Evaluation of the Indonesian Early Warning Alert and Response System (EWARS) in West Papua, Indonesia
Mersi K Manurung1, Sarce EN Reo2, Jerico F Pardosi3, David J Muscatello4
1 University of New South Wales, Kensington, New South Wales, Australia; Health Department of West Papua Province, Manokwari, Indonesia
2 University of New South Wales, Kensington, New South Wales, Australia; Health Department of Kupang Regency, East Nusa Tenggara, Indonesia
3 Queensland University of Technology, Brisbane, Queensland, Australia
4 University of New South Wales, Kensington, New South Wales, Australia
Dr David J Muscatello
University of New South Wales, Kensington, New South Wales
Source of Support: This research received no specific grant from any funding agency in the public, commercial or not-for-profit sector, Conflict of Interest: Mersi K Manurung is employed by the Health Department of West Papua Province, where the study was conducted. To limit conflict of interest, interviews were conducted by an Indonesian-speaking coauthor, Sarce EN Reo, who is not employed by the Health Department of West Papua Province. All authors declare no other conflict of interest
Background: The Early Warning and Response System (EWARS) is Indonesia’s national syndromic and early warning surveillance system for the rapid detection of infectious diseases and outbreaks. We evaluated EWARS in the remote West Papua province of Indonesia.
Methods: Structured telephone interviews were conducted with 11 key informants from West Papuan health services. EWARS data were analysed for usefulness of reporting.
Results: Most respondents reported that EWARS is important and useful in improving early detection of outbreaks. The system has led to increased disease control coordination among health jurisdictional levels in the province. However, respondents noted that the limited number of districts involved in the system affected representativeness, and some stated that only about 30–35% of districts in each regency were involved and trained in EWARS reporting, partly owing to lack of a mobile telephone network. Barriers to complete reporting and response to alerts included limited human and funding resources for surveillance, lack of epidemiological training, and technical limitations imposed by limited internet and mobile communication infrastructure in this remote region.
Conclusion: Great progress has been made in integrating West Papua into a nationally consistent disease and outbreak detection system. Strategies for addressing barriers resulting from remoteness, constrained human, funding and laboratory resources, lack of training, and limited internet and communications infrastructure are needed if EWARS in West Papua is to advance.