Prima Yosephine: Digital Technologies to Boost Immunization Coverage in Indonesia

 

In 2017, UNDP Indonesia supported the Ministry of Health in developing an innovative technological solution that aims to strengthen the immunization supply chain system in Indonesia. Prima Yosephine, as the Expanded Programme on Immunization (EPI) Manager within the MoH during that period, was super excited by the logistics management information system that provides data on vaccine supply and demand. This system also could help her colleagues, particularly health workers in the field, in monitoring vaccine logistics, including distribution, and provide updated reports. Based on this system, they decided to prepare an integrated application to monitor vaccine distribution in the country.

Prima was well aware of the difficulties in obtaining data related to immunization in a country of numerous islands. Be it logistics, vaccine lifespan, or monitoring stock and supply chain movement of vaccines from the national level to the nearest health service center - there would be many challenges to overcome.

In early 2018, the Ministry of Health, with support from UNDP Indonesia, introduced a pilot cloud- based digital system, based on the Electronic Vaccine Intelligence Network (eVIN) under the name Sistem Monitoring Imunisasi Logistik Secara Elektronik (SMILE / The Immunization and Logistics Electronic Monitoring System). The system aims to ensure that safe and effective vaccines are available to all children, at all times. SMILE enables real-time visibility of vaccine cold chain logistics by digitizing stock supplies and storage temperatures across vaccine cold chain points for all populations. Having begun during the COVID-19 pandemic, SMILE has been scaled up to create routine immunization programs for nearly 5 million birth cohorts as EPI targets.

 

Ms. Prima, could you share a bit about your background? Additionally, do your parents hail from this field, and did they provide you with support and guidance in your educational and professional journey?

I was born into a family of doctors in Medan, North Sumatra. My father was an obstetrician and gynaecologist, and my mother was a general practitioner at a community health center. Because I was born and raised in a family of doctors, I am more or less used to seeing what a doctor does. My parents supported me to pursue a career in medicine. My father was my partner in discussing health program challenges, and factors that influenced health policy formulation in the country.

During my school years, I was the type of individual who felt compelled to excel in my studies, even if I didn't fully comprehend the material. Nevertheless, when it came to examinations, I had to perform. Consistently ranking in the top 10 during my school tenure, I gained admission to the Faculty of Medicine at the University of North Sumatra (USU) via the Interest and Talent-based Selection (PMDK) pathway, without undergoing a formal test but rather through a school recommendation. I used this opportunity to learn about clinical medicine for the community, which then motivated me to enroll in a Masters of Public Health with an orientation in Health Economics at the University of Indonesia. This was while I was working for the Expanded Program Immunization Ministry of Health, as part of the organization's investment and my self-competency to contribute to the implementation of the effectiveness of child health through vaccination intervention.

What initially sparked your interest in delving into immunization? What aspects of this field did you find particularly appealing?

Initially, I aspired to pursue a career as a dermatologist and venereologist. However, due to experiencing a prolonged period of infertility, I finally decided to focus on having children. After my first child was born, I thought about not just being a housewife. In 2002, the Ministry of Health opened a large number of roles for civil servants, around 50 doctors. I was fortunate to be selected and began working at the Ministry of Health in December 2002. During that period, the SARS outbreak was unfolding. I was then assigned to the Immunization Sub-Directorate in 2003. It was there that I gained my initial exposure to and understanding of immunization practices. While I had learned about immunization during medical school, the complexities of vaccinology were not fully explored. Topics such as vaccine storage and administration were not extensively covered in my college education.

However, upon joining the Immunization Sub-directorate, I realized the multitude of responsibilities involved in immunization management. Coincidentally, I remained in that role until assuming the position of Section Head in 2007. However, during that period, my fervent interest was primarily focused on immunization, as it had been my area of expertise for quite some time. In 2021, I rejoined EPI to handle the COVID-19 pandemic management, and I was promoted to Director of Immunization at the end of 2022.

When did you realize the need for technological assistance to bolster the implementation of the immunization program?

I understand that our main problem with immunization is timely, high quality data . We provide logistics for consumables such as vaccines, AD syringes, and safety boxes, and we must calculate the required quantities from central distribution to provinces, and further down to community health centers for eventual delivery to end users. Monitoring this process is crucial as vaccines have specific lifespans and conditions that must be met to ensure vaccine efficacy upon administration. Any proper system must detect errors, storage discrepancies, or temperature fluctuations, without the need for manual intervention, thereby ensuring prompt action to prevent vaccine damage and also vaccine stock at all levels.

Monitoring these things is not a simple task. How can we establish effective monitoring mechanisms, especially in remote areas? At that time, our options were limited to SMS. Subsequently, BlackBerry Messenger (BBM) emerged, expanding our communication capabilities. Leveraging telephones became increasingly integral to enhancing communication channels. Moreover, our engagements with our health workers in regional areas likely surpass those of colleagues from other directorates.

What has your professional journey looked like, particularly your involvement in the SMILE project?

In 2017, UNDP held an audience with us to convey a technological innovation to support the vaccine logistics monitoring system. This system would significantly streamline the tasks of our logistics team in the field and enhance logistics monitoring at all administration levels. UNDP proposed implementing a system in Indonesia, a suggestion I enthusiastically endorsed. After all, why not adopt something beneficial? Consequently, we embarked on pilot projects in three regions — Tangerang, DKI, and West Java (Bogor). By 2019, the implementation process was proceeding smoothly.

In 2020, amidst the COVID-19 vaccination initiative, the Minister of Health sought a digital application for monitoring to ensure the vaccines arrived in optimal condition. SMILE was chosen for monitoring the COVID-19 vaccine. Initially deployed in only three cities, this digital application was rapidly scaled nationwide even though the adoption of this digital system might have faced considerable challenges.

Why is it crucial to implement digital health technology in immunization management? What specific objectives do you aim to accomplish through this digital utilization?

Using digital technology in immunization management is extremely crucial. First, digital technology is part of the pillar of health system transformation, and is pivotal in enhancing the efficiency of logistics management systems, thereby minimizing the wastage of supplies due to expiration resulting from inadequate planning or storage. Second, it fosters discipline among colleagues in regional areas by ensuring meticulous adherence to coverage recording procedures. Now we use an application called Sehat Indonesiaku. This application facilitates the seamless transmission of crucial information regarding immunization recipients, including their demographic details, directly to the central database as colleagues in regional areas administer immunization services. The digital health ecosystem platform provides data connectivity, analysis, and services to support the National Immunization Program (NIP).

What obstacles have you encountered in this professional field, particularly in driving digital transformation, and how do you overcome them?

The initial challenge is aligning perceptions. While program participants may have numerous aspirations, the reality is that developing even a single application can be quite challenging. Therefore, to embark on this development journey, we require partners who share our vision. We leverage the digital health transformation advocated by the Minister, and as a result, the Ministry of Health has established a dedicated unit called the Digital Transformation Office.

Secondly, fostering the adoption of this application among colleagues in regional areas poses a challenge, especially the compliance of health workers to input data in a timely manner. The Ministry of Health collaborated with development partners to conduct on-the-job training to increase utilization and data quality.

Thirdly, there are inevitable financial considerations. How can we secure an adequate budget to ensure the sustainability of our developments, given the ongoing maintenance expenses? This includes provisioning for sizable servers to accommodate the substantial volume of immunization data. In addition, we have conducted the economic analysis of SMILE for the immunization program and used the results of the assessment as a tool to advocate with decision makers to guide their future investment to achieve our country’s health outcomes and sustainability.

What do you think about gender equality for health professionals?

As we know, gender equality is key to building resilient health systems, and gender transformative health and social care policies are key to achieving gender equality globally. In fact in Indonesia, within the realm of healthcare professionals, there is a higher representation of women compared to men. According to available data from the Ministry of Health, the proportion of women exceeds that of men. Furthermore, at the leadership echelons, the gender proportion is rather balanced, although the minister is male.

In my view, gender inequality is more prevalent inside the households where men do not yet take on domestic responsibilities like women usually do, such as cooking, cleaning, and caring for children. When career women wish to reach higher positions, this consideration often pulls them back because they would need to spend most of their time on work instead of caring for their children. It is not because they don’t have the capability; they do. But it is more about our culture here. So it is crucial to promote gender equality in the health profession.

In your opinion, what do you think needs to be done/done to make more opportunities in this field of work available to women?

First, starting from the family. Avoid restrictions such as "this is for men" or "this is for women." For instance, in STEM fields such as science and technology, there tends to be a higher concentration of men. Therefore, families - especially spouses - should proactively encourage women to pursue careers in these domains.

Second, education. Starting from an early age, children should be introduced to the concepts and opportunities within STEM fields. They should be exposed to successful individuals, both women and men. This exposure allows children, regardless of gender, to develop an interest and understanding of the potential career paths in science. Consequently, they can make informed decisions about their future and equip themselves with the necessary skills and knowledge even though there are scholarships for women who have the talent to improve their education.

Regardless of gender, the key lies in nurturing and supporting individuals based on their passions and interests.

Do you have any advice for other women in this field out there?

It is essential to cultivate confidence. Once we have made a decision, we can surely achieve it. Foster self-motivation and take pride in being a woman, as women are inherently resilient and strong. It is often said that women are among the strongest beings created by God, capable of finding joy amidst adversity. I firmly believe that with the right knowledge and skills, you can certainly excel. You may even surpass individuals of other genders, as women typically exhibit exceptional precision and accuracy.