Developing community-based surveillance systems for vaccine-preventable diseases: lessons learned from Indonesia

Abstract

Background: Routine immunization was severely disrupted during the COVID-19 pandemic, leading to a resurgence of vaccine-preventable diseases (VPDs) in Indonesia. While community-based surveillance (CBS) was instrumental in COVID-19 detection, its role in VPD monitoring remains limited. Objective: This study explores practices, challenges, and future opportunities to develop a CBS for vaccine-preventable diseases (VPDs). Methods: We applied a convergent mixed-method study in Sleman regency, Indonesia. We interviewed 41 stakeholders–health staff, community health volunteers (CHVs), and community leaders–and surveyed 70 caregivers of under-5. Interviews were analysed using content analysis according to the health systems combined with public health surveillance frameworks. The survey was examined descriptively. Results: Existing community involvement in communicable disease surveillance includes systematized reporting for TB, dengue, and COVID-19 using tools like mobile apps and formal guidelines, and non-systematized case reporting for leptospirosis and VPDs. While health facilities have established procedures for recording, reporting, and responding to VPDs, community roles remain undefined. Challenges include CHVs’ limited surveillance knowledge, high workloads, lack of digital literacy, inconsistent incentives, absence of case definitions and reporting procedures, and resource shortages. Additionally, unintegrated reporting systems hinder health staff from utilizing and monitoring CBS reports effectively. Future CBS development should focus on neighbourhood committees and CHVs, with 61% of surveyed community members willing to participate. Conclusion: Strengthening CBS for VPDs requires formalized guidelines on community-to-health facility reporting, integration of both conventional and digital reporting systems, improved coordination with facility-level systems, certified CHV training, and a supportive policy and financing framework to ensure long-term sustainability.