The EWORS program in Indonesia has experienced many challenges, particularly the high cost to continue the program, difficulties in creating team work, and struggling to maintain enthusiasm and commitment by participating hospitals. In our experience, successful implementation and continuation of the EWORS program in a hospital will depend on human resources, hospital commitment, the EWORS package, finances, computer networking, technical aspects, and data analysis results.
We are convinced that to be able to effectively implement the EWORS Program, a hospital needs the following human resources:
• A hospital program manager who is an epidemiologist or a person who likes working with statistics or data analysis.
• A data entry clerk who is dedicated exclusively to entering data for the EWORS program. This is the heart of the system's success. Using a clerk who has other duties has not been successful.
• Physicians and nurses in the emergency room, pediatric clinic, and internal medicine clinic to maintain continuity and train new physicians and nurses in documenting information for the EWORS cleark. Training and re-training of physicians and nurses should be conducted on a regular basis.
Each hospital director must be committed to the EWORS program to create hospital policies that support the system. One possible benefit to the hospital is the early warning of increased workload due to an outbreak. To further increase support from hospitals, we have been trying to embed the EWORS Program in the MoH system. We have invited the directorate general in charge of medical services to co-sponsor the EWORS system along with the NIHRD and the Indonesian CDC.
This program requires information technology support, such as special phone lines, dedicated computers, as well as suitable data collection forms in the emergency room/internal medical room/pediatrician room for each patient visit. The team (doctor, nurse, data entry clerk) must be well trained and have delegation of authority to continue this program. The data entry clerk should have suitable work space, ideally a room dedicated to EWORS.
The program manager must be able to analyze the data in a manner that is clear, standardized, and useful for public health control measures. The analysis should be more frequent during an outbreak. This program needs team work among all the people who make the system work, from the hospital to the provincial or district health officer. The delivery system of the data can be day by day.
Discussions are currently underway about expanding the EWORS system to all provincial hospitals in Indonesia in 2008. We are also considering including private hospitals in the EWORS program. We would like to give a Quality Award to hospitals who properly maintain the EWORS program. We have improved guidance on data analysis in 2007. In 2008, we plan to study EWORS data using a sensitivity test in nine hospitals, so we can compare EWORS data with routine surveillance data collected at the district health office.