Surveilans Masyarakat
Published on September 25, 2026
Category | Details |
|---|---|
Definition | The ongoing, systematic collection, analysis, interpretation, and dissemination of health data essential for the planning, implementation, and evaluation of public health practice |
Legal Basis (Indonesia) | UU No. 17/2023 on Health; PP No. 28/2024 (implementing regulation); Permenkes No. 45/2014 on Health Surveillance; Permenkes No. 1501/2010 on Notifiable Diseases and Outbreak Response |
Core Components | Data collection, data processing/analysis, interpretation, dissemination, and feedback |
Types | Active vs. Passive surveillance; Indicator-Based Surveillance (IBS) vs. Event-Based Surveillance (EBS) |
Key System in Indonesia | SKDR (Sistem Kewaspadaan Dini dan Respons) / EWARS (Early Warning Alert and Response System) |
Reporting Units | Puskesmas, hospitals, laboratories, port health offices (Kantor Kesehatan Pelabuhan/KKP) |
Reporting Flow | Health facility --> District Health Office (Dinkes Kab/Kota) --> Provincial Health Office (Dinkes Provinsi) --> Ministry of Health (Central/Pusat) |
Keywords | "W1 report," "W2 weekly report," "SKDR alert," "KLB criteria," "24-hour notification," "Penyelidikan Epidemiologi (PE)," "7 KLB criteria," "notifiable diseases," "IHR 2005," "PHEIC" |
01Conceptual Foundation and Principles
Public health surveillance is not a research activity and is not the same as individual patient monitoring. It is the continuous, systematic process of collecting, analyzing, and interpreting population-level health data to guide public health decision-making. The purpose is information for action, meaning every data point collected must ultimately feed into a decision about prevention, control, or resource allocation.
In the Indonesian context, surveillance is governed by Permenkes No. 45/2014, which establishes the national framework for health surveillance (Surveilans Kesehatan). This regulation was later reinforced at a higher legislative level when Health Law No. 17 of 2023 was enacted, followed by Government Regulation No. 28 of 2024 as its implementing regulation, which includes a dedicated chapter on community surveillance.
The core cycle of surveillance has five sequential steps, and exam questions will frequently test whether you can identify which step is being performed in a given scenario:
Data Collection (pengumpulan data): Gathering morbidity, mortality, and vital-event data through active or passive methods.
Data Compilation and Processing (pengolahan data): Organizing raw data into usable formats such as tables, graphs, and spot maps.
Analysis and Interpretation (analisis): Applying epidemiological methods (person-place-time) to detect patterns, trends, and deviations from baseline.
Dissemination (penyebarluasan): Communicating findings to stakeholders and decision-makers who need the information.
Feedback and Response (umpan balik dan respon): Translating data into action, and informing data sources about results and actions taken.
A test writer will often present a vignette where a surveillance officer performs one of these steps and ask you to identify the step, or ask what the "next step" should be.
02Classification of Surveillance Systems
By data source approach
Type
Passive Surveillance
Description
Health facilities report routinely without active case-seeking by the health office. The surveillance system waits for reports to arrive. Lower cost but tends to undercount cases.
Indonesian Context
Routine monthly reports from Puskesmas
Type
Active Surveillance
Description
Surveillance officers actively seek and collect data by visiting health facilities, communities, or laboratories. Higher accuracy but more resource-intensive.
Indonesian Context
Polio AFP surveillance (door-to-door case finding), outbreak investigation
By analytical framework
Type
Indicator-Based Surveillance (IBS)
Description
Uses structured, routine data sources to monitor pre-defined indicators (e.g., weekly case counts of dengue).
Indonesian Context
SKDR/EWARS weekly reporting of 24 diseases using the W2 format is a form of indicator-based surveillance
Type
Event-Based Surveillance (EBS)
Description
Captures health events that fall outside routine reporting channels, such as media reports, rumors, community alerts, and unusual clinical clusters.
Indonesian Context
Media scanning, community-based surveillance (CBS), rumor verification
By coverage
Type
Sentinel Surveillance
Description
Only selected sites report, chosen for representativeness or capacity.
Indonesian Context
ILI (Influenza-Like Illness) sentinel sites in selected hospitals
Type
Population-Based Surveillance
Description
All cases in the population are captured through comprehensive reporting.
Indonesian Context
National SKDR system (all Puskesmas required to report)
By data type
Type
Epidemiologic Surveillance
Description
Tracks disease morbidity and mortality
Indonesian Context
Most disease surveillance programs
Type
Environmental/Risk Factor Surveillance
Description
Tracks environmental determinants (water quality, air pollution, vector density)
Indonesian Context
Vector surveillance for Aedes mosquitoes
Type
Behavioral Surveillance
Description
Tracks risk behaviors in the population
Indonesian Context
HIV behavioral surveillance surveys
Classification Basis | Type | Description | Indonesian Context |
|---|---|---|---|
By data source approach | Passive Surveillance | Health facilities report routinely without active case-seeking by the health office. The surveillance system waits for reports to arrive. Lower cost but tends to undercount cases. | Routine monthly reports from Puskesmas |
Active Surveillance | Surveillance officers actively seek and collect data by visiting health facilities, communities, or laboratories. Higher accuracy but more resource-intensive. | Polio AFP surveillance (door-to-door case finding), outbreak investigation | |
By analytical framework | Indicator-Based Surveillance (IBS) | Uses structured, routine data sources to monitor pre-defined indicators (e.g., weekly case counts of dengue). | SKDR/EWARS weekly reporting of 24 diseases using the W2 format is a form of indicator-based surveillance |
Event-Based Surveillance (EBS) | Captures health events that fall outside routine reporting channels, such as media reports, rumors, community alerts, and unusual clinical clusters. | Media scanning, community-based surveillance (CBS), rumor verification | |
By coverage | Sentinel Surveillance | Only selected sites report, chosen for representativeness or capacity. | ILI (Influenza-Like Illness) sentinel sites in selected hospitals |
Population-Based Surveillance | All cases in the population are captured through comprehensive reporting. | National SKDR system (all Puskesmas required to report) | |
By data type | Epidemiologic Surveillance | Tracks disease morbidity and mortality | Most disease surveillance programs |
Environmental/Risk Factor Surveillance | Tracks environmental determinants (water quality, air pollution, vector density) | Vector surveillance for Aedes mosquitoes | |
Behavioral Surveillance | Tracks risk behaviors in the population | HIV behavioral surveillance surveys |
03The Indonesian Surveillance Architecture
3A. SKDR: The National Early Warning System
SKDR (Sistem Kewaspadaan Dini dan Respons) was developed since 2009 by the Ministry of Health in collaboration with WHO and CDC to monitor 24 diseases with outbreak potential on a weekly basis. This is the backbone of Indonesia's outbreak detection system.
The 24 diseases monitored by SKDR include malaria, dengue fever, leptospirosis, diarrhea, cholera, diphtheria, anthrax, rabies, and COVID-19, among others. The full list also includes diseases such as acute flaccid paralysis (AFP/suspected polio), measles, pertussis, tetanus neonatorum, hepatitis, typhoid, chikungunya, meningitis/encephalitis, pneumonia, bloody diarrhea/dysentery, and syndromes suggestive of emerging infections.
How SKDR works:
SKDR monitors the trend of outbreak-potential communicable diseases over time in weekly periods and issues an alert signal when cases exceed a predetermined threshold value, prompting program managers to respond. Critically, an alert from the system does not mean an outbreak has occurred; rather, it represents a pre-outbreak condition that requires rapid response to prevent a full outbreak from developing.
Beyond weekly data, SKDR also includes a 24-hour immediate reporting pathway for diseases that could trigger a public health emergency, with data sources from media, communities, and health workers.
3B. Reporting Formats
W1 (Laporan KLB)
Purpose
Outbreak notification report. One W1 form per disease event.
Timing
Must be reported within 24 hours of an outbreak occurring, submitted in a tiered manner to the District Health Office, Provincial Health Office, and Central level (PHEOC)
Filed By
Puskesmas head / hospital / KKP
W2 (Laporan Mingguan)
Purpose
Weekly aggregate case count for the 24 SKDR diseases
Timing
Weekly (typically submitted Monday/Tuesday)
Filed By
Puskesmas, hospitals, laboratories
Epidemiological Investigation Report (Laporan PE)
Purpose
Detailed findings from outbreak field investigation
Timing
As soon as PE is completed
Filed By
District/Provincial epidemiological investigation team
Report | Purpose | Timing | Filed By |
|---|---|---|---|
W1 (Laporan KLB) | Outbreak notification report. One W1 form per disease event. | Must be reported within 24 hours of an outbreak occurring, submitted in a tiered manner to the District Health Office, Provincial Health Office, and Central level (PHEOC) | Puskesmas head / hospital / KKP |
W2 (Laporan Mingguan) | Weekly aggregate case count for the 24 SKDR diseases | Weekly (typically submitted Monday/Tuesday) | Puskesmas, hospitals, laboratories |
Epidemiological Investigation Report (Laporan PE) | Detailed findings from outbreak field investigation | As soon as PE is completed | District/Provincial epidemiological investigation team |
3C. KLB (Kejadian Luar Biasa / Extraordinary Event) Criteria
The criteria for declaring a KLB are codified in Permenkes No. 1501/2010 on Notifiable Communicable Diseases. This is extremely high-yield material. A region can be declared in a KLB state if it meets any one of the following seven criteria:
No. | KLB Criterion |
|---|---|
1 | A communicable disease appears that previously did not exist or was not recognized in the area |
2 | Continuous increase in morbidity over 3 consecutive time periods (hours, days, or weeks) |
3 | Increase in morbidity of two-fold or more compared to the previous period (hours, days, or weeks) |
4 | New case count in one month shows a two-fold or greater increase compared to the average monthly count of the previous year |
5 | Average number of cases per month over the current year shows a two-fold or greater increase compared to the average monthly count in the previous year |
6 | Case Fatality Rate (CFR) of a disease in a given period increases by 50% or more compared to the CFR of the same disease in the preceding period |
7 | Proportional rate of a disease in a given period rises compared to the proportional rate of the same disease in the previous period (in a comparable time frame) |
High-yield note: The question stem does not need to mention all seven. Fulfilling even one criterion is sufficient to declare a KLB. The exam may present data in a table or graph and ask whether KLB criteria are met.
04Operational Procedures and Response
4A. Steps in Outbreak Investigation (Penyelidikan Epidemiologi/PE)
Step | Action |
|---|---|
1 | Verify the diagnosis and confirm the outbreak meets KLB criteria |
2 | Establish the case definition (suspect, probable, confirmed) |
3 | Search for and count cases systematically |
4 | Organize data by person, place, and time (descriptive epidemiology) |
5 | Construct an epidemic curve (kurva epidemik) to determine epidemic pattern |
6 | Develop and test hypotheses about source and mode of transmission |
7 | Implement control and prevention measures |
8 | Communicate findings and submit the PE report |
In practice, steps 7 (control measures) and steps 3 through 6 (investigation) often run in parallel, because these steps can be performed simultaneously; the important thing is that the entire process contains all the required elements.
4B. Timeline Requirements
Per Permenkes 1501/2010, outbreak response must begin within less than 24 hours from the moment a KLB occurs. This is a testable point. The "less than 24 hours" rule applies to both the initial reporting (W1) and the initiation of field response.
4C. International Health Regulations (IHR 2005) and Indonesia
Indonesia's National Action Plan for Health Security (NAPHS) serves as the country's roadmap for preventing, detecting, and responding to public health threats, supporting IHR implementation. Under IHR, Indonesia is obligated to notify WHO of any event that may constitute a Public Health Emergency of International Concern (PHEIC) using the IHR decision instrument (Annex 2 algorithm).
Diseases that always require notification under IHR regardless of context include: smallpox, poliomyelitis (wild-type), human influenza caused by a new subtype, and SARS. These are "always notify" diseases. Other unusual or unexpected events are assessed through the Annex 2 decision tree.
05Differential Concepts and Distractors
Surveillance
Often Confused With
Screening
Key Discriminator
Surveillance is population-level, ongoing data collection for public health action. Screening is individual-level testing to identify disease in asymptomatic persons.
KLB (Kejadian Luar Biasa)
Often Confused With
Wabah (Epidemic/Plague designation)
Key Discriminator
KLB is declared at the local administrative level by the Bupati/Walikota. Wabah is declared at the national level by the Minister of Health and carries different legal consequences (including quarantine authority under UU No. 4/1984). KLB can progress to Wabah but they are not synonymous.
Active Surveillance
Often Confused With
Passive Surveillance
Key Discriminator
Active surveillance involves health officers going out to collect data. Passive surveillance relies on routine reports sent in by health facilities. If the vignette says "officers visited villages door-to-door," that is active.
Indicator-Based Surveillance
Often Confused With
Event-Based Surveillance
Key Discriminator
IBS uses structured, routine data (e.g., weekly case counts). EBS captures unstructured signals like rumors, media reports, or community alerts. If the source is a newspaper article about a cluster, that is EBS.
Epidemic
Often Confused With
Endemic
Key Discriminator
Endemic means the disease is consistently present at a predictable baseline in the population. Epidemic means cases exceed expected levels. A vignette showing dengue in a consistently high-endemic area is not a KLB unless it exceeds the prior baseline by the criteria above.
W1 Report
Often Confused With
W2 Report
Key Discriminator
W1 is the immediate 24-hour outbreak notification form (one form per disease event). W2 is the routine weekly aggregate report covering all 24 SKDR diseases. If the question asks what should be done "within 24 hours of a confirmed outbreak," the answer is W1.
Sensitivity (of surveillance)
Often Confused With
Positive Predictive Value (PPV)
Key Discriminator
A sensitive system catches most true cases (few false negatives). A system with high PPV has few false alarms. Passive systems tend to have lower sensitivity; active systems have higher sensitivity but cost more.
Concept | Often Confused With | Key Discriminator |
|---|---|---|
Surveillance | Screening | Surveillance is population-level, ongoing data collection for public health action. Screening is individual-level testing to identify disease in asymptomatic persons. |
KLB (Kejadian Luar Biasa) | Wabah (Epidemic/Plague designation) | KLB is declared at the local administrative level by the Bupati/Walikota. Wabah is declared at the national level by the Minister of Health and carries different legal consequences (including quarantine authority under UU No. 4/1984). KLB can progress to Wabah but they are not synonymous. |
Active Surveillance | Passive Surveillance | Active surveillance involves health officers going out to collect data. Passive surveillance relies on routine reports sent in by health facilities. If the vignette says "officers visited villages door-to-door," that is active. |
Indicator-Based Surveillance | Event-Based Surveillance | IBS uses structured, routine data (e.g., weekly case counts). EBS captures unstructured signals like rumors, media reports, or community alerts. If the source is a newspaper article about a cluster, that is EBS. |
Epidemic | Endemic | Endemic means the disease is consistently present at a predictable baseline in the population. Epidemic means cases exceed expected levels. A vignette showing dengue in a consistently high-endemic area is not a KLB unless it exceeds the prior baseline by the criteria above. |
W1 Report | W2 Report | W1 is the immediate 24-hour outbreak notification form (one form per disease event). W2 is the routine weekly aggregate report covering all 24 SKDR diseases. If the question asks what should be done "within 24 hours of a confirmed outbreak," the answer is W1. |
Sensitivity (of surveillance) | Positive Predictive Value (PPV) | A sensitive system catches most true cases (few false negatives). A system with high PPV has few false alarms. Passive systems tend to have lower sensitivity; active systems have higher sensitivity but cost more. |
06Traps and High-Yield Pearls
Trap 1: Confusing KLB with Wabah. The most common error is treating KLB and Wabah as the same thing. The exam will test whether you know that KLB is a local-level epidemiological designation (declared by the district/city head), while Wabah is a national-level legal declaration by the Minister of Health under the Communicable Disease Outbreak Law (UU No. 4/1984). A KLB may lead to a Wabah declaration, but they are governed by different authorities and carry different legal powers.
Trap 2: Forgetting the "any one criterion" rule. Students often think all seven KLB criteria must be met simultaneously. Only one of the seven criteria needs to be fulfilled for a KLB to be declared. This frequently appears as a data-interpretation question where the exam provides weekly case counts and expects you to apply the criteria.
Trap 3: Mixing up W1 and W2. W1 is the immediate outbreak report (within 24 hours, one form per disease event). W2 is the routine weekly surveillance report. If a question describes a newly detected outbreak, the correct next step in reporting is filing the W1, not the W2.
Trap 4: Active vs. Passive misidentification. When a health officer goes to the community to search for cases, that is active surveillance. When a Puskesmas sends its monthly case tally, that is passive. A vignette that describes "an officer noticed an increase from the monthly Puskesmas report" is describing passive surveillance, not active.
Trap 5: IHR "always notify" diseases. The four diseases that always require immediate IHR notification (smallpox, wild-type polio, novel influenza subtype, SARS) are a classic list-recall question. Do not confuse this with diseases that "may" require notification after assessment through the IHR Annex 2 decision instrument.
The core competency being tested is whether you understand that surveillance is a system for generating actionable information, not merely data collection. Questions will test your ability to identify the type of surveillance, apply KLB criteria to numerical data, sequence the correct reporting and investigation steps, and distinguish between overlapping public health concepts.