at the lower level (from subdistrict to village level), to changes peoples’
knowledge, attitudes and skills, and practices as well.
4.3.3 Research of Molecular Genetic & Antigenic Features of the Virus
A total of five-research projects on molecular genetic and antigenic features of the virus were funded by
INSPAI project.
4.3.3.1 Elucidation of the Molecular Mechanisms that Lead to the Emergence of Pandemic Influenza
Viruses Via Surveillance Studies in Poultry, Pigs and Environmental materials
Airlangga University completed the study to characterize avian influenza virus. The samples were collected
from nine high-risk provinces: Jakarta, Tangerang (Banten), West Java, Central Java, East Java, Jambi,
North Sumatra, Bali Island, South Sulawesi.
The research team collected 2,260 samples from nine high risk
provinces and conducted sequencing all segments
of H5N1 influenza viruses isolated from poultry
and pigs.
The team also conducted phylogenetic analysis of
H5N1 influenza viruses isolated from poultry and
pigs as well as characterization of biological
properties of representative strain and
determination of amino acids responsible for each
biological property using reverse genetics.
The picture shows sample collection activities during research
During the research, pathogenicity and virulence of AI virus to primate (Macacca fascicularis) was also
examined. From the animal samples, it was found that Haemagglutinin protein from the isolated viruses
indicated mutation of several amino acids compared with the viruses before 2005. The research has
successfully determined one of the viruses (Ck-Riau-2010) to inoculate M. fascicularis. The body
temperature of the animal was increased and the virus replicated in the respiratory tracts.
The study developed reverse genetic analysis for one of the viruses (ck-Riau 2010). The reverse genetic
virus can be used for the future experiments such as biological properties and the impact of an influenza
vaccine to virus dynamics.
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4.3.3.2 Molecular Infection Mechanism of H5N1 Subtype Avian Influenza Virus from Poultry
(Animal) to Mammalian (Human)
Following the success of the first round research,
University of Airlangga conducted second round
research on molecular genetics. The research analysed
the transmission model of H5N1 infection from birds
to mammals (human-animal interface) and compared
the virulence, mutation and transmission, which have
potential cause of pandemic.
The collected samples of the H5N1 virus from
endemic areas were characterized and the team
performed transmission to animals in the BSL3
facility in Airlangga University. The H5N1 virus
gained the same clade with the H5N1 virus circulating
in Indonesia so far.
The test result showed the pathogenesis of H5N1 viruses from mammals and birds had a different virulence
in animals (ferrets and chickens) with IVPI. The human H5N1 virus being infected to animals and it turned
out to have the same pathogenicity of H5N1 virus that was originally from animals.
3.3.3 Characterization of Influenza (H5N1) for Vaccine Candidates: Cross-Neutralization of
Antibodies Anti Influenza A (H5N1) From Patients Confirmed H5N1 Infection that Can Neutralize
Viruses Isolated in Different Year and Location Origin in Indonesia
Antibodies are a major component of specific immune protection against influenza and remain the
established immune correlate of protection for influenza vaccines. Identification of neutralizing antibodies
against the conserved epitope regions of hemagglutinin from H5N1 influenza virus has the potential to
provide a vaccine, which can be developed ahead of time in preparation for a possible pandemic due to
H5N1 viruses.
One of the strategies to reduce the morbidity and mortality of influenza infection especially H5N1 infection
in Indonesia is vaccination. The main aim of vaccination policies is to protect the subjects who are most
likely to suffer or die from H5N1 influenza and related complications. A vaccine whose virus strains match
with the influenza A/H5N1 viruses circulating should protect recipients efficiently. Therefore, Centre for
Biomedical and Basic Health Technology, NIHRD commenced research on characterization of influenza A
(H5N1) for vaccine candidates.
The research team cultured Influenza A (H5N1) from archive clinical specimens from patients confirmed
H5N1 infection since 2005 – 2011. Sequence analysis was conducted for the seven isolate representing each
year. Rabbit was vaccinated with one of the seven inactivated H5N1 isolate and the team performed
Hemagglutination Inhibition (HI) assay for antibodies to influenza A (H5N1) to determine the serological
response to vaccination, while virus neutralization assays were performed to detect cross-reactive antibody
to H5N1 virus.
The seven viruses were cultured in BSL3 facility in National Institute of Health Research and Development.
The HA protein sequence analysis of the known neutralizing epitopes A to E of seven Influenza A (H5N1)
viruses have almost the same homology, therefore the research team selected one of the viruses from 2007
to vaccinate the rabbits to get the antibody to Influenza A (H5N1). The titter of rabbits antibody were 160
with HI assay after two weeks of vaccination with heat inactivated H5N1 virus. The HI assays performed
using Influenza virus H5N1/2005 RG (provided by CDC Atlanta) and the virus itself in BSL3 facility. It
was found that there were cross reactivity between 2005 and 2007 viruses.
The rabbits were boosted with the same virus to see the increasing titter of antibody and continue with the
virus neutralization assay with the six other viruses.
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These data revealed that humoral immunity elicited can give cross-reaction against H5N1 infection in
different year. These results suggest that we have to test the rabbits using different dose of antigen, to better
understand about viruses that can induce immunity.
4.3.3.4 Molecular Characterization of Influenza A/H5N1 Viruses Isolated from 2008-2010 Patients in
Indonesia
Up to date, no sufficient information regarding molecular characterization of influenza A/H5N1 viruses
from Indonesia has been published, even though mortality rate of H5N1 human cases in Indonesia is high
(CFR : 83%). Responding to the needs of molecular characterization information, in 2010, NIHRD
conducted research on molecular characteristic of Influenza A/ H5N1 viruses in Indonesia.
The research team generated full-length sequences from approximately 20 Indonesian H5N1 isolates. These
data provided information into public health, virus evolution pattern analysis, virulence database, vaccine
development, drug resistant studies, and pandemic preparedness.
RT-PCR and Sanger Sequencing method of H5N1 RNA was conducted on 20 isolates from 20 H5N1
patients. The comprehensive genetic characterization of Indonesian H5N1 isolated during the outbreak of
2008-2010 was reported. No mutation occurs in the PA gene (T515A), encoding a protein involved in
higher pathoghenicity in mice.
NA gene of all isolates has 20 amino acids deletion associated with adaptation to growth in chicken or
avian. There was no mutation associated with resistance to oseltamivir in the NA protein. All the NS gene
of the viruses have the 5 amino acid deletion seen in Genotype Z viruses, and has Asp at position 92. In
addition, all the PB2 gene has Glu (E) 627 and Asp (D) 701. These findings raised concern for the
importance of genome characterization for human and the need for increased efforts to monitor the
evolution of A/H5N1 viruses across the Indonesia provinces.
Throughout this research project, NIHRD molecularly characterized and conducted the phylogenetic
analysis of protein HA surface and the other influenza A/H5N1 genes isolated from Indonesia. These data
provided useful information on virus evolution pattern analysis, virulence database, vaccine development,
drug resistant studies, public health intervention and pandemic preparedness.
4.3.3.5 Molecular Marker Characterization of H5N1 Avian Influeza Virus That Can Be Used for
Identification of The H5N1 Virus in Poultry That Have The Potential Ability to Infect Humans
The University of Indonesia completed research on molecular marker characterization of H5N1 AI virus.
The purpose of this research was to find a marker that can be used to predict the possibility of the virus that
able to infect human easily in poultry. Molecular analysis of the viruses from poultry cases, viruses from
human cases and the virus from vaccinated poultry may indicate a unique molecular pattern which can be
used to identify virus changes that result in human infection.
This research isolated and characterized the H5N1 virus from human cases and birds/chickens from H5N1
outbreaks of vaccinated chickens and surrounding or housing at the environment of the human cases. The
research team conducted specimen inventory and collection. The viruses studied were propagated in 10- to
11-days-old embryonic specific pathogen free (SPF) chicken eggs for 48 to 72 hours. The virus presence in
allantoic fluid were tested by HA method. Seven H5N1 virus isolates from human origin, six isolates from
poultry/avian origin around human cases and five isolates from vaccinated poultry were cultured. The virus
isolates culture followed by RNA extraction, RNA/DNA amplification and purification, Sequencing and
data analysis of the target gene.
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The result showed that the specific pattern of M1 and M2 amino acids might be used as a marker for genetic
monitoring in poultry to predict the possibility of H5N1 avian influenza virus ability to infect human.
Further studies using more H5N1 isolates from human and birds/chickens around human cases, and analysis
of others genes that play a role in the pathogenesis are needed to confirm the potential use of these amino
acid patterns as a marker.
This study was published in the international journal “ Virus Genes”, a platform for the publication of
experimental and computer studies on genes from all virus general and families. The journal emphasizes
evaluations of current developments as well as reviews and correspondence on scientific matters dealing
with virus genes.
4.4 Monitoring and Evaluation
All twelve research projects were completed. NIHRD and WHO conducted monitoring and delivered
technical assistance and site visits during commencement of research projects to ensure quality of
researches. The monitoring program has improved the collaboration among NIHRD and research
institutions as well as fostering knowledge and experience sharing and transfer among researchers.
The result of the research projects were presented in the international forum during TEPHINET scientific
seminar in Bali, November 2011. The research results will also be published in national and International
journal.
PROJECT MANAGEMENT
Overall, the programme succeeded in making good use of available resources and
completed all activities within the prescribed timeframe. The Steering Committee delivered
strategic direction for the success of the program. The Steering Committee framework
enhanced the experience of relevant stakeholders in managing multi sectoral project, thus
build the capacity of GoI in the project management.
Administration, Finance, Procurement, and Logistics
Project Administration
The new Global Management System (GSM) has been implemented in WHO Indonesia office since
1st January 2010. Health programme information are now provided in a more integrated way to support the
programme implementation. GSM provides all country offices, regions and HQ real-time access to the
same data, it is essential in implementing health programmes.
Financial Management
WHO is responsible for the financial management of all project funds and is accountable to EU for project's
expenditures. The contribution agreement was signed in December 2007 for an amount of EUR 13.5M.
WHO received the 1st instalment (EUR 6,181,600) upon signature of the agreement with the EU, the 2nd
instalment (EUR 2,309,200) was received by WHO HQ in August 2009 and the 3rd instalment (EUR
2,309,200) was received in December 2010.
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The total expenditure converted into Euro at 0.712, being the rate of exchange at which the EU’s
contribution were recorded in WHO’s accounts.
The project has successfully disbursed its allocated budget (EUR 13.5 M) for implementation of the
activities. A detailed expenditure report and the certified financial report from the controller at WHO
Headquarter is attached in Annex 14.
Following the recommendation of EU Project Mid Term Review in 2009 to adjust the project budget
allocation according to priority current needs for effective implementation, in March 2010, The EU
approved the addendum budget proposed by WHO. The principal modifications of the original budget were
the reallocation of budget for medical equipments to isolation room development and additional allocation
of budget for the Field Epidemiology Training Programme (FETP) from all other under utilized budget
lines.
Procurement & Logistics
The procurement process is according to WHO’s procurement policies as set out in WHO’s procurement
manual guidelines. From 1 January 2010, when GSM has become operational, all procurements are
processed through WHO Global Service Centre (GSC), based at Kuala Lumpur, Malaysia, using the new
GSM system. All procurements funded by INSPAI project were completed.
Human Resource Management

Project Personnel
All positions to support project implementation were filled. All technical officers delivered technical
assistance to each of activity component to accomplish the activities. UNOPS project personnel to support
isolation room development were recruited and mobilized. A complete list of project personnel is available
in Annex 15. In addition, MoH officials are contributing to the implementation of all activities. A list of
key MoH Directorates involved in the project is in Annex 16.
Planning, Monitoring, and Reporting

Planning
Annual work plans were developed. WHO technical and management officers provided continues
assistance to MoH on all planning and technical aspects of the project. The counterparts actively involved
in the planning process and conducted the analysis of priority activities to fill the gaps in Implementing the
National Strategic Plan for Avian influenza and Pandemic Preparedness.

Monitoring
WHO and MOH monitored the progress of activities, to ensure timely completion of activities, and
disseminated reports to EU. Technical support provided as needed and periodic visits by project personnel
(MOH and WHO) were conducted to monitor various activities, such as trainings, meetings, and
workshops. WHO participated in the coordination and technical meetings. WHO also participated in the
high-level meeting with MOH and other key stakeholders for the implementation of the National Strategic
Plan for AI and donor harmonization meetings.
As part of monitoring mechanism, EU external consultants conducted Result Oriented Monitoring (ROM)
missions in June 2009 and November 2010 to ensure the program implemented according to the logical
framework and to improve the quality of programmes.
In addition, a verification mission was held in November 2010 to verify the legality and regularity of the
expenditures as well as to establish that the funds concerned have been disbursed in accordance with
provision laid down in the contribution agreement.
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The INSPAI secretariat at the Director General Disease Control and Environmental Health (DC&EH),
MOH facilitated coordination and smooth implementation of project’s activities. The secretariat was also
responsible for planning and coordinating Project Steering Committee (PSC) and Project Technical
Implementation Committee (PTIC) meetings, preparing agendas, minutes and circulating documents and
reports.

Project Steering Committee (PSC)
To oversee the project planning, implementation and evaluation, a Project Steering Committee (PSC) was
formed by a ministerial decree during start up of the project. The PSC was chaired by Directorate General
of Diseases Control and Environmental Health MoH RI , while the vice chairman was Directorate Basic
Medical Care MoH RI and Directorate of Vector Borne and Diseases Control as secretariat.
The members were all cross sectoral directorates within MoH involved in the implementation, Universities,
Indonesia Doctor Association and National Committee of Avian Influenza. The PSC reported the project
implementation to the Ministry of Health RI.
The PSC monitored the implementation of the project and
responsible to :
 Provide overall strategic direction and policy advice to
achieve smooth delivery of the project.
 Review periodically activity progress with the GoI and
WHO, and ensure implementation is in accordance
with the AI National Strategic Plan
 Maximize coordination between the various
implementation partners particularly the various
Directorate Generals of the MoH and provided
feedback as necessary to the project manager and staff.
PSC Meeting on 30 May 2011 in Bekasi
During implementation of project period, eight PSC meetings were held:
Date
30 January 2008
25 September 2008
2 June 2009
3 March 2010
16 September 2010
23 December 2010
30 May 2011
12 December 2011
Key points
Opening of INSPAI project and gaining commitment from key stakeholders
Endorsement of Project Steering Committee and Project Technical Committees
PSC approved 2009 work plan.
PSC approved the one-year no-cost extension of the INSPAI project up to 2011,
proposed amendment budget for action and INSPAI 2010 work plan.
PSC approved collaboration with United Nation Operation Project Services
(UNOPS) for isolation room development.
PSC endorsed the isolation room management committee.
PSC designed exit strategy for project closure.
PSC approved reduction of isolation room development form 15 initially planed
to 10 and approved additional budget for the isolation room development.
All key stakeholders were committed to implement the project within the time
frame (before 12 December 2011) and to complete activity report for proper
documentation of project activities.
Closing of the INSPAI project. Commitment from all stakeholders to initiate
exit strategy beyond the project closure.
71

Project Technical Implementation Committee (PTIC)
The PSC formed a Project Technical Implementation Committee (PTIC) as focal points within the MoH for
the various implementation activities and facilitate communication and coordination among various
stakeholders.
The Technical Committee delivered technical inputs in
planning, implementing, monitoring and evaluating the
project activities to ensure the project complementary
with the AI National Strategic Plan and met eligible
quality standard.
The PTIC reported the progress of activities, constrains,
challenges and recommendations to the project Steering
Committee (PSC) to improve the implementation of
project activities.
During implementation of project period, six PTIC meetings were held:
Date
7 November 2008
31 March 2009
10-11 November 2009
24 September 2010
10-11 March 2011
24 November 2011
Key points
Defining structure of Project Technical Committees and Project Steering
Committees and development of project work plan.
Expansion of HFM to 10 sites
Mid Term review results and recommendation for one year no cost extension
Reallocation of under spent budget form medical equipments to isolation room
development. Expansion of AI early detection socialization for primary
healthcare workers.
Approval 2011 work plan with priority budget reallocation for HFM, isolation
room and FETP.
Discussion on final evaluation initial findings and recommendations.
Through the PSC and PTIC mechanism, all key stakeholders actively involved in planning, implementation,
monitoring and evaluation of the INSPAI program, thus they had good ownership spirit of the program. The
steering committee mechanism improved cross sectoral collaboration and networking among key stakeholders
from various institutions and enhance the management experience of the Government of Indonesia in
managing intersectoral complex activities as well as harmonizing AI control efforts funded by various
funding sources.
Final Evaluation Mission
An independent comprehensive final evaluation of the performances and achievements of INSPAI
programme towards its objectives and purposes were held in November 2011. The evaluation covered
relevancy, effectiveness, efficiency, coherence, impact prospect and sustainability of the program. The
evaluation was furthermore intended to contribute towards broader review of the current National Strategic
Plan for H5N1 control and Pandemic Preparedness, and to recommend feasible and strategic actions to
control animal related emerging diseases under the leadership of Komnas Zoonosis.
The evaluation team concluded that the programme largely achieved its stated objectives and succeeded in
disbursing its budget. The final evaluation has suggested a number of useful lessons and valuable
recommendations for possible future ways forward.
72
The recommendations are in line with the WHO bi-regional Asia Pacific Strategy for Emerging Infectious
Diseases (APSED) 2010 :
 Strengthen the integrated surveillance model being piloted in East Jakarta with coordination between
various sectors, especially health and agriculture.
 Further work on public/private partnership to secure the engagement of the private sector both in health
facilities and in the animal sector.
 Continue efforts on strengthening case management, focusing on district hospitals and the lower level
in the health system to improve early detection and response as well as infection prevention and control.
 Strengthen role and function of the National Referral Laboratory and expand the computerized
laboratory information system to interconnect all the laboratories in the network.
 Continue training in research methods, epidemiology and biostatistics given that clinical and social
research capacity is still below optimum.
 Support the function of National and Provincial Zoonosis Committees.
 Further improvement and systematic training in live bird market management, hygiene and behavior
change as well as strengthening food hygiene legislation, and development of effective enforcement
mechanisms.
Seminar Dissemination Lesson learned INSPAI in Indonesia Towards One Health Framework for
Pandemic Preparedness
Through the INSPAI project, there were
valuable lesson learned in strengthening
country capacity to prepare the country in
facing pandemic. Therefore, during 28-29 May
2012, MoH successfully held a seminar in
Bekasi to disseminate valuable lesson learned
of INSPAI toward one health concept.
Mr. Collin Crooks (European Union), Dr. Rita
Kusriastuti,MSc (MoH) and Dr. Graham Tallis
(WHO) delivered remark during opening of the
seminar.
It is critical that One World One Health concepts are broadly understood among Indonesian medical
practitioners, public health and wildlife management officials, veterinarians, policy makers and
academicians to increase the country’s capacity and resources to devise and implement appropriate,
effective multi-disciplinary solutions to epidemics and pandemics caused by emerging infectious diseases.
In so doing, their potential impact can be better managed and diminished over time.
Through a two days seminar attended by around 100 key stakeholders from various institution (MoH, MoA,
hospitals, Provincial offices, Health Centres, National Zoono sis Commission, donors), best practices and
lesson learned in AI control were disseminated through plenary presentation, interactive discussion and
experience sharing. The seminar served as advocacy media to raise awareness of key stakeholders on AI
early detection and pandemic preparedness as well as the importance of cross sectoral coordination in
zoonosis control, including AI within one health concept linking to International Health Regulation (IHR)
and Asia Pacific Strategy for Emerging Infectious Diseases (APSED) framework. The topic of the
conference touched AI epidemiology and molecular genetics, integrated surveillance, zoonosis control in
one health concept, AI case management, pandemic preparedness and response, as well as healthy food
market in preventing the spread of H5N1.
73
Reporting
WHO submitted INSPAI mid-annual and annual year progress reports and financial reports to EU. WHO
also submitted the third party payment reports as requested by EU. The third party payment report is the
report on the compilation of activities and payment that have been implemented by the third party
(including MoH, UNOPS, Provincial Health Office, etc).
Visibility Action
Visibility actions were carried out during the reporting period. EU logo was included in the banner of
various activities such as meetings, trainings and workshops as well as printing materials and training kits.
The EU logo was installed on the ambulances, medical equipments and laboratory equipments. The EU
logo was also included in the TEPHINET brochure and website. During the activities, WHO and MoH
conveyed to the participants that EU funded the activities. Furthermore, various INSPAI activities such as
INSPAI seminar, HFM, TEPHINET, isolation room development funded by EU were captures in media
coverage. Media coverage of INSPAI implementation is attached in Annex 17.
Example inclusion of EU logo as part of visibility action implementation
Constraints and Challenges
Strong countrywide action and cooperation are essential in combating avian influenza virus. This becomes
challenging in decentralization system. Constraints and challenges affected the implementation of project.
Overall, shifting in the MoH organization structure and terms of reference and changes in staffing within
MoH counterparts impacted the programme management and project implementation.
The MOH is the main counterpart to implement this project and is occupied with many different
programmes. The recipient of significant external donor funds for AI, in addition to government funds, this
also represents a challenge to implement the project and manage all the requirements of the different
funding sources and cycles.
Given the extended geography and the large population of Indonesia, the programme’s impact was limited;
therefore, further work is still needed for strengthening capacity within the framework of the one health
approach for battling emerging diseases in Indonesia.
74
The project implementation spread across the country, thus it is challenging to monitor and collect
significant information of output and impact of the program from the implementation sites as well as to
monitor the use of medical equipments donated by INSPAI to the hospitals. Efforts have been done to
collect the reports and information on the valuable lesson learn, output and impact of the project and its
contribution to build health system as a whole. Through monitoring evaluation of activities components and
external EU evaluation missions as well as extensive efforts by MoH in liaising with all stakeholders in all
levels, the results of project implementations were collected and documented for valuable lesson learnt for
future improvement.
The specific issues include:
 Reduction of isolation room sites from ten sites initially planned to five sites, due to limited budget
available and very tight deadline for project completion. UNOPS practically completed isolation rooms
at the ten hospitals by 12 December 2011. However, as identified in the external Final Evaluation of the
programme, this posed “a limitation in terms of the intended follow-up activities, including competence
development through on-site training, and simulation exercises designed to develop practical skills.”
Therefore, in the interest of safeguarding human welfare and the environment, recommended that
beneficiaries receive additional on-site training and participate in testing and commissioning after
completion of the isolation rooms. As such, UNOPS and its contractor took additional time to fulfill this
requirement as part of an augmented exit strategy in early 2012 before handing-over the facilities to the
relevant authorities together with operations and maintenance manuals and as-built records. The EU
approved the implementation of the on-site training and the monitoring of isolation rooms during the
liability period.
 Shifting of staffs in the hospitals which received medical equipments donation funded by EU and various
medical equipments donation received by hospitals from various donors resulted in the difficulty to track
the position and registration number of medical equipments donation in hospitals. However, the MoH has
sent letters to hospitals to register the medical equipments and use it for Avian influenza and other critical
case management.
Deviation from Description of the Action
Considering the needs of effective and efficient AI case management applicable to hospitals in Indonesia,
there were deviations in the numbers of medical equipments procured:
Medical Equipments
Ventilators
Patient monitor
Syringe pumps
Infusion pumps
Intubation set
Original
quantity
20
20
20
20
18
Revised
Quantity
0
0
15
15
0
Medical Equipments
Nebulizer
UV Light
Film Processor
ECG 12 channel
Defibrillator
Original
quantity
41
24
12
18
17
Revised
Quantity
0
0
0
0
0
The isolation room development sites were reduced from 15 sites to 10 sites as per original description of
action in the contribution agreement. Cost of seven CRRTs along with hemodynamic monitors were
transferred to another donor.
The target of FETP students were expanded from 60 students from original target to 73 students in total.
Additional of FETP students is a valuable asset for country surge capacity. Most of the target of trainees of
various trainings have been exceeded the original target stated in the logical framework.
75
In the HFM implementation, HFM pilot sites were expanded from five sites originally to 10 sites involving
key stakeholders from national to grass root level.
Considering the needs to improve the quality of research, training of research methodology for researchers
were conducted. This is a new initiative, which was not described in the original description of action.
During 2009, 4799 doses of seasonal influenza vaccines were purchased for laboratory staffs, district and
provincial surveillance officers, and healthcare workers at AI referral hospitals. However, due to the limited
budget and its complexity, seasonal vaccination was not feasible to cover all high-risk health care workers.
Therefore, in 2010 and 2011, the PSC endorsed to cancel the seasonal vaccination activity from the INSPAI
work plan. No influenza vaccination were conducted in 2010 and 2011.
Conclusion
Many lessons have been learnt from the emergence of influenza H5N1. The government has been
intensifying the control measures focusing on the core aspects of its national strategic plan. The government
is highly committed in battling avian influenza. Integrated response plan were developed and are being
implemented by various agencies.
Building local public health capacity as well as building the capacity at primary health care level to
empower practitioners to identify and treat AI cases is essential. Healthcare workers were trained to
recognize the diseases and to initiate surveillance for infection in humans at healthcare facilities. Health
promotion campaigns were carried out to educate people on the signs and symptoms of avian influenza
H5N1. Researches were conducted to improve understanding of H5N1. The GoI developed the national
pandemic preparedness and response plan to meet the imminent threat of an avian influenza pandemic.
GoI has been enhancing surveillance for human cases through active surveillance, improving capacity
development of national laboratories to enable rapid testing for H5N1, upgrading capacity of 100 AI
referral hospitals around the country to manage patients, and enabling rapid case-outbreak investigations.
Furthermore, A KOMNAS zooonosis has been set up as interministerial framework to ensure adequate
allocation of the resources and support to combat AI.
There are considerable challenges to control the epidemic of potential human pandemic virus such as
H5N1. Good clinical and epidemiological investigation and management together with balanced approach
by the global community are critical to achieve this goal.
Continuous support for capacity building of country public health core capacities for battling emerging
infectious diseases within one health approach is important to protect global health security.
76
Annex 1
Implementing the National Strategic Plan for Avian Influenza
77
ANNEX 1
ACHIEVEMENTS TOWARD OBJECTIVE VERIFIABLES INDICATORS (OVIS) OF LOGICAL FRAMEWORK
Project Description
Overall
objectives
Indicators
Improvement in the accessibility and quality of
health services for the community through
Improved outcomes of case management, more
supporting the GoI in its efforts to implement effective diseases surveillance, improved
the health related aspects of prevention and
community and scientific understanding of Avian
control of AI (AI), specifically H5N1 and
Influenza
pandemic preparedness nationwide.
Key Achievement
Overall, there have been continuing efforts to improve capacity in AI early detection, case management, and
diseases surveillance through various trainings, workshops and infrastructure improvement. These have resulted
in improvement of knowledge of healthcare workers. However, the trainings have not yet reached all
healthcare workers in Indonesia, and the multiflier effect of the training to disseminate the knowledge to other
healthcare workers has only been done in some areas. There is still a need to improve the knowledge of case
management and diseases surveillance for AI and pandemic potential diseases to improve outcome of AI case
management.
Efforts in surveillance through building public health work force and strengthening surveillance system have
contributed to improve reporting of AI cases under IHR (2005) and improve the collaboration between human
and animal health under one world one health frame work for better intervention to control AI in community.
Through community empowerement activities, there have been improvement of community understanding on AI
in some areas, however, there is still a need to continue risk communication efforts for AI control.
The research activities funded by this project have contributed in improving understanding on diseses ecology
and transmition of AI, clinical spectrum and mangement of diseases and molecular genetic / antigenetic features
of H5N1 virus.
Specific
objectives
Strengthen mechanism and capacity to reduce
Reduced case fatality rate; reduction in delay
human exposure to the virus, thereby reducing
between onset of illness and admission to hospital
morbidity; improved case management of
for treatment
patients, thereby reducing mortality
Through efforts in strengthening case management, there have been improvement of healthcare workers
knowledge on AI early detection, case management and infecton control for control measure.
However,translating the knowledge in to the sustaibale daily working practice is still a challenge, which also
influences by other factors. Therefore there is still a need to improve capacity of healthcare workers in AI early
detection and case management to reduce case fatality rate of AI.
Through establishment of Rapid Response Team (RRT) and surveillance trainings, there has been improvement
in AI surveillance system and integrated surveillance with animal health sector. However, there is still a need to
improve data management and AI surveillance for effective diseases surveillance.
Overall, eventhough the number of AI cases have reduced, however, the case fatality rate still remains high and
delay between onset of illness and administration of oseltamivir is still a challenge. Therefore, MoH keeps
continuing efforts to improve early detection and case management for better outcome.
ANNEX 1
Project Description
Indicators
Key Achievement
GoI has conducting continue efforts to improve knowledge of healthcare workers on AI early detection, case
management and infection control through trainings and workshops. Around 700 healthcare workers from
hospitals were trained in IPC, HAI and AI case management, and 8500 primary healthcare workers from public
health centres and private clinics in seven high risk provinces were exposed to AI early detection and
socialization. Although a lot of efforts in improving capacity of helathcare workers in AI case management and
infection control, however, due to high turn over of healthcare workers at health facilities, there is still a need to
continue the effort in improving human resource capacity in AI case management.
Results
Strengthened case management
By the end of the project period, improved
knowledge of case management for H5N1 by
hospital staffs in 100 referral hospitals, adequately
equipped referral hospitals and increased human
resource capacity in laboratory management in 44
laboratories
52 suction pumps, 15 syringe pumps, 15 infusion pumps, 90 three position beds and mattreses, 180 strechers
and 22 ambulances were delivered to AI referral hospitals. GoI and other donors also provided medical
equipments for AI referral hospitals to support AI case management. However, there are still needs to improve
the operational of medical equipments, monitoring of proper use and maintenance of the medical equipments in
AI referral hospitals.
For rapid diagnostic of emerging diseases, NIHRD has strengthened the 44 new emerging and reemerging
infectious diseases laboratory network through trainings, quality control and procurement of reagents. To
monitor influenza activity in Indonesia, NIHRD also established SARI and ILI sentinels. Based on the quality
control program done by NIHRD at laboratories network, most of laboratories were able to performed H5N1
avian influenza or influenza diagnosis, however, there is still needs to maintain and improve the quality of
laboratory diagnostic.
73 graduates of the Field Epidemiology Training Program (FETP) in University of Indoensia (UI) and University
of gadjah Mada (UGM) provide the competence to strengthen public health work force in conducting
surveillance and responding to outbreak.
Strengthen diseases surveillance
At least 36 graduates of FETP, training of rapid
response teams in at least 300 districts
RRTs have been established in all 33 provinces, covering 345 districts of the total 492 districts/cities. INSPAI
supported RRT trainings for 518 public health officers from nine provinces : (Aceh, Riau Island, East
Kalimantan, Bengkulu, North Sulawesi, Southeast Sulawesi, West Kalimantan, North Maluku, West
Nusatenggara). This brings a total of 1669 healthcare workers from 345 districts of 29 provinces were trained
using multiple donor funding. In addition, 180 health officers were trained in one-month Field Assistance
Epidemiology short course.
ANNEX 1
Project Description
Indicators
Key Achievement
HFM program at 10 pilot sites have served as model to develop understanding of risks of AI transmission, its
containment and control in traditional market through: (i) Strengthening government capacity on HFM model
intervention in Indonesia; (ii) Improving market community awareness and preparedness using Participatory
Hygiene And Sanitation Transformation (PHAST) approach; (iii) Reforming market’s basic hygiene and
sanitation facilities and practices; (iv) Building market capacity to regularize cleaning and disinfection of wetmarket compartment, and (iv) In-house audio-communication along with dissemination of Information
Education, and Communication (IEC) materials for minimizing health hazards.
Promotion of Healthy Food Markets and
effective risk/ outbreak communication
Around nearly 5000 trained personnel including vendor, market community, managers and stakeholders in
provincials and districts level in 10 pilot sites are cadres to convey the message of HFM program in their
communities. MoH commitment in replicating HFM in selected provinces has been obtained as an initial step for
Improvement and community level knowledge of AI
the larger coverage of HFM in the country. Overall, the healthy food market program resulted in improved
healthy practice
community knowledge and awareness to prevent the spread of AI and commitment of key stakeholders at
community level to reduce AI transmission.
Production and distribution of 1000 VCDs and manual instructional on community empowerement in preventing
AI served as an effective learning media for healthcare staff to mobilize community active participation in AI
control. COMBI implementation in Central Java initiated community active participatory in sustaiable healthy
behaviour incuding preventing spread of emerging diseases. Although a lot of efforts have been done to improve
community knowledge in battling emerging diseases, however, there is still need improvement in community
awareness on AI in Indonesia.
Twelve research projects to improve knowledge on Avian Influenza were completed. The research projects
covered study of diseases ecology and transmission, study of clinical spectrum and management of the diseases,
and study of molecular genetic and antigenic features of the virus.
Improved knowledge of avian influenza in
humans
Increased in basic science research to understand
diseases at least one study published in each area of
(a) diseases ecology and transmission (b) clinical
spectrum and management of diseases and genetic
and antigenic features of the virus
The result of the studies have improved the understanding on diseses ecology and transmission, clinical
spectrum and management of diseases and genetic, antigenetic features of the virus. The result of the studies
have contributed to evidance based policy and programe planning to control AI and other emerging infectious
diseases.
In addition, to improve the quality of research project, NIHRD conducted training on epidemiology, biostatistic
and research methodology for researchers.
ANNEX 1
Project Description
Activities
Strengthened case management and treatment of avian influenza
Indicators
Key Achievement
Assessment of isolation room at 15 selected AI referral hospitals was done by UNOPS in collaboration with
MoH and WHO.
Need assessment of infrastructure and
equipment in 44 referal hospitals
Purchase and delivery of needed medical
equipment
Due to limited budget available and tight deadline for project completion, INSPAI PSC endorsed the reduction
An independent consultant is recruited to carry out
of isolation room sites from 15 sites initially planned to 10 sites, as per original description of INSPAI project.
needs assesment
Phase one hospitals are Persahabatan hospital Jakarta, Gatot Subroto army hospital Jakarta, Tangerang hospital
Banten, Kandau hospital Manado and Gunung Jati hospital Cirebon. Phase two hospitals are Sulianti Saroso
hospital Jakarta, Soetomo hospital Surabaya, Moewardi hospital Solo, Abdoel Moeloek hospital Lampung, Ulin
hospital Banjarmasin. The isolation room at the ten sites are now completed.
100 AI referral hospitals fully equipped
Medical equipments and PPE donations were delivered to AI referral hospitals :
52 suction pumps for 51 AI referral hospitals.
15 syringe pumps and 15 infusion pumps for 15 AI referral hospitals.
90 three position beds and mattreses for 50 AI referral hospitals.
180 strechers for 99 AI referral hospitals.
22 ambulances for 22 AI referral hosptials.
355 packages of PPE for 100 AI referral hospitals and 53 other hospitals
AI referral hospitals also received medical equipments donations from other donors and GoI. Eventhough AI
referral hospitals received medical equipments to support AI case managment, there is still a need for
operational, maintainance, and training for using the equipments.
Development, revision and dissemination of
guidelines for case management for AI and
infection control
5000 copies of revised AI clinical management were printed and distibuted to 100 AI referral hospitals, 33
provincial health offices, 465 district health offices and also to 1528 public and private hospitals in Indonesia.
One national guideline in clinical management and
one guideline in infection control printed, and
2000 copies of IPC technical guideline and 2000 copieas of IPC managerial guideline were printed and
copies available in all AI referal hospitals
distributed. MoH also developed IPC hospital surveillance guideline, IPC hospital surveillance practical
handbook and hospital pandemic preparedness for hospitals.
At least one training course held at each of 100 AI
Training and workshops on case management
referal hospitals tergetted a mix of district and
and infection control at provincial and district
private hospitals and community health centres
INSPAI supported IPC trainings for 556 healthcare workers from hospitals, one batch Hospital Acquired
Infection (HAI) surveillance Training for Trainer (ToT) for 26 participants from 20 hospitals, HAI surveillance
trainings for 80 healthcare workers from 41 hospitls and AI case management training for 92 healthcare workers
from hospitals. To improve early detection, MoH conducted AI early detection socialization for 8500 primary
healthcare workers from health centres and private cliics in seven high risk provinces (Riau, DKI Jakarta,
Bengkulu, West Kalimantan, South Sulawesi, DI Yogyakarta and North Sumatera).
External monitoring and evaluation of IPC structure in Indoensia hwere conducted. The recomendations are very
usefull for IPC program planning.
Given to high turn over of the health care workers, and vast geographic of Indonesia, there is still a need to
improve the capacity of helthcare workers in AI case management and IPC.
ANNEX 1
Project Description
Provision of PPE for healthy system at all
levels
Vaccination of high risk human and animal
health care workers with seasonal human
influenza vaccine
Indicators
Key Achievement
Personal protective equipment will be made
available at all 100 AI referal hospitals
355 PPE packages delivered to 100 AI referral hospitals have been used.
Vaccines procured and delivered annualy to 2000
high risk health care workers
During 2009, 4,799 doses of seasonal influenza vaccines were purchased. 1,000 doses for laboratory staff of
National Influenza Centre and regional/sub regional laboratories; 100 doses for staffs of MoH D.G. DG & EH
involved in AI field investigation, 999 for District and Province Surveillance Officers in 170 districts and for
rapid response team in three priority provinces (Banten, West Java, DKI Jakarta); 2,600 doses for high risk AI
referral hospital healthcare workers.
Laboratory need assessment in 2008 recomended the improvement of Laboratory Information and Management
System (LIMS) at NIHRD. As a follow up, NIHRD has been implemeting LIMS which is proven to be useful to
improve the management of specimens in NIHRD laboratories.
Training needs asseement for national and
provincial laboratory technicicians and
establishment of an AI laboratory network
An International consultant will be recruited to carry
Road map to to strengthen the National Influenza Centre (NIC) for integrated influenza surveillance and
out needs assesment and provide technical
research has been developed.
assistance to laboratories in management systems
New emerging and re emerging laboratory network has been strengthened through trainings, quality control
program and supply of laboratory reagents to support laboratory diagnostic. NIHRD has established SARI
sentinels and ILI sentinels to monitor influenza trend in Indonesia.
Training of lab technicians in national and
provincial laboratories
Training on the utilization of laboratory information system (LIMS) software was conducted covering 28
participants from NIHRD. A total of 213 staffs from laboratory networks undergone PCR diagnostic training
in 2009-2011 and 55 laboratory staffs were trained in biosafety-biosecurity. Indonesia also participated in
Training will be carried out for technicians in eight international trainings and conferences on laboratory diagnostic for emerging diseases, to strengthen the
referral laboratories
international networking.
In addition,INSPAI supported laboratory network quality control program in 2010-2011. The laboratory quality
control program is important for laboratory network to maintain and improve the laboratory diagnostic quality.
Purchase of laboratory reagents for expanded 44 laboratories will be equipped with reagents for
network
influenza diagnosis
Laboratory equipments and reagents to support laboratory diagnostic of AI and other emerging diseases were
procured and delivered.
ANNEX 1
Project Description
Strengthened diseases surveillance and detection
Indicators
Key Achievement
During the previous year, various efforts were conducted to form a local committee in controling AI and other
major zoonotic diseases. The local commitee were established in 17 provinces.
Establishment of provincial influenza
coordinating commitees
A national consultant will be recruited to carry out
needs assesment for establishment of provincial
commitees
National Committee for Avian Influenza (KOMNAS FBPI ) is no longer in function since march 2010.
However, since zoonotic diseases are remaining threats in Indonesia, and it has a potential to cause pandemic,
the National Committee on Zoonosis and Communicable Diseases Contro has been established as an interministerial framework to ensure adequate allocation of the resources and support to combat AI. A Presidential
Decree no 30/2011 on National Committee for Zoonotic Control has been released. The efforts in the past in
establishing influenza coordination committee through INSPAI has contributed in building the national and
provincial capacity to establish the Zoonosis Committee to strengthen the cross sectoral collaboration in facing
emerging infectious diseases and zoonotic threats.
Seventy three students (37 in UI and 36 in UGM) were funded by INSPAI project to commence FETP in UI and
UGM. 41 field supervisors were recruited to supervised students at field sites.
Continous Quality Improvement (CQI) evluation were conducted and resulted in recomendations to improve
FETP in Indonesia. The evaluation revealed that throughout FETP revitalization, considerable progress has been
made.
Scalling up of FETP
A FETP secretariat will be established at Ministry of
A secretariat office has been operational. A curriculum was developed to re-emphasize field projects and a 70/30
Health, a revitalized FETP will be in operation at
field to classroom ratio. Efforts being made to recognize epidemiology as a profession. International networking
least two universities
has been established.
MoH policy support on the FETP revitalization has been expressed in the development of a national decree
which was issued by the Ministry of Health that identified FETP as one of national strategies for health
workforce development. The MoH has committed to allocate budget for FETP on step wise basis until the
program is fully funded by the Indonesian government budget. The commitment from the MoH to FETP gives a
solid foundation to the programme for the foreseeable future.
Training course for provincial and district
A national consultant will be appointed to oversee
health services in epidemiology with emphasis the training in AI rapid response teams in all
on AI and emerging infections
provinces and at least 300 districts
Technical assistance provided by a National Profesional Officer- Surveillance to strengthen the effort on AI
surveillance and response, including improving human resource capacity.
RRTs have been established in all 33 provinces, covering 345 districts of the total 492 districts/cities. INSPAI
supported RRT trainings for 518 public health officers from nine provinces : (Aceh, Riau Island, East
Kalimantan, Bengkulu, North Sulawesi, Southeast Sulawesi, West Kalimantan, North Maluku, West
Nusatenggara). This brings a total of 1669 healthcare workers from 345 districts of 29 provinces have been
trained using multiple donor funding. In addition, 180 health officers were trained in one-month Field
Assistance Epidemiology short course.
MoH has taken efforts to integrate and harmonize surveillance activities supported by multi donor funding.
Other donor supports in surveillance strengthening include : establishment of outbreak command post, Early
Warning Alert and Response System (EWARS), trainings and operational support for district surveillance
officers for field investigations.
ANNEX 1
Project Description
Healthy Food Markets and effective risk / outbreak
Indicators
Key Achievement
HFM pilot sites have been established in 10 selected markets.
Set up Healthy Food Market pilots
Technical and financial support will establish five
pilot " healthy Food Markets"
Procurement for food safety kit and sanitation facilities were completed. All supplies now have been distributed
and used in all ten pilot market and the facility improvement at the HFM pilot sites were completed.
The improvement of HFM facility has supported the realization of behaviour change of traders, managers and
visitors to perform clean, healthy and hygienic practices by improving quantity and quality of the basic physical
facilities of water and sanitation for healthy food market.
MoH developed a risk communication strategy for the market community followed by development of
communication materials. WHO printed and distributed 30,000 flyers, 10,000 booklets, 5,000 pocket books,
1,000 posters and 240 sign boards to 10 pilot sites. 14 Audio Public Service Announcement (PSAs) were
produced to be aired in market communities within ten pilot sites.
Raise awareness for preventing and controling A risk communication strategy for the market
the spread of the AI virus in live animal
community will be developed, inputs for health
markets
promotion activities in market community
Ten radio land pilots have been installed and operational in 10 HFM pilot sites. 157 cadres of market community
were trained in using radio as a tool for promotion and communication of food borne diseases risks and healthy
food market messages, at the pilot sites.
The HFM pilot also implemented PHAST (Participatory Hygiene and Sanitation Transformation) training to
develop understanding and awareness regarding the risks of AI transmission, its containment and control in
traditional market.
Strengthen capacity to implement healthy food Development of training courses, full time staff
markets
members, meetings and coordination activities
HFM training modules were developed followed by HFM trainings.
A total of 4916 market managers and market communities in 10 pilot sites were trained in HFM. The trainings
included :
* Participatory Hygiene and Sanitation Transformation (PHAST) training
* Market cleaning training (promoting basic hygiene and sanitation practices including
cleaning and disinfection as part of diseases control in wet market)
* HFM management for district/ municipility stakeholders.
The Ministry of Health is planning to scale-up this approach on HFM initiatives in other provinces of the
country.
MoH led the coordination of HFM implementation and encouraged local government to support the HFM
implementation within their resective area. Monitoring visits were conducted to ensure optimal implementation
in the field.
Coordination, management and monitoring of
Monitoring and evaluation
HFMP
Advocacy to local government for sustainability of healthy food market program resulted in gaining positive
respond from the market community, local government as well as central level and private sectors. The positive
respond are expressed in the publication of HFM program in local newspapers and commitment from
stakeholders to support the HFM program.
ANNEX 1
Project Description
Indicators
Key Achievement
Various activities to raise community awareness for preventing the spread of the diseasees have been done in
collaboration with MoH, and other UN agencies and NGOs.
Production and distribution of 1000 VCDs and manual instructional on community empowerement in preventing
Development of risk communication content, One national consultant will be appointed , and one AI and influenza pandemic preparedness served as an effective active learning media for healthcare staffs to
materials and methode appropriate to the
evaluation of the effectiveness of the material
mobilize community active participatory in AI control. Moreover, initiation of COMBI implementation in
Indonesia context
developped will take place
Central Java mobilized available resources in the community to achieve a condition which individual and
community are able to practice sustainable healthy life behaviour including preventing spread of emerging
diseases.
Although some improvements of community awareness and knowledge about AI at community level have been
noted in some provinces, however, community awareness on AI is still need to be improved.
Improved knowledge of avian influenza
Four research projects on diseases ecoogy and transmission were completed
Study of diseases ecology and transmission
A research group or institution will be selected to
conduct relevant research
The result of the studies have contributed to improve understanding on epidemiology and transmission of H5N1
virus as evidence based reference in policy decision making for effective effort in controlling emerging
infectious diseases.
Three research projects on clinical spectrum and management of AI and influenza were completed.
Study of clinical spectrum and management of A research group or institution will be selected to
the diseases
conduct relevant research
The result of the studies have improved the understanding on AI referral hospital pandemic preparedness,
identification of other microbial infection among suspected AI specimens and community response to AI in
Bali and Lombok. The result of the studies also have contributed to evidance based policy and programme
planning to control AI and other emerging infectious diseases.
Five research projects on molecular genetic and antigenetic features of the H5N1virus were completed.
Study of molecular genetic and antigenic
features of the virus
A research group or institution will be selected to
conduct relevant research
The result of the studies have improved the understanding on the elucidation of molecular mechanism that lead
to the emergence of pandemic influenza virures, characterization of influenza (H5N1) for vaccine candidate,
molecular characterization of H5N1 virus and molecular infection mechanism of H5N1 subtype avian influenza
virus from poultry to mammalian.
In addition, to improve the quality of research, NIHRD held a training on (1) Basic epidemiology, statistic and
research methodology for 38 researchers; (2) Intermediete training on epidemiology, biostatistic and research
methodology for 26 researchers.
As part of research management and to ensure the quality of research funded by this project, NIHRD conducted
monitoring of the research projects.
NIHRD has been designated to be a WHO Collaborating Centre- Influenza focusing on human and animal
interface.
ANNEX 2
AVIAN INFLUENZA REFERRAL HOSPITAL
Province
Nanggroe Aceh
Darrusalam
North Sumatera
West Sumatera
No
Hospital
Address
1
RSU Dr Zainoel Abidin Banda Aceh*
Jl. Tgk. Daud Beuruh No. 108, Banda Aceh
2
RSU Cut Meutia Lhoksemawe**
Jl. Banda Aceh-Medan KM. 6, Buket Rata,
Lhoksemawe
3
RSUP H Adam Malik Medan*
Jl. Bunga Lau No. 17, Medan
4
RSU Kabajahe**
Jl. KS Ketaren 8, Kabanjahe
5
RSU Pematang Siantar**
Jl. Sutomo No. 230, Pematang Siantar
6
RSU Tarutung**
Jl. Bin Harun Said, Tarutung
7
RSU Padang Sidempuan**
Jl. Dr FL Tobing, Padang Sidempuan
8
RSUP Dr M Djamil Padang*
Jl. Perintis Kemerdekaan, Padang
9
RSU Dr Achmad Mochtar**
Jl. Dr A Rivai, Bukittinggi
10 RSUP Arifin Ahmad Pekanbaru*
Jl. Diponegoro No. 2, Pekan Baru
11 RSUD Tanjung Balai Karimun*
Jl. Poros No. 1, Tanjung Balai Karimun
12 RSUD Tanjung Pinang*
Jl. Sudirman No. 795, Tanjung Pinang
13 RSUD Dumai*
Jl. Tanjung Jati No. 4, Dumai
14 RSUD Tembilahan*
Jl. Veteran No. 52, Hilir Tembilahan
Riau Islands
15 RS Otorita Batam*
Jl. Dr Ciptomangunkusumo, Sekupang, Batam
Jambi
16 RSU Raden Matteher Jambi*
Jl. Letjend. Soeprapto No. 31, Telanaipura, Jambi
Riau
Bengkulu
South Sumatera
Bangka Belitung
Lampung
Banten
DKI Jakarta
West Jawa
17 RSUD M Yunus Bengkulu*
Jl. Bhayangkara Sidomulyo, Bengkulu
18 RSU Arga Makmur**
Jl. Siti Khadijah, Arga Makmur, Bengkulu Utara
19 RSU Manna**
Jl. Fatmawati Soekarno N0. 31, Manna
20 RSUP Dr Moeh Hossein Palembang*
Jl. Jendral Sudirman, Palembang
21 RSU Lubuk Linggau**
Jl. Yos Sudarso, Lubuk Linggau
22 RSU Kayu Agung**
Jl. Raya Lintas Timur, Kec. Kota Kayuagung
23 RSD Kab. Lahat**
Jl. Mayor Ruslan I No. 28, Lahat
24 RSU Tanjung Padan*
Jl. Melati Tanjung Pandan
25 RSU Pangkal Pinang**
Jl. M. Syafrie Rachman I, Pangkal Pinang
26 RSU Abdul Moeloek*
Jl. Dr Rivai No. 6, Tanjung Karang, Lampung
27 RSU Kalianda**
Jl. Lettu Rohani No. 14B, Kalianda
28 RSU Mayjend HM Ryacudu**
Jl. Jend Sudirman No. 2, Kotabumi
29 RSU Ahmad Yani
Jl. Jend A Yani, Metro
30 RSU Serang*
Jl. Rumah Sakit No. 1, Serang
31 RSU Tangerang**
Jl. Ahmad Yani No. 9, Tangerang
32 RSUP Persahabatan*
Jl. Persahabatan Raya
33 RSPI Dr Sulianti Saroso*
Jl. Baru Sunter Permai Raya, Jakarta
34 RSPAD Gatot Subroto**
Jl. Dr A Rahman Saleh No. 24, Jakarta Pusat
35 RSUP Dr Hasan Sadikin Bandung*
Jl. Pasteur No. 38, Bandung
36 RSUD Dr Slamet Garut*
Jl. Rumah Sakit No. 10, Garut
37 RSU Gunung Jati Cirebon**
Jl. Kosamabi No. 56, Cirebon
38 RSTP Dr HA Rotinsulu Bandung**
Jl. Bukit Jarian No. 40, Bandung
39 RSU R Syamsudin SH Sukabumi**
Jl. Rumah Sakit No. 1, Sukabumi
40 RSU Indramayu**
Jl. Rumah Sakit No. 1, Indramayu
41 RSU Subang**
Jl. Brigjen Katamso No. 37, Subang
ANNEX 2
AVIAN INFLUENZA REFERRAL HOSPITAL
Province
Central Jawa
DI Yogyakarta
East Jawa
Bali
Nusa Tenggara
Barat
Nusa Tenggara
Timur
West Kalimantan
Central Kalimantan
No
Hospital
Address
42 RSUD Banyumas*
Jl. Rumah Sakit No. 1, Banyumas
43 RSUP Dr Kariadi Semarang*
Jl. Dr Sutomo No. 16, Semarang
44 RSUD H Suwondo Kendal*
Jl. Laut No. 21, Kendal
45 RS Prof Dr Muwardi Surakarta*
Jl. Kol Sutarto No. 132, Surakarta
46 RSU Kudus **
Jl. Dr Lukmonohadi No. 19, Kudus
47 RSU Dr H RM Soeselo W**
Jl. Dr Sutomo No. 63, Slawi
48 RSU Pekalongan**
Jl. Veteran No. 31, Pekalongan
49 RSU Tidar**
Jl. Tidar No. 30A, Magelang
50 RSU Prof Dr Margono Soekarjo
Jl. Dr Gumbreg No. 1, Purwokerto
51 RSU Dr Suraji Tirtonegoro**
Jl. Dr Soeradji T No. 1, Klaten
52 RSUP Dr Sardjito Yogyakarta*
Jl. Kesehatan No. 1, Sekip, Yogyakarta
53 RSU Panembahan Senopati Bantul**
Jl. Dr Wahidin SH, Bantul
54 RSUD Dr Soetomo Surabaya*
Jl. Prof Dr Moestopo No. 6 - 8, Surabaya
55 RSUD Dr Subandi Jember*
Jl. Dr Soebandi No. 1, Jember
56 RSUP Dr Syaiful Anwar Malang*
Jl. Jaksa Agung Suprapto No. 2, Malang
57 RS Dr R Koesma Tuban**
Jl. Dr W S Husodo, Tuban
58 RS Dr S Djatikoesoemo**
Jl. Dr Wahidin No. 36, Bojonegoro
59 RS Pare**
Jl. Pahlawan Kusuma No. B1, Pare
60 RS Blambangan**
Jl. Istiqlah No. 49, Banyuwangi
61 RS Dr Soedono**
Jl. Sumbawa No. 6, Madiun
62 RSUP Sanglah Denpasar*
Jl. Diponegoro, Denpasar
63 RSU Tabanan**
Jl. Pahlawan No. 14, Tabanan
64 RSU Sanjiwani Gianyar**
Jl. Ciung Wenara No. 2, Gianyar
65 RSU Mataram*
Jl. Pejanggik No. 6, Mataram
66 RSU Raba**
Jl. Langsat No. 1, Raba, Kab. Bima
67 RSU Dr R Sudjono**
Jl. Prof M Yamin SH No. 55, Selong
68 RSU Praya**
Jl. Basuki Rahmat No. 11, Praya
69 RSU Dr WZ Johanes Kupang*
Jl. Dr Moch Hatta No. 19, Kupang
70 RSU Dr T C Hillers**
Jl. Keshatan, Maumere
71 RSU Dr Soedarso Pontianak*
Jl. Adi Sucipto, Pontianak
72 RSU Dr Abdul Aziz**
Jl. Dr Soetomo No. 28, Singkawang
73 RSU Sintang**
Jl. Pattimura, Sintang
74 RSU Dr Doris Sylvanus Palangkaraya*
Jl. Tambun Bungai No. 4, Palangkaraya
75 RSU Dr Murjani Sampit**
Jl. H M Arsyad No. 65, Sampit
76 RSU Tarakan*
Jl. Merapi No. 1, Tarakan
77 RSU Dr Kanujoso Djatiwibowo Balikpapan* Jl. MT Haryono Ring Road, Balikpapan
East Kalimantan
South Kalimantan
78 RSU H A Wahab Sjahranie**
Jl. Dr Soetomo, Samarinda
79 RSU Kota Bontang**
Jl. A Yani RT 11, Bontang
80 RSU Panglima Sebaya**
Jl. Ciptomangunkusumo No. 2, Tanah Grogot
81 RSU Tanjung Selor**
Jl. Cendrawasih, Tanjung Selor
82 RSU Ulin Banjarmasin*
Jl. Jend A Yani No. 79, Banjarmasin
83 RSU H Boejasin Pelahari**
Jl. A Syahrani, Pelaihari
ANNEX 2
AVIAN INFLUENZA REFERRAL HOSPITAL
Province
North Sulawesi
Gorontalo
Central Sulawesi
No
Hospital
Address
84 RSU Prof Dr RD Kandau*
Jl. Raya Tanawangko
85 RSU Dr Sam Ratulangi**
Jl. Luaan Tondano, Minahasa
86 RSU Prof Dr H Aloei Saboe*
Jl. S Batutihe No. 7, Gorontalo
87 RSU Prof Undata Palu*
Jl. Dr Suharso No. 14, Palu
88 RSU Luwuk**
Jl. Imam Bonjol No. 14, Luwuk
89 RS Mokopido Toli-Toli**
Jl. Lanoni, Toli-Toli
90 RSU Kolonedale**
Jl. W Monginsidi No. 2, Kolonedale
91 RSUP Dr Wahidin Sudirohusodo Makassar* Jl. Perintis Kemerdekaan KM. 11, Makassar
92 RSU Andi Makassau Pare-Pare*
Jl. Nurussamawati No. 3, Pare-Pare
93 RSU Lakipadada Tana Toraja**
Jl. Pongtiku Mandetek, Tana Toraja
94 RS Islam Faisal**
Jl. A P Pettarani, Makassar
95 RS Akademis Jaury**
Jl. Bulusarang No. 57, Makassar
96 RSU Sinjai**
Jl. Jend Sudirman No. 47, Sinjai
Southeast Sulawesi
97 RSU Prof Kendari Kendari*
Jl. Dr Sam Ratulangi No. 151, Kendari
Maluku
98 RSU M Haulussy Ambon*
Jl. Dr Kayadoe, Ambon
North Maluku
99 RSU Chasan Basoeri Ternate*
Jl. Tanah Tinggi, Ternate
Papua
100 RSU Jayapura*
Jl. Kesehatan I Dok II, Jayapura
South Sulawesi
* Designated based on Ministrial Decree No. 1371/Menkes/SK/IX/2005
** Designated based on Ministrial Decree No. 414/Menkes/SK/IV/2007
ANNEX 3
DISTRIBUTION LIST- MEDICAL EQUIPMENT, PPE AND AMBULANCES, 2010-2011
NO
1
2
3
4
Hospitals
Provinces
NAD
North Sumatera
West Sumatera
Riau
1
Address
Three beds &
matress
Suction
pumps
Stretcher
RSU Dr. Zainoel Abidin
Jl. Tgk. Daud Beuruh No. 108, Banda Aceh
2
RSU Cut Meutia Lhokseumawe
Jl. Banda Aceh-Medan KM. 6, Buket Rata,
Lhoksemawe
1
1
3
RSU H. Adam Malik
Jl. Bunga Lau No. 17, Medan
1
2
1
4
RSU Kaban Jahe
Jl. KS Ketaren 8, Kabanjahe
1
2
1
5
RSU Pematang Siantar
Jl. Sutomo No. 230, Pematang Siantar
1
1
6
RSU Tarutung, Tapanuli Utara
Jl. Bin Harun Said, Tarutung
1
2
7
RSU Padang Sidempuan
Jl. Dr FL Tobing, Padang Sidempuan
1
1
8
RSU Dr. M. Djamil
Jl. Perintis Kemerdekaan, Padang
2
1
2
9
RSU Ahmad Mochtar Bukit Tinggi
Jl. Dr A Rivai, Bukittinggi
2
1
2
10
RSU Tj. Balai Karimun
Jl. Poros No. 1, Tanjung Balai Karimun
1
11
RSU Dumai
Jl. Tanjung Jati No. 4, Dumai
1
12
RSU Puri Husada Tembilahan
Jl. Veteran No. 52, Hilir Tembilahan
1
13
RSU Tj Pinang
Jl. Sudirman No. 795, Tanjung Pinang
14
RSU Arifin Ahmad Pekan Baru
Jl. Diponegoro No. 2, Pekan Baru
Jl. Dr Ciptomangunkusumo, Sekupang, Batam
1
2
15
RSU Otorita Batam
6
Jambi
16
RSU Raden Mattaher, Jambi
Jl. Letjend. Soeprapto No. 31, Telanaipura, Jambi
7
Bengkulu
17
RSU M. Yunus
Jl. Bhayangkara Sidomulyo, Bengkulu
18
RSU Arga Makmur, Bengkulu Utara
Jl. Siti Khadijah, Arga Makmur, Bengkulu Utara
1
1
19
RSU Manna, Bengkulu Selatan
Jl. Fatmawati Soekarno N0. 31, Manna
1
1
20
RSU Tj Pandan
Jl. Melati Tanjung Pandan
21
RSU Pangkal Pinang
Jl. M. Syafrie Rachman I, Pangkal Pinang
1
2
22
RSU Dr. M. Hoesin
Jl. Jendral Sudirman, Palembang
1
2
23
RSU Lubuk Linggau
Jl. Yos Sudarso, Lubuk Linggau
24
RSU Kayu Agung
Jl. Raya Lintas Timur, Kec. Kota Kayuagung
1
25
RSU Lahat
Jl. Mayor Ruslan I No. 28, Lahat
2
26
RSU Dr. Abdul Muluk
Jl. Dr Rivai No. 6, Tanjung Karang, Lampung
27
RSU Kalianda, Lampung Selatan
Jl. Lettu Rohani No. 14B, Kalianda
28
RSU HM Ryacudu, Lampung Utara
29
RSU Ahmad Yani, Metro
30
RSPI Prof Sulianti Saroso
Jl. Baru Sunter Permai Raya, Jakarta
31
RSU Persahabatan
9
10
11
South Sumatera
Lampung
DKI Jakarta
32
12
West Java
RS
PAD Gatot Soebroto
1
1
2
1
2
1
1
1
1
1
1
1
1
1
1
1
1
1
2
1
1
2
2
2
1
2
1
1
2
Jl. Jend Sudirman No. 2, Kotabumi
2
1
2
Jl. Jend A Yani, Metro
2
2
Jl. Pasteur No. 38, Bandung
1
2
Jl. Persahabatan Raya
Jl. Dr A Rahman Saleh No. 24, Jakarta Pusat
1
1
1
Riau Islands
Bangka Belitung
Syringe
pump
2
5
8
Ambulance and Infusion
equipments
Pump
2
1
2
1
1
2
1
1
2
1
1
33
RSU Hasan Sadikin
34
RSU Dr. Slamet Garut
Jl. Rumah Sakit No. 10, Garut
1
2
35
RSU Gunung Jati Cirebon
Jl. Kosamabi No. 56, Cirebon
3
1
2
36
RSU Dr. H A Rotinsulu
Jl. Bukit Jarian No. 40, Bandung
2
1
2
37
RSU R. Syamsudin SH, Sukabumi
Jl. Rumah Sakit No. 1, Sukabumi
1
2
38
RSU Indramayu
Jl. Rumah Sakit No. 1, Indramayu
2
2
39
RSU Subang
Jl. Brigjen Katamso No. 37, Subang
2
2
ANNEX 3
DISTRIBUTION LIST- MEDICAL EQUIPMENT, PPE AND AMBULANCES, 2010-2011
NO
13
14
15
16
17
18
Banten
Central Java
East Java
Yogyakarta
Bali
West Nusa tenggara
19
East Nusa Tenggara
20
West Kalimantan
21
Hospitals
Provinces
East Kalimantan
Address
Three beds &
matress
Ambulance and Infusion
equipments
Pump
Suction
pumps
Stretcher
1
2
1
2
1
1
40
RSU Serang
Jl. Rumah Sakit No. 1, Serang
41
RSU Tangerang
Jl. Ahmad Yani No. 9, Tangerang
42
RSU Dr Kariadi Semarang
Jl. Dr Sutomo No. 16, Semarang
1
2
43
RSU H Suwondo Kendal
Jl. Laut No. 21, Kendal
1
1
44
RSU Dr Moewardi Solo
Jl. Kol Sutarto No. 132, Surakarta
1
2
45
RSU Banyumas
Jl. Rumah Sakit No. 1, Banyumas
1
1
46
RSU Kudus
Jl. Dr Lukmonohadi No. 19, Kudus
47
RSU Dr. HRM Soeselo Slawi, Tegal
Jl. Dr Sutomo No. 63, Slawi
48
RSU Keraton, Pekalongan
Jl. Veteran No. 31, Pekalongan
49
RSU Tidar, Magelang
Jl. Tidar No. 30A, Magelang
50
RSU Dr. Margono S, Purwokerto
Jl. Dr Gumbreg No. 1, Purwokerto
51
RSU Dr. Soeradji T., Klaten
Jl. Dr Soeradji T No. 1, Klaten
3
52
RSU Dr Soetomo
Jl. Prof Dr Moestopo No. 6 - 8, Surabaya
2
53
RSU Dr Subandi Jember
54
55
56
RSU Dr. S Djatikusumo, Bojonegoro
Jl. Dr Wahidin No. 36, Bojonegoro
2
2
57
RSU Pare Kediri
Jl. Pahlawan Kusuma No. B1, Pare
2
2
58
RSU Blambangan Banyuwangi
Jl. Istiqlah No. 49, Banyuwangi
59
RSU Dr. Soedono Madiun
Jl. Sumbawa No. 6, Madiun
60
RSU Dr Sardjito
Jl. Kesehatan No. 1, Sekip, Yogyakarta
61
RSU Panembahan Senopati Bantul
Jl. Dr Wahidin SH, Bantul
62
RSU Sanglah
Jl. Diponegoro, Denpasar
63
RSU Tabanan
Jl. Pahlawan No. 14, Tabanan
64
RSU Sanjiwani, Gianyar
Jl. Ciung Wenara No. 2, Gianyar
2
2
Syringe
pump
1
1
1
1
1
1
1
1
1
1
1
1
1
2
2
2
2
2
2
2
1
2
1
Jl. Dr Soebandi No. 1, Jember
1
1
1
RSU Dr Saiful Anwar
Jl. Jaksa Agung Suprapto No. 2, Malang
1
2
RSU Dr. R Koesma, Tuban
Jl. Dr W S Husodo, Tuban
2
2
2
2
1
2
1
2
1
2
1
4
1
2
1
3
1
2
1
2
2
65
RSU Mataram
Jl. Pejanggik No. 6, Mataram
66
RSU Dr. R. Sudjono, Selong Lotim
Jl. Prof M Yamin SH No. 55, Selong
67
RSU Raba Bima
Jl. Langsat No. 1, Raba, Kab. Bima
68
RSU Praya, Lombok Tengah
Jl. Basuki Rahmat No. 11, Praya
69
RSU Dr WZ Johannes
Jl. Dr Moch Hatta No. 19, Kupang
70
RSU Dr. TC Hillers Maumere
Jl. Keshatan, Maumere
71
RSU Dr Soedarso Pontianak
Jl. Adi Sucipto, Pontianak
72
RSU Abdul Aziz Singkawang
Jl. Dr Soetomo No. 28, Singkawang
2
2
73
RSU Ade M. Djoen Sintang
Jl. Pattimura, Sintang
2
2
2
1
2
2
2
2
1
1
2
2
1
2
74
RSU Tarakan
Jl. Merapi No. 1, Tarakan
1
1
75
RSU Dr Kanujoso Djatiwibowo
Jl. MT Haryono Ring Road, Balikpapan
1
2
76
RSU HA Wahab Syahrani
Jl. Dr Soetomo, Samarinda
2
2
77
RSU Panglima Sebaya, Grogot
Jl. Ciptomangunkusumo No. 2, Tanah Grogot
2
2
1
1
78
RSU Kota Bontang
Jl. A Yani RT 11, Bontang
2
2
1
1
79
RSU Soemarno S, Tj. Selor
Jl. Cendrawasih, Tanjung Selor
2
2
1
1
ANNEX 3
DISTRIBUTION LIST- MEDICAL EQUIPMENT, PPE AND AMBULANCES, 2010-2011
NO
22
23
Central Kalimantan
South kalimantan
24
North Sulawesi
25
Gorontalo
26
central Sulawesi
27
Hospitals
Provinces
South Sulawesi
Address
Three beds &
matress
Suction
pumps
Stretcher
1
1
2
1
2
2
2
1
2
1
1
1
2
80
RSU Murjani Sampit
Jl. H M Arsyad No. 65, Sampit
81
RSU Doris S, Palangkaraya
Jl. Tambun Bungai No. 4, Palangkaraya
82
RSU Ulin Banjarmasin
Jl. Jend A Yani No. 79, Banjarmasin
2
83
RSU H. Boejasin Pelaihari Tanah Laut
Jl. A Syahrani, Pelaihari
1
84
RSU Prof RD Kandou
Jl. Raya Tanawangko
1
85
RSU Dr. Sam Ratulangi Minahasa
Jl. Luaan Tondano, Minahasa
1
86
RSU H. Aloe Saboe
Jl. S Batutihe No. 7, Gorontalo
2
87
RSU Undata
Jl. Dr Suharso No. 14, Palu
RSU Luwuk
Jl. Imam Bonjol No. 14, Luwuk
1
2
89
RSU Mokopido Toli-Toli
Jl. Lanoni, Toli-Toli
1
2
90
RSU Kolonedale
Jl. W Monginsidi No. 2, Kolonedale
1
91
RSU Dr Wahidin SH
Jl. Perintis Kemerdekaan KM. 11, Makassar
2
92
RSU Andi Makkasau
Jl. Nurussamawati No. 3, Pare-Pare
93
RSU Lakipadada Tana Toraja
Jl. Pongtiku Mandetek, Tana Toraja
2
94
RSU Islam Faisal, Makassar
Jl. A P Pettarani, Makassar
2
2
95
RS
Jl. Bulusarang No. 57, Makassar
2
2
2
96
RSU Sinjai
Jl. Jend Sudirman No. 47, Sinjai
1
2
1
2
1
1
1
2
1
2
28
South East Sulawesi
97
RSU Kendari
Jl. Dr Sam Ratulangi No. 151, Kendari
1
2
30
Maluku
98
RSU M Haulussy Ambon
Jl. Dr Kayadoe, Ambon
1
1
31
North Maluku
99
RSU Chasan Basoeri Ternate
Jl. Tanah Tinggi, Ternate
1
1
32
Papua
Basic Medical Services MoH
Buffer Stock*)
100
RSU RSU Jayapura
52
180
33
Syringe
pump
2
88
Akademis Jaury
Ambulance and Infusion
equipments
Pump
Basic Medical Care- MoH RI
90
1
Justification of prioritized hospitals :
High case detection of human H5N1 / pultry outbreak
2
High risk transmission area (Due to dense poultry area)
3
Availability of medical equipments in hospitals
4
Capacity of hospitals
5
Commitment from hospital management to ensure long term maintainance of the medical equipments.
22
15
15
ANNEX 4
INFECTION PREVENTION CONTROL TRAININGS
NO
Training Venue
Hospital
# of trinees
1
Bandung
4 - 9 September 2007
1
2
3
4
5
6
RSUP Persahabatan, Jakarta
RSUD Banyumas, Jawa Tengah
RSUD Dr. Slamet, Garut, Jawa Barat
RSUD Serang, Banten
RSUD Dr. Soewondo, Kendal, Jawa Tengah
RSU Andi Makasau Pare-Pare, Sulawesi Selatan
5
4
4
5
5
4
2
Yogyakarta
7 - 12 April 2008
1
2
3
4
5
6
7
RS Panembahan, Bantul, D.I. Yogyakarta
RSU Moewardi Surakarta, Solo, Jawa Tengah
RSU Dr.H.R.M. Soeselo, Tegal, Jawa Tengah
RSU Pekalongan, Jawa Tengah
RSU Tidar, Magelang, Jawa Tengah
RSU Prof. Dr. M. Soekarjo, Purwokerto, Jawa Tengah
RSU Dr. Suraji Tirtonegoro, Klaten, Jawa Tengah
5
5
4
3
4
5
5
3
Bandung
21 - 25 April 2008
1
2
3
4
5
6
7
8
RSUD Gunung Jati, Cirebon , Jawa Barat
RSUD R. Syamsudin, S.H, Sukabumi, Jawa Barat
RSUD Indramayu, Jawa Barat
RSUD Subang, Jawa Barat
RSU Tangerang, Banten
RS Paru Dr. H.A. Rotinsulu, Bandung, Jawa Barat
RSU Dr. Sudarso, Pontianak, Kalimantan Barat
RSU Dr. Abdul Azis, Singkawang, Kalimantan Barat
5
4
5
5
5
5
5
5
4
Surabaya
25 - 29 Mei 2008
1
2
3
4
5
6
7
8
RSUD Dr. R. Koesma, Tuban, Jawa Timur
RSUD Bojonegoro, Jawa Timur
RSUD Pare Kediri, Jawa Timur
RSU Dr. Soedono, Madiun, Jawa Timur
RSUD Dr Subandi, Jember, Jawa Timur
RSUD Blambangan , Jawa Timur
RSU Dr.Kanujoso Djatiwibowo, Kalimantan Timur
RSU H. A. Wahab Sjahrani, Samarinda, Kaltim
4
4
4
4
2
4
4
3
5
Medan
29 Juni - 3 Juli 2008
1
2
3
4
5
6
7
8
RSUD Dr. Zainoel Abidin, Banda Aceh
RSUD Cut Meutia, Lhokseumawe
RSU Dr. M. Djamil, Padang
RSUD Dr. Achmad Mochtar, Bukittinggi
RSUD Kabanjahe
RSUD Pematang Siantar
RSUD Tarutung
RSUD Padang Sidempuan
4
3
4
4
3
4
4
4
6
Bali
27 - 31 Juli 2008
1
2
3
4
5
6
7
8
9
RSU Tabanan
RSU Sanjiwani, Gianyar
RSU Raba, Bima
RSU Dr. R. Sudjono, Selong
RSU Praya
RSU Prof. Dr. W. Z. Johanes, Kupang
RSU Dr. T. C. Hillers, Maumere
RS Islam Faisal, Makasar
RSU Akademis Jaury, Makasar
3
3
3
3
3
4
3
3
2
ANNEX 4
NO
Training Venue
Hospital
# of trinees
7
Bandung
10 - 14 Agustus 2008
1
2
3
4
5
6
7
8
9
RSU Dr. M. Yunus, Bengkulu
RSU Arga Makmur, Bengkulu
RSU Abdul Moeloek, Lampung
RSPAD Gatot Subroto, Jakarta
RSPI Prof. Dr. Sulianti Saroso Jakarta
RSU Dr. Doris Sylvanus, Palangkaraya
RSU Dr. Murjani, Sampit
RS Ulin, Banjarmasin
RSU H. Boejasin, Pelaihari
4
3
4
4
2
4
2
4
2
8
Yogyakarta
14 - 18 September 2008
1
2
3
4
5
6
7
RSU Kabupaten Kudus, Jawa Tengah
RSU Mayjen H.M Ryacudu Kotabumi, Lampung
RSU Jend. Ahmad Yani, Metro Lampung
RSUD Tarakan, Kaltim
RSUD Taman Husada, Bontang, Kaltim
RSU Panglima Sebaya, Tanah Grogot, Kaltim
RSUD Dr.H.Soemarno Sosroatmodjo,Tj Selor, Kaltim
2
3
3
4
3
2
2
9
Makasar
21 - 25 Oktober 2008
1
2
3
4
5
6
7
RSU Prof.DR.R.D. Kandou, Manado
RSU Dr. Sam Ratulangi, Minahasa
RSU Sinjai
RSU Kendari
RSU Prof. Dr. H. Aloei Saboe, Gorontalo
RSU Ternate
RSU Jayapura
3
3
3
3
3
3
4
10
Batam
4 - 8 Nopember 2008
1
2
3
4
5
6
7
RSU Karimun
RSU Tanjung Pinang
RSU Puri Husada, Tembilahan
RSU Dumai
RSU Tanjung Pandan
RSU Pangkal Pinang
RSU Kalianda, Lampung
3
3
2
3
4
4
2
11
Bali
15-20 January 2009
1
2
3
4
5
6
RSUD Undata Palu
BRSD Luwuk South sulawesi
RSU Mokopido toli-toli
RSUD Lakipada
RSUD Haulussy, Ambon
RSUD Kolonedale
6
3
5
6
5
5
12
Medan
27-31 Jan 2009
1
2
3
4
5
6
7
RSUP Dr. M. Hoesin, Palembang
RSU Lubuk Linggau
RSU Kayu Agung
RSU Kab. Lahat
RSU Manna Bengkulu
RSU Raden Mattaher Jambi
RSUD Ade M Djoen Sintang
5
4
5
5
4
5
2
13
Bekasi
15 - 20 June 2009
1
2
3
4
5
6
7
8
9
10
11
12
RSUP Dr. Cipto Mangunkesuma
RSU Pasar Rebo
RSU Soreang, west java
RSUD Cibitung
RSUD Kota cilegon
RSUD Karawang
RSUD Bekasi
RSU Dr. Rubini mempawah, west kalimantan
RSU Pemangkat , west kalimantan
RSUD Banjarbaru, south kalimantan
RSUD Ratu zalecha martapura, south kalimantan
RSUD Sangatta, east kalimantan
4
5
3
5
3
3
3
3
3
3
3
3
ANNEX 4
NO
Training Venue
Hospital
# of trinees
14
Palembang
3-8 August 2009
1
2
3
4
5
6
7
8
9
10
11
12
RSU Pringadi Medan North Sumatera
RSUD Sidakalang North Sumatera
RSUD Kota Batam, Riau Island
RSUD Pariaman Padang, West Sumatera
RSU Solok west Sumatera
RSUD Muara Bulian Batang Hari Jambi
RSUD Curup Bengkulu
RSUD Liwa West Lampung
RSUD Pringsewu lampung
RSUD Sungai Liat Bangka
RSUD Prabumulih Palembang
RSU Palembang Bari, medan
3
2
2
2
2
2
2
2
2
2
3
4
15
Surabaya
26-31 October 2009
1
2
3
4
5
6
7
8
9
10
11
12
13
14
RSU Kardinah Tegal
RSU Pandan Arang , Boyolali
RSU Wates, Yogyakarta
RSU Selman, Yogyakarta
RSU Ibnu Gresik, East java
RSU Dr. Soeroto Ngawi, East Java
RSU Jombang, East Java
RSU Ngundi Waluyo Wlingi, East java
RSU Klungkung, Bali
RSU Wangaya, Bali
RSU Patut Patuh Patju, West Nusa Tenggara
RSU Dompu, West Nusa Tenggara
RSU Larantuka, East Nusatenggara
RSU Wamena, Papua
3
3
3
3
3
3
3
3
2
2
2
2
2
2
16
Jayapura, Papua
6-11 June 2010
1
2
3
4
5
6
7
8
9
10
Sorong hospital
Sele Be Solu hospital, Sorong
Fak-fak hospital
Biak hospital
Serui hospital
Abepura hospital
Merauke hospital
Paniai hospital
Timika hospital
Jayapura hospital
2
3
3
3
3
4
3
3
2
5
17
Makasar,
South Sulawesi
10-15 May 2010
1
2
3
4
5
6
7
8
9
10
11
Dr. Wahidin Sudirohusodo hospital
Andi Makasau hospital
Lakipadada hospital, Makale
Sinjai hospital
Labuang Baji hospital, Makasar
Massenrempulu hospital, Enrekang
Lasinrang hospital
H. Andi Sulthan Daeng Radja hosptal, Bulukumba
Sawerigading hospital, Palopo
Islam Faisal hospital, Makasar
Akademis Jaury Yusuf Putra hospital, Makasar
3
3
3
3
3
3
3
3
3
3
3
ANNEX 4
NO
Training Venue
18
Surabaya ,
East Java
26-30 December 2010
(2 pararel batches)
Hospital
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
Tulungagung hospital
Madiun hospital
Dr. Mohamad Saleh hospital
Dr. Sayidiman hospital, Magetan
Kertosono hospital
Dr. Soegiri hospital, Lamongan
Dr. H Moh Anwar hospital, Sumenep
Dr. Abdoer Rahem hospital, Situbondo
Balung hospital, Jember
Prof.Dr. Soekandar hospital, Mojokerto
Nganjuk hospital
Dr Mohamad Soewandhie hospital
Syarifah Ambami Rato Ebu hospital
Haji hospital Surabaya
Dr. Harjono S hospital, Ponorogo
Dr. Sedomo hospital Trenggalek
Kanjuruhan hospital, Kepanjen
Dr. Wahidin Sudirohusodo hospital
Dr. Haryoto hospital, Lumajang
Caruban hospital, Madiun
Bojonegoro hospital
Dr. H Koesnadi hospital, Bondowoso
Ngudi Waluyo hospital, Wlingi
Kalisat hospital Jember
Pacitan hospital
Bangil hospital
Mardi Waluyo hospital, Blitar
# of trinees
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
1
ANNEX 4
HEALTHCARE ASSOCIATED INFECTION (HAI) SURVEILLANCE TRAININGS
Hospital
# of
trainees
No
Training Venue
1
HAI surveillance ToT
Batam
19-23 December 2010
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Dr. Soetomo hospital , Surabaya
Dr. Karidi hospital, Semarang
Dr. Sardjito hospital, Yogyakarta
Dr. Wahidin Sudirohusodo hospital, Makasar
Tangerang hospital
Pusat Jantung Harapan Kita hospital, Jakarta
Dr. Hasan Sadikin hospital, Bandung
Siloam Lipo Cikarang hospital, West Java
Dr. Cipto Mangunkusumo hospital, Jakarta
Prof. Dr. Sulianti Saroso hospital, Jakarta
Arifin Achmad hospital, Pekanbaru
Otorita Batam hospital, Riau Island
Sanglah hospital, Bali
Mataram hospital, West Nusa Tenggara
Prof. Dr. W.Z. Johannes hospital, Kupang
Undata hospital, Palu
Dr. M. Haulussy hospital, Ambon
H. Adam Malik hospital, Medan
Dr. Soedarso hospital, Pontianak
A Wahab Sjahranie hospital, Samarinda West Kalimantan
2
1
2
2
2
2
2
1
1
1
1
1
1
1
1
1
1
1
1
1
2
IPC surveillance training
(Three paralel batches)
Surabaya
26-30 December 2010
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
Dr. Suradji Tirtonegoro hospital, Klaten
Tabanan hospital, Bali
Dr. Soebandi hospital, Jember
Dr. Saiful Anwar hospital, Malang
Dr. R Koesma hospital, Tuban
Dr. R Sosodoro Djatikusumo hospital
Blambangan hospital, Banyuwangi
Madiun hospital
Tangerang hospital
Dr. Hasan Sadikin hospital, Bandung
Dr. Kariadi hospital, Semarang
Dr. Soedarso hospital
Dr. Doris Sylvanus hospital
Ulin hospital, Banjarmasin
Dr, Kanujoso hospital, Balikpapan
Dr. Sardjito hospital, Yogyakarta
Dr. Zainoel Abidin hospital, Banda Aceh
Dr. M. Djamil hospital, Padang
Otorita hospital, Batam
Raden Mattaher hospital, Jambi
Dr. M. Hoesin hospital
Dr. M Yunus hospital, Bengkulu
Dr. Abdul Moeloek hospital, Lampung
Depati Hamzah hospital, Pangkal Pinang
H Adam Malik hospital, Medan
West Nusa Tenggara hospital
Prof. Dr. W.Z. Johannes hospital, Kupang
Dr. Wahidin Sudirohusodo hospital, Makasar
Prof. Dr. RD. Kandou hospital, Manado
Prof. Dr. Aloei Sabu hospital, Gorontalo
Kendari hospital, Sulawesi Tenggara
Dr. M Haulussy hospital, Ambon
Sorong hospital
Jayapura hospital
Dr. Soetomo hospital, Surabaya
Sidoarjo hospital
Islam Siti Hajar hospital, Sidoarjo
Sanjiwani hospital, Gianyar
Chasan Busoirie hospital
Polewali hospital, West Sulawesi
Harapan Kita hospital, Jakarta
2
2
2
2
2
1
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
1
ANNEX 4
INFECTION PREVENTION CONTROL NATIONAL MEETING
No
Training Venue
15-16 December 2010
Hospital
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
Sanglah hospital, Bali
Dr. Sardjito hospital, Yogyakarta
Dr. Arifin Ahmad hospital, Pekanbaru
Dr. Soetomo, Surabaya
Persahabatan hospital, Jakarta
Fatmawati hospital, Jakarta
Harapan Kita hospital, Jakarta
Cipto Mangunkusumo hospital, Jakarta
Pasar Rebo hospital, Jakarta
Mataram hospital, NTB
H. Adam Malik hospital, Medan
Tangerang hospital
Dr. Kariadi hospital, Semarang
Dr. Hasan Sadikin hospital
Dr. Wahidin Sudirohusodo hospital
Dr. H. Abdul Moeloek hospital
Prof. Dr. Sulianti Saroso hospital
Prof. Dr. W.Z Johannes hospital, Kupang
M. Hoesin hospital, Palembang
Undata hospital, Palu
Dr. Soedarso hospital, Pontianak
Dr. M. Haulussy hospital, Ambon
A. Wahab Sjahranie hospital, Samarinda
Dr. Zainoel Abidin hospital, Banda Aceh
Prof. Dr. RD. Kandou hospital, Manado
Dr. M. Djamil hospital, Padang
Otorita hospital, Batam
Dr. Doris Sylvanus hospital
Jayapura hospital, Jayapura
Dr. H.A. Rotinsulu hospital, Bandung
Indonesia Society of Infection Control (PERDALIN)
Indonesia Pulmonologist Association (PDPI)
Indonesia Hospital Association (PERSI)
Indonesia Clinical Microbiologist Association (PAMKI)
Central IPC Committee
Directorate General of Medical Care, MoH
West Java Provincial Health Officer
# of
trainees
2
1
1
1
2
1
2
1
1
1
2
2
2
2
2
1
1
1
1
1
1
2
1
1
1
1
1
1
2
1
1
1
2
1
4
9
1
ANNEX 4
INFECTION PREVENTION CONTROL MONITORING & EVALUATION
No
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Hospital
H. Adam Malik hospital, Medan
Arifin Achmad hospital, Pekanbaru
Dr. Mattaher hospital, Jambi
Fatmawati hospital, Jakarta
Tarakan hospital, Jakarta Pusat
Dr Cipto Mangunkusumo hospital
Kota Bandung hospital
Karawang hospital, West Java
Subang hospital, West Java
Gunung Jati hospital, Cirebon
Dr. Moewardi hospital, Solo
Dr. Sardjito hospital, Yogyakarta
Dr. Saiful Anwar hospital, Malang
Dr. Soedono hospital, Madiun
Singkawang hospital
Tarakan hospital
Mataram hospital West Nusa Tenggara
Dr Wahidin Sudirohusodo hospital, Makasar
Sanglah hospital, Denpasar
Sanjiwani hospital
Province
North Sumatera
Riau
Jambi
DKI Jakarta
DKI Jakarta
DKI Jakarta
West Java
West Java
West Java
West Java
Central Java
D.I. Yogyakarta
East Java
East Java
West Kalimantan
East Kalimantan
West Nusa Tenggara
South Sulawesi
Bali
Bali
INTERNATIONAL IPC CONFERENCES/ TRAININGS
No
Training Venue
Participants
1
8th East Asia IPC Conference in Japan, 11-12 November
2009
Drg. Sophia Hermawan (Specialistic Medical care,MoH RI)
Dr. Ester Marini Lubis ( Specialistic Medical care, MoH RI)
Drg. Wahyuni Prabayanti ( Specialistic Medical care, MoH RI)
dr. Aziza Ariyani (Pasar Rebo hospital)
Nrs. Costy Panjaitan (Indonesia Infectious Diseases Association)
2
27th annual meeting of the European society for pediatric
infectious diseases in Brussels, Belgium,
9-13 June 2009.
Dr. Lutfah Rif'ati
3
Join Infection Prevention and Control African Network
(IPCAN) and International Federation of Infection Control
(IFIC) conference in Cape Town, August-September 2010
Dr Andi Wahyuningsih (Director Specialistic Medical Care, MoH)
Drg Sophia Hermawan (Specialistic Medical care, MoH RI),
Dr Julianto Witjaksono (Director Cipto Mangunkusumo Hospital)
Dr Aziza Aryani, Sp.PK (Pasar Rebo Hospital)
Drg Nusati Ikawahyu, MMR (Fatmawati hospital)
4
IFIC conference in Venice Italy 12-15 October 2011.
dr. Sardikin Giriputro (National IPC team)
dr. Ester Lubis (Referral Medical Care, MoH RI)
dr. Cut Putriane (Referral Medical Care, MoH RI)
Infection Prevention Control Posters
ANNEX 4
Infection Prevention Control Posters
ANNEX 4
ANNEX 5
CRITICAL CARE MANAGEMENT COURSE
Cochin Hospital - France, 4-8 May 2009
No
Name
Institution
1
2
3
4
5
Dr. Teuku Marwan Nusri, MPH
Dr. Wuwuh Utami Ningtyas
Dr. Alia Puji Hartanti Budi
Dr. I wayan Suranadi
Ns.I komang Widarma Atmaja
Director of Basic Medic Care , MoH RI
Chief of subdirectorate and evacuation, Directorate of Basic Medic Care , MoH RI
NPO Clinical Management -WHO
ICU-RSUP Sanglah Hospital Denpasar
ICU - RSUP Sangla Hospital - Denpasar
6
7
8
Dr. Bambang Wahjuprajitno
Ns. Juni
Dr. Tinni Trihartini Maskoen
ICU - Soetomo Hospital Surabaya
ICU Hasan Sadikin Hospital Bandung
Anasthesiology Airlangga Faculty of Medicine- Soetomo Hospital
9
Ns. Wahju Anggoro Pradjijanto
ICU -Hasan Sadikin Hospital Bandung
10
11
12
Dr. I dewa Ketut Sidharta
Ns.Abu Bakar
Dr. Sylvana Martina Kalibonso
ICU-Persahabatan Hospital - Jakarta
ICU-Persahabatan Hospital - Jakarta
RSPAD - Gatot Subroto Hospital Jakarta
13
14
15
Ns.Tri Astuti Erawati
Dr. Syamsul Hilal Salam
Ns. Rita Resminingsih
RSPAD -Gatot Subroto Hospital Jakarta
ICU Wahidin Sudirohusodo Hospital - Makasar
ICU Wahidin Sudirohusodo Hospital - Makasar
AI CASE MANAGEMENT TRAININGS & WORKSHOPS
Training Venue
Hospital/ Primary Helthcare Centres
AI case managmement workshop,
Military doctors and nurses of 12 provincial military offices and
RSPAD Jakarta
from 74 districts.
8-10 November 2008
# of trainees
32
1
2
AI Case management workshop
Padang, West Sumatera
8-9 August 2011
3
AI Case management workshop
Banjarmasin, East Kalimantan
19-20 August 2011
4
AI Case management Training
Bogor, West Java
15-16 September 2011
M Djamil Hospital, West Sumatera
Yos Sudarso Hospital, West Sumatera
Tk III.06.01 Dr Reksodiwiryo Hospital, West Sumatera
Achmad Mochtar Hospital,West Sumatera
Ibnu Sina Islamic Hospital, West Sumatera
RSUD Solok Selatan Hospital, West Sumatera
PHC Ambacang, West Sumatera
PHC Lubuk Pasung, West Sumatera
PHC Kapau, West Sumatera
PHC Tanjung Paku, West Sumatera
PHC Nanggalo Padang, West Sumatera
West Sumatera Provincial Health Office, etc
Sub total
4
1
1
3
1
1
1
1
1
1
1
4
20
AW. Sjahranie Hospital, East Kalimantan
Pupuk Kaltim Hospital, East Kalimantan
Taman Husada Hospital, East Kalimantan
Sangatta Hospital, East Kalimantan
Kanujoso Hospital, East Kalimantan
Dr. R. Hardjanto Hospital, East Kalimantan
Tarakan Hospital, East Kalimantan
Bhakti Nugraha Hospital, East Kalimantan
PHC Palaran, East Kalimantan
PHC Sepinggan, East Kalimantan
PHC Tanah Grogot, East Kalimantan
PHC Perangat, East Kalimantan
PHC Bontang, East Kalimantan
PHC Karang Rejo, East Kalimantan
East Kalimantan Provincial Health Office, etc
Sub total
RSPAD Gatot Subroto Hospital, DKI Jakarta
Persahabatan Hospital,DKI Jakarta
RSPI Sulianti Saroso Hospital, DKI Jakarta
Tangerang Hospital, Banten
Serang Hospital, Banten
Hasan Sadikin Hospital, West Java
Rotinsulu Hospital, West Java
Dr Slamet Hospital,West Java
R Syamsudin Hospital,West Java
Indramayu Hospital, West Java
Abdoel Moeloek Hospital, Lampung
Ahmad Yani Hospital, Lampung
Sub total
TOTAL
3
1
1
1
1
1
1
1
1
1
1
1
1
1
5
21
1
1
2
1
2
1
1
2
2
2
2
2
19
92
ANNEX 6
NEW EMERGING and RE-EMERGING
INFECTIOUS DISEASES LABORATORY NETWORK
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
NIHRD
Eijkman Institut
UISU
Lab Kesda Palembang
FKUI
Lab Kesda Bandung
FK UNDIP
Lab Kesda Surabaya
FK Udayana
FK Unhas
BTKL Jakarta
BBLK DKI
RSPI DR. Sulianti Saroso
RSUP Persahabatan
BTKL Yogyakarta
BLK Yogyakarta
RSUP DR Sardjito
BTKL Surabaya
RSUP DR. Soetomo
RSUD Saiful Anwar
RSUP Hasan Sadikin
RSUD Dr. Slamet
BLK Semarang
RSUP Dr. Kariadi
RSUP Dr. Moewardi
RS Zainul Abidin
BLK Medan
RSUP Adam Malik
BLK Pekanbaru
RSU Otorita Batam
RSUP DR. M. Djamil
RSUP M. Hoesin
RSU Abdul Moeloek
RSUP Sanglah
BLK Denpasar
RSUP Mataram
RSUP DR. Wahidin Sudirohusodo
BLK Makasar
RSU Prof.Dr. Kandau
RSUP Ulin Banjarmasin
RSUP Kanujoso Djati Balikpapan
BLK Samarinda
RSU Dr. Soedarso
BLK Jayapura
DKI Jakarta
DKI Jakarta
North Sumatera
South Sumatera
Jakarta
West Java
West Java
East Java
Bali
South Sulawesi
DKI Jakarta
DKI Jakarta
DKI Jakarta
DKI Jakarta
DI Yogyakarta
DI Yogyakarta
DI Yogyakarta
East Java
East Java
East Java
West Java
West Java
Central Java
Central Java
Central Java
DI Aceh
North Sumatera
North Sumatera
Riau
Riau Island
West Sumatera
South Sumatera
Lampung
Bali
Bali
West Nusa Tenggara
South Sulawesi
South Sulawesi
North Sulawesi
South Kalimantan
East Kalimantan
East Kalimantan
West Kalimantan
Irian Jaya
ANNEX 7
Influenza Like Illness (ILI) Health Centres Sentinels-2011
No
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Province
NAD
Riau
Kepulauan Riau
Sumatera Selatan
Bangka Belitung
Jambi
Bengkulu
West Sumatera
East Kalimantan
West Kalimantan
South Kalimantan
Central Kalimantan
South Sulawesi
North Sulawesi
Southeast Sulawesi
Central Sulawesi
West Nusa Tenggara
Maluku
North Maluku
West Papua
No
1
2
3
4
5
6
Province
DKI Jakarta
DKI Jakarta
Central Java
Bali
South Sulawesi
South Sumatera
No
1
2
3
4
5
6
7
8
9
10
Province
Banten
South Sulawesi
DKI Jakarta
West Nusa Tenggaara
West Java
Central Java
West Sumatera
Bali
West Kalimantan
Papua
District/ Municipility
Banda Aceh
Kampar
Bintan
Palembang
Bangka
Muara Jambi
Bengkulu
Tanah Datar
Balikpapan
Pontianak
Banjarbaru
Kapuas
Makasar
Bitung
Konawe
Palu
West Lombok
Ambon
Ternate
Sorong
Health Centre
Kuta Alam
Air Tiris
Tanjung Uban
Merdeka
Pemali
Sei Durian
Sukamerindu
Lima Kaum 1
Klandasan Ilir
Pontianak kota
Banjarbaru
Selat
Jongaya
West Bitung
Lambuya
Birobuli
Kediri
Waihaong
Siko
Remu
ILI laboratory sentinels -2011
District
Jakarta
Jakarta
Semarang
Denpasar
Makasar
Palembang
Health Centre
NIHRD (National Referral Laboratory)
University of Indonesia
University of Diponegoro
University of Udayana
University Hasannudin
Public Health Laboratory Palembang
Severe Acute Respiratory Infection (SARI) Sentinels-2011
District/Municipality
Tangerang
Makasar
East Jakarta
Mataram
Bandung
Semarang
Padang
Denpasar
Pontianak
Jayapura
Health Centre
Tangerang hospital
Wahidin Sudirohusodo hospital
Sulianti saroso hospital
Mataram hospital
Hasan Sadikin hospital
Kariadi hospital
Djamil hospital
Sanglah hospital
Pontianak hospital
Jayapura hospital
ANNEX 7
Influenza Like Illness (ILI)
Health Centres Sentinels-2012
No
Province
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Health Centre
Nanggroe Aceh
Darussalam
Sumatera Utara
Sumatera Barat
Kepulauan Riau
Riau
Jambi
Bengkulu
Sumatera Selatan
Bangka Belitung
Lampung
Banten
DKI Jakarta
Jawa Barat
Jawa Tengah
DI Yogyakarta
Jawa Timur
Kalimantan Timur
Kalimantan Selatan
Kalimantan Tengah
Kalimantan Barat
Nusa Tenggara Barat
Nusa Tenggara Timur
Bali
Sulawesi Selatan
Sulawesi Utara
Sulawesi Barat
Sulawesi Tengah
Maluku
Papua
Papua Barat
Banda Raya
Teladan
Lubuk Buaya
Batu Aji
Umban Sari
Sei Duren
Suka Merindu
Plaju
Pomali
Sumur Batu
Curug
Utan Kayu Utara
Padasuka
Pandanaran
Kota Gede I
Dinoyo
Klandasan Ilir
Pekauman
Selat
Siantar Hilir
Karang taliwang
Sikumana
Denpasar Selatan I
Sudiang
Tikala Baru
Mamuju
Birobuli
Waihaong
Mopah
Jayapura
ILI laboratory sentinels - 2012
No
1
2
3
4
5
6
7
Province
DKI Jakarta
DKI Jakarta
Central Java
Bali
South Sulawesi
South Sumatera
North Sumatera
District
Jakarta
Jakarta
Semarang
Denpasar
Makasar
Palembang
Medan
Health Centre
NIHRD (National Referral Laboratory)
University of Indonesia
University of Diponegoro
University of Udayana
University Hasannudin
Public Health Laboratory Palembang
Medan Islamic University
No
1
2
3
4
5
6
7
8
Province
Banten
South Sulawesi
DKI Jakarta
West Java
Central Java
West Sumatera
Bali
Papua
District/Municipality
Tangerang
Makasar
East Jakarta
Bandung
Semarang
Padang
Denpasar
Jayapura
Health Centre
Tangerang hospital
Wahidin Sudirohusodo hospital
Sulianti saroso hospital
Hasan Sadikin hospital
Kariadi hospital
Djamil hospital
Sanglah hospital
Jayapura Doc II hospital
9
10
West Nusa Tenggara
West Kalimantan
Mataram
Pontianak
Mataram hospital
Soedarso hospital
Severe Acute Respiratory Infection (SARI) Sentinels-2012
ANNEX 8
PCR DIAGNOSTIC LABORATORY TRAININGS
#
1
2
3
4
5
6
7
Laboratory diagnosis workshop, 17-23 May 2009 in Denpasar-Bali
Laboratory diagnosis training, 13-19 July 2009 in Denpasar-Bali
Laboratory diagnosis training, 3-9 August 2009 in Bandung
PCR refresher training, 8-11 August 2010 in Yogyakarta
PCR refresher training, 22-25 September 2010 in Palembang
PCR refresher training, 15-19 December 2010 in Bekasi
PCR Refresher training, 31 May- 3 June 2011
# of trainees
25
22
44
23
25
30
44
213
BIOSAFETY LABORATORY TRAININGS
1 Biosafety and biosecurity training,15-19 December 2010 in Bekasi
2 Biosafety and biosecurity training, 9-15 May 2011 in Bekasi
30
25
55
ANNEX 9
FIELD EPIDEMIOLOGY TRAINING PROGRAM (FETP) STUDENTS
UNIVERSITY OF INDONESIA (UI)
NO
Name
Institution
Field Site
Field Supervisor
University of Indonesia Batch I
1
Dwi Oktavia
DKI Municipility Helath Office
West Java PHO
Rusli,M.Epid
2
Dwinda Ramadhani
Jakarta Public Helath Laboratory (BTKL)
Temanggung DHO
Khabib Mualim, SKM, M.Kes
3
Charles Edward Bobby Pontoh
Jakarta Port Health Office Level 1
North Sumatera PHO
Dr. Suryadharma
4
Darmawali Handoko
Directorate DG & EH MoH
South Sulawesi PHO
H.M Adjad, SKM, M.Epid
5
Ritanugraeni
Banten Provincial Health Office
Public Health Laboratory Jakarta
Suherman, SKM, M.Sc
6
Tubianto Anang Zulfikar
Makassar Port Health Office
Bengkayang DHO, West Kalimantan
Arya H.M. Purba, SKM, M.Kes
7
Listiono
Lampung Utara District Health Office
Bogor DHO
Dr. Eulis Wulantari, M.Epid
8
Karnely Herlena
Subdit Diarhea, D.G. DC & EH
Kebumen DHO
drg. Baning Rahayujati
9
Ketut Ngurah
Batam Port Health Office
Kebumen DHO
Kusbiyantoro, SKM, M.Kes
10
Rumatora Matelda
Fakfak District Health Office
West Kalimantan PHO
Antonius Suprayogi, SKM, MKM
Institution
Field Site
Field Supervisor
Suwandi Sawadi, SKM, M.Kes
University of Indonesia - Batch 2
NO
Name
1
Andi Pananrang
Barru Sulsel District Health Office
Central Java PHO
2
Arwinda
Merangin Jambi District Health Office
West Java PHO
Rusli, M.Epid
3
Fifi nur Afifah
KKP Kelas 1 Tanjung Priok Port Health Office Level 1
Cilacap DHO
Kuswantoro, SKM, M.Kes
4
Gian Sugianto
Tasikmalaya District Health Office
North Sumatera PHO
Dr. Suryadharma
5
H.Supriyadi
Marabahan Hospital, South Kalimantan
Purbalingga DHO
Semedi, SKM, M.Kes, SH
6
Herra Superiyatna
Cirebon District Health Office
Bengkayang DHO, West Kalimantan
Arya H.M. Purba, SKM, M.Kes
7
I Made Utama
West Nusa Tenggara Provincial Health Office
Pontianak DHO, West Kalimantan
Dr. H. Jajat Hidajat, M.Epid
8
Meirista Qomariah
Bangka Belitung Provincial Health Office
Central Java PHO
Suwandi Sawadi, SKM, M.Kes
9
Sri Setiawati
Palembang Port Health Office
Public Health Laboratory Jakarta
Suherman, SKM, M.Sc
10
Mailani
Banjarbaru Kalsel District Health Office
Temanggung DHO
Khabib Mualim, SKM, M.Kes
11
Nur Fuadiati
Jepara District Health Office
Bogor DHO
Dr. Eulis Wulantari, M.Epid
12
Sumarman
BNK OKU Timur
East Java PHO
Drg. Ansarul Fahrudda, M.Kes
13
I Made Winarta
TNI AU Atang Senjaya Bogor
Kapuas DHO
Bambang Edy Wicaksono
14
Noviani
North Lampung DHO
East Java PHO
Lilik Endahwati, SKM, M.Kes
Institution
Field Site
Field Supervisor
University of Indonesia - Batch 3
NO
Name
1
Adang Mulyana
Bogor District Health Office
Kebumen DHO
dr. Tri Prabowo, MScPH
2
Ali Rahmansyah
Batang hari District Health Office
South Sumatera PHO
dr. Matdani Nurcik, M.Epid
3
Aprinianis RI bay
Timur Tengah Selatan District Health Office
South Tangerang DHO
dr. Siane Nursianti Tanuwudjaja, M.Kes
4
Arief Mustofa
Kulonprogo District Health Office
East Java PHO
Drg. Ansarul Fahrudda, M.Kes
5
Dwi Agus Setiabudi
Tangerang District Health Office
Kota Banjar Baru DHO
Edi Santana, M.Kes
6
Harisnal
Salimpaung I Health centre
South Kalimantan PHO
Sukamto, M.Kes
7
I Wayan Gede
Faculty of Medicine Udayana university
Temanggung DHO
Khabib Mualim, SKM, M.Kes
8
Muhammar Muslih
Jambi Port Heealth Office
Kulonprogo DHO
drg. Th. Baning Rahayujati, M.Kes
9
Nur Purwoko Widodo
Jakarta level 1 Port Health Office
West Nusa Tenggara PHO
I DG Oka Wiguna
10
Ade Irawan Afandi
Serang District Health Office
Wonosobo DHO
Junaedi, SKM, M.Kes
11
Evi Fachlaeli
Provincial Development Agency (BPPD)
Public Health Laboratory Jakarta
Suherman, SKM, M.Sc
12
Muhammad Ali Rambey
South Tapanuli District Health Office
Public Health Laboratory surabaya
Bambang Wahyudi, SKM, MM
13
Opin Mananta
Gintu, Poso Health Centre
Cilacap DHO
Kuswantoro, SKM, M.Kes
ANNEX 9
FIELD EPIDEMIOLOGY TRAINING PROGRAM (FETP) STUDENTS
UNIVERSITY OF GADJAH MADA (UGM)
University of Gadjah Mada - Batch 1
NO
Name
Institution
Field Site
Field Supervisor
1
Bambang Supraptono, SKM
West Kalimantan PHO
2
Misti Rahayu, SKM
banyumas DHO
3
Amad Suwandi, SKM
DKK kota Semarang
4
Andreas Purwanto, dr
Pmelonguane puskesmas, Sangihe DHO
5
Ratna Wijayanti, dr
BBTKL-PLM Yogyakarta (environmental health and public
laboratory)
6
Sugiarto, SKM
Kulonprogo DHO
7
Agung Nugroho, SKM
East Java PHO
Southeast Sulawesi PHO
dr. H. Thamrin Datjing, M.Kes
8
I Made Swastika B, SKM
Denpasar Port Health Office (KKP Kelas I)
Sidrap South Sulawesi DHO
Dr. Syamsa Latief
9
Muhammad Asdar, SKM
RSUD Kendari, Southeast Sulawesi
Gorontalo PHO
Sabri Panigoro, SKM, M.Kes
Central Java PHO
Suwandi Sawadi, SKM, M.Kes
Public Health Laboratory Surabaya
Bambang Wahyudi, SKM, MM
East Java PHO
Drg. Ansarul Fahrudda, M.Kes
South Sulawesi PHO
Drs. Sukardi Pangade, SKM, M.Kes
Kulonprogo DHO
drg. Th. Baning Rahayujati, M.Kes
Central Sulawesi PHO
Wayan Aktriani, SKM, M.Epid
University of Gadjah Mada - Batch 2
Institution
Field Site
Field Supervisor
1
Samsu Aryanto
Bantul DIY District Health Office
South Sulawesi PHO
Drs. Sukardi Pangade, SKM, M.Kes
2
Budi Santoso
Surabaya Public Health Laboratory (BTKL PPM)
South Sumatera PHO
H.M Adjad, SKM, M.Epid
3
Andri Setya Dwi Nugroho
Yogyakarta Provincial Health Office
Gorontalo PHO
Sabri Panigoro, SKM, M.Kes
4
Aprilia Rubiana
Yogyakarta Public Health Laboratory (BTKL PPM)
Public Health Laboratory Jakarta
Suherman, SKM, M.Sc
5
Ali Rosyidi
Dinkes Kota Semarang
Lebong DHO
dr. H. Iwan Suwarsa, M.Kes
6
Solikhin Dwi Ramtana
Pekalongan District Health Office
Central Sulawesi PHO
Wayan Aktriani, SKM, M.Epid
7
Purnama Magdalena
West Java Provincial Health Office
Wonogiri DHO
Suprio Heryanto, SKM, M.Kes
8
Fitri Agustina
Barito Kuala, Kalsel District Health Office
West Java PHO
Rusli, M.Epid
9
Frans Yosep Sitepu
Sumatera Utara Provincial Health Office
West Kalimantan PHO
Antonius Suprayogi, SKM, MKM
10
Sidiq Heri Sukoco
Ngawen I, Kab Gunungkidul, DIY Health Centre
Sidrap DHO South Sulawesi Dr. Syamsa Latief
11
Asih Setiasih
Tasikmalaya Municipility Health Office
Public Health Laboratory Surabaya
Bambang Wahyudi, SKM, MM
12
Hadi Sutami
Bengkulu Municipility Health Office
Kebumen DHO
Kusbiyantoro, SKM, M.Kes
13
I Kadek Mulyawan
Mataram, NTB District Health Office
Southeast Sulawesi PHO
dr. H. Thamrin Datjing, M.Kes
14
RD Halim
Muaro Jambi District Health Office
15
Bai Kusnadi
Bogor District Health Office
Kebumen DHO
West Nusa Tenggara PHO
Dr. H. Dwi Budi Satrio
I DG Oka Wiguna, M.Kes
NO
Name
University of Gadjah Mada - Batch 3
Institution
Field Site
Field Supervisor
1
Hermawan
M. Yunus Hospital, Bengkulu Province
Public Health Laboratory Surabaya
Bambang Wahyudi, SKM, MM
2
Zumrotul Chomariah
Purworejo District Health Office
West Bandung DHO
Rusli, M.Epid
3
Yuyung Setiyowati
KKP Surabaya
Kebumen DHO
Kusbiyantoro, SKM, M.Kes
4
I Wayan Sugihana
Dinkes Prov Bali
Pontianak DHO, West Kalimantan
dr. H. Jajat Hidajat, M.Epid
5
Agoes Yudi Purnomo
RSUD Sayidiman Kab Magetan
West Kalimantan PHO
dr. Kodasi, M.Kes
6
Fransisca Susilastuti
BBTKL PPM Surabaya
West Java PHO
Suwandi Sawadi, SKM, M.Kes
7
Kartini Syam
RSUD Amanah Husada, Tanah Bumbu, Kalsel
Banjarmasin municipality health office
Sukarlan
8
Ni Komang Artini Aristyawati
Puskesmas Labuhan Badas, NTB
South Tangerang municipality health office
dr. Siane Nursianti Tanuwudjaja, M.Kes
9
Eka Budi Satria
Dinkes Kota Bukittinggi District Health Office
Tapin DHO, South Kalimantan
Humam Arifin
10
Aprizal
Dinkes Kab Bengkulu Utara District Health Office
East Java PHO
Lilik Endahwati, SKM, M.Kes
11
Sigunawan
Dinkes Kab Lamongan District Health Office
South Kalimantan PHO, Banjarmasin
Sukamto
12
Masnun Pulungan
Dinkes Kab Aceh Tengah District Health Office
East Java PHO
Drg. Ansarul Fahrudda, M.Kes
NO
Name
ANNEX 10
RAPID RESPONSE TEAM (RRT) TRAININGS
No
Date of training
Province
# of Districts
# of trainees
1
18-23 May 2008
Aceh
44
44
2
23-28 March 09
East kalimantan
6
30
3
17-22 August 09
East kalimantan
7
35
4
16-21 March 09
Bengkulu
5
30
5
30 March - 4 April 09
Bengkulu
5
30
6
2-7 March 09
North Sulawesi
15
60
7
27 Jul- 1 August 09
West Nusa Tenggara
5
25
8
5 - 10 August 09
West Nusa Tenggara
5
25
9
17 - 22 August 09
West Kalimantan
6
40
10
17 -22 August 09
West kalimantan
7
40
11
20-25 July 09
Southeast Sulawesi
12
60
12
29 Sept- 8 Oct 09
North Maluku
8
34
13
Dec-10
Central Sulawesi - Palu
5
30
14
20-25 June 2011
Riau Island
7
137
35
518
FIELD EPIDEMIOLOGY ASSISTANCE TRAININGS
No
1
Date of training
11 July- 11 August 2010
Venue
# trainees
Public Health Training Centre / Balai Besar
Kesehatan (BBPK) Cilandak- Jakarta
30
2
11 July- 11 August 2010
BBPK Bogor, West Java
30
3
11 July- 11 August 2010
BBPK Makasar-South Sulawesi
30
4
15 March-13 April 2011
Ciloto Bogor West Java
30
5
15 March- 13 April 2011
Ciloto-Bogor West Java
30
6
20 March - 18 April 2011
BBPK Makasar-South Sulawesi
30
Total
180
ANNEX 10
FIELD EPIDEMIOLOGY ASSISTANCE TRAININGS-2010
Batch , Cilandak, 11 July- 11 August 2010
NO
Participant
1 Andi Firmanda, SKM
Duty Station
Dinkes Kota Tanjung Pinang Prov. Kepulauan Riau
2
3
Andri Ayani, AMK
Astri Yolandiah, AMKep
KKP Kelas I Batam
Dinkes Kota Cilegon Prov. Banten
4
Budi Arianto, PS, SKM
Dinkes Kota Subulussalam Prov. Aceh
5
Darto Wahab, AMK
Dinkes Kab Demak Prov. Jawa Tengah
6
Dina Iliyani, AMKL
Puskesmas Teritip Prov. Kalimantan Timur
7
Dwi Joko Purnomo, SKM
Dinkes Kabupaten Serang Prov. Banten
8
Fadli Ilyas, AMG
Dinkes Prov. Kep. Babel Belitung
9
Faetria Lestari, SKM
Dinkes Kab. Balangan Prov. Kalimantan Selatan
10
Fahruddin, SKM
Dinkes. Kab. Sampit Prov. Kalimantan Tengah
11
Fajar Isnaini
KKP Denpasar Prov. Bali
12
Faridah, SKM, MKM
FKK UMJ
13
Firmansyah, SKM
Dinkes Kab.Batang Hari Prov. Jambi
14
H. Syam Julas, SKM
Dinkes Kab. Kampar Prov. Riau
15
Hary Satrisno
Dinkes. Kab. Kapuas Prov. Kalimantan Tengah
16
Heni Amikawati, AMKL
Jufri B, SKM
BBTKL - PPM Yogyakarta
Dinkes Kab. Bengkulu Utara Prov. Bengkulu
Muhammad Syukri, SKM
Dinkes Kab. Sumbawa Prov. NTB
Musiyanto, SKM
Nopalina Ragito, SKM
Nyoman Suardani, ST
Dinkes Kab. Gunung Kidul Prov. DIY
Dinkes Kab. Aceh Tengah Prov. Aceh
Dinkes Kab. Buleleng Prov. Bali
Rafles, SKM
Dinkes Kab. Lingga Prov. Kepulauan Riau
23
Rahmayani Triani
KKP Kelas II Mataram Prov. NTB
24
Rina Agustin, SKM
Dinkes Kab. Kebumen Prov. Jawa Tengah
25
Samsuri, SKM
Siti Rahmawati, SKM
Sri Sunaryo, SST
KKP Samarinda Prov. Kalimantan Timur
Dinkes Kab. Tanjung Jabung Barat Prov. Jambi
Dinkes Kab. Lampung Timur Prov. Lampung
Wawan Budiawan, AMD.KL
Weni Silvia, SKM
Yustina Ari Kustyani, SKM
Dinkes Kab.Tulang Bawang Barat Prov. Lampung
Dinkes Kab.Ogan Ilir Prov. Sumatera Selatan
Dinkes Propinsi Sumatera Selatan
17
18
19
20
21
22
26
27
28
29
30
ANNEX 10
Batch 2, Bogor, 11 July - 11 August 2010
NO
Participant
Duty Station
1
Darwinsyah, S Kep
Dinkes Kab. Aceh Tenggara
2
Wahid Hamdan, S, Sos
Dinkes Kab. Lebak
3
Eko Taufik Zulfikar
KKP Kelas II Banten
4
Muhammad Yamin
Dinkes Propinsi Riau
5
Lasdi Eka Putra, AMKL
Dinkes Kab. Sorolangun
6
Deny Ramdani, Amd.Kep
Dinkes Kab. Pontianak
7
Muhammad Hefni Rahim
Dinkes Kab. Hulu Sungai Tengah
8
Meidi Wirawandi
Dinkes Kab. Hulu Sungai Utara
9
Yudi Susanto, SKM
Dinkes Kab. Kepahiang
10
Aidi Fithriawan, Amd,Kep
Dinkes Kab. Kaur
11
Sira Elko
KKP Kelas I Batam
12
Luluk Setiawan, Amd, Kep
Dinkes Kab. Dharmasraya
13
As'ari, S,Kep
Dinkes Kab. Tanah Datar
14
Saeful Uyun, SKM
Dinkes Kab. Bandung Barat
15
Rita Kusmawati, SKM
Dinkes Pandeglang
16
Nuning Yayuk Wulandari, Amd
KKP Cirebon
17
Intan Pandu Pratiwi, ST
BBTKL PPM Jakarta
18
Heriati Panjaitan, SKM
BTKL-PPM kelas I Medan
19
Mirza Yusrizal, SST
Dinkes Kota Pangkal Pinang
20
Mohammad Hasbi
Dinkes Kab. Karimun
21
Ardani Akhirudin
Dinkes Prov Kepulauan Riau
22
R. Doddy Iskandar, SKM
Dinkes Kab. Tanah Laut
23
Sriwaresky Ismal, SKM
Dinkes Kota Sawahlunto
24
Supinah
Dinkes Prov Riau
25
Aidah. AM
Dikes Prov Kalimantan Barat
26
27
Noorveliani Rokhaida, SKM
Ayu Desi Hastuti, SKM
Dinkes Prov Kalteng
Dinkes Aceh Jaya
28
Purhanis, ST
Dinkes Kab. Kerinci
29
Irfan Agus
Dinkes Kab. Ogan Komering Ulu Timur
30
Iman Dirjaman, SKM
Dinkes Kab. Tasikmalaya
ANNEX 10
Batch 3, Makasar, 11 July- 11 August 2010
NO
Participant
1 Ahmad Pada Elo, SKM
Duty Station
Dinkes Penajam Pasere Utara (PPU)
2
St. Sufiati, SKM
Dinkes Kota Bontang
3
Fitria Wakano, SKM
Dinkes Kab. Seram Bagian Timur
4
Cornalius Timisela
Dinkes Kab. Seram Bagian Barat
5
6
Lukman Hakim Larubun, SKM
Yusminardi, AMK
Dinkes. Kota Tual
Dinkes Kab Wajo
7
8
9
10
Nur Alam, SKM
Jefri Yustance Sologia, SKM
Ibrahim Doru, SKM
Irsan AMKL
Puskesmas Bua Kab. Luwu
Dinkes Kab. Toraja Utara
DinKes Kab. Mamuju Utara
Dinkes Prov. Sulawasi Tengah, UPT Surveilans, Data & Informasi
11
Tendi Adeng Ponubu, SKM
Dinkes Kab. Bolang Mongondow Timur
12
Relly Streines Rumbay, SKM
Dinkes Kab. Minahasa Tenggara
13
Charles Hanny Anwa, SKM
Dinkes Kab. Kepulauan Sitaro
14
Herman Jais, SKM
Dinkes Kab.Buton
15
Deasy Christina Matulessy, S.Kep
Puskesmas Remu Dinkes Kota Sorong
16
Hanok Waprak
Dinkes Kab.Teluk Wondama
17
April Lemo Isu, SKM
Dinkes Prov. NTT
18
Jonsenius Jibrail Bola
Dinkes Kab. Sikka
19
20
Samuel Bulu Malo. A.Md. Kep
Nahad S.E Baunsele, SKM
Dinkes Kab. Sumba Tengah
Dinkes Kab. Timor Tengah Selatan
21
Paschalis Alfaris Howay
Dinkes Prop Papua
22
Yan Kayame, Amk
Dinkes Kab.Paniai
23
Dwi Ardei Dompas, SKM
Dinkes Kab.Jayawijaya
24
Abd. Rahman S, AMDKL
KKP Makasar
25
Yanse H. Oematan, SKM
KKP Kelas III Kupang
26
Dahlan Napitupulu. SKM
KKP Kelas II Jayapura
27
Karsinem, SKM
KKP Kendari
28
Yohana Yosephine Usmany, SKM
KKP Manokwari
29
Deny I.Tuhumury
BTKL-PPM Kelas II Ambon
30
Josef Normal Efendi Morong, S.ST
BTKL-PPM Klas I Manado
ANNEX 10
ASSISTANCE FIELD EPIDEMIOLOGY TRAININGS-2011
No
Participant
District/ municipality
Batch 1 - Ciloto Bogor West Java - 15 March-13 April 2011
1 Sis Nugroho, AMKL
Boyolali Healthcentre Central Java
2 Tuti Anggraini, AMK
West Bangka DHO Bangka Belitung
3 dr.. Emilda Arasanti
Tapanuli DHO North Sumatera
4 Gusrida, SKM
West Pasaman DHO West Sumatera
5 Mego Windyningtyas, SKM
Badung DHO Bali
6 Hj. Fitriani, SKM
Banjarmasin DHO South Kalimantan
7 Edi Hasan Murodi, AMK
Bekasi DHO West Java
8 Asep Helmiono, Amd, Kep.
Cianjur DHO West Java
9 Ach. Rusfandi Badianto, AMD KL Denpasar DHO Bali
10 Rasyidin, SKM
Kota Dumai DSO Riau
11 Muhammad Rudi AR, SKM
Thousand island DHO- DKI Jakarta
12 Saepudin Juhri
Banten DHO West
13 H. Junaedi, SKM
Serang DHO Banten
14 Elmi
Kayong North Kalimantan Barat
15 Ramli, SKM
Bireun DHO Aceh
16 Myristica Dwijayanti, SKM
Pringsewu DHO Lampung
17 Anizar, AMD KL
Kota Metro DHO Lampung
18 Katharina S. Kelen, SKM
East Flores DHO East Nusa Tenggara
19 Rahmi Suswanti, SKM
Bengkulu PHO
20 Ranji Azwar, AMK
Asahan DHONorth Sumatera
21 Yutiful
West Kutai DHO East Kalimantan
22 Asep Achmad Zein
Batam Port Health Office Riau Island
23 Jahiroh
Sulianti Saroso Hopsital, DKI Jakarta
24 Dian Tri Mustika, AM.KEP
Merangin DSO Jambi
25 Masfhufha, SKM
Bayuwangi DHO East Java
26 Supriyatno, SKM
Yogyakarta PHO DI Yogyakarta
27 Nanang Saifudin, ST
Blitar DHO East Java
28 Yosi Rizal, SKM
Musi Banyuasin South Sumatera
29 Nasrullah, SKM
Dompu West Nusa Tenggara
30 Harapan P.
Mentawai island DHO West Sumatera
Batch 2 Ciloto-Bogor West Java, 15 March-13 April 2011
West Manggarai DHO East Nusa Tenggara
1 Elias Esron, S.Kep
2 Hafiz Alkas , Amd.Kep
Tulang Bawang DHO Lampung
3 Budi Hikmat Sonjaya, SKM
Ciamis DHO West Java
4 Ario Yudho W, Amd.Kep
Malang DHO East Java
5 Agus Wahyudi, SKM
Lumajang DHO East Java
6 Dewi Ermalia, SKM
Banten PHO
7 Wawan Darmawan, AMK
SouthTangerang DHO, Banten
8 Erik Sastriyadi , SKM
Bangka Belitung island PHO
9 Junaidi, Amd
Jambi PHO
10 Siti Maemu, SKM
Sulianti Saroso hospital, East Jakarta
11 Mistiyati , Amk
Tapin DHO South Kalimantan
12 Putu Antika Dewi, SKM
Gianyar DHO Bali
13 Ade Nurlina, SKM
Cirebon DHO West Java
14 Risno Hendra Putra, SKM
Pasaman DHO West Sumatera
15 Moh. Armin Jayadi, SKM
West Lombok West Nusa Tenggara
ANNEX 10
No
Participant
District/ municipality
16 Sri Wahyuni, SKM
Batam Public Helath Laboratory , Riau island
17 Darmawati Cecek
Landak DHO West Kalimantan
18 Fitriana M, SKM
Batola DHO South Kalimantan
19 Indri Vidyanurina, Am.K.L
Mandailing natal DHO, North Sumatera
20 Ristrina T, SKM
Indragiri Hulu DHO Riau
21 Muzakir, SKM,M.Kes
Aceh PHO
22 Talkah, SKM,M.Kes
South Lampung DHO
23 Dwi Susetyo, SKM,M.Kes
Magelang DHO Central Java
24 Musrani, SKM
Belitung DHO Bangka Belitung
25 Arif Firman, Am,K,L
Tangerang DHO Banten
26 Abd. Karim, SKM
Bintan DHO Riau Island
27 Reni Yulita Sari, SKM
Rejang Lebong DHO Bengkulu
28 Fonimon , A.Md.KL
Central Bengkulu DHO Bengkulu
29 Yusrianto, SKM
Nunukan DHO, East Kalimantan
30 Ipah Saripah, SE
Banten PHO
Batch 3- Makasar , 20 March- 18 April 2011
1 Hariyanto
Pare-pare DHO
2 Arif Gessa
Maluku PHO
3 Sulastri
Gorontalo DHO
4 Miswati
Morotai island DHO North Maluku
5 Ebitrianto
Buol DHO
6 Fitria Sukari
North Sulawesi PHO
7 HALIDA NURIAH, SKM
Central Sulawesi PHO
8 Neny Mulyani
Papua PHO
9 Agnes Caroline
Bitung DHO, North Sulawesi
10 Havid
Ternate DHO
11 Martinus
Teluk Bintuni DHO, West Papua
12 Asyarulia
North Maluku PHO
13 Surono
Gorontalo PHO
14 Jamin Ginting
West Kotawaringin DHO Central Kalimantan
15 I Nyoman Sudiarta
North Lombok DHO, Lombok
16 Subhan
mamuju DHO west Sulawesi
17 Markus
Kaimana DHO West Papua
18 Tatap Shinta
Jayapura Port Health Office
19 Junnu
North Barito DHO Central Kalimantan
20 Sri Wahyuni
Kotamobagu DHO, North Sulawesi
21 Hidayat
North Gorontalo DHO Gorontalo
22 Anita Santi
East Brito Central Kalimantan
23 Mariana
Mamasa DHO, West Sulwasi
24 Myardi
West Sulawesi PHO
25 M Rusmiaji
South Konawe DHO Southeast Sulawesi
26 Irwan
Barru DHO, East Kalimantan
27 M. Kamil
Poso Port Health Office
28 Mushaddiq
South East Sulawesi PHO
29 Jacobus
Ambon Municipality DHO , Ambon
Directorate Immunization, Quarantine and
30 Fajrianto,SKM
Matra Health, MoH
ANNEX 11
HEALTHY FOO MARKET TRAININGS, 2010
List of Training in Batches on Healthy Food Market Management For Market Stakeholders
Venue
Date
Number of Participants
Remarks
Payakumbuh
20-21 July 2010
30 Participants
1 City Secretary Office
2 City Food Security Office
2 Community Health Center
5 City Health Office
1 BAPPEDA
2 City Cleaning Office
1 Healthy City Forum
3 City Agriculture Office
1 Sub Municipality Office
2 City Environmental Office
3 City Industrial and Trade Office
1 City Public Work Office
2 Market Manager
1 City Public Police Service
Pekalongan
5-7 August 2010
30 Participants
1 City Public Work Office
4 City Technical unit
1 City Environment Office
1 District Office
5 City Industrial and Trade Office
1 Community Health Center
3 DPPK
1 Healthy City Forum
5 City Health Office
2 Market Manager
1 Market Association
1 City Agriculture Office
1 BAPPEDA
1 PKKS
Sragen
5-7 August 2010
30 Participants
1 District Office
1 Sub District Office
1 BAPEDA
4 District Trade Office
7 District Health Office
2 District Forum
2 Community Health Center
1 Market Manager
1 District Environment Office
3 Market Task Force
1 District Agriculture Office
4 District Animal Husbandry
1 District Public Work Office
Gianyar
19 – 21 August 2010
30 Participants
East Jakarta
24-26 August 2010
30 Participants
1 District Transportation Office
9 Market Manager
1 District Office
3 District Health Office
1 BAPPEDA
2 District Household Office
1 District Industrial and Trade Office
1 Dispenda
1 District Environment Office
1 Sub District Office
1 District Secretary Office
1 District Transportation Office
1 Community Health Center
2 District Market Office
1 District Public Work Office
2 Healthy City Forum
1 District Cleaning Office
4 Sub Municipality Health Office
4 Sub Municipality Animal Husbandry Office
2 Municipality Secretary Office
3 Community Health Center
2 PKM
1 City Environmental Office
2 Market Association
9 Market Office
1 Sub Municipality Cleaning Office
2 Ministry of Health
ANNEX 11
List of Training in Batches on Healthy Food Market Management For Market Stakeholders
Venue
Date
Number of Participants
Remarks
1 District Agriculture Office
Gunung Kidul
21-23 September 2010
30 Participants
2 District Community
1 District Secretary
1 District Industrial and Trade Office
1 District Drinking Water Office
5 Market Manager
1 District Transportation Office
2 District Public Work Office
2 Healthy District Forum
1 Market Association
2 Community Health Center
3 District Office
2 District Animal Husbandry Office
5 District Health Office
1 BAPPEDA
1 Market Taskforce
Malang
28-30 September 2010
30 participants
4 Community Health Center
1 City Transportation Office
3 City Health Office
5 City Market Office
2 City Agriculture Office
3 Healthy City Forum
1 City Cleaning Office
1 Bappeda
1 City Public Work Office
1 City Industrial and Trade Office
1 City Office
1 District Office
1 Market Vendor
3 Market Task force
1 Sub-district Office
Bontang
19 – 21 October 2010
30 Participants
4 Healthy City Forum
2 Market Taskforce
5 Associations
1 City Secretary Office
1 City Public Work Office
3 City Health Office
1 Community Health Center
4 City Industrial and Trade Office
1 City Environment Office
1 City Spatial Office
4 City Market Office
1 City Transportation Office
1 Bappeda
Mataram
28-30 October 2010
30 participants
5 Dispenda
1 City Marine office
3 City Civil Police (Satpol PP)
2 Community Health Center
6 City Health Office
1 City Public Work Office
1 Bappeda
1 City Transportation Office
2 City Cooperation Office
4 City Cleaning Office
2 Sub-District Office
1 District Office
1 Healthy City Forum
Metro
23-25 November 2010
30 Participants
4 City Health Office
3 City Agriculture Office
3 City Market Office
1 Bappeda
1 City Public Work Office
1 City Environment Office
1 Dislako
1 City Communication Office
4 Community Health Office
2 Market Taskforce
1 District Office
1 Sub-District Office
2 Market Manager
1 Food Security Office
1 Household Organization
1 Market Vendor
1 City Secretary Office
ANNEX 11
Venue
Payakumbuh
Pekalongan
Gianyar
List of Training in Batches on Healthy Food Market Management For Market Community
(Participatory Risk Assessment and Managmeent
using Participatory Hygiene and Sanitation Transformation)
Date
Number of Participants
Remarks
23-25 September 2010
30 Participants
23 Market Vendor and Managers
2 Community Health Center
1 City Secretary Office
1 City Public Work Office
2 City Health Office
1 Market Association
5-7 October 2010
30 Participants
3 City Health Office
3 City Industrial and Trade Office
1 City Agriculture Office
19 Market Vendors
2 Community Health Center
1 City Secretary Office
6-8 October 2010
30 Participants
4 District Health Office
2 Community Health Center
20 Market Vendor and Managers
1 District Agriculture Office
1 District Industrial and Trade Office
1 District Public Work Office
1 District Secretary Office
Sragen
20 – 22 October 2010
30 participants
1 District Public Work Office
3 District Health Office
1 Bappeda
3 District Agriculture Office
2 Community Health Center
19 Market Vendor and Managers
2 District Animal Husbandry office
East Jakarta
18-20 November 2010
30 Participants
Gunung Kidul
24-26 November 2010
30 Participants
1 Provincial Health Office
3 Sub Municipality health Office
16 Market Vendors
2 Community Health Center
1 Sub Municipality Animal Husbandry office
1 Municipality Office
3 Market association
1 MoH
20 Market vendors and market Managers
2 Community Health Center
1 District Animal Husbandry office
1 Sub District
1 District Cleaning Office
1 District Secretary Office
3 District Health Office
1 District Industrial and Trade Office
Bontang
14-16 December 2010
30 Participants
3 City Agriculture Office
12 Market Association
5 City Health Office
2 Community Radio Land
8 Market Vendor
Malang
28-30 October 2010
30 Participants
20 Market Vendor and Manager
10 Local Government Including City Health Office,
City Industrial and trade office, City Agriculture
Office, Community health center
Mataram
25-27 January 2011
30 Participants
Metro
20-22 October 2010
30 Participants
2 City Health Office
1 Market Parking Staff
14 Market Vendor
1 Market cleaning Staff
1 City Public Work Office
1 City Agriculture Office
2 Community Health Center
1 Market Security
2 City Secretary Office
3 Dispenda
1 City Industrial and Trade Office
Related Agency
NGO
Community Leader
ANNEX 11
List of Training in Batches for Community Radio Land for Healthy Food Market Pilots
Venue
Date
Number of Participants
Remarks
Pekalongan
12 - 16 November 2010
26 participants
8 vendors
5 market staff/management
4 local office
1 central
2 sub district officials
3 JRKI
2 community radio Pekalongan
Bontang
20 - 24 November 2010
17 participants
7 vendors
4 market management
2 task force
2 community health center
1 health office
1 central
Lombok
23 - 28 November 2010
16 participants
2 animal husbandry officials
Gianyar
29 Nov -03 December 2010
13 participants
Malang
02 - 06 December 2010
17 participants
Gunung Kidul
06 - 10 December 2010
29 participants
Payakumbuh
13 - 17 December 2010
22 participants
Lampung
20 - 24 December 2010
17 participants
4 market management staff
2 local health officials
2 local trade officials
6 vendors
1 central
7 market management
1 transportation office
1 trade office
1 information and communication office
1 health office
1 central
1 community radio from Bedugul
9 vendors
1 transportation office
4 market management
1 m,arket unit from trade office
1 health office
1 central
14 vendors
6 task force
1 health office
1 Puskesmas
1 central
3 community radio from Gunkid
3 JRKI
14 vendors
2 health office
2 health promotion from Puskesmas
1 Parking man/ motorcycle taxi
2 task force
1 central
3 local health office
4 market management
1 market unit from trade office
8 vendors
1 central
ANNEX 11
HEALTHY FOO MARKET TRAININGS, 2011
Training on “Promoting basic hygiene and sanitation practices including cleaning and disinfection as a part of disease control
in wet markets.
A joint collaboration programme between WHO and FAO”
Venue
Gunung Kidul
Date
28-29 April 2011
Number of Participants
25 Participants
Payakumbuh
18-19 April 2011
30 Participants
Pekalongan, Central
Java
20-21 June 2011
30 Participants
Malang
25-26 Mei 2011
29 Participants
DKI Jakarta
26-27 November 2011
60 Participants
Metro
6-7 November 2011
30 Participants
Remarks
1 Market manager
2 Market unit from Trade district office
2 Radio staff
2 Vendor association
3 Provincial and District Veterinary Office
3 Provincial and District Health Office
1 HFM task force
1 Health Centre
10 Central officer + provincial of health office
1 Market manager
3 Municipality planning office
1 West Sumatera Provincial Veterinary Office
1 West Sumatera Provincial Health Office
1 Municipality planning office
1 Healthy City Forum
12 Vendors
1 Trade district office
2 Cleaning officers
1 Market Manager
2General Cooperation unit
2 Market Manager and staf
1 Health Promotion
1 Municipality Health Office
1 Market manager
3 Dinas Tata Ruang dan Kebersihan
1 Dinas peternakan (West Sumatera)
1 Dinas kesehatan provinsi (west Sumatera)
1 Dinas Tata Ruang dan Kebersihan
1 Forum Kota Sehat
12 Vendors
1 Dinas Perdagangan
2 Cleaning officers
1 Bidang pasar
2 Dinas Kooperasi Umum
2 Manager market and staf
1 Promosi kesehatan
1 Dinas kesehatan kota
11 vendors
3 Market managers
4 Cleaning service
2 DHO
2 Market office
2 Radio Land Staff
2 Market Associations
2 Animal Husbandry Office
1 HFM task force
1 Puskesmas
1 Cleaning Office
1 JRKI
Vendors
PD Pasar Jaya
DHO
PHO
Radio Land
Cleaning Service
Koperasi
Animal Husbandry Office
Agriculture Office
Puskesmas
MoH
vendors
Market managers
Cleaning service
DHO
Market office
Radio Land Staff
Market Associations
Animal Husbandry Office
HFM task force
Puskesmas
Cleaning Office
JRKI
ANNEX 11
Venue
Gianyar
Date
3-4 July 2011
Number of Participants
30 Participants
Bontang
6-7 July 2011
30 Participants
Mataram
4-5 October 2011
30 Participants
Sragen
13-14 July 2011
30 Participants
Remarks
10 Vendors
1 PHO
1 MOH
4 Market Managers
2 Radio Land Staff
6 Cleaning Service
1 Landscape Division
1 DHO
1 Market division
1 Regional Income Division
1 Trade Division
1 Sanitarian
vendors
Market managers
Cleaning service
DHO
Market office
Radio Land Staff
Market Associations
Animal Husbandry Office
HFM task force
Puskesmas
Cleaning Office
JRKI
24 vendors
1 DHO
1 Animal Husbandry Office
1 Regional Income Division
1 PHO
1 Government Official
1 Puskesmas
vendors
Market managers
Cleaning service
DHO
Market office
Radio Land Staff
Market Associations
Animal Husbandry Office
HFM task force
Puskesmas
Cleaning Office
JRKI
PHAST (Participatory Hygiene and Sanitation Transformation) Training
Venue
Malang
Date
1 March - 30 Sept 2011
Number of Participants
400 Participants
Remarks
Market Vendor, Cleaning service and Manager
Mataram
Payakumbuh
Metro
DKI Jakarta
Sragen
Pekalongan
Gunung Kidul
Gianyar
October 2011
8 Nov - 2 Dec 2011
5-30 September 2011
19-30 December 2011
1-30 November 2011
1 Apil - 30 June 2011
1-30 November 2011
17 - 29 November 2011
500 Participants
400 Participants
240 Participants
290 Participants
400 Participants
400 Participants
400 Participants
400 Participants
Market Vendor, Cleaning service and Manager
Market Vendor, Cleaning service and Manager
Market Vendor, Cleaning service and Manager
Market Vendor, Cleaning service and Manager
Market Vendor, Cleaning service and Manager
Market Vendor, Cleaning service and Manager
Market Vendor, Cleaning service and Manager
Market Vendor, Cleaning service and Manager
Bontang
September - November 2011
400 Participants
Market Vendor, Cleaning service and Manager
Total HFM Trainings : 4916 participats.
ANNEX 11
List of Procurement to Support HFM Program
ANNEX 11
List of HFM EIC Distribution
ANNEX 11
HFM PHYSICAL IMPROVEMENT
No
Pilot Market
1
Payakumbuh - West Sumatra
- Ibuh Market-
2
Metro - Lampung
- Margorejo Market-
Outcome on facility
- 2 additional toilets
- Drainage cover (grill) along vegetable area and wet area
- 3 Health information boards
- 1 unit of water hydrant
- 5 hand washing facilities
- 4 additional toilet
- Waste water treatment facility
- Establishment of garbage bin contianer
3
Cibubur - East Jakarta
-Cibubur Market-
- Flooring leveling for 659m2 in wet market area
- Installation of 15 unit exhaust fan in wet market area
- Additional 4 unit of submersible pump
- Construction of 5 unit hand washing facilities in wet area
4
Pekalongan - Central Java
- Podosugih Market-
- Construction of 11 unit of hand washing facilities
- Instalation of drainage grill along the market area
- Renovation of toilets
5
Sragen - Central Java
- Bunder Market-
- Additional 6 unit septictanks
- Additional 5 unit hand washing facilities
- Drainage grill cover
- Renovation of health clonic in the market
6
Gunung Kidul - DI Yogyakarta - Construction of handwashing facility
-Argosari Market- Construction of vendor table with ceramic and drain
- Construction of drain
- Construction of flooring
7
Gianyar - Bali
- Gianyar Market-
- Installation of 3 tables / kiosks for 19 meat vendors
- Construction of 10 units of hand wash facilities
- Construction of 2 areas of fish cleaning
- Construction of septictank
- Floor ceramic
- Wall and ceiling painting
8
Malang-East Java
- Madyopuro-
- Construction of hand washing facilities: 4 Units
- Construction of clean water supply in the market
- Construction of rain gutter for later zoning plan
- Construction of flooring
- Improvement of paving in the market
- Construction of water pipe Construction of control tank
9
Mataram - East Nusa Tenggara - Construction of ceramic table for poultry vendors
-Pagesangan Market- Installation of 1 unit well
- Construction of 6 unit hand washing facilities
- Renovation 4 public toilet
- Construction of 2 Septictank
- Construction of 1 water pump
10
Bontang-East Kalimantan
-Rawa Indah Market-
- Construction of 1 toilet in the market
- Construction of market clinic room
- Construction of Radio land room in the market
ANNEX 12
Intermediete Level Training
Epidemiology, Biostatistic and Researh Methodology
2011
No
1
2
3
4
5
6
7
8
9
10
11
Name
dr. Rini Rohaeni
Widoretno, Ssi
Dra Noeer Endah, Mkes
Meryani Girsang,Ssi,Mkes
Nazarina MCN
Yunita Diana Sari, SKM
Dasuki,SF,MSc,Apt
Cahyorini,ST
Moch Syaripudin,Ssi,Apt,MKM
dr. Elsa Elisi MK3
Dian Perwitasari,SKM
Institution
Centre of Biomedic and Basic Health Technology
Centre of Biomedic and Basic Health Technology
Centre of Biomedic and Basic Health Technology
Centre of Biomedic and Basic Health Technology
Centre of Health Technology and Clinical Epidemiology
Centre of Health Technology and Clinical Epidemiology
Centre of Technology on Public Health Intervention
Centre of Technology on Public Health Intervention
Centre of Technology on Public Health Intervention
Centre of Technology on Public Health Intervention
Centre of Technology on Public Health Intervention
12 Kristina L Tobing,SKM,M.Epid
Centre of Technology on Public Health Intervention
13
14
15
16
17
dr. Rukmini
Ni Ketut Aryastami,MCN
dr. Idawati Muas
dr. Dwi Susilowati
Akhid Darwin SK,MSc
Centre of Humoniora, Health policy and Public Healh Mobilization, Surabaya
Centre of Humoniora, Health policy and Public Healh Mobilization, Jakarta
Centre of Humoniora, Health policy and Public Healh Mobilization, Jakarta
Centre of Humoniora, Health policy and Public Healh Mobilization, Jakarta
Research and development laboratory for vector borne and diseases reservoir Salatiga
18
19
20
21
22
23
24
Nita Supriyati M,Biomed
Ina Kusrini,SKM
Heni Prasetyowati,Ssi,Mkes
Tri Ramadhani,SKM,MSc
Santoso,SKM,MSc
Anida,SKM,MSc
Made Agus Nurjana
Research and development laboratory for herbal and traditional medicine Tawangmangu
Research laboratory for Iodium defisiency- Magelang
Functional unit (Loka) Ciamis
Vector borne diseases laboratory and research functional unit (Loka) Banjar Negara
Vector borne diseases laboratory and research functional unit (Loka) Batu Raja
Functional unit (Loka) Tn Bambu
Functional unit (Loka) Donggala
25 Moh Kazwairani,SKM,Mkes
Functional unit (Loka) Waibubak
26 Samuel Sandi,Ssi
Functional unit (Loka) Papua
ANNEX 13
LIST OF RESEARCH PROJECTS
1st Round Research Projects
No.
Title
Principal Investigator
Institution Name
1. Study of disease ecology and transmission
Epidemiological Study on Highly Phatogenic Avian Influenza (HPAI) of
1 H5N1 in Chicken and Duck Farams. In the Disease Endemic and Enzootic
Area of Riau Province, Indonesia
Ima Nurisa Ibrahim, DVM, MSc Center for Research and Development of Ecology
and Health Status, NIHRD
Trop.Med - NIHRD
2 Spatsial Epidemiological analysis of Human Avian Influenza
Triwibowo Ambar Garjito NIHRD
Vector Borne Disease Research and Development
Unit (BDRDU) of Donggala (Balai Litbang P2B2
Donggala). NIHRD, MoH Indonesia, Hp :+62-81241-63712; e-mail : triwibowo_a@hotmail.com,
triwibowo@litbang.depkes.go.id
Bambang Wispriyono, Univ. Of
Indonesia
Faculty of Public Health UI B Building , 2nd
Floor., University of Indonesia, Depok Indonsia
16411-Phone (021) 7864671 ,Hp. 08129084206
2. Study of clinical spectrum and management of the diseases
3
The Avian Influenza Preparedness at the Referral Hospitals in Indonesia
Year 2009
4
Identification of other microbial infection among suspected Avian influenza
C.Whinnie Lestari - NIHRD
specimens from negative influenza H5, H1 and H3
Center for Biomedical and pharmaceutical research
and development NIHRD
whinielestari@yahoo.com
Dr. I Nyoman Adiputra
Faculty of Medicine, Universitas Udayana
Jl. PB Sudirman, Denpasar
Bali 80232
(Technical assistance)
Cynthia
University of Sydney
C. A. Nidom - Airlangga Univ.
Avian Influenza Laboratory, Institute Tropical
Disease, Airlangga University Kampus C-Unair
Jl.Mulyorejo,Surabaya,60115 HP : (+)62315993016
(+)62811372683
5 A Community response to Avian Influenza - Bali- Lombok
3. Study of molecular genetic and antigenic features of the virus
Elucidation of the Molecular Mechanisms that Lead to the Emergence of
6 Pandemic Influenza Viruses Via Survaillance Studies in Poultry,Pigs and
Environmental materials.
Characterization of influenza (H5N1) for vaccine candidates : crossneutralization of antibodies anti influenza A (H5N1) from patients confirmed
7 H5N1 infection that can neutralize viruses isolated in different year and
Dr. Vivi - NHIRD
location origin in Indonesia.
Center for Biomedical and Pharmaceutical Research
and Development NIHRD
2nd Round Research Projects
No.
Title
Principal Investigator
Institution Name
1. Study of disease ecology and transmission
1
Spatial Epidemiology Analysis of Human Avian Influenza (H5N1)
using molecular approach, remote sensing and Geographical
Information System (GIS) in 6 Provinces in Indonesia
Vector Borne Disease Research and
Triwibowo Ambargarjito, SSi.,
Development Unit (BDRDU) of Donggala (Balai
Mkes
Litbang P2B2 Donggala). NIHRD, MoH
2
Chicken Ration Fortification with Lactic Acid Bacteria to Prevent
H5N1 Infection in Poultry
PI. Dr.Drh.Heru Nurcahyo,
Yogyakarta State University
3. Study of molecular genetic and antigenic features of the virus
3
Molecular Characterization of Influenza A/H5N1 Viruses Isolated from Hana Apsari Pawestri, SSi,
2008-2010 Patients in Indonesia
MSc
NIHRD, MoH
4
Molecular marker Characterization of H5N1 avian influeza virus that
can be used for identification of the H5N1 virus in poultry that have
the potential ability to infect humans
University of Indonesia (UI)
5
The Molecular Infection Mechanism of H5N1 Subtype Avian Influenza
Drh. CA. Nidom, PhD
Virus from Poultry (Animal) to Mammalian (Human)
Dr. Fera Ibrahim, MSc. PhD.,
SpMK(K).
University of Airlangga
Annex 14
APPROVED BUDGET
(ADDENDUM NO 1)
EXPENDITURES
ExpenditureY1
ExpenditureY2
Expenditure Y3
Expenditure Y4
2009
2010
2011
INSPAI All Years-Financial Report
2008
Expenses
Notes (numbers refer to
Unit
# of
Unit rate
Total Costs
Unit
# of
Unit rate
Total Costs
Unit
# of
Unit rate
Total Costs
Unit
# of
Unit rate
62,656
Per month
88
2,239
139,489 Per month
68
2,671
-
Per month
35
658
16,386 Per month
17
600
Total Costs
Unit
Expenditure Y5
TOTAL All Years
ANNEX 14
2012
# of
Unit rate
Total Costs €
Unit
180,265 Per month
91
4,151
268,927 Per month
9,898 Per month
15
1,291
13,790 Per month
# of
Unit rate
12
2,532
12 Dec 2007-12 Dec 2012
Total Costs €
Unit
# of
Unit rate
Total Costs €
1. Human Resources
1.1 Salaries (gross amounts, local staff)3
1.1.1 Technical
WHO National Professional Officer
1.3.2, 2.3, 3.1.2 , 3.13, 3.2, 4,
project management (NO-B) ;
3.1.2 ; 3.13 (NOA)
Per month
337
2,076
699,519 Per month
41
2,173
Project assistance, Logistic
assistance, HFM admin
assistants (DJ4.1)
Per month
137
772
105,817 Per month
12
0
30,380 Per month
299
2,284
681,770
Per month
79
511
40,077
61,176 Per month
132
8,326
1,099,066
1.1.2 Administrative/ support staff
WHO General Staff
-
1.2 Salaries (gross amounts, expat/int.
staff)
WHO technical expert (P4)
-
1.1.2, Project Administrator,
Team leader,Logistic
Per month
106
9,345
Subtotal Human Resources
990,549 Per month
23
2,993
49,011
Per month
43
11,172
111,667
1,795,885
342,048 Per month
19
11,663
497,924
221,601
Per month
41
14,564
411,763
425,144 Per month
6
10,196
707,861
91,557
1,820,913
4
2. Travel (Duty Travel-Air ticket +
DSA)
2.1. International travel
per trip
48
1,753
84,166
per trip
12
2,145
18,324
per trip
7
2,296
11,443
per trip
3
1,590
4,770
per trip
4
2,604
7,415
per trip
per trip
227
345
78,382
per trip
15
610
6,520
per trip
49
968
33,770
per trip
61
270
16,486
per trip
104
448
33,136
per trip
per trip
15
3,081
46,220
per trip
10
4,781
34,043
per trip
8
4,418
25,166
per trip
2
3,126
6,251
per trip
12
1,962
16,764
per trip
-
per trip
26
1,614
41,954
7,881
per trip
252
388
97,801
-
per trip
32
2,570
82,231
2.2 Local transportation
23
481
2.3 Travel grants for national staff
Activity 1.6
Subtotal Travel
3. Equipment and supplies5
3.1 Purchase or rent of vehicles
3.2 Furniture, computer equipment
3.5 Other (Hospital equipment and
supplies)
208,768
FETP
FETP
Per vehicle
2
1
14,033
43,000
58,887
28,065 Per vehicle
43,000
-
70,379
Per vehicle
2
1
20,652
35,298
Ventilator (Child + Adult)
including support equipments
(Infusion pump, syringe pump)*
27,507
29,408 Per vehicle
25,132
-
0
Per unit
15
22,197
332,953
Per unit
-
Per unit
Three position bed and mattress
Per unit
90
1,528
137,502
Per unit
-
Per unit
Intubation Set
Nebulizer
Suction Pump
UV light
Film processor
ECG 12 channel
Defibrillator
Stretcher
Vena Sectie
Per unit
Per unit
Per unit
Per unit
Per unit
Per unit
Per unit
Per unit
Per unit
0
0
52
0
0
0
0
180
0
0
0
262
0
0
0
0
698
0
0
0
13,629
0
0
0
0
125,706
0
Per unit
Per unit
Per unit
Per unit
Per unit
Per unit
Per unit
Per unit
Per unit
-
Per unit
Per unit
Per unit
Per unit
Per unit
Per unit
Per unit
Per unit
Per unit
Isolation Room (double
compartment) for selected AI
referral hospitals
Per unit
-
Per unit
0
90
2,307
52
198
180
1,160
57,315
Per vehicle
-
-
15
2,093
22,348
Per unit
15
147,852
Per unit
90
140
12,565
Per unit
90
0
0
7,347
0
0
0
0
148,715
0
Per unit
Per unit
Per unit
Per unit
Per unit
Per unit
Per unit
Per unit
Per unit
12,565
-
Per unit
Per unit
Per unit
Per unit
Per unit
Per unit
Per unit
Per unit
Per unit
0
Per unit
515,812
Per unit
10
(71,528)
(509,281)
22
1,264
70
10
51,581
Per vehicle
52
-
25
180
Per unit
506,016
Per unit
-
Per unit
22
33,850
530,226
Per unit
-
Per unit
19,796
Per unit
26,983
242,848
Per Unit
-
Per Unit
7
40,331
201,010
Per Unit
-
Per Unit
-
Per Unit
Hemodynamic monitor**
Per Unit
9
17,083
153,748
Per Unit
-
Per Unit
7
24,753
123,368
Per Unit
-
Per Unit
-
Per Unit
Blood Gas Analyzer
Per Unit
7
18,346
128,424
Per Unit
-
Per Unit
0
Per Unit
-
Per Unit
-
Per Unit
Per package
350
Flu vaccine
Per unit
4700
Laboratory Reagents
per lab
44
Subtotal Equipment and supplies
17
81,103
Per unit
-
Per unit
6,857
301,694
4,716,632
per lab
7,200
per lab
####
13
42,264
Per unit
4699
53,735
1,471,589
per lab
44
0
5,503
242,133
850,755
355
Per unit
per lab
299
Per unit
52
159
180
896
163,822
(249,088)
(2)
(14)
Per unit
22
25,003
550,065
7
(37,474)
(186,770)
Per Unit
7
2,034
14,241
(121,437)
Per Unit
7
276
1,932
356
818
291,235
-
2
Per unit
per lab
8,258
161,293
-
10
75,665 Per package 355
-
44
160,430
6,518
23,001
45,330 Per package
1,783
652
9
179
90
10
22
355
22,350
Per unit
Per unit
162,532 Per package
1,490
Per unit
Per Unit
643
15
Per unit
Per unit
Per unit
Per unit
Per unit
Per unit
Per unit
Per unit
Per unit
CRRT**
355
Per unit
-
New
7,200 Per package
-
-
New
10,112
-
29,410
25,134
Per unit
2,321,982
1
14,705
25,134
Per unit
Per unit
Per unit
Per unit
Per unit
Per unit
Per unit
Per unit
Per unit
154,799
299,962 Per package
2
1
-
15
857
Per vehicle
910
-
Per unit
PPE
221,987
-
Emergency ambulances for
referral hospitals
New
-
-
Per unit
180
7,881
486 Per package
-
44
2,394
Per Unit
75,007
(232,727)
-
Per unit
4,699
9
42,267
per lab
44
12,153
534,738
1,847,871
APPROVED BUDGET
(ADDENDUM NO 1)
EXPENDITURES
ExpenditureY1
ExpenditureY2
Expenditure Y3
Expenditure Y4
2009
2010
2011
INSPAI All Years-Financial Report
2008
Expenses
Notes (numbers refer to
Unit
# of
Unit rate
Total Costs
Unit
# of
Unit rate
Total Costs
Unit
# of
Unit rate
Total Costs
Unit
# of
Unit rate
Total Costs
Unit
Expenditure Y5
TOTAL All Years
ANNEX 14
2012
# of
Unit rate
Total Costs €
Unit
12 Dec 2007-12 Dec 2012
# of
Unit rate
Total Costs €
Unit
# of
Unit rate
Total Costs €
6
4. Other costs, services
5.1 Publications7
1.2 - Clinical management and
iInfection control guidelines
2
71,292
142,583
2
14,614
20,810
2
40,615
57,835
2
18,422
36,845
2
5,385
10,770
2
2,518
3,585
2
64,927
129,855
3.2 - Production and distribution
of risk communication materials
1
86,735
86,735
1
2,574
1,833
1
20,650
14,703
1
8,076
8,076
1
3,789
3,789
1
2,781
1,980
1
30,382
30,382
3
176,000
528,000
3
1,235
2,637
3
25,292
54,023
3
93,538
280,613
3
84,623
253,868
3
9,732
20,788
3
203,992
611,976
3
11,206
33,618
2
6,632
9,443
4
11,288
32,148
0
-
6
6,932
41,595
1.3.1, 1.6.2, 2.3 - training in AI
85
19,647
1,669,982
11
25,244
197,710
23
25,024
409,786
21
23,986
503,710
11
25,962
285,581
11
19,785
154,955
77
20,154
1,551,861
1.3.2 - clinical management
training
70
9,383
656,795
2
14,167
20,174
1
43,370
30,879
122
2,937
358,365
125
2,898
362,244
28
3,710
73,965
278
3,042
845,692
24
3,093
0
0
10
13,902
98,984 per meeting
10
9,899
98,992
1
2,629
1
799
1
1,349
5.2 Studies, research7
5.4 Evaluation costs and needs
assessments
-
-
-
5.7 Costs of conferences/seminars7
2.1.2 - Provincial Coordinating
Committees
per meeting
74,242 per meeting
-
per meeting
0
-
per meeting
-
-
per meeting
-
-
per meeting
5.8 Visibility actions
Subtotal Other costs, services
2,629
0
3,194,584
252,606
569
-
698,928
1
780
1,187,609
-
917,031
255,272
1,349
3,311,702
6. Other - Implementation of Healthy
Food Market Plan
3.1.1: Setting up health food
market pilots (HFM model
markets)
1
337,093
337,093
1
26,332
18,748
1
27,098
19,294
1
11,739
11,739
1
170,286
121,244
1
2,128
1,515
1
242,331
172,553
3.1.2: Raising awareness for
preventing and controlling the
spread of AI (HFM
communications)
1
190,776
190,776
1
18,897
13,455
1
73,578
52,388
1
91,760
91,760
1
76,433
76,433
1
9,782
6,965
1
241,019
241,019
3.1.3: Building capacity to
implement healthy food markets
1
380,169
380,169
1
0
-
1
341,869
243,411
1
153,858
153,858
1
352,856
352,856
1
4,156
2,959
1
753,142
753,142
3.1.4: Coordination,
management, working meetings,
progress report meetings
1
119,823
119,823
1
3,133
2,231
1
102,723
73,139
1
4,530
4,530
1
19,225
19,225
1
(6,199)
(4,414)
1
94,718
94,718
78
14,975
48
293
10,001
73
10,857
792,584
1
473,675
1
74,840
53,286
1
467,265
467,265
15
2,089
3
1,578
15
3,784
56,754
FETP University Fee & Student
Lodging
2.2
FETP Secretariat
2.2
Project Steering committee (PSC)
meetings & Project Technical
Implementation Committee (PTIC)
meeting
Project management
per student
per meeting
Subtotal Other
7. Total direct eligible costs of the
Action (1-6)
8. Provision for contingency reserve
(maximum 5% of 7, subtotal of direct
eligible costs of the Action)
1,168,075 per student
473,675
31,342 per meeting
3,371 per meeting
48
5,328
1
168,227
3
8,667
182,096 per student
73
2,083
119,778
1
139,789
4
2,211
18,513 per meeting
2,700,953
101,091
-
708,618
12,616,822
531,451
3,447,438
0
9. Sub total WHO direct eligible costs
of the Action (7+ 8)
10a. Administrative costs (maximum 7%
of 9, total direct eligible costs of the
Action)
per student
-
0
152,063 per student
139,789
8,844 per meeting
562,585
3,040,219
73
6,180
1
131,025
4
3,120
451,145 per student
131,025
8,886 per meeting
73
(54)
(2,782) per student
1
32,796
23,351
1
24,066
17,135 per meeting
1,160,813
44,729
2,578,036
2,593,933
166,712
9,780,508
-
-
12,616,822
531,451
3,447,438
3,040,219
2,593,933
166,712
9,780,508
883,178
37,202
241,321
212,815
181,575
11,670
684,636
10b. Administrative costs 1% of UNOPS
isolation room
28,363
11. Sub Total WHO eligible costs
(9+10a+10b)
13,500,000
568,653
3,688,758
3,253,034
12a UNOPS Cost for Isolation Room
12b UNOPS Administrative cost for
Isolation room (6%)
Sub Total UNOP Cost (12a+12b)
178,382
2,836,095
TOTAL ELIGIBLE COST
Exchange rate
2,775,508
13,500,000
0.712
568,653
3,688,758
3,253,034
10,493,507
2,836,315
170,166
170,179
3,006,261
3,006,494
5,781,769
178,382
13,500,000
ANNEX 15
List of PROJECT PERSONEEL (WHO)
Name
Function
International
dr. Graham Tallis
Programme Manager
Abdulatipova Havaskhon
Procurement & Logistics Coordinator
Muhammad Asif
Technical Officer Administrative and Finance
(Bussiness Manager)
National
dr. Endang Wulandari
Project Officer
dr. Marlinggom Silitonga
Surveillance Officer
dr. Slamet Hidayat
Clinical management and infection control
Officer
Dewi Nursila
Risk Communication Officer
Prof. Mohammad Sudomo
Research national consultant
Marini Mansoer
Administrative Assistant
Sugeng Irianto
Healthy Food Markets
Indah Devianty
Food Safety Officer
Dinar Pandan Sari
Communication Officer- HFM
Saverina Arsadjaja
Administrative Assistant -HFM
Syahrul Fauzi
Logistic Assistant
Other Staff involved in implementation
(WHO's in-kind contribution)
dr. Khanchit Limpakarnjanarat
WHO Representative
dr. Pinyowiwat Vason
International Epidemiologist
dr. Nirmal Kandel
International Epidemiologist
Sharad Adhikary
Environmental Health Team Leader
Maria Early
DSE (Diseases Surveillance & epidemiology)
unit Secretary
Arief Reny
Finance Officer
Kamilani Usodo
Acting Human Resource Assistance
Faisal Romi
Logistic Assistant
ANNEX 16
LIST OF IMPLEMENTING PARTNERS- MOH
Result
Result 1
Activity 1.1
Activity 1.2.a
Description of Activity
Isolation room development
Directorate of Referral Medical Services
D.G. Medical Services, MoH RI
Jl. H.R Rasuna Said Blok X5
Kav. 4-9 Jakarta 12950, Indonesia
Phone: 021- 5201590
Fax: 021-5261814 ; 021 5203872
Medical equipment
Directorate of Basic Medical Services
D.G. Medical Services, MoH RI
Jl. H.R Rasuna Said Blok X5
Kav. 4-9 Jakarta 12950, Indonesia
Phone: 021- 5201590
Fax: 021-5261814 ; 021 5203872
Dr.H.Chairul RadjabNasution, SpPD, KGEH,FINASIM,MKes
Director of Referral Medical Services, MoH RI
Phone : 0811155665
dr. Cut Purti Arianie
Head of Sub Directorate Hospital Specialistic Medical Care
Email : cutputriarianie@yahoo.com
Phone : 081807927700
Dr. Bambang Sardjono, MPH
Director of Basic Medical Services, MoH RI
Email : gadardepkes@yahoo.com
Develop, revise and disseminate guidelines for case management for AI
AI early detection socialization for primary
healthcare
Directorate of Referral Medical Services
D.G. Medical Services, MoH RI
Jl. H.R Rasuna Said Blok X5
Kav. 4-9 Jakarta 12950, Indonesia
Phone: 021- 5201590
Fax: 021-5261814 ; 021 5203872
Directorate of Vector Borne Diseases
D.G. DC & EH, MoH
Jl. Percetakan Negara No. 29 Jakarta
Phone : 021- 4247573
Fax : 021- 4207807
Develop, revise and disseminate guidelines for
Infection Control
Training of Infection Control
Activity 1.4
Key Contact Person
Enhance infrastructure at referral hospitals
Training of AI case management for hospital
Activity 1.2.b
Implementing Partners within MOH
Strengthened case management
Provision of PPE
Directorate of Referral Medical Services
D.G. Medical Services, MoH RI
Jl. H.R Rasuna Said Blok X5
Kav. 4-9 Jakarta 12950, Indonesia
Phone: 021- 5201590
Fax: 021-5261814 ; 021 5203872
Dr.H.Chairul RadjabNasution, SpPD, KGEH,FINASIM,MKes
Director of Referral Medical Services, MoH RI
Phone : 0811155665
dr. Cut Purti Arianie
Head of Sub Directorate Hospital Specialistic Medical Care
Email : cutputriarianie@yahoo.com
Phone : 081807927700
Dr. Rita Kusriastuti, MSc
Director of Vector Borne and Diseases Control
Email : ritakus@yahoo.com
drh. Misriyah
Head of sub division zoonosis
Directorate of Vector Borne and Diseases control MoH RI
Email : misriyahimut@yahoo.com
Dr.H.Chairul RadjabNasution, SpPD, KGEH,FINASIM,MKes
Director of Referral Medical Services, MoH RI
Phone : 0811155665
dr. Cut Purti Arianie
Head of Sub Directorate Hospital Specialistic Medical Care
Email : cutputriarianie@yahoo.com
Phone : 081807927700
ANNEX 16
Result
Activity 1.5
Description of Activity
Implementing Partners within MOH
Directorate of Basic Medical Services
D.G. Medical Services, MoH RI
Jl. H.R Rasuna Said Blok X5
Kav. 4-9 Jakarta 12950, Indonesia
Phone: 021- 5201590
Vaccination with seasonal human influenza vaccine Fax: 021-5261814 ; 021 5203872
Directorate of Surveillance, Immunization,
Quarantine and Matra Health, D.G. DC & EH, MoH RI
Jl. Percetakan Negara No. 29 Jakarta
Activity 1.6
Result 2
Activity 2.1
Activity 2.2
Activity 2.3
Capacity building for laboratories
National Institute of Health Research and Development (NIHRD), MoH
Jl. Percetakan Negara No. 29 Jakarta
Phone : 021- 4244375
Fax : 021- 4245386
Key Contact Person
Dr. Bambang Sardjono, MPH
Director of Basic Medical Services, MoH RI
Email : gadardepkes@yahoo.com
Hari Santoso , SKM. MKes
Head of Subdivision Outbreak
Directorate Surveillance, Immunization and Matra Health MoH RI
Email : hari18us@yahoo.com
Phone : 081310008533
Drs. Ondri Dwi sampurno,Msi,Apt
Chief of Centre for Research and Development in Biomedics and Pharmacy NIHRD-MoH RI
Email : odsam19@yahoo.co.id
Phone : 08129942953
dr. Vivy Setiawaty
Staff of NIHRD
Email : vilitbang@yahoo.com
Phone : 08179804571
Strengthened disease surveillance
Establish and Support Thirty-three Provincial
Influenza Coordination Committees
National Committee for Avian Influenza Control and Pandemic Preparedness
(KOMNAS FBPI) Discontinued since March 2010
Build Capacity in Field Epidemiology
Build Capacity in Disease Surveillance and Avian
Influenza Response
Directorate of Surveillance, Immunization,
Quarantine and Matra Health, D.G. DC & EH, MoH RI
Jl. Percetakan Negara No. 29 Jakarta
Phone : 021- 4247608
Fax : 021-4207807
Dr. Bayu Krishnamurti
Email : info@komnasfbpi.go.id
Phone : 021-385-4227
Bachtiar Moerad
Email : bmoerad@yahoo.com
Phone : 081219781111
Hari Santoso , SKM. MKes
Head of Subdivision Outbreak
Directorate Surveillance, Immunization and Matra Health MoH RI
Email : hari18us@yahoo.com
Phone : 081310008533
Dr. I. Nyoman Kandun, MPH
Director of FETP Indonesia
Email : n_kandun@yahoo.com
Phone : 08129189720
ANNEX 16
Result
Result 3
Activity 3.1
Activty 3.2
Result 4
Activty 4.1
Activty 4.2
Activty 4.3
Description of Activity
Implementing Partners within MOH
Key Contact Person
Healthier Food Markets and Risk / Outbreak
Communication
Healthy food markets (HFMP)
Risk/outbreak Communication
Directorate of Environmental Health,
D.G. DC & EH, MoH RI
Jl. Percetakan Negara No 29, Jakarta
Centre of Health Promotion, MoH RI
Jl. H.R Rasuna Said Blok X5
Kav. 4-9 Jakarta 12950, Indonesia
Drh. Wilfried Purba
Director of Environmental Health
Phone : 08129677944
Dirman Siswoyo
Staff of Directorate Environmental health, MoH RI
Email : dirman_siswoyo@yahoo.com
Phone : 08129336399
Bayu T. Aji
Staff Centre of Health Promotion MoH RI
Phone : 08129192627
Email : ajires@yahoo.com
Marlina
Staff Centre of Health Promotion MoH RI
Phone : 081310954097
Email : marlina_4045@yahoo.co.id
Conduct of essential research
Drs. Ondri Dwi sampurno,Msi,Apt
Chief of Centre for Research and Development in Biomedics and Pharmacy NIHRD-MoH RI
National Institute of Health Research and Development (NIHRD) MoH RI
Email : odsam19@yahoo.co.id
Phone : 08129942953
Study of clinical spectrum and management of the Jl. Percetakan Negara No. 29 Jakarta
Phone : 021- 4244375
diseases
dr. Vivy Setiawaty
Fax : 021- 4245386
Staff of NIHRD
Email : vilitbang@yahoo.com
Study of molecular genetic and antigenic features of
Phone : 08179804571
the virus
Study of diseases ecology and transmission
Project Management
Project management, monitoring and reporting
Directorate of Vector Borne Diseases
D.G. DC & EH, MoH
Jl. Percetakan Negara No. 29 Jakarta
Phone : 021- 4247573
Fax : 021- 4207807
Dr. Rita Kusriastuti, MSc
Director of Vector Borne and Diseases Control
Email : ritakus@yahoo.com
drh. Misriyah
Head of sub division zoonosis
Directorate of Vector Borne and Diseases control MoH RI
Email : misriyahimut@yahoo.com
Annex 17
http://www.thejakartapost.com/news/2011/12/13/ri-opens-first-who-airborne-infection-isolationrooms.html-0
http://megapolitan.kompas.com/read/2011/12/12/12515083/Menkes.Resmikan.10.Ru
ang.Isolasi.Flu.Burung
PELITA ONLINE
Rabu, 14 Desember 2011
Flu Burung
RS Tangerang Miliki Ruang Isolasi Pasien Flu Burung
Jenis ruang isolasi ini, pertama di Indonesia, teramat penting bagi penatalaksanaan kasus dan
pencegahan penularan terutama wabah Avian Influenza.
Rumah Sakit Tangerang (Foto: google)
Tangerang, PelitaOnline –SEBAGAI bagian dari proyek INSPAI (Implementing the National Strategic
Plan for Avian Influenza), yang merupakan kerjasama dengan didanai Uni Eropa (UE) dan diselenggarakan
oleh Kementerian Kesehatan Indonesia dan Badan Kesehatan Dunia (WHO). Menteri Kesehatan akhirnya
meresmikan ruang isolasi baru yang dirancang untuk menghadapi wabah flu burung di Rumah Sakit
Tangerang.
Wakil WHO untuk Indonesia, Dr Khanchit Limpakarnjanarat menyerahkan ruang isolasi lengkap di Rumah
Sakit Tangerang kepada Menteri Kesehatan Endang Rahayu Sedyaningsih, disaksikan oleh Colin Crooks
yang mewakili UE. Jenis ruang isolasi ini, pertama di Indonesia, teramat penting bagi penatalaksanaan
kasus dan pencegahan penularan terutama wabah Avian Influenza.
“INSPAI bertujuan untuk meningkatkan ketersediaan dan mutu pelayanan kesehatan bagi masyarakat,”
jelas Dr Khanchit Limpakarnjanarat dalam rilis kepada PelitaOnline di Jakarta, Rabu (14/12).
“Kemitraan UE-Indonesia dalam bidang kesehatan didasarkan pada komitmen yang sama terhadap
kerjasama global dalam memerangi penyakit-penyakit menular yang baru bermunculan (emerging
infectious diseases) berikut dampak negatif yang ditimbulkan penyakit-penyakit tersebut,” ujar Colin
Crooks.
Memahami pentingnya sumber daya manusia dalam penanganan flu burung, INSPAI telah melatih sekitar
8.000 tenaga kesehatan dari provinsi-provinsi berisiko tinggi (Yogyakarta, Sulawesi Selatan, Sumatera
Utara, DKI Jakarta, Bengkulu, dan Kalimantan Barat). Sekitar 600 tenaga kesehatan dari berbagai rumah
sakit di Indonesia telah menjalani pelatihan pengendalian pencegahan infeksi.
Selain itu, sekitar 70 pegawai dari sektor kesehatan mendapatkan beasiswa untuk mempelajari
epidemiologi di Universitas Indonesia dan Universitas Gadjah Mada. Hampir 200 pengelola kesehatan
telah menjalani kursus singkat untuk mengerti tentang epidemiologi lapangan.
http://www.pelitaonline.com/read-nusantara/10941/rs-tangerang-miliki-ruang-isolasi-pasien-flu-burung/
http://buk.depkes.go.id/index.php?option=com_content&view=article&id=232%3Asi
apkan-sepuluh-rumah-sakit-rujukan-flu-burung&catid=1%3Alatestnews&Itemid=141
http://www.mediaindonesia.com/read/2012/01/05/289220/293/14/-Kemenkes-Antisipasi-MerebaknyaKembali-Flu-Burung
http://tangerangnews.com/baca/2011/12/12/6031/10-ruang-isolasi-flu-burung-dibangun-who-di-rsukabupaten-tangerang
Kabar banten
http://www.kabar-banten.com/news/detail/4036
http://www.antaranews.com/berita/290545/penyakit-menular-masih-jadi-ancaman
Healthy Food Market News
1. News From Payakumbuh- Ibuh Market
a. Source : http://bum-news.com/single.php?id=744 .
2. News from Malang- East Java . Madyopuro Market
a. Source: http://www.greenradio.fm/news
b. Source : http://www.mediacenter.malangkota.go.id
c. Source : http://www.mediacenter.malangkota.go.id
f. Source : http://regional.kompas.com/read/
3.News From Gunung Kidul. Argosari Market
a.
Source : http://argosariradioline-blogspot.com
4. News From DKI Jakarta. Cibubur Market
a. Source : Kontras Newspaper
5. News From Sragen. Bunder Market
a. Source : http://www.depkes.go.id/index.php/berita/press-release/1648-menkes-tinjaupasar-sehat
b. Source : Newspaper Solopos
c. Source : www.sragenkab.go.id
d. Source : http://dp2d.sragenkab.go.ig
f. Source : http://pasarbundersragen.wordpress.com
i. Source : Newspaper Espos
6. News From Pekalongan. Podosugih Market
a. Source : http://perindagkop.pekalongankota.go.id/
b. Source : Suara Merdeka 4 April 2012
7. News From Mataram. Pagesangan Market
a. Source : http://www.iannnews.com/
8. News From Bontang. Rawa Indah Market
a. Source : http://kaltim.antaranews.com/berita/
b. Source : Bontang press-Newspaper
c. Source : Bontang Press
d. Source : Newspaper-Bontang Tribun
9. News From Metro Lampung. Margorejo Market
a. Source : http://radarlampung.co.id/read/metro-bisnis/4082-2010-lampungkembangkan-pasar-sehat
10. News From Gianyar
a. Source : http://www.gianyarkab.go.id/bupati-tinjau-pasar-gianyar/
b. Source : http://health.okezone.com/read/2012/01/05/482/552013/inilah-10-pasar-sehatdi-indonesia
BERSAMA KITA CEGAH PANDEMI INFLUENZA
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BERSAMA KITA CEGAH PANDEMI INFLUENZA
DOMAIN UNIT UTAMA
Sekertariat Jenderal
Bekasi, 29 Mei 2012
Inspektorat Jenderal
Ditjen PP & PL
Ditjen Bina Kefarmasian & Alkes
Ditjen Bina Upaya Kesehatan
Flu Burung (FB) adalah penyakit bersumber binatang (zoonosis) yang
berpotensi menimbulkan kejadian luar biasa (KLB) dan pandemik di Indonesia
maupun di dunia. Oleh karenanya, baik Indonesia maupun negara di dunia
melakukan program pengendalian flu burung dengan seksama. Potensi
penularan flu burung dari manusia ke manusia jelas ada, meski sampai saat ini
belum terjadi. Dengan demikian, butuh perhatian yang besar dan kerjasama
lintas sektoral untuk bersama-sama mengatasi masalah zoonosis.
Ditjen Bina Gizi dan KIA
Demikian disampaikan Direktur Pengendalian Penyakit dan Penyehatan
Lingkungan (PP dan PL) Kemenkes RI, Prof. dr. Tjandra Yoga Aditama, SpP(K),
MARS, DTM&H, DTCE saat menutup kegiatan Diseminasi Hasil Pembelajaran
Implementing The National Strategic Plan for Avian Influenza (INSPAI) in Framework for Pandemic Preparedness, Selasa siang
(28/5/12). Hadir dalam kegiatan tersebut, Direktur Pengendalian Penyakit Bersumber Binatang, dr. Rita Kusriastuti, MSc. dan
Perwakilan WHO Indonesia, dr. Graham Tallis.
Badan Litbangkes
Badan PPSDM Kesehatan
WEB UNIT
“Kita tidak bisa memperkirakan kapan pandemi dapat terjadi atau masalah-masalah kesehatan yang dapat ditimbulkan”, ujar Prof.
dr. Tjandra Yoga Aditama.
Kepegawaian
Gizi
Pembiayaan dan Jaminan Kesehatan
Promosi Kesehatan
Prof. dr. Tjandra menjelaskan Indonesia sebagai salah satu negara dengan jumlah kasus FB terbanyak, mendapat dukungan
pihak Uni Eropa yang disalurkan oleh WHO melalui program dari Implementing The National Strategic Plan for Avian Influenza
(INSPAI) dan telah dilaksanakan pada kurun waktu 2007-2011.
“Meskipun program tersebut selesai tahun ini, Pemerintah akan meneruskan dengan program-program yang ada di Kementerian
Kesehatan menggunakan sarana yang ada secara maksimal”, jelas Prof. dr. Tjandra Yoga Aditama.
Penanggulangan Krisis
Lebih lanjut Prof. dr. Tjandra Yoga Aditama mengatakan, salah satu manfaat dari INSPAI di Indonesia, diantaranya adalah
penerapan dasar pemikiran “fair, transparent and equitable” dalam mekanisme virus sharing dan benefit sharing yang disetujui
oleh World Health Organization (WHO) untuk dapat diterapkan dalam program kesehatan lainnya. Selain itu, koordinasi lintas unit
dan lintas sektoral di bidang penelitian juga dirasa penting untuk dilakukan, mungkin dengan Badan Penelitian dan
Pengembangan Kesehatan (Balitbangkes) ataupun dengan sektor kesehatan hewan.
Hukum dan Organisasi
Kesehatan Kerja
Kesehatan Ibu
Kesehatan Haji
“Ini penting untuk kita pikirkan, bagaimana kita dapat mengkolaborasikan berbagai data-data yang ada, baik itu data influenza
maupun data masalah kesehatan lainnya, untuk menciptakan sebuah gambaran yang menyeluruh, guna pengambilan langkah
penanggulangan secara tepat”, kata Prof. dr. Tjandra Yoga
PROFIL KESEHATAN
Pada kesempatan tersebut, Prof dr. Tjandra Yoga Aditama mengharapkan dukungan berbagai pihak, baik yang memiliki
keterkaitan langsung dengan kesehatan maupun kalangan terkait lainnya seperti kesehatan hewan, lingkungan hidup, dan wild
life, untuk bersama-sama menanggulangi flu burung dan berbagai penyakit zoonosis lainnya.
Kesehatan Anak
Masalah flu burung terjadi di banyak Provinsi di Indonesia, karena itu, Prof. dr. Tjandra Yoga mengharapkan agar Pemerintah
Daerah bersama masyarakat untuk terus menjaga kewaspadaan tentang kemungkinan kasus flu burung.
Indonesia
-- Pilih Tahun -- 
“Tetap lakukan langkah-langkah untuk mendeteksi, melakukan surveilans, dan tindakan penanggulangan flu burung di daerah
masing-masing”, tandas Prof. dr. Tjandra Yoga Aditama.
Propinsi
-- Pilih Propinsi --
Kegiatan Diseminasi Hasil Pembelajaran Implementing The National Strategic Plan for Avian Influenza (INSPAI) in Framework for
Pandemic Preparedness, telah dilaksanakan selama dua hari di Bekasi, Jawa Barat. Kegiatan tersebut dihadiri oleh sekitar 100
undangan yang merupakan perwakilan dari 10 RS Rujukan Flu Burung penerima bantuan pembangunan ruang isolasi;
Akademisi; Dinas Kesehatan, Rumah Sakit Umum Daerah, juga para dokter klinik swasta dari berbagai Provinsi di Indonesia.

Kabupaten/ Kota
-- Pilih Kabupaten/ Kota --
DIRECTORY
Apotik




Puskesmas




Rumah Sakit





Nanggroe Aceh D 
Go

Pada sesi penutupan, Direktur Pengendalian Penyakit Bersumber Binatang (P2B2), dr. Rita Kusriastuti mengatakan Indonesia
telah melaksanakan berbagai usaha pengendalian Flu Burung (FB) dan zoonosis lainnya melalui program INSPAI meliputi
peningkatan manajemen kasus, perbaikan fungsi laboratorium, sistem surveilans, komunikasi risiko, pembangunan pasar sehat,
kesiapsiagaan pandemik, pendanaan berbagai penelitian, serta pembangunan ruang isolasi bertekanan negatif di 10 RS Rujukan
Flu Burung.
“Pentingnya pengendalian zoonosis di Indonesia, tidak hanya berfokus pada FB, tetapi juga meliputi berbagai penyakit zoonosis
lainnya. Dalam diskusi, dibahas juga berbagai Emerging Infectious Disease (EID), serta penyakit-penyakit lain yang termasuk
New Emerging Disease”, ujar dr. Rita Kusriastuti.
Pada kesempatan tersebut, dr. Rita juga menyebutkan beberapa hal penting yang menjadi pembahasan di dalam kegiatan yang
telah dilangsungkan selama dua hari tersebut. Pertama, perlunya penguatan koordinasi dan kolaborasi multi sektor yang
melibatkan pubic health, animal health, wild health dan animal health dalam satu konsep “One Health” dalam rangka
pengendalian penyakit zoonosis. Kedua, diperlukan adanya mapping terintegrasi untuk kegiatan penanggulangan FB dan
penyakit zoonosis lainnya, sehingga tidak terjadi multiplikasi kegiatan. Ketiga, pentingnya survilans yang terintegrasi. Keempat,
peningkatan kapasitas laboratorium dan para klinisi dalam upaya deteksi penanganan kasus FB, dalam rangka penurunan angka
kematian akibat FB. Kelima, pentingnya keterkaitan dan informasi data epidemiologi dan data virologis, baik itu pada manusia
maupun hewan, guna pengembangan upaya pengendalian FB dan penyakit zoonosis lainnya. Keenam, penguatan infrastruktur,
pemantauan kesehatan dan lingkungan, serta peningkatan kesiapsiagaan pandemi pada sektor esensial.
Berita ini disiarkan oleh Pusat Komunikasi Publik, Sekretariat Jenderal Kementerian Kesehatan RI. Untuk informasi lebih lanjut
dapat menghubungi melalui nomor telepon: (021) 52907416-9, faksimili: (021) 52921669, Pusat Tanggap Respon Cepat (PTRC):
<kode lokal> 500-567 dan 081281562620 (sms), atau e-mail kontak@depkes.go.id
http://www.depkes.go.id/index.php/berita/press-release/1932-bersama-kita-cegah-pa... 18-Jun-2012
Kompas, 29/05/2012
MENKES BUKA KONFERENSI ILMIAH BIREGIONAL TEPHINET KE-6
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KEGIATAN
DOMAIN UNIT UTAMA
Sekertariat Jenderal
Inspektorat Jenderal
Ditjen Bina Gizi dan KIA
Ditjen Bina Upaya Kesehatan
Ditjen PP & PL
Ditjen Bina Kefarmasian & Alkes
MENKES BUKA KONFERENSI ILMIAH BIREGIONAL
TEPHINET KE-6
Bali, 8 November 2011
Hari ini Menkes dr. Endang Rahayu Sedyaningsih, MPH, Dr.PH membuka
Konferensi Ilmiah Biregional TEPHINET ke-6, di Bali. Sedikitnya 550 peserta hadir
pada pertemuan ini, yaitu 350 peserta lokal dan 200 peserta internasional. Mereka
berasal dari Indonesia, Afghanistan, Amerika Serikat, Australia, Bangladesh,
Bhutan, Canada, China, Filipina, Haiti, Hongkong, India, Inggris, Jepang, Kamboja,
Korea Selatan, Lao PDR, Malaysia, Mongolia, Myanmar, Nepal, Singapura,
Spanyol, Sri Lanka, Syria, Taiwan, Thailand, Timor Leste, Uganda, dan Vietnam.
Pada acara ini akan dipaparkan 120 presentasi oral dan 60 presentasi poster.
Lowongan Pekerjaan Pada Principle
Recipient(GF-HSS)
Pengumuman Pendaftaran Penempatan
Calon Bidan ke RDTL
Peringatan Hari Standar Dunia & Bulan
Mutu Nasional 2011
Badan Litbangkes
Badan PPSDM Kesehatan
WEB UNIT
Kepegawaian
Gizi
Pembiayaan dan Jaminan Kesehatan
Promosi Kesehatan
Penanggulangan Krisis
Hukum dan Organisasi
Kesehatan Kerja
Kesehatan Ibu
Kesehatan Anak
Kesehatan Haji
Intelegensia Kesehatan
Pejabat Pengelola Informasi &
Dokumentasi
PROFIL KESEHATAN
Indonesia
-- Pilih Tahun -Propinsi
-- Pilih Propinsi -Kabupaten/ Kota
-- Pilih Kabupaten/ Kota --
DIRECTORY
 Apotik




 Puskesmas




 Rumah Sakit





Nanggroe Aceh D
Go
Konferensi TEPHINET tahun ini mengangkat tema Global Surveillance Networking
for Global Health, berlangsung pada tanggal 8-11 November 2011. Organisasi
internasional yang turut membantu konferensi ini adalah WHO, European Union,
TEPHINET, SAFETYNET, UNICEF, US CDC, RESPOND, CAREID, REDI, Tuft
University, dan lainnya.
TEPHINET (Training Programs in Field Epidemiology and Public Health Intervention
Network) adalah jaringan epidemiologi global yang didedikasikan untuk menjaga
standar kualitas pendidikan epidemiologi. Melalui TEPHINET, para tenaga
kesehatan dapat meningkatkan kemampuannya dalam mengaplikasikan ilmu
epidemiologi. Selain itu, untuk memperkuat sistem kesehatan masyarakat dengan
program pendidikan FETP (Field Epidemiology Training Programme) dan FELTP
(Field Epidemiology and Laboratory Training Programme) di seluruh dunia. FETP
Indonesia merupakan salah satu anggota TEPHINET.
Dalam sambutannya Menkes menyatakan epidemiologi adalah pilar utama dalam
kesehatan masyarakat. Dengan epidemiologi memungkinkan kita menentukan
besarnya masalah, mengidentifikasi faktor-faktor risiko dan populasi rentan,
merancang metode pengendalian dan memungkinkan pemantauan dan penilaian
program.
“Melalui pengawasan rutin dan respon wabah, praktisi kesehatan masyarakat dapat
mengatasi tantangan kesehatan dan mengalokasikan sumber daya untuk isu-isu
penting. Pemerintah tidak dapat bekerja sendiri. Kami berbagi tanggung jawab
dengan masyarakat, lembaga-lembaga akademik dan swasta,” kata Menkes.
Memahami epidemiologi, mekanisme kontrol dan alat respon bukanlah tugas mudah
bagi sebuah negara. Sebagaimana negara lain, pemerintah Indonesia bekerja untuk
mencapai target internasional dan mematuhi agenda global untuk meningkatkan
kesehatan dan kesejahteraan penduduk, tambah Menkes.
Salah satu program regular TEPHINET adalah menyelenggarakan konferensi ilmiah
internasional 2 tahunan. Setiap tahun konferensi global dan biregional ilaksanakan
bergantian. Konferensi ini didesain sebagai sarana saling berbagi informasi
mengenai epidemiologi dan terapannya. Selain itu juga sebagai latihan untuk
menambah wawasan terbaik bagi mahasiswa. Mahasiswa dapat mengambil
manfaat dari pengalaman berpresentasi di hadapan peserta internasional dan para
ahli. Sementara para tenaga kesehatan masyarakat dapat saling bertukar kontak
dan membangun jejaring untuk saling membantu bila menghadapi permasalahan
ketika kembali ke negara masing-masing.
Dalam konferensi ini akan digelar 4 Simposium dengan 10 pembicara. Adapun topic
yang dibahas yaitu International Health Regulation (IHR), Non Communicable
Disease (NCD), Disaster and Epidemiology, Emerging Diseases).
Sejumlah pembicara diantaranya adalah Kepala Badan Litbangkes Kemenkes RI
Prof. Trihono membahas Human and Animal Interface – the future challenges in
zoonosis; Chairman of the Board of the UK Health Protection Agency, UK Dr David
Heymann yang akan membahas mengenai Surveillance: Past, Present and future;
dan Director of China FETP and Chief Epidemiologist, Chinese Center for Disease
Control and Prevention, China Prof. Guang Zeng membahas Non Communicable
Diseases – Epidemiology: The key to evidence.
Dalam konferensi tersebut akan ada Presentasi Oral dan Poster oleh 120 orang
presentan oral dan 60 poster yang terpilih dari 383 abstrak yang masuk. Abstrak ini
telah di review oleh reviewer internasional. Abstrak yang terpilih untuk presentasi
oral berasal dari Indonesia (26), China (23), India Chennai (14), Filipina (9), Thailand
(8), Australia (7), Vietnam (7), Mongolia (6), Kamboja (4), Malaysia (4), Laos (3),
India Delhi (3), Jepang (2), Nepal (1), Singapura (1), Spanyol (1), Taiwan (1), dan
Korea Selatan (1).
Berita ini disiarkan oleh Pusat Komunikasi Publik, Sekretariat Jenderal Kementerian
Kesehatan RI. Untuk informasi lebih lanjut dapat menghubungi melalui nomor
telepon: 021-52907416-9, faksimili: 52921669, Pusat Tanggap Respon Cepat
(PTRC): 021-500567, atau alamat e-mail: kontak@depkes.go.id .
http://www.depkes.go.id/index.php/berita/press-release/1712-menkes-buka-konferen... 24-Jan-2012
Menkes Buka Konferensi Ilmiah Biregional TEPHINET
ke-6 di Bali
08/11/2011 12:57:00
Font size:
Hari ini Menkes dr. Endang Rahayu Sedyaningsih, MPH, Dr.PH membuka Konferensi Ilmiah
Biregional TEPHINET ke-6, di Bali. Sedikitnya 550 peserta hadir pada pertemuan ini, yaitu 350
peserta lokal dan 200 peserta internasional.
Mereka berasal dari Indonesia, Afghanistan, Amerika Serikat, Australia, Bangladesh, Bhutan, Canada,
China, Filipina, Haiti, Hongkong, India, Inggris, Jepang, Kamboja, Korea Selatan, Lao PDR, Malaysia,
Mongolia, Myanmar, Nepal, Singapura, Spanyol, Sri Lanka, Syria, Taiwan, Thailand, Timor Leste, Uganda,
dan Vietnam. Pada acara ini akan dipaparkan 120 presentasi oral dan 60 presentasi poster.
Konferensi TEPHINET tahun ini mengangkat tema Global Surveillance Networking for Global Health,
berlangsung pada tanggal 8-11 November 2011. Organisasi internasional yang turut membantu konferensi
ini adalah WHO, European Union, TEPHINET, SAFETYNET, UNICEF, US CDC, RESPOND, CAREID,
REDI, Tuft University, dan lainnya.
TEPHINET (Training Programs in Field Epidemiology and Public Health Intervention Network) adalah
jaringan epidemiologi global yang didedikasikan untuk menjaga standar kualitas pendidikan epidemiologi.
Melalui TEPHINET, para tenaga kesehatan dapat meningkatkan kemampuannya dalam mengaplikasikan
ilmu epidemiologi. Selain itu, untuk memperkuat sistem kesehatan masyarakat dengan program pendidikan
FETP (Field Epidemiology Training Programme) dan FELTP (Field Epidemiology and Laboratory Training
Programme) di seluruh dunia. FETP Indonesia merupakan salah satu anggota TEPHINET.
Dalam sambutannya Menkes menyatakan epidemiologi adalah pilar utama dalam kesehatan masyarakat.
Dengan epidemiologi memungkinkan kita menentukan besarnya masalah, mengidentifikasi faktor-faktor
risiko dan populasi rentan, merancang metode pengendalian dan memungkinkan pemantauan dan penilaian
program.
“Melalui pengawasan rutin dan respon wabah, praktisi kesehatan masyarakat dapat mengatasi tantangan
kesehatan dan mengalokasikan sumber daya untuk isu-isu penting. Pemerintah tidak dapat bekerja sendiri.
Kami berbagi tanggung jawab dengan masyarakat, lembaga-lembaga akademik dan swasta,” kata Menkes.
Memahami epidemiologi, mekanisme kontrol dan alat respon bukanlah tugas mudah bagi sebuah negara.
Sebagaimana negara lain, pemerintah Indonesia bekerja untuk mencapai target internasional dan mematuhi
agenda global untuk meningkatkan kesehatan dan kesejahteraan penduduk, tambah Menkes.
Salah satu program regular TEPHINET adalah menyelenggarakan konferensi ilmiah internasional 2
tahunan. Setiap tahun konferensi global dan biregional ilaksanakan bergantian. Konferensi ini didesain
sebagai sarana saling berbagi informasi mengenai epidemiologi dan terapannya. Selain itu juga sebagai
latihan untuk menambah wawasan terbaik bagi mahasiswa. Mahasiswa dapat mengambil manfaat dari
pengalaman berpresentasi di hadapan peserta internasional dan para ahli. Sementara para tenaga
kesehatan masyarakat dapat saling bertukar kontak dan membangun jejaring untuk saling membantu bila
menghadapi permasalahan ketika kembali ke negara masing-masing.
Dalam konferensi ini akan digelar 4 Simposium dengan 10 pembicara. Adapun topic yang dibahas yaitu
International Health Regulation (IHR), Non Communicable Disease (NCD), Disaster and Epidemiology,
Emerging Diseases).
Sejumlah pembicara diantaranya adalah Kepala Badan Litbangkes Kemenkes RI Prof. Trihono membahas
Human and Animal Interface – the future challenges in zoonosis; Chairman of the Board of the UK Health
Protection Agency, UK Dr David Heymann yang akan membahas mengenai Surveillance: Past, Present and
future; dan Director of China FETP and Chief Epidemiologist, Chinese Center for Disease Control and
Prevention, China Prof. Guang Zeng membahas Non Communicable Diseases – Epidemiology: The key to
evidence.
Dalam konferensi tersebut akan ada Presentasi Oral dan Poster oleh 120 orang presentan oral dan 60
poster yang terpilih dari 383 abstrak yang masuk. Abstrak ini telah di review oleh reviewer internasional.
Abstrak yang terpilih untuk presentasi oral berasal dari Indonesia (26), China (23), India Chennai (14),
Filipina (9), Thailand (8), Australia (7), Vietnam (7), Mongolia (6), Kamboja (4), Malaysia (4), Laos (3), India
Delhi (3), Jepang (2), Nepal (1), Singapura (1), Spanyol (1), Taiwan (1), dan Korea Selatan (1).
http://sehatnews.com/kabar-menkes/8693-Menkes-Buka-Konferensi-Ilmiah-Biregional-TEPHINET--Bali.html
PERTEMUAN ILMIAH EPIDEMIOLOGY NASIONAL 2010
Friday, 10 December 2010 15:28 administrator
Pertemuan llmiah Epidemiologi Nasiona I tahun 2010
diselenggarakan atas dukungan WHO, Kementrian
Kesehatan dan FETP Indonesia pada tanggal 1-3
Desember 2010 di Yogyakarta. Pertemuan ini bertujuan
untuk membangun jejaring epidemiologi terutama untuk peningkatan kerjasama
dan koordinasi sektor serta program dalam rangka surveilans epidemiologi.
Pertemuan ini merupakan salah satu wadah bagi mahasiswa FETP untuk
menyajikan kerja yang telah dilakukan selama magang di daerah. Selain itu,
dalam situasi desentralisasi saat ini setiap daerah mempunyai kebijakan dan
keunikan sendiri dalam rangka menyelenggarakan kegiatan surveilans penyakit
dan upaya pencegahan, pengendalian penyakit serta penanggulangan ketika
terjadi kejadian luar biasa, sehingga dalam pertemuan ini kita bisa mengetahui
apa yang telah dilakukan oleh dinas kesehatan di daerah-daerah serta inovasiinovasi yang dilakukan dalam upaya pencegahan, pengendalian dan
penanggulangan. Pengalaman dan praktek kesehatan yang baik dan didukung
oleh bukti ilmiah dapat diadaptasi dan diadopsi oleh daerah lain. Semoga
pertemuan ini tetap langgeng sehingga dapat mendukung praktek kesehatan
masyarakat berbasis bukti (Evidence based public health practice) di Indonesia
sebagai visi ke depan dan semoga di pertemuan yang akan datang lebih banyak
lagi peserta dari dinas kesehatan di seluruh Indonesia baik di presentasi oral dan
poster.
http://fetpugm.com/index.php?option=com_content&view=article&id=147:nsce&catid=4
4:berita&Itemid=88
FIELD EPIDEMIOLOGY TRAINING PROGRAM (FETP)
Penerimaan
MAHASISWA & PEMBIMBING LAPANGAN FETP
ANGKATAN KEDUA
KETENTUAN:
MAHASISWA
PEMBIMBING LAPANGAN
A. Sehat jasmani dan rohani
B. Memiliki pengalaman 2 tahun pada bidang kesehatan masyarakat
C. Bersedia berpindah tempat selama FETP
D. Diusulkan oleh pimpinan
D.1 Peserta dari puskesmas, Rumah Sakit Kab/Kota, Dinas Kesehatan Kabupaten, Laboratorium Kesehatan Daerah Kabupaten/Kota, UPTD Kabupaten/Kota usulan ditandatangani Kepala Dinas Kesehatan Kab/Kota
D.2 Peserta dari Dinas Kesehatan Propinsi, RS Propinsi, Balai Laboratorium
Kesehatan Propinsi, UPTD propinsi usulan ditandatangani oleh Kepala
Dinas Kesehatan Propinsi
D.3 Peserta dari pusat dan UPT pusat di lingkungan Depkes usulan ditandatangani oleh pejabat setingkat eselon I yang bersangkutan (Sekretaris
Jenderal, Direktur Jenderal, Kepala Badan)
D.4 Peserta dari luar jajaran kesehatan ditingkat pusat usulan ditandatangani
oleh pejabat setingkat eselon I
D.5 Peserta dari luar jajaran kesehatan di daerah usulan ditandatangani oleh
pejabat serendah-rendahnya eselon II
E. Umur peserta maksimal 45 tahun dan tidak menduduki jabatan struktural
eselon III ke atas
F. Formulir pendaftaran bisa diperoleh dengan cara:
A. Meng-copy berkas formulir dari kantor Dinas Kesehatan Prov/Kab/Kota
B. Mengirim permintaan soft copy formulir ke alamat e-mail:
fetpindonesia@yahoo.com
MEMENUHI KRITERIA:
A
B
C
D
E
F
G.
H.
Latar belakang pendidikan yang sesuai (misalnya alumni FETP, Magister
Kesehatan/ MPH, dll.);
Pengalaman praktis yang memadai dalam epidemiologi lapangan
(termasuk penyelidikan KLB, pengelolaan sistem surveilans, pelaksanaan
kajian epidemiologi);
Pengalaman dalam membimbing (misalnya kepada mahasiswa atau staf
lain);
Menyisihkan waktu yang cukup untuk membimbing (l.k. 10% dari jumlah
jam kerja);
Kesediaan untuk menghadiri lokarya/rapat pembimbing yang
diselenggarakan oleh FETP.
Kondisi daerah yang mendukung seperti:
A. Adanya masalah kesehatan yang dapat dijadikan proyek lapangan
bagi mahasiswa FETP
B. Adanya dukungan logistik, misalnya adanya komputer yg dapat ikut
digunakan oleh mahasiswa FETP
C. Adanya kemungkinan mengikut sertakan mahasiswa dalam berbagai
kegiatan lapangan di daerah tersebut.
Mengisi dan melampirkan formulir usulan (formulir terlampir)
Mengajukan usulan secara tertulis.
Kemampuan akademis:
PENEMPATAN LAPANGAN
1. IPK S1 minimal 2, 75
2. Memiliki kemampuan Bahasa Inggris (good speaking, writing, listening and
reading)
3. Latar belakang pendidikan S1 (kedokteran umum/gigi/hewan, kesehatan
masyarakat/lingkungan, keperawatan, biologi, farmasi, sarjana teknik kesehatan, entomologi, psikologi)
A. Penentuan lokasi ditetapkan melalui 2 cara:
1.Atas permintaan dari instansi yang diajukan kepada sekretariat FETP
2.Atas penunjukan oleh universitas dan atau sekretariat FETP
B. Pelamar yang berhasil diharapkan melakukan perjalanan ke penempatan
lapangan segera setelah awal perkuliahan di perguruan tinggi.
LAMARAN TERTULIS
UJIAN MASUK DAN WAWANCARA
Lamaran harus dilengkapi dengan berbagai dokumen sebagai berikut:
•
1.
2.
3.
4.
•
5.
6.
7.
8.
Formulir usulan FETP
Transkrip akademik
Foto berwarna (4X6 sebanyak 3 buah),
Surat usulan mendaftar FETP tertandatangan pejabat (lihat Kriteria Mahasiswa butir D)
Surat pernyataan kesanggupan memiliki laptop selama masa pendidikan
Menandatangani surat pernyataan tentang kesanggupan untuk menyelesaikan pendidikan maksimal 3 tahun, dan akan dilakukan evaluasi bila lebih dari
3 tahun
Menandatangani surat pernyataan kesanggupan mengembalikan semua
biaya yang telah diterima apabila:
A. Tidak disiplin yang dikuatkan oleh surat pernyataan dari universitas
B. Mengundurkan diri atas kemauan sendiri
Surat keterangan sehat keterangan sehat dari dokter pemerintah / Rumah
Sakit / Puskesmas
MEKANISME PEREKRUTAN (*)
Hanya mahasiswa yang telah memenuhi kriteria administrasi yang akan dipanggil mengikuti seleksi yang waktunya akan diberitahukan kemudian. Tes terdiri
dari:
A.
Ujian tertulis
B.
Wawancara
(*)
Ket: Seluruh mekanisme seleksi penerimaan mahasiswa FETP dilaksanakan
oleh tim yang terdiri dari Universitas dan Depkes (Sekretariat FETP).
Lamaran dapat dikirim :
Lewat pos:
Sekretariat FETP
Ditjen PP&PL Depkes RI
Gd. C, Lt. 4
Jl. Percetakan Negara
no. 29, Jakarta
Lewat fax:
021-42877601
Lewat e-mail:
fetpindonesia@yahoo.com
•
•
•
Hanya pelamar yang memenuhi persyaratan administrasi yang akan
diundang untuk mendaftar di Universitas Indonesia atau Universitas Gadjah Mada untuk mengikuti ujian tertulis.
Pelamar harus menanggung sendiri biaya perjalanan yang berkaitan
dengan pendaftaran ujian dan kehadiran di perguruan tinggi.
Ujian meliputi tiga mata ujian, yaitu: Kompetensi akademik, Kemampuan
Bahasa Inggris, dan Kemampuan Bahasa Indonesia.
Setelah ujian masuk, setiap pelamar akan diwawancarai. Hal ini bertujuan
untuk mengetahui pengetahuan pelamar mengenai FETP, motivasi, dan
kesesuaian pelamar terhadap program ini.
Ujian masuk dan wawancara akan dilaksanakan pada tanggal April 2009.
Pelamar yang memenuhi persyaratan akademis akan diberi tahu mengenai kepastian waktu wawancara melalui telepon/e-mail.
KEPUTUSAN AKHIR
Keputusan akhir ditetapkan oleh Panitia Seleksi FETP berdasarkan kesesuaian mahasiswa, hasil ujian, daerah asal, dan ketersediaan dari penempatan lapangan. Kemudian, secepatnya pelamar ditawari tempat penempatan. Penempatan tersebut tidak hanya didasarkan pada pertimbangan
pilihan pada pilihan pelamar di lamaran awal, melainkan juga didasarkan
pada keputusan Panitia Seleksi FETP. Pelamar yang tidak lulus seleksi
dapat melamar kembali pada tahun-tahun berikutnya. Keputusan akhir
bersifat mutlak, tidak dapat diganggu gugat, dan tidak diadakan konsultasi.
PENDAFTARAN DITUTUP TANGGAL
31 MARET 2009
Pertanyaan yang berkenaan dengan
berkas lamaran dan proses usulan
mahasiswa dan pembimbing
lapangan FETP dapat ditujukan
kepada
Dr. Hari Santoso, SKM, M.Epid.,
telp.: 021-42877601 atau melalui
HP: 081310008533, atau e-mail ke
fetpindonesia@yahoo.com
UNOPS INDONESIA PROJECT CENTRE (IDPC)
Final Report
‘Isolation Room Development as Part of the Implementing the
National Strategic Plan for Avian Influenza (INSP-AI)’
UNOPS Project ID 00075760
Project Funded by the European Union
CRIS no. ASIE/2007/145-079
Jakarta, December 2012
1. Introduction
1.1 Acknowledgements
The United Nations Office for Project Services (UNOPS) would like to thank the
World Health Organization (WHO), the European Union (EU), and the Ministry of
Health in the Republic of Indonesia (MoH) for the concerted effort and close
collaboration to achieve the common goal of increasing the nation’s capacity to
prevent and control cases of human infection with avian influenza (AI), or more
specifically the H5N1 virus. UNOPS is most appreciative of the opportunity to be of
service to WHO to help strengthen Indonesia’s health system. The final outcome of
the project is the result of a joint effort with many committed and talented individuals
who have worked tirelessly to ensure the project’s success.
Isolation Room Simulation training at Tangerang hospital
1 1.2 Executive Summary
The Final Report is a requirement of the Inter-Agency Agreement (IAA) between the
WHO and UNOPS. The IAA was signed in July 2010 to support the development of
isolation rooms at designated referral hospitals throughout Indonesia as part of the
Implementing the National Strategic Plan for Avian Influenza (INSP-AI). The
purpose of the Final Report is to summarize the project implementation process, the
main project achievements, factors influencing the project and lessons learned
following operational project closure.
1.3 Background
Since outbreaks of highly pathogenic avian influenza were first reported in Hong
Kong, China in 1997 and re-emerged in 2003, many countries worldwide have been
affected. The strain identified as H5N1 which has led to massive die-offs in birds,
chicken and duck population has also infected a number of people. Most vulnerable
population groups include those who are in direct contact with poultry or
contaminated environments.
On a global scale, Indonesia is the country worst hit by avian influenza with over 190
reported cases of humans infected since 2003, the majority of which resulted in death.
The fatality rate is estimated to be around 80% and according to the Indonesian
Ministry of Agriculture, the disease is now endemic in 31 of the country’s 33
provinces. In light of this huge challenge to the country, the global spread of avian
influenza and its pandemic potential, WHO is working hand-in-hand with the
Government of Indonesia to respond to the outbreak. Key factors in adequately
dealing with cases of humans infected with avian influenza, improving treatment and
reducing mortality include enhanced surveillance, outbreak management, hospital
preparedness and pandemic preparedness and contingency planning.
In 2005, the Government of Indonesia adopted a National Strategic Plan for
Controlling Avian Influenza. In direct support to this initiative, the Implementing the
National Strategic Plan for Avian Influenza (INSPAI) project was a four year project
(December 2007 – 2011) implemented by WHO and funded by the EU. The WHO
implemented the project in partnership with the Ministry of Health. The project
consisted of four components: (i) strengthening disease management; (ii)
strengthening disease surveillance; (iii) healthy food markets and risk communication;
and (iv) improving understanding of H5N1 infection through research.
In order to increase Indonesia’s capacity for improved disease management, the
development of isolation rooms for case management of avian influenza at designated
referral hospitals throughout Indonesia was included in component (i).
Implementation of isolation rooms at referral hospitals has been a challenge for all
actors and stakeholders active in the project. Apart from the varied physical
2 conditions of existing hospitals and the fact that Indonesia comprises an archipelago
of 17 thousands islands spread across a vast region, stretching from east to west with a
length of 5,200 km and a width of 1,870 km, the project had not been attractive
enough for a large pool of competent contractors. It is against this background that the
UNOPS team has moved forward. Any consideration of any serious activity must take
into account this uneasy and difficult background.
1.4 Cooperation between EU, WHO, UNOPS and Other Partners
In December 2007, a Contribution Agreement was signed between the EU and WHO.
A description of the Action to be undertaken by WHO is provided in Annex 1 of the
Contribution Agreement. Avian influenza case management is strengthened through
the first group of activities, including enhanced infrastructure at designated referral
hospitals and the training of healthcare workers. An integral part of health system
strengthening infrastructure at referral hospitals was the development of isolation
rooms at 10 referral hospitals, (according to the Contribution Agreement), which was
later increased up to 15 referral hospitals. The final number of hospitals with
upgraded isolation rooms was 10, as originally planned.
A national consultant was selected by WHO in October 2008 to conduct a needs
assessment and report containing detailed designs and specifications for the isolation
rooms at the hospitals. To complement this effort and to ensure sound technical
quality in the assessment and report, WHO requested technical assistance from
Professor Yuguo Li, an international isolation room expert from the University of
Hong Kong. Following a committee review, several recommendations were made in
February 2009. However, the final report submitted by the national consultant was not
of sufficient standard and was incomplete.
Faced with this problem, WHO decided to seek assistance in completing the health
infrastructure component of the project as this component did not fall within WHO’s
mandate, which contributed to early delays. Given UNOPS role, reaffirmed by the
General Assembly, “as a central resource for the United Nations system in
procurement and contracts management as well as in civil works and physical
infrastructure development, including the related capacity development activities” and
pursuant to the general partnership between WHO and UNOPS in a number of
countries, WHO sought the assistance of UNOPS.
WHO and UNOPS management met with MoH and EU officials in September 2009
to present the partnership as a possible solution. The proposal charged UNOPS with
the responsibility for completing the designs and tender documentation and
implementing the renovation works in accordance with UNOPS procurement regime,
Financial Regulations and Rules (FRR) and General Conditions of Contract (GCC).
The proposal was endorsed at the INSP-AI Project Steering Committee meeting in
March 2010.
3 Individual site agreements were jointly signed by MoH, WHO, UNOPS, and
representatives from each hospital in April 2010 confirming that UNOPS would
manage all activities related to the tender process, implementation, monitoring and
supervision of the renovation works by national contractors selected through a
competitive process.
As a first step, UNOPS reviewed the national consultant’s assessment report for
isolation rooms at the 15 dedicated referral hospitals. Despite the fact that some
progress had been made since the consultant’s initial submission, the design had to be
significantly improved and tender documents drafted before works could be tendered.
With the aim of addressing these concerns, UNOPS and its isolation room expert from
Hong Kong met with MoH representatives from the Basic Medical Care Directorate,
Centre of Health Care Facility, WHO and EU during a start-up meetings and site
visits between 16 and 18 June 2010. The objective of the start-up meeting was to
collect essential information and to consult with key stakeholders. UNOPS carried out
similar investigations and consultations at all 15 hospitals.
1.5 Strategy and Revised Scope
Strategy
According to WHO guidelines, when new infectious diseases, such as avian influenza,
are recognized, Airborne and Contact Precautions should be added to the routine
standard precautions whenever possible to reduce the risk of transmission. And the
quality of ventilation is one of the major factors in determining the risk of exposure in
the isolation rooms. Environmental ventilation refers to the process of introducing and
distributing outdoor air, and/or properly treated recirculated air into a building or a
room. Isolation rooms with adequate ventilation controls and controlled unidirectional flow of air should be available whenever possible. This strategy was
employed for INSP-AI.
Scope
Early-on, it was found that existing hospital conditions vary widely. A thorough
investigation of the site specific issues was required to ensure that the isolation rooms,
once renovated, were fit-for-purpose and provide an acceptable level of patient care
and healthcare worker and visitor safety. Site visits and assessments at the 15 referral
hospitals were completed by November 2010 and detailed engineering designs and
tender documents were completed for all 15 referral hospitals by March 2011.
Tendering was initially done for the first lot of hospitals in December 2010. UNOPS
ultimately presented the results from several rounds of pre-qualification and tendering
at the Technical Steering Committee Meeting on 10 March 2011. Pursuant to that
meeting, MoH agreed to reduce the total number of referral hospitals to be renovated
under the project to 10, as originally planned under the Contribution Agreement, to
ensure that sufficient funds and time would be available for implementation of
4 comprehennsive isolatio
on rooms att all location
ns in line with
w internattional best practices
p
using WHO
O guidelinees. An increease in budg
get and a decrease
d
in number of hospital
sites were finally
f
agreeed by way oof Addendu
um No.1 to the
t IAA by WHO and UNOPS
in October 2011.
Phase 1 hospitals included: RSPAD Gatoto
G
Soeebroto Hoospital in Jakarta;
Persahabataan Hospitall in Jakarta;; Tangerang
g Hospital in
i Tangeranng Banten; Gunung
Jati Hospitaal in Cirebo
on; and Kanndau Hospitaal in Manad
do North Suulawesi, Ind
donesia.
Phase 2 hosspitals inclu
uded: RSPI Sulianti Sarroso in Jakaarta; RSUD
D Moewardi in Solo;
Dr. Soetom
mo in Surab
baya; RSU
UD Abdul Muluk
M
in Lampung;
L
aand RSUD Ulin in
Banjarmasiin, Indonesiia.
1.6 Coordin
nation and Communicat
C
tion
Annual Workplans
W
and
a
Semi-A
Annual Reeports weree preparedd by UNO
OPS and
submitted to WHO. These docuuments, alo
ong with monthly
m
uppdates on progress,
p
t
to monitor progrress and track deadlinees, procedurral hold-points and
served as tools
approvals in
i line with
h the projecct agreemen
nt. Strategicc direction aand oversig
ght were
provided thhrough regu
ular meetinggs with the Managemen
M
nt Committeee, Project Steering
Committee, and Projeect Technicaal Steering Committeee as well ass hospital staff
s
and
the contracttor.
The Visibillity action was
w carriedd out during
g the coursee of the prooject. The EU
E logo
was includeed in all ad
dvertisemennts in the local newspaper and on signboardss at each
construction site.
Sign att construction
n site, displaaying
EU-lo
ogo
Plaque at completed isoolation roomss with EU-loogo
2. Projeect Implementation Process
2.1 Verificaation and Deesign
Adequate environmen
ntal ventilaation is a key
k engineeering conttrol for resspiratory
mary engineeering conttrols for
infections and needs to be careefully consiidered. Prim
aerosols innclude enviironmental ventilationn of at leasst 12 air
infectious respiratory
r
changes per hour (ACH
H). Isolatioon rooms caan be naturally or mechhanically veentilated.
5 Mechanical ventilation uses fans to drive the air flow through a building and can be
combined with air conditioning and filtration systems. Natural ventilation uses
natural forces to drive the air flow through a building. However, there are two major
concerns with natural ventilation. Firstly, the rate of ACH provided by natural
ventilation is variable. Secondly, negative pressure is suggested for isolation rooms,
and natural ventilation may not be able to create negative pressure.
After an extensive review of the revised report prepared by the national consultant,
UNOPS found several flaws and needs for revision. These needed to be addressed
before the works could be tendered. Specifically, UNOPS made the following
observations:








The drawings did not necessarily conform to the needs identified and the scope
of work presented in the draft assessment report;
The design needed to be verified against relevant WHO guidelines and expert
opinion in isolation room development;
The design needed to be verified with and approved by the respective hospital
authorities and other stakeholders;
Design documents were available for only 14 out of the 15 sites (information
for RSPI Sulianti Saroso Jakarta hospital was missing);
Architectural details, structural drawings, plumbing and drainage, medical gas
and fire-fighting drawings were not available for the 14 sites,
Architectural, structural, electrical, mechanical and services technical
specifications were not available for the 14 sites;
A Bill of Quantity was provided but lacked certain essential information for it
to be useful;
The estimated cost for the 14 hospitals as stated in the draft assessment report
could not be verified without conducting detailed investigations at each site
and interviews with project stakeholders to confirm project needs.
The original expectation of being able to modify existing drawings had not
eventuated due to errors and omissions in the files received by UNOPS, which could
not be ascertained until the site visits were conducted by UNOPS personnel. The
detailed assessment by UNOPS of actual work required for the 15 sites revealed an
increase in the physical complexity and associated costs of the interventions required
for each site to enable the successful completion of the isolation rooms.
Furthermore, the site verification of all site dimensions and the preparation of all
building layouts from first principles increased the time required to prepare suitable
documents for tendering purposes.
UNOPS explored the feasibility of natural ventilation at a few hospitals. To enable a
realistic and verifiable analysis of natural ventilation, UNOPS obtained
meteorological records from the Meteorology, Climatology, and Geophysics Agency
(BMKG) for seasonal information on wind speeds, wind directions, as well as
temperature and humidity levels. However, as illustrated in the figures below, the
6 unfavouraable buildin
ng layoutss for crosss ventilatio
on and higgh fluctuattions in
ventilationn rates at th
hese sites inndicated thaat natural veentilation coould not satisfy the
recommennded ventilaation require
rements.
Wind speedd and directiion 2009 datta
Wind speed and directioon 2010 data
The Steering Committee, therefoore, agreed that UNOPS prioritizee works for negative
n
pressure systems
s
on the basis off mechanicaal ventilatio
on systems w
with airtigh
ht doors,
and windoows.
Schematic diagram of an
a ideal venttilated isolattion room with a mechaniical ventilatiion
system
Complex architecturral and enngineering designs weere prepareed to avoiid cross
infection and to main
ntain the deesired desig
gn pressure and air flow
w relationsh
hip. The
mechanicaal ventilatio
on system w
was designeed to regulaate air exchhange in the rooms
dedicated to patients..
7 Partial details for mechanical ventilation system at Persahabatan hospital
A Fresh Air Handling Unit (F-AHU)
supplies fresh air from the outdoor
environment and the Recirculation
Air Handling Unit (R-AHU)
refreshes room air. Both units are
equipped with filters and the RAHU accommodates a UV-light as
an additional safety measure. An
exhaust fan utilizes negative
pressure to safely discharge used air
to the outdoor environment in a
controlled manner. As factors such HEPA filter access / maintenance at R-AHU
as pressure differential, room temperature and humidity are key elements for
achieving negative pressure and maintaining patient comfort levels, these indicators
are measured constantly. The mechanical ventilation system is operated by an
automatic system to manage negative pressure, so that air will flow in one direction
from clean to less clean areas (i.e., from the corridor into the isolation room). The air
is replenished by outdoor air intake into isolation room upon mixing with the return
air. The air drawn into isolation rooms is then exhausted through vents at the
patient’s bedside and ceiling mounted vents in the toilet of each isolation room.
The design pressure gradient between isolation rooms and corridors is 5 Pa. Good air
tightness is important and installing air pressure regulating dampers helped to
maintain a stable pressure gradient. The system also includes a pressure alarm alert
for each isolation room.
8 Differential pressure sensors with digital
indication
Pressure alarm system located at nurse
station
The HVAC system was designed with minimum maintenance requirements to be
carried out by resident hospital engineering staff as well as with optimal energy
consumption implications. The system components and equipment were especially
selected so that they are readily available within realistic delivery lead times and
spare parts affordable. Furthermore, consideration was given to non-isolation mode
of operation to save energy and HEPA replacement costs. Moreover, an operation
protocol including maintenance practice was established during the setting up of the
physical infrastructure to warrant for achieving intended isolation functions in the
long run.
Great attention to the design was also paid to ensure controlled access to the
isolation rooms, decontamination of waste, decontamination of lab clothing before
laundering, and baseline serum. Correct isolation required facilities to be physically
separated from access corridors as well as the installation of self-closing and doubledoor access. The provision of anterooms was generally preferred as a solution in
absence of space and budget constraints.
2.2 Project Management
The INSP-AI Project Steering Committee chaired by the MoH was responsible for
the implementation of the project. UNOPS was accountable to the MoH and WHO
to manage and implement all activities related to the design, planning, tender
process, implementation, monitoring, financial aspects, and supervision of the
construction works, which were undertaken by a contractor that was selected
through a competitive process in accordance with UNOPS procurement regime and
Financial Regulations and Rules.
Pursuant to the Management Committee meeting on 4 April 2011, WHO’s
Representative to Indonesia sent a letter to the MoH’s Director of Referral Medical
Care on 6 April 2011 concerning the Management Committee’s decision to reduce the
numbers of hospitals from “up to 15” to 10, as originally committed in the
Contribution Agreement. The letter summarized the discussion regarding the number
of hospital sites and informed that isolation room development in line with
9 international best practices may require a reduction in the number of sites from 15 to
10. It further requested the MoH’s advice on the confirmation of recommended sites
of isolation rooms. On 21 April 2011, the MoH’s Director of Referral Medical Care
sent a reply to the WHO, confirming the selection of five out of ten hospitals in Phase
II. Addendum No. 1 to the IAA, was signed by WHO and UNOPS Regional Directors
on 12 October 2011.
EU external consultants visited Jakarta between 4 and 30 November 2011 to conduct
a comprehensive final evaluation of the performances and achievements of INSP-AI
programme towards its objectives and purposes set in the Contribution Agreement
with WHO. The consultants held discussions with WHO, MoH and UNOPS and
conducted field visits at selected sites. The discussion focused on project activities,
achievements, efficiency, effectiveness, impact prospect, and sustainability of the
activities. The Final Evaluation findings on the INSP-AI were presented during the
Project Technical Committee meeting on 24 November 2011.
Key achievements and the exit strategy were discussed during the Project Steering
Committee Meeting on 12 December 2011 following the opening ceremony at
Tangerang hospital with the Minister of Health.
Health Minister Endang Rahayu Sedyaningsih at opening of isolation rooms
at Tangerang hospital
With the completion of the isolation rooms at the 10 hospitals by 12 December 2011,
UNOPS considered recommendations made during the external Final Evaluation of
the programme, which identified a limitation in terms of the intended follow-up
activities, including competence development through on-site training, and simulation
exercises to develop practical skills. This sentiment was shared by the Isolation Room
Expert from Hong Kong, who attended the Project Steering Committee meeting. He
recommended that beneficiaries receive additional on-site training and participate in
testing and commissioning before handing-over of the isolation room facilities. As
10 such, UNOPS and its contractor took additional efforts to fulfill this requirement as
part of an augmented exit strategy, before handing-over the facilities to the relevant
authorities.
A. Financial Management
UNOPS was responsible for the administration and finance of the project according to
UNOPS Financial Regulations and Rules. The Inter-Agency Agreement was signed
on 1 July 2010 with a budget of US$ 3,622,277. Addendum No. 1 to the IAA, signed
in October 2011, increased the budget to US$ 4,222,277. Furthermore, the US$
600,000 contingency money, identified as potential funds available to be reallocated
to this project in order to address the needs at Phase II hospitals, was additionally
required.
The relevant Financial Statement and Expenditure Report are attached hereto as
Annex 1.
B. Procurement
A procurement plan as well as monitoring system was developed for the procurement
of items being purchased. The latter outlined quantities needed, estimated costs,
procurement mode, and schedule for the procurement process and delivery.
Given the high importance of specialized equipment for the project (e.g. late delivery
or the delivery of the wrong equipment would have costly implications) UNOPS
opted for a pre-qualification process. As stated in the Inter-Agency Agreement and as
agreed during the Management Committee Meeting held on 11 October 2010, an open
invitation for pre-qualification was published in the Kompas national newspaper on
16 October 2010, as well as on the UNOPS and UNDB websites. Firms were given
until 6 November 2010 (more than 3 weeks) to prepare responsive applications.
Another round of pre-qualification was published in the Kompas national newspaper
on 4 December 2010, as well as on the UNOPS and UNDB websites as agreed during
the Management Committee Meeting held on 26 November 2010. Firms in the second
round were given until 7 January 2011 (more than 4 weeks) to prepare responsive
applications.
Concerning the two advertisement rounds, 7 firms submitted pre-qualification
documents for the first round and 2 firms submitted pre-qualification documents for
the second round. Ultimately 5 firms overall were considered to have the requisite
capacity to pre-qualify to participate in the bidding process. The limited number of
responses highlights the specialized nature of works as well as the difficulties related
to the ubiquitous locations.
The first phase tender was issued on 6 December 2010 and combined five hospitals in
Phase 1. Including all civil, mechanical, services and equipment, the tender was aimed
at larger contractors with capacity to mobilize adequate resources for
construction/renovation works. Three offers were received for Phase 1. One offer was
11 rejected, as it was received
r
aft
fter the datte and time stated ass the dead
dline for
he validity period of the bid
submissionn. Another offer was eliminated because th
security waas shorter th
han what waas stated in the solicitattion docum
ments. Thus, the first
round of teender only produced a single com
mpliant bid
d that quoteed a relativeely high
price. Therefore, it waas deemed pprudent to ree-tender. Affter cancellaation on 3 February
F
p
com
mbining Phaase 1 hospitals was re--tendered onn 7 Februarry 2011.
2011, the package
The re-tendder was succcessful as iit led to thee lowest com
mpliant biddder quoting
g a price
that was 466% lower th
han the previ
vious.
Bids rece
eived for P
Phase 1 tender pack
kage
25,000,000
0,000
20,000,000
0,000
15,000,000
0,000
1st Tender
Re‐tender
10,000,000
0,000
5,000,000
0,000
‐
PT
T. Satria
Gun
na Utama
PT. Jasira
Utama
PT. Deltamass
Solusindo
PT. Karyaa
Intertek
Kencana
Following comparison
n of prices quoted in substantiallly responsivve bids, thee lowest
priced respponsive biid was evvaluated fo
or technicaal responsivveness. Th
he final
recommenddation of aw
ward was too PT Deltam
mas Solusin
ndo for Phaase 1 hospittals. The
firm had prrevious exp
perience in uup-grading HVAC systems for phharmaceuticcal clean
rooms at PT
P Bayer In
ndonesia annd HVAC system
s
imp
provements for PT Meedifarma
Laboratoriees as well ass others, whhich was deemed to be relevant to the project.
The seconnd phase of tendder
commencedd on 22 Feebruary 20111.
Only two offers
o
weree received bby
the date off submissio
on, 31 Marcch
2011. The bid
b prices were
w based oon
designs for isolation rooms at 8
additional hospitals where
w
desiggns
were comppleted at th
he time. Booth
P
Pre-Bid Con
nference
12 bids received were found substantially responsive. After price examination, PT
Deltamas Solusindo emerged as the lowest bidder – the same firm that was already
awarded the contract for the five Phase 1 hospitals.
Following successful negotiations, the contractor agreed to lower his original price –
originally set for eight hospitals – by 10.8% based on the five selected sites. After
analyzing the results of negotiations, the evaluation committee considered the price
offered fair and reasonable and PT Deltamas Solusindo was awarded the contract.
C. Human Resource Management
With the start of the project, the recruitment, appointment and mobilization of project
personnel was initiated for the positions of Project Manager, Liaison Officer, Expert
Advisor, Quantity Surveyor, Quality Inspector, Site Monitors, Administrative
Assistant and Finance Officer in line with UNOPS procurement policies and
procedures. UNOPS Officer-in-Charge had been serving as Project Manager
beginning in June 2010.
In an effort to efficiently and effectively streamline the project, UNOPS started in
early 2011 to share the costs of the national project personnel including Admin
Assistant and Finance Officer with another new project being implemented by
UNOPS. Furthermore, a national Finance Assistant and a Procurement Associate were
hired, again on shared costs with a second UNOPS project, to ensure adequate
segregation of duties. As the initial UNOPS Quality Inspector left the project in
February 2011, a new replacement was recruited in March 2011. Moreover, the
project team was now supported by a HVAC/Mechanical and Electrical engineer who
started in May 2011. In addition, eight site engineers were hired to supervise and
monitor work at their respective locations in Medan, Cirebon, Jogjakarta, Manado,
Banjarmasin, Bali, Lampung and Surabaya. All newly recruited personnel were
Indonesian nationals. Annex 2 lists project personnel and contact information.
UNOPS’ Physical Infrastructure Design Unit (PIDU) based in Sri Lanka was also
engaged in the project providing additional export support. Furthermore, UNOPS sent
a letter of invitation together with a recommendation letter from WHO for the
appointment of the Expert Advisor on isolation room development, Mr. Yuen PakLeung.
2.3 Construction and Monitoring
Upon the approval of award following the re-tendering of Phase 1 hospitals,
renovation works started in March 2011. Renovation works for the remaining five
Phase 2 hospitals followed closely behind, after the contract could be awarded. PT
Deltamas Solusindo undertook the works for both phases.
13 Progress of civil works at Phase 1 hospital
corridor by June 2011
Inspection of ducting during installation
The original hospital conditions were generally poor and service diversions and
substantial demolition works were required at most locations. In particular, seals were
required at openings to secure room pressure differentials. Leaking pipes had to be
repaired and electrical supply had to be strengthened at many locations. Taps and
floors were replaced on a case by case basis to improve hygiene.
Construction work for Phase 2 hospitals could commence one week after the signing
of the contract on 15 April 2011.
Following the start of preliminary and demolition works at Phase 1 hospitals in May,
the next key achievement was marked by the completion of ducting and insulation
works.
By June 2011, fabrication, assembly
and insulation works of ducting had
been concluded for all five Phase 1
hospitals. A pre-delivery inspection
of the HVAC equipment for all
hospitals was conducted by an
independent testing Agency (SGSNederland) on 4th and 5th of July at
the McQuay factory in Sengalore,
SGS Inspection Report Equipment
Malaysia. After the thorough
inspection of the HVAC equipment in Malaysia, delivery to the final destination was
delayed due to complications of shipment and customs clearance at Tanjung Priok
port. However, progress at all sites caught up once the HVAC equipment arrived and
was ready for installment.
14 Delivery of HVAC Equipment
Installation of Equipment
Once the HVAC equipment was fully installed at sites, it was subject to a thorough
technical inspection. For this purpose, the isolation room expert visited hospitals. The
close examination of the functionality of the HVAC system was conducted by
monitoring the air flow through various means, such as flow velometers, flow hood
and smoke tubes.
Isolation room expert using smoke tube
to monitor air flow
Measuring air exchange using carbon
dioxide as tracer
Isolation room expert cross checking
air changes using flow hood
Isolation room expert cross checking
air changes using flow hood
15 2.4 Capacity Building
With the new system in place, it was
important that hospital health care
workers are familiar with the equipment
and know how to handle it. Capacity
building constituted an important crosscutting component of the project.
Attention was paid to strengthen the
capacity of key hospital staff in
operating,
maintaining
and
troubleshooting of the new system.
Training session
Guided by WHO, the hospitals provided
comprehensive trainings with hospital
staff aimed at promoting an institutional safety climate in hospitals, improving
conformity with various safety measures, helping to reduce the risk of pathogen
exposure and transmission associated with health care.
Special attention was paid to key strategies such as administrative controls,
engineering and environmental controls, and the use of Personal Protective
Equipment (PPE). Training included briefings on the effective use of PPE,
specifically addressing infection control issues to ensure effective precaution
including regulations on adequate and regular supplies of PPE, adequate staff training,
proper hand hygiene, and in particular, appropriate human behavior.
Trainings emphasized the importance of proper implementation environmental control
methods such as cleaning and disinfection of contaminated surfaces and items such as
clothing.
Trainings also focused on capacity strengthening in administrative control measures
including early recognition, isolation, reporting, and surveillance of episodes of ARD
of potential concern.
In addition to capacity building for
healthcare workers at each hospital
sites, special two-day workshops and
simulation activities to prepare for case
management took place at hospital sites
prior to the official hand-over
ceremonies. All in all, 225 people
benefitted directly from receiving
training in working in isolation rooms
and handling equipment.
16 Training in the use of PPE
Administrative Training
Training Session at Gatot Soebroto
Military Hospital
In order to ensure sustainable benefits manuals were designed and distributed to
hospitals. Moreover, capacity building was also supplemented by way of a video that
explains the working and handling of the isolation rooms in detail. Distributed
manuals aim at the long-term sustainability of the project. Therefore, they tackle a
wide range of issues and possible situations occurring in relation to operating the
isolation room and working with the equipment installed.
Illustrations as integral part of the manual, here: components of the F-AHU
Standard Operating Procedures (SOP) include details about what should be checked
before running the system, how to operate the system both manually and
automatically, maintenance procedures including detailed descriptions and recurrence
(monthly, daily etc.) as well as comprehensive guidelines for start-up and system
maintenance. A large section on troubleshooting also makes up a crucial part of the
manual. Here, hospital staff can check for observed symptoms and sources of
problems and then find advise on appropriate actions to take. The manual also
includes inmportant additional suggestions and recommendations, such as tips on how
to save energy.
Contact information for maintenance services was also provided. After installation
and substantial completion at hospital sites, the contractor and UNOPS revisited sites
checking the correct handling of the system and supporting health care workers and
other stakeholders.
17 Illu
ustration off A F-AHU uunit installeed at site
2.5 Defects Liability Peeriod
The projecct timeline for all hoospitals und
der the projject was fr
from June 2010 to
substantial//practical co
ompletion bby 12 Decem
mber 2011 and hand-oover to the Ministry
M
of Health. On completion of thhe works, inspections
i
took placee to advisee of any
unsatisfactoory workmaanship or bbuilding maaterials and
d a list wass prepared for
f each
site. As is standard practice for pphysical infrastructuree works, thee “Defects Liability
L
Period” undder the projject was 1 yyear, which
h meant the period of 3365 days caalculated
from the daate of comp
pletion of thhe works. The
T contracttor was respponsible to execute
all work off repair, ameendment, reeconstructio
on, rectification and maaking good defects,
imperfectioons or otherr faults as rrequired durring the defects liabiliity period. All
A such
outstandingg work waas carried oout by thee contractorr at his ow
wn expense. Final
completionn was reach
hed at the eend of the defects liab
bility periodd by 12 Deecember
2012.
3. Projeect Achievem
ments
This projecct was in support
s
of the Nation
nal Strategicc Plan for Controlling
g Avian
Influenza established
e
by the Minnistry of Heealth and th
he Ministry of Agricultture and
coordinatedd by the Staate Ministryy for Nation
nal Develop
pment Plannning demon
nstrating
strong natioonal ownersship.
18 Within the relatively short project period between June 2010 and December 2011,
isolation rooms with negative
pressure systems at ten
hospitals were developed –
from design, procurement
through implementation of the
works. Creating negative
pressure in the isolation rooms
allows air to flow into the
rooms
but
prevents
contaminated
air
from
escaping. This type of
isolation room facility, the
Handover-ceremony at hospital, Minister of Health
first ever in Indonesia, has
present.
greatly enhanced the nation’s
ability to manage infectious cases and limit transmission. Through the collective
efforts of various partners, the project achieved its aim of promoting the control of
Avian Influenza and pandemic preparedness throughout Indonesia and improved the
accessibility of quality healthcare services to the public. Owing to the INSPAI
programme, Indonesia is better equipped to handle and contain future flu pandemics.
Moreover INSPAI has provided
substantial support to the
capacity building in hospital
systems. As part of the INSPAI
project, UNOPS helped train
more than 225 healthcare
workers and technicians in
infection
prevention
and
operation and maintenance of
the isolation rooms.
Case management simulation
4. Lessons Learned
A significant problem was that the period available for the design, tendering and
implementation of isolation rooms was too short. This was the result of delays in
engagement of UNOPS and the requirement for retendering. In the case of the
isolation rooms, undertaking physical infrastructure works does not fall within
WHO’s mandate also contributed to this delay. UNOPS involvement in the INSPAI
programme did not come until later, as a mechanism to manage the procurement and
physical infrastructure processes. As a result of the late start, follow-up activities,
including defect rectification, testing and commissioning and competence
19 development through on-site training, and simulation exercises designed to develop
practical skills and take-over of sites were constrained. The exit strategy required
careful planning to take this into account. UNOPS therefore provided additional
training and capacity building in early 2012 to ensure a smoother transition.
It was necessary to reduce the number of isolation room facilities from 15 to 10 as per
the original plan of the INSPAI programme. As mentioned above, this was the first
time negative pressure isolation rooms were implemented in Indonesia. Moreover, it
was necessary to increase the overall budget, despite the reduction in the number
hospitals where isolation rooms were to be constructed. The costs of works could not
be verified up-front without first conducting detailed inspections and consultations
with hospital staff and other stakeholders which only occurred after the agreement
was signed.
During
project
implementation,
several limitations in the existing
hospital
infrastructure
were
uncovered. In order to provide quality
isolation rooms in accordance with
international standards and best
practices at each site, additional
variations had to be included.
Space was limited and structural
Externally installed RAHU
support insufficient at all hospital
sites. Recirculation air-handling units (RAHU) had to be relocated to the outside of
the buildings. Noise levels within the isolation rooms exceeded acceptable levels and
a system for noise abatement was necessary in order to make it more comfortable for
patients. Likewise, existing electrical, water and sanitation services were inadequate
and had to be upgraded at most hospitals.
There will be a need for national and local budget allocation for ongoing maintenance
of the isolation rooms within the Avian Influenza referral hospitals. Due to the
enhanced negative pressure systems in each hospital power consumption has
increased and appropriate stock levels for spare parts (i.e. fan belt, controls, sensors,
coils, condenser, compressor etc.) and consumables (i.e. filters) as well as regular
exercises to maintain staff's skills – especially where there is a high staff turn-over –
are considered essential.
20 Annex 1: Financial Statementss
21 22 Annex 2: Human Resources
UNOPS Indonesia Project Centre (IDPC)
Menara Ravindo 11th floor. Jl. Kebon Sirih Raya, Kav 75 Jakarta Pusat 10340. Office phone number :
+62 021- 3145031 ; Fax number : +62 021- 3905513.
Physical Infrastructure Design Unit (PIDU)
Nawala Road, Colombo 5, No.118/5, Sri Lanka
Phone : +94 (11) 2 506 096
Fax : +94 (11) 2 506 097
No
Name
Position
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Asiani Tamimi
Brett More
Bryan Taylor
Budi Hartanto
David Mahendra
Elfian Syamsu
Gordon Nuttall
Gunawan Napitupulu
Henny Dwi Purnamasari
John Girsang
Lina Arumsari
Nurhafni Hanafiah
Olivia Sope
Samantha Jayasekara
Sigi Prabowo
Suneeram Brenda
Ridwan Ridwansyah
Tonny Talomanafe
Tony Soetanto
Waryanti Setyawan
Yogi Anggoro
Yoni Herbowo
Yosafat Zakaria
Yuen Pak Leung (PL)
Zulfikri Latief
Admin Assistant
PIDU Architect
Project Manager
Procurement Associate
Quantity Surveyor
Quantity Surveyor / Senior Site Engineer
PIDU Manager
Site Engineer
Quality Inspector
Quality Inspector
Procurement Associate
Drafter
Database Associate
PIDU Services Engineer
Site Engineer
Design Office Manager
Finance Officer
Site Engineer
Site Engineer
Admin/Finance Assist
Site Engineer
Finance Associate
Site Engineer
Expert Advisor- Hong Kong
HVAC/Mechanical & Electrical Engineer
23 Annex 3: Key Dates and Achievements
No
6
7
8
Key Deliverables
Introduction and Presentation on isolation room development and
proposed PIP at Project Technical Implementation Committee meeting
Endorsement of Project Steering Committee (PSC) that UNOPS to
implement the isolation room development
Presentation of PIP on the emerging diseases national meeting and
Signing of Site Agreements with each of the 15 selected AI referral
hospitals.
Approval of the final version of the IAA and PIP and signing of the
IAA by Regional Director WHO and Regional Director UNOPS and
signing the partnership agreement by MoH
Developments of Term of Reference (TOR) and advertisement of
positions for isolation room development at local newspaper
(KOMPAS) and UNOPS website
Project start-up meeting and select site visits
Request for 1st installment of the IAA to WHO
1st installment received by UNOPS
9
Project Steering Committee Meeting
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
Project Technical Implementation Committed Meeting
Management Committee Meeting
Invitation for Pre-qualification #1
Management Committee Meeting
Verification and measure-up for all 15 hospitals completed
Invitation for Pre-qualification #2
Pre-bid conference Phase 1
Project Steering Committee Meeting
Bid opening – Phase 1
Re-tender – Invitation to Bid Phase 1
Management Committee Meeting
Invitation to Bid Phase 2
Project Technical Steering Committee Meeting
Amendment to ITB Phase 2 to include more sites
Bid opening Phase 2
UNOPS HQ Contracts and Property Committee (HQCPC) approved
award of Phase 1 hospitals subject to contingency arrangements
Management Committee Meeting
Start-up meeting with Phase 1 hospitals
Project Technical Steering Committee Meeting
Start-up meeting with Phase II hospitals
Project Technical Steering Committee Meeting
Project Steering Committee Meeting
INSPAI One Health Seminar
Monitoring Meeting Defects Liability Period
Final Completion
1
2
3
4
5
25
26
27
28
29
30
31
32
33
34
24 Time
10-11 Nov 2009
3 Mar 2010
7 Apr 2010
Jun 2010
5 Jun 2010
16-18 Jun 2010
14 Jul 2010
Aug 2010
16 September
2010
24 Sep 2010
11 Oct 2010
16 Oct 2010
26 Nov 2010
31 Nov 2010
4 Dec 2010
8 Dec 2010
23 Dec 2010
17 Jan 2011
7 Feb 2011
8 Feb 2011
22 Feb 2011
10 Mar 2011
15 Mar 2011
31 Mar 2011
31 Mar 2011
04 Apr 2011
11 Apr 2011
30 May 2011
15 Jun 2011
24 Nov 2011
12 Dec 2011
28-29 May 2012
20 Jul 2012
12 Dec 2012