Minahasa district animal health officer conducted rabies response in the field after receiving data from SIZE Nasional (©FAO/Sadewo)

Over recent decades, Indonesia has been affected by several zoonotic disease outbreaks, including highly pathogenic avian influenza, rabies, and anthrax. These outbreaks posed substantial threats to public health and the economy, and it became obvious that the country needs to fight such diseases comprehensively.

The cornerstone of infectious disease control hinges on prompt detection and the availability of reliable data, which are critical for the effective and comprehensive management of disease outbreaks.

Field officers play a pivotal role in zoonotic and infectious disease control. Their responsibilities include reporting cases as they occur in the field, enabling a swift response to curb the spread of diseases. "Coordinating efforts between veterinary medicine and public health has been a significant hurdle", says Lalu Madahan, an animal health officer from the West Nusa Tenggara (NTB) Provincial Health Service, as a major challenge.  Madahan also stressed the urgent need for enhanced collaboration in disease reporting across the human, animal, and wildlife health sectors.

Properly addressing and managing emerging infectious diseases (EIDs) and zoonotic cases necessitates prompt and proactive measures. This is where the One Health approach becomes vital, integrating and coordinating efforts across public, animal, and wildlife health sectors. This holistic approach ensures a comprehensive and efficient response to health threats at the interface of humans, animals, and ecosystems.

Breaking down silos through technology

SIZE Nasional mobile application and website (©FAO/Saskia Soedarjo)

Minahasa district animal health officers shared disease data and reports through SIZE Nasional (©FAO) 

To effectively prevent and control zoonotic diseases, a robust, integrated information system must underpin the One Health collaboration. This system should facilitate real-time data sharing among various stakeholders across all health components. Such a system is not just a tool but a critical infrastructure that ensures timely and coordinated responses to health threats, leveraging the collective insights and expertise of diverse health sectors. This integrated approach is essential for a comprehensive and effective disease prevention and control strategy.

The Coordinating Ministry of Human Development and Cultural Affairs, The Ministry of Agriculture, the Indonesian Ministry of Health, the Ministry of Communication and Information Technology, the Ministry of Home Affairs, the Ministry of Environment and Forestry, the Geospatial Information Agency, the Food and Agriculture Organization of The United Nations (FAO), the World Health Organization (WHO), the Indonesia One Health University Network (INDOHUN) have jointly developed a One Health information sharing platform called SIZE Nasional (Sistem Informasi Zoonosis dan EID Nasional/National Zoonosis and EID Information System) since 2020, and this initiate is supported by the United States Agency for International Development (USAID)

The SIZE application connects three health surveillance systems in three agencies, namely the Early Awareness and Response System /Sistem Kewaspadaan Dini dan Respon (SKDR) at the Ministry of Health, the National Integrated Animal Health Information System/Sistem Informasi Kesehatan Hewan Nasional (ISIKHNAS) at the Ministry of Agriculture, and the Wildlife Health Information System/Sistem Informasi Kesehatan Satwa Liar (SEHATSATLI) at the Ministry of Environment and Forestry.

Coordinating Minister for Human Development and Cultural Affairs, His Excellency Muhadjir Effendy, launched SIZE Nasional in December 2023 with the anticipation that through this app, the control of numerous zoonotic diseases could be carried out more effectively and measurably. The launch of SIZE Nasional also became a major collaborative achievement in tackling the challenge of integrating data and reports on disease cases from the field across the sectors.

“SIZE Nasional underlines and supports the roles of field officers from the three different sectors. This platform also facilitates cross-sectoral collaboration and coordination from field officers to decision-makers”, says Luuk Schoonman, Team Leader of the FAO Emergency Centre for Transboundary Diseases (ECTAD) in Indonesia. ”Sharing data through SIZE benefits by producing strategies to prevent and control EID and zoonoses”, adds Schoonman further.

The initiation of the integrated information system is specifically designed to address the escalating threat of various zoonoses, including rabies, anthrax, avian influenza, and other zoonotic diseases. Additionally, establishing SIZE Nasional is a strategic move to enable swift detection and response to any emerging infectious diseases that can potentially escalate into extraordinary events, outbreaks, or even pandemics. This system underscores a proactive approach, focusing on early detection and rapid response, which are crucial in mitigating the impacts of such health crises.

HE the Minister of Coordinating Ministry of Human Development and Cultural Affairs gave appreciation to FAO ECTAD Indonesia during SIZE Nasional launching event (©FAO/Saskia Soedarjo)

At the launch event, HE the Minister expressed gratitude to FAO Indonesia and other development partners for their pivotal role in initiating and offering technical assistance to develop SIZE Nasional. "Our collective responsibility now is to ensure the enduring success of SIZE Nasional so it’s benefits can be experienced nationally. Looking ahead, FAO is committed to fostering further innovations to enhance the control of zoonoses and EIDs in Indonesia", stated Rajendra Aryal, FAO Representative for Indonesia and Timor Leste. This acknowledgement highlights the importance of continued collaboration and innovation in tackling health challenges effectively in Indonesia.

Improved response in the field

A puppy in Minahasa district received rabies vaccine (©FAO/Sadewo)

SIZE has already been tested in five areas with a risk of zoonoses, including Minahasa (North Sulawesi), Ketapang (West Kalimantan), Boyolali (Central Java), Bengkalis (Riau), and Mataram (West Nusa Tenggara). Gradually, this application will be adopted by all districts/cities in 38 provinces across Indonesia.

Field officers from Minahasa and West Nusa Tenggara (NTB) districts find SIZE Nasional useful and beneficial for improving their work. “With SIZE, we can quickly find out about diseases that have spread in the community, allowing us to respond to the cases directly in the field,” says Endang Rosidayanti, West Sumbawa Regency Agriculture Service Officer.

The testimonial from the Minahasa district government in North Sulawesi province also supports this view.  Since the introduction of SIZE in 2020 to the health officers in the Minahasa district, the number of rabies-transmitting animal bite case reports has remarkably increased.

 “SIZE National is very helpful; we now receive real-time reports daily through one app”, says Louise Kumaunang, Head of the Animal Health Section of Agriculture, Livestock, and Plantation Office of Minahasa district. She discovered that this new integrated app simplifies the disease reporting process.

“From now on, we will use SIZE Nasional to help us coordinate and collaborate across sectors to combat zoonotic diseases in our district,” expressed Nismawardah, Bima District Health Service Officer. SIZE Nasional is set to be employed at various administrative levels, including districts, cities, and the national government, functioning as a One Health platform. This implementation will empower Indonesia to enhance its capabilities in preventing, detecting, and responding to zoonoses and Emerging Infectious Diseases (EIDs). The widespread use of SIZE Nasional across different levels of governance underscores its significance as a comprehensive tool in strengthening the nation's health infrastructure against these health threats.