As the COVID-19 pandemic made its way around the world, many countries struggled to present a united healthcare response. Perhaps nowhere has that challenge been greater than in Indonesia, a country of more than 14,000 islands where checking the spread of the virus fell to a network of 514 administrative districts over 35 provinces, each with autonomy to shape the local pandemic response.

As president of the Indonesia Epidemiological Association (PAEI), a professional organization of epidemiologists with 32 branches across Indonesia, it was a challenge Dr. Hariadi Wibisono had faced before.

“During the bird flu epidemic in 2008, I was the director of Vector Borne Disease Control Programs at the Ministry of Health, and we learned that not all policy from the national level was recognized at the district level,” Wibisono said. “When COVID-19 hit, we faced that same problem.”

As COVID-19 took hold in Indonesia, this dilemma left many district-level healthcare workers and epidemiologists ill-trained to respond, creating holes in the country’s surveillance network.

“We focused on the epidemiological workforce, and we identified that there was a problem at the front lines with detecting COVID-19 cases and conducting contact tracing and specimen collection,” Wibisono said. “That’s the backbone of containment in this pandemic.”

With funding from the CDC Foundation, PAEI launched a project to strengthen the capacity of the surveillance workforce at both the national and the sub-national levels. To do that, PAEI provided training and technical assistance for surveillance officers at the sub-national level and worked with epidemiologists to implement robust data collection and analysis. In addition, PAEI established an epidemiology task force to support provincial and district health offices and conducted infection prevention and control training in selected hospitals.

“We thought there was a big opportunity for us to help strengthen the frontline capacity, particularly in epidemiological investigation and contact tracing,” Wibisono said.

Working in four provinces hard-hit by COVID-19, the goal of the project was to build an epidemiological surveillance system trained to collect, interpret and present valid COVID-19 data, while also training frontline healthcare workers to protect themselves—knowledge that was lacking in many districts in the early days of the pandemic. Less than three months after the first case of COVID-19 was confirmed in Indonesia in early March, 190 Indonesian doctors and paramedics had died from the virus, a figure that spurred PAEI to action.

“My personal feeling was that it wasn’t fair that the people on the front lines dealing with COVID were passing away,” Wibisono said. “We decided we had to focus on infection control in hospitals as well as building surveillance capacity at the health center level.”

While it is still too early to determine the success of the project from disease reduction figures alone, Wibisono said the project reached its goal of strengthening the disease surveillance network in the target areas. By the end of the five-month project in September 2020, the PAEI intervention helped to standardize the district-level epidemiologic investigation forms and implemented a real-time contact tracing data management system where none had existed. Further, the percentage of provincial and district health offices in the project area who used the proper data collection framework rose from just 9 percent in a pre-project assessment to 75 percent by project’s end.

As Wibisono and his team at PAEI continue to assess the impact of the project, they remain thankful for the support of the CDC Foundation, which from the outset, Wibisono said, understood what PAEI hoped to accomplish.

“Now that we are connected with the CDC Foundation, we hope to continue this collaboration,” Wibisono said. “They really understood our mission and their support has been very helpful for us.”