Pioneering Joint Surveillance: How Indonesia and Nepal Transform Public Health Systems

Indonesia and Nepal are pioneering a multi-source collaborative surveillance model that unites health, climate, laboratory, water, and research sectors to generate faster, smarter public health intelligence. Their integrated approach replaces fragmented systems, enabling more coordinated, data-driven responses to outbreaks such as dengue and cholera.

Indonesia and Nepal have become early laboratories for a new model of disease surveillance that draws on the combined strengths of ministries of health, climate agencies, universities such as the Bandung Institute of Technology and the National University of Singapore, and research institutions across both countries. As detailed in the WHO report on advancing multi-source collaborative surveillance, this model replaces fragmented information channels with an integrated ecosystem capable of generating real-time public health intelligence. Rooted in WHO’s 2022 framework on collaborative surveillance, the approach strengthens both system capacity and multisectoral cooperation, linking data from laboratories, climate services, community reporting, water systems, animal health agencies, and more.

When Siloes Undermine Response

Both countries turned to MSCS after years of struggling with isolated data systems that weakened outbreak preparedness. In Indonesia, dengue information, ranging from syndromic surveillance and serotype data to meteorological indicators, was collected by different institutions that rarely shared insights. This hindered the Ministry of Health’s ability to triangulate patterns during outbreaks. Nepal faced a similarly fragmented landscape for cholera, reliant on EWARS, SORMAS, research projects, hotline reports, and water-quality surveillance scattered across ministries. With water, food, and health agencies using separate systems, coordination lagged when rapid cross-sector data was needed most. These weaknesses became stark during Indonesia’s surge of nearly 150,000 dengue cases by mid-2024 and Nepal’s recurring cholera outbreaks, catalyzing urgency for reform.

Workshops That Shifted Mindsets

The first step toward collaborative surveillance was selecting priority diseases requiring multisectoral cooperation, dengue for Indonesia and food- and water-borne diseases for Nepal. Ahead of their national workshops, ministries mapped data sources, decision processes, and system gaps. This preparation set the stage for two highly interactive 2.5-day workshops in Central Java and Kavre, bringing together more than 50–60 stakeholders from government, academia, civil society, and the private sector. Images in the report show participants clustered around whiteboards, building shared surveillance objectives and challenging longstanding assumptions. One remark captured the heart of the problem: “We don’t share data because we don’t know if you need it.” These workshops not only clarified gaps but also built trust, an essential ingredient for any collaborative surveillance ecosystem.

Turning Plans into Practical Platforms

Following the workshops, Indonesia moved swiftly to integrate diverse sources into its existing surveillance platform, originally launched in 2023. What once depended solely on monthly lab-confirmed dengue reports expanded to include climate data, real-time syndromic reporting, and weekly EWARS bulletins. Dashboards shown in the report display maps of precipitation, temperature trends and case numbers for Java, enabling daily joint monitoring by surveillance teams and emergency operations centres. Nepal, meanwhile, identified priority actions such as developing SOPs and MOUs for data sharing, training surveillance and laboratory staff, and designing interoperable information systems aligned with the country’s evolving Alert and Response Framework. Both countries demonstrated that MSCS is not just a conceptual shift, it is operational, measurable and already influencing decision-making.

Scaling Intelligence for the Future

Looking ahead, Indonesia aims to strengthen outbreak forecasting in partnership with climate agencies and universities, apply predictive models in provincial pilots, expand serotyping and vector surveillance capacity, and extend the MSCS approach to rabies and vaccine-preventable diseases. It also seeks to build structured channels between researchers and policy-makers to ensure scientific insights inform public health action. Nepal is formalizing MSCS within its national alert framework, preparing a detailed roadmap, expanding municipality-level surveillance and institutionalizing multi-sector data-sharing protocols across human health, animal health, water, food safety, and environmental sectors. Together, their progress signals a powerful shift: when surveillance systems embrace collaboration, they gain the intelligence needed for faster, smarter, life-saving decisions.