The AeHIN team, led by Dr. Guardian Yoki Sanjaya (the first person on the left), visited the Dr. Soetomo Regional General Hospital in Surabaya, East Java Province, to observe a landscape assessment.

Indonesia faces a critical challenge in ensuring equitable access to quality healthcare and tackling the growing threat of antimicrobial resistance (AMR). The availability of good-quality health data to various actors and decision-makers is critical to addressing complex and interconnected issues such as AMR. The Ministry of Health (MoH) of the Republic of Indonesia and FIND have forged a strategic collaboration and identified digital health and AMR as two of the areas of cooperation in the joint action plan, in line with Indonesia’s health transformation agenda. Specifically, developing and adopting a standards-based approach to data management is important in promoting the availability of quality data. Through the Health Technology Transformation and Digitalization Team (TTDK), formerly Digital Transformation Office (DTO), in Indonesia, the MoH has made big strides in developing data standards for use cases such as tuberculosis (TB) and immunization. 

In collaboration with the MoH, FIND partnered with the Asia eHealth Information Network (AeHIN) under the ‘The Development of Interoperability Data Standards (IDS) for Fast Healthcare Interoperability Resources (FHIR)-based Antimicrobial Resistance One Health Surveillance (FAMROHS)’ project. Guided by the One Health approach, this project aims to enhance the availability of quality AMR surveillance data across human and animal health sectors in Indonesia by developing interoperability data standards leveraging international standards like FHIR. 

As part of this initiative, a comprehensive landscaping exercise was conducted to examine the current state of AMR surveillance policies, practices, and systems. The study employed a qualitative approach, gathering insights through stakeholder interviews, field observations, and consultative workshops. Seventeen out of 25 stakeholder groups from the government sector, professional associations, international development partners, and relevant private sectors accumulated 28 hours of in-depth discussions, which provided valuable information on the challenges and opportunities in AMR surveillance in Indonesia. Field observations were conducted at five hospitals, two community health centers (puskesmas), two national reference laboratories, and one veterinary hospital to assess on-site practices and systems, offering a comprehensive understanding of AMR surveillance implementation. A series of consultative workshops was also held to triangulate findings from the interviews and observations. 

Surveillance systems of AMR and AMU/C in Indonesia (Source: Preliminary Report: Development of Interoperability Data Standards for Antimicrobial Resistance One Health Surveillance: Landscape Analysis Report and Recommendations.)

Opportunities in AMR Surveillance: use of data recording and reporting systems

Indonesia is making progress in addressing AMR and antimicrobial use and consumption (AMU/C) through data recording and reporting systems, especially in the human and animal health sectors compared to the environment sector. The rapid development in these sectors can be attributed to the heightened awareness of AMR’s impact and the efforts to mitigate its consequences. National ministries and directorates have tailored their data collection frameworks to meet local needs, with some indicators aligning with global standards. For example, AMR data from hospitals are reported using the WHO’s Global Antimicrobial Resistance Surveillance System (GLASS), while the animal sector, particularly in chicken farms, uses digital platform ANImal antiMicrobial USE (ANIMUSE) by the World Organisation for Animal Health (WOAH).

Challenges in AMR surveillance: data integration

Despite these advancements, Indonesia faces significant challenges in data integration. Currently, AMR and AMU/C data are reported across various government bodies, leading to fragmented systems. This sector-specific approach, while ensuring specialized oversight, hampers cross-sector collaboration and integration. In the human health sector, hospitals and laboratories utilize platforms like laboratory information systems (LIS) and WHONET, a microbiology laboratory database software, to record AMR data, while AMU and AMR data are incorporated into hospital information systems (HIS). However, data sharing between these systems is hindered by a lack of interoperability standards, creating inefficiencies and potential inconsistencies.

In terms of reporting, data is submitted via various channels, including email, Indonesia’s online hospital information system known as Sistem Informasi Rumah Sakit Online (SIRS Online),  and GLASS reporting systems. Although these methods provide some level of structure, concerns regarding data security, standardization, and timeliness persist. The emerging One Health initiative, part of Indonesia’s national electronic medical records system, holds promise for integrating AMR and AMU/C data into a unified platform, potentially improving data quality and real-time surveillance.

The study also highlights significant challenges in the animal health sector. The Ministry of Agriculture’s AMR surveillance network, consisting of regional laboratories and an information management system called Integrated Veterinary Laboratory Information System (IVLAB), faces issues such as limited sampling capacity and the lack of specialized data management applications. Similarly, in the aquaculture sector, data on AMU and AMR are reported separately through different directorates, further complicating data integration.

Conclusion

Overall, the fragmentation of AMR and AMU/C data collection and reporting in Indonesia highlights the critical need for a more integrated approach. Harmonizing reporting systems, creating data-sharing protocols, and developing interoperable platforms would significantly enhance the nation’s ability to monitor and respond to AMR threats. This integration would support a more effective One Health approach to AMR surveillance, enabling better policymaking and fostering more coordinated responses to AMR across human, animal, and environmental sectors. Moving forward, the development of more streamlined and standardized data reporting systems is critical to effectively address AMR.

 

For more information about this project please reach out to:

AeHIN at | secretariat.indonesia@aehin.net | secretariat.indonesia2@aehin.net 

UGM at | anis.fuad@gmail.com 

FIND Digital Health at | Joseph.Njunge@finddx.org | santi.maulintania@finddx.org