3 Secrets of PUSPA Strengthen Outbreak-handling in West Java

The Center for Indonesia's Strategic Development Initiatives (CISDI) carries out learning dissemination of the Puskesmas Terpadu dan Juara (PUSPA) strengthening program through Kisah 100 Mata Angin: Lembar Akhir dan Babak Baru Penguatan Puskesmas di Tanah Pasundan (The Story of 100 Directions: Final Paper and a New Chapter on the Strengthening the Community Health Centers in the Land of Pasundan).

The PUSPA program has made various successful achievements, such as:

• increase community 3M compliance by up to 84.8%
• strengthening the number of puskesmas that meet WHO test standards to 55%
• increase case tracking capacity up to 96.53%
• ensure monitoring of cases in people positive for COVID-19 up to 98.46%

The PUSPA program held a 6-month dissemination (from March 15th-September 16th, 2021) that integrated community-based approaches and cross-sectoral coordination to strengthen efforts to deal with outbreaks through community health centers (Puskesmas).

Puskesmas is the regional coordinator at the primary level and the anchor for horizontal and vertical coordination between levels of health services,” said Diah Saminarsih, Senior Advisor on Gender and Youth for the Director-General of WHO and founder of CISDI, at the event.

She then explained the various 'secrets' behind PUSPA's success in strengthening various indicators for handling the outbreak. First, implementing various innovations through the principle of a whole society approach. The PUSPA team trained puskesmas health workers, health cadres, and local community leaders to reduce the workload in speeding up the test by using the antigen rapid test. The promotion is also carried out in public open spaces.

 "Consistent coordination of messages and activities in various communication channels can reach various levels of society," Diah said again.

The dashboard of PUSPA is updated in real-time to ensure the outbreak handling situation in the region (Doc. CISDI)

Second, monitoring real-time data through the PUSPA dashboard. Every PUSPA activity is monitored through daily monitoring dashboard data which can be updated in real-time by 100 puskesmas in the placement area. The PUSPA management team discusses and plans mitigation based on dashboard data when a critical event occurs. The dashboard describes the situation of handling the outbreak at the village to sub-district levels, and is also presented to the public to maintain transparency. The dashboard is a marker of the degree of emergency that can be accessed by the community and local stakeholders.

Third, build a network of partnerships. The PUSPA program involves at least 26 national organizations and 100 regional entities that provide assistance at various stages of intervention that is based on the partner's capacity and work area.

Several partners were involved, for example, Paragon Corps, Philips Foundation, and Unilever to support shelter procurement, Mercy Corps Indonesia to optimize community-based surveillance (SBM) cadres, the Faculty of Psychology of University of Indonesia for psychological support for health workers, student volunteers from various organizations for other needs, and other partners that support PPE.

Maintaining the continuity of the puskesmas strengthening program

Although the PUSPA program has succesfully ended, CISDI's mission to strengthen primary health services has not yet been completed. In her presentation, Diah explained the milestones of the puskesmas strengthening program that CISDI has planned that are in four phases:

1. In the first phase, testing the strengthening model through PN-COVID-19 in eight puskesmas in Jakarta and Bandung in the period last June to December 2020.
2. The second phase, program escalation to a wider working area through PUSPA that is controlled at the provincial level with 500 trained health workers in 100 health centers in 12 districts/cities.
3. The third phase, accelerating treatment based on inclusion and equity through an intervention program that will run in the near future."The third phase will take place by encouraging institutional community health cadres, designing a vaccination access system that is sensitive to vulnerable groups, and building digital health innovations," Diah said again.
4. The fourth phase, strengthening primary health services through other intervention programs based on international consensus, such as the Political Declaration of Universal Health Coverage, the Astana Declaration, and the Global Action Plan SDG 3.

The Evaluation

The evaluation of the PUSPA organizing team will be supplemented by survey findings and research by independent academic institutions. The Association of Indonesian Community Health Promoters and Educators (PPPKMI) is currently conducting a survey to measure differences before and after the PUSPA intervention.

The survey was conducted to determine PUSPA's 3T achievements, the capacity of 3T implementation by puskesmas staff, capacity building for SBM cadres, and changes in community 3M behavior in public places.

"All of PUSPA's targets have been achieved, but we have to make sure that PUSPA's intervention is indeed good. That's why we conducted this survey," said Dr. Rita Damayanti, MSPH, General Chairperson of PPPKMI in the response session.

On the other hand, the Center for Economics and Development Studies, University of Padjadjaran (CEDS Unpad) conducted an analysis of the cost-effectiveness of the PUSPA program. This research is divided into two major topics, namely evaluating the PUSPA Program from an economic perspective and testing the resilience of the PUSPA puskesmas during a pandemic.

CEDS Unpad targeted several research outputs, namely the outcome of the minimum service standard (SPM) for puskesmas and patient satisfaction with services during a pandemic. Apart from that, from the side of health workers, they are currently researching the conditions of burnout, anxiety, and symptoms of depression of health workers during a pandemic.

"So far, even though it's not final, the health conditions of these three conditions (burn out, anxiety, and depression) are extraordinary. Some do experience depression, but most of them can survive it,” said Dr. Adiatma Siregar, ME. conSt., Head of CEDS Unpad.

PUSPA's health workers often innovate in handling epidemics in the midst of high job demands.

"One of our innovations is to create an Excel formula for patient data so that when the data is requested there is no need to look at manual records," said Putri, PUSPA Team Leader at the Pondok Gede Health Center, Bekasi City, in the same response session.

The dissemination of PPPKMI and CEDS Unpad survey and research results will be carried out at the end of November or early December 2021. Towards this agenda, CISDI will display various innovations by the PUSPA Team in the field through the organization's social media.