Indonesia's iSIKHNAS

Case Study: Indonesia

 

Most recently, the Omnisyan team has been working in Indonesia, with colleagues in the Directorate-General of Livestock and Animal Health Services, Ministry of Agriculture.  Our work was one component of a larger capacity building programme in partnership with the Department of Agriculture, Australia to improve the detection and management of emerging infectious diseases - Australia-Indonesia Partnership for Emerging Infectious Diseases (AIP-EID).

Ever since anyone could remember, animal health disease data reporting was a slow trudge on a sticky, one way street.  Every month, staff from the 500 district offices composed paper-based reports of aggregated, monthly data about various national priority diseases.  These were eventually signed off on, rubber stamped and sent the to provincial departments. These reports were arduous and time consuming to compile and dependent on memory or scribbled records. They perhaps weren't always accurate, were rarely produced on time and they occupied a considerable amount of staff resources.  At the provincial office, the district information was collated again, further aggregated and sent to the regional office.  More handling, a few more rubber stamps later and the summarised report was sent through to the central level staff in Jakarta.  If they were lucky, by the time the regions sent through the data, it was only 4 months' out of date.  A pretty sorry scene, but not an altogether unfamiliar one.  A year or so later, a thick book would be published and sent back to districts, detailing the fully collated, national animal disease data.

Three years ago, a small team of creative epidemiologists, visionary managers and senior decision makers got together and dared to imagine an entirely new way of collecting, managing and analysing Indonesia's animal health information.  Looking back, you could be forgiven for thinking we were all foolhardy and ignoring all the signs that were pointing to doom - 250 million people serviced by 500 autonomous administrative units spread over 17,000 islands; great cultural and linguistic diversity; 90% of the population engaged in traditional forms of agriculture.  Many millions of small-holder farmers, each with animals representing most of their life's savings.  Poorly trained and equipped animal health staff and some ambitious national goals for self-sufficiency.  Not really the ideal environment for creating a new, integrated national animal health information system.

But with courage, faith and optimism, our multidisciplinary team went forth and iSIKHNAS was born.  Twenty years of experience in information system design and implementation, unbridled creativity, fearless design, tenacious programming, incredibly supportive and enthusiastic management, great Indonesian leadership and vision, technology ready, and everyone just screaming for change - an alignment of the planets occurred. 

What was only ever intended as a pilot in 3 districts has now been adopted as a national system with over 20% of districts trained and actively adopting the system (feature by new feature).   Before the end of 2015, fully under the steam of the Government of Indonesia, the rest are inline for inclusion.  What was basically intended as a field disease reporting system integrated with existing laboratory data management systems has now grown into what we think has to be the most comprehensive and integrated animal health information system in the world.

So what concrete changes have occurred?   What can Indonesia do now that they couldn't three years ago?   Where are the tangible benefits?

Without by any means trying to be exhaustive, farmers can now, for example

  • contact the veterinary services more easily and with greater confidence.
  • report signs of disease and get veterinary assistance
  • receive a unique movement certificate ID on their phone.
  • receive lab results for tests on their phone.
  • send an oestrus alert to inseminators in the area.
  • individually identify all his cattle.
  • register new cattle or transfers in ownership.
  • keep all his production and reproduction records secure and accessible.
  • be better supported by animal health staff in his district because the the system is helping their work.
  • feel more reassured that the risk of disease through animal movements in her area are being much better managed.

The Districts and Provinces and their staff can now

  • See what movements are coming in and out of their district, and see the disease status of the district of origin.
  • Detect patterns in routine reporting so that more farmers can benefit from wider treatments instead of just one to one.
  • Tell a farmer the results of lab tests using a query via mobile phone.
  • Get a recent list of cases, or a list of cases in any village to check up on cases.
  • Start to build proof of freedom from disease in areas using the village level negative reporting.
  • See if vaccination campaigns are really working.
  • Trace the origins of outbreaks using the Movement data
  • Consult and update village level animal population figures when planning for vaccination campaigns or dealing with crises
  • Analyse treatments to see if they are effective, appropriate or over or incorrectly prescribed
  • Monitor staff and resources and advocate for new budget based on real evidence. 
  • Measure the real demand for services and how well staff and resources are meeting these needs.
  • Analyse routine disease for patterns - seasonal diarrhoea, skin or eye problems and can be dealt with more efficiently – not on individual basis but at village level which is cheaper and more effective.
  • Measure slaughter targets accurately.
  • Analyse insemination records for semen integrity or technical efficacy.
  • Feel infinitely more confident about their early detection capacity and the tools they have to deal with outbreaks.
  • Get access to expert assistance more easily and efficiently in times of difficulty.
  • Put much more trust in all the data because it is entered at source, by the person, at the time of the event without being handled again, collated (aggregated).
  • Set more informed and realistic production goals, and monitor them using the insemination and production records.
  • Link photo IDs to animal identification if desired to assist with security and validation of ownership.
  • Access detailed case information in the field just using a phone.
  • Update village animal population records at any time – without having to rely on an infrequent, costly and onerous national census.
  • Capture an animal’s full breeding history and productivity.
  • Staff can be better supported and training needs identified.  Supervisors can actually see where the weaknesses are and respond to them faster.
  • Advocate for better budget and for more resources using evidence-based decision making.
  • Involve human health staff in alerts and management of zoonotic events.

The laboratories can now

  • receive alerts from the field as soon as samples are taken.
  • connect their data to unique case IDs.
  • enjoy automated client reports once results are in.
  • get access to detailed case reports and be more involved in the diagnostic process.
  • take advantage of the system's computing power for epidemiological, activity, and performance analysis.

Public Health department can now

  • see, real time, the slaughter records for the entire country
  • reassure consumers about meat safety standards
  • contribute to surveillance through meat inspection reporting
  • reward staff for meeting quotas, reporting and showing measurable improvement

The central level decision-makers and epidemiologists can now

  • Can provide better assistance to outbreaks or other crises
  • Set evidence-based priorities based on science, not just guess work,
  • Set realistic national goals for self-sufficiency,
  • Monitor adherence to regulation,
  • Boast an astonishing level of transparency
  • Fulfill regional and international reporting commitments with the press of a button, quite literally.
  • and on and on and on it goes

What was once a data impoverished veterinary service is now data rich, emboldened by potential and in charge of guiding their own development, using the power of true, current and accurate evidence.

The things we learned along the way are what allows us to help you create your new system with absolute confidence and in a spirit of great optimism.  But be careful, it's infectious.