Overview of the Implementation of the Early Warning Alert Response System (EWARS) at the Suak Ribee Public Health Center, West Aceh District

Mardi Fadillah; Onetusfifsi Putra; Perry Boy Chandra Siahaan

doi:10.35308/j-kesmas.v12i2.14870

Overview of the Implementation of the Early Warning Alert Response System (EWARS) at the Suak Ribee Public Health Center, West Aceh District

Mardi Fadillah, Onetusfifsi Putra, Perry Boy Chandra Siahaan

Abstract

The Early Warning Alert and Response System (EWARS) is an important system for early detection and response to extraordinary events (KLB) in health facilities. The Suak Ribee Public Health Center has implemented EWARS, but evaluation of its implementation and operational challenges is still needed. This study aims to analyze the accuracy and completeness of EWARS reporting at the Suak Ribee Public Health Center and to identify challenges and strategies for improving the quality of the system. A descriptive study was conducted through observation and interviews with surveillance officers at the Suak Ribee Public Health Center. EWARS report data for the 2022–2024 period were analyzed quantitatively for accuracy and completeness, and qualitatively to identify obstacles and recommendations for improvement. The accuracy and completeness of reporting reached 100% every year, demonstrating the consistency and effectiveness of the reporting system. The main challenges encountered are limited internet connectivity and funding support, which could potentially affect the sustainability of the system. Improvement strategies include implementing a hybrid offline-online reporting system, increasing human resource capacity through training and clear SOPs, and collaborating with the Health Office, NGOs, and the private sector for operational and funding support. Although reporting is already optimal, improvements in infrastructure, funding, and human resource capacity are still needed to maintain the sustainability of EWARS. The implementation of these strategies can strengthen the surveillance system, support early detection, and improve the response to outbreaks in the working area of the Suak Ribee Public Health Center.

Keywords

Accuracy of reporting; Completeness of reporting; EWARS; Health surveillance; Suak Ribee Public Health Center

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References

Aisyah, D. N., Setiawan, A. H., Lokopessy, A. F., Aryanti, C., Mayadewi, Endryantoro, M. T. A., Wibowo, V., Disviana, S., Laksana, I., Aviandito, M., Kozlakidis, Z., & Manikam, L. (2025). Assessing Internet Quality Across Public Health Centers in Indonesia : Cross-Sectional Evaluation Study. JMIR Medical Informatics, 13, 1–19. https://doi.org/10.2196/65940

Akhlaq, A., Mckinstry, B., Muhammad, K. Bin, & Sheikh, A. (2016). Barriers and facilitators to health information exchange in low- and middle-income country settings : a systematic review. Health Policy and Planning, 31(9), 1310–1325. https://doi.org/10.1093/heapol/czw056

Archer, N., Lokker, C., Ghasemaghaei, M., Diliberto, D., & Archer, N. (2021). eHealth Implementation Issues in Low-Resource Countries : Model , Survey , and Analysis of User Experience Corresponding Author : Journal of Medical Internet Research, 23(6), 1–12. https://doi.org/10.2196/23715

Aron, M. B., Nkhomah, W. E., Dullie, L., Matanje, B., Kachimanga, C., Ndarama, E., Chibvunde, S., Mulwafu, M., Banda, G. M., Mpinga, K., Kutsamba, M., Mikwamba, M., Mphande, I., & Matiya, K. (2024). Towards improving district health information system data consistency, report completeness and timeliness in Neno district, Malawi. BMC Medical Informatics and Decision Making, 24, 1–11. https://doi.org/10.1186/s12911-024-02802-x

Baker, R. E., Yang, W., Vecchi, G. A., Metcalf, C. J. E., & Grenfell, B. T. (2020). Susceptible supply limits the role of climate in the early SARS-CoV-2 pandemic. In Science (Vol. 369).

Depkes RI. (2016). Sistem Kewaspadaan Dini dan Respon (SKDR): Manual Petugas Puskesmas.

Fitriani, H., Hargono, A., & Isfandiari, M. A. (2023). Development of Use of Digital Technology Surveillance System Early Awareness and Response (SKDR)/EWARS In Indonesia. Majalah Saintekes, 10(2), 103–116.

Gaetano, S. De, Ponzo, E., Midiri, A., Mancuso, G., Infortuna, G., Zummo, S., Biondo, C., & Filippone, D. (2025). Global Trends and Action Items for the Prevention and Control of Emerging and Re-Emerging Infectious Diseases. Hygiene, 5(18), 1–23. https://doi.org/10.3390/ hygiene5020018

Hardhantyo, M., Djasri, H., Nursetyo, A. A., Yulianti, A., Adipradipta, B. R., Hawley, W., Mika, J., Praptiningsih, C. Y., Mangiri, A., Prasetyowati, E. B., & Brye, L. (2022). Quality of National Disease Surveillance Reporting before and during COVID-19 : A Mixed-Method Study in Indonesia. International Journal of Environmental Research and Public Health, 19. https://doi.org/10.3390/ ijerph19052728

Haryanto, B., Nugroho, A., & Setiawan, R. (2021). Implementation of early warning and response system in primary health care settings in Indonesia: A case study in Aceh Province. Jurnal Kesehatan Masyarakat Nasional, 16(2), 101–110.

Ikuta, K. S., Swetschinski, L. R., & Aguilar, G. R. (2022). Global mortality associated with 33 bacterial pathogens in 2019 : a systematic analysis for the Global Burden of Disease Study 2019. Lancet, 400, 2221–2248. https://doi.org/10.1016/S0140-6736(22)02185-7

Jetoh, R. W., Yeabah, T. O., Shobayo, B. I., Kokro, J. S., Brown, L., Lamorde, M., Harries, A. D., & Dewitt, M. E. (2026). Adoption and use of the 7-1-7 timeliness metrics for detection , notification , and early response actions to public health events : an observational study in Liberia , January 2024 – June 2025. Wellcome Open Research, 10, 1–31. https://doi.org/10.12688/wellcomeopenres.24992.2

Kemenkes RI. (2015). Indikator nasional kelengkapan dan ketepatan laporan mingguan di Puskesmas.

Kementerian Kesehatan Republik Indonesia. (2016). Pedoman Pelaporan dan Pemantauan EWARS. Kemenkes RI.

Kementerian Kesehatan Republik Indonesia. (2021). Pedoman Sistem Kewaspadaan Dini dan Respon (SKDR). Kemenkes RI.

Khubone, T., Tlou, B., & Mashamba-thompson, T. P. (2020). Electronic Health Information Systems to Improve Disease Diagnosis and Management at Point-of-Care in Low and Middle Income Countries : A Narrative Review. Diagnostic, 10, 1–10. https://doi.org/10.3390/diagnostics10050327

Lesmana, A. E., Sihole, P. O., Anggreini, A. L., Kiswanto, J., Rochmah, D. L., & Wasir, R. (2024). Challenges and opprtunities for Implementing The EWARS System in Indonesia : Literature Riview. Jurnal Kesehatan Tambusai, 5(2), 4878–4887.

Li, Z., Meng, F., Wu, B., Kong, D., Geng, M., Qiu, X., Cao, Z., & Li, T. (2024). Reviewing the progress of infectious disease early warning systems and planning for the future. BMC Public Health, 24, 3080–3093. https://doi.org/10.1186/s12889-024-20537-2

Meckawy, R., Stuckler, D., Mehta, A., Ahdal, T. Al, & Doebbeling, B. N. (2022). Effectiveness of early warning systems in the detection of infectious diseases outbreaks : a systematic review. BMC Public Health, 22, 1–62. https://doi.org/10.1186/s12889-022-14625-4

Nansikombi, H. T., Kwesiga, B., Aceng, F. L., Ario, A. R., Bulage, L., & Arinaitwe, E. S. (2023). Timeliness and completeness of weekly surveillance data reporting on epidemic prone diseases in Uganda, 2020 – 2021. BMC Public Health, 23, 1–12. https://doi.org/10.1186/s12889-023-15534-w

Nascimento, I. J. B. do, Abdulazeem, H., Vasanthan, L. T., Martinez, E. Z., Zucoloto, M. L., Østengaard, L., Azzopardi-Muscat, N., Zapata, T., & Novillo-Ortiz, D. (2023). Barriers and facilitators to utilizing digital health technologies by healthcare professionals. NPJ Digital Medicine, 1–28. https://doi.org/10.1038/s41746-023-00899-4

Nsubuga, P., White, M. E., Thacker, S. B., A., M. A., Blount, S. B., Broome, C. V., Chiller, T. M., Espitia, V., Imtiaz, R., Sosin, D., Stroup, D. F., Tauxe, R. V., Vijayaraghavan, M., & Trostle, M. (2006). Strengthening Health Systems. In Public Health Surveillance: A Tool for Targeting and Monitoring Interventions (pp. 997–1015).

Simamora, A., Subuh, & Ernawati. (2025). Strategi Meningkatkan Surveilans Penyakit yang Dapat Dicegah dengan Imunisasi di Kabupaten Tanjung Jabung Timur. Jurnal Ilmiah Kesehatan, 24(2), 81–92. https://doi.org/10.33221/jikes.v24i02.3661

Song, Y., Ma, R., Liu, J., Guo, Y., & An, S. (2025). How can timeliness and accuracy be balanced ? The surveillance information reporting mechanism for public health emergencies based on the online direct reporting system. BMC Public Health, 25, 3148–3169. https://doi.org/10.1186/s12889-025-24637-5

Susanti, T. P. (2024). Tantangan dan Solusi Terkini dalam Penanganan Penyakit Menular. Surabaya Biomedical Journal, 4(1), 40–46.

World Heath Organization. (2022). Early warning surveillance systems for epidemic-prone diseases: Implementation framework. Geneva.

World Heath Organization. (2025). Advancing the Responsible Use of Digital Technologies in Global Health A report of the World Health Organization Science Council. https://cdn.who.int/media/docs/default-source/research-for-health/science-council_report_7january2025_for-public-comment.pdf

Zavuga, R., Okello, P. E., Migisha, R., Gonahasa, D. N., Kadobera, D., Bulage, L., Aceng, F. L., Kayiwa, J., & Makumbi, I. (2023). Timeliness and completeness of monthly disease surveillance data reporting , Uganda , 2020-2021. PanAfrican Medical Journal, 46(3), 1–10.

DOI: https://doi.org/10.35308/j-kesmas.v12i2.14870