The COVID-19 pandemic has posed significant challenges to Indonesia’s routine immunization activities. As a result of the pandemic, a significant number of children either missed or only partially received their vaccinations, making the vulnerable to vaccine-preventable diseases (VPDs).
In a bid to counteract these setbacks, the Ministry of Health (MoH) rolled out a catch-up immunization campaign in 2022 known as the National Immunization Month (BIAN). However, the initiative did not achieved all its intended outcomes, as the immunization coverage rates did not meet the set targets. By 2023, the situation became more critical, as several districts reported a surge in VPD cases. Provinces with low coverage in 2022 needed to adopt aggressive strategies to catch-up on immunization during BIAN.
Notably Riau, Nusa Tenggara Timur (NTT), and East Java provinces were recommended due to their consistent shortfalls in meeting the annual immunization coverage targets. Among these, Sampang District in East Java emerged as a high-risk area, where 10,849 children missed at least one vaccination over a four-year period. This accounts for 19% of the targeted 56,629 children, meaning 1 in 5 children in the district lacked vital protection for their health. Concurrently, the Indragiri Hilir District in Riau Province drew attention for having most of the children with zero doses – 2,575 children, making up 25% of the targeted children – compared to other districts in the province. In NTT, there was a significant drop in children receiving immunizations in 2022, from 84.4% in their first year to 72.6% in the second year. The decline is most pronounced in Manggarai Timur and Malaka districts, where first-year immunization coverage was 97.9% and 96.7% but dropped to 39.7% and 42.4% in the second year, respectively. The re-introduction of the cohort book system is anticipated to enhance the efficiency of monitoring and catch-up immunization processes.
Immunization officers and village midwives practicing the use of the defaulter tracking tool “My Village My Home” (Credit: WHO/ Dewi Ayu)
To tackle this pressing issue, the MoH issued directives to healthcare professionals, emphasizing the need to complete immunization for children under five. Recognizing the challenges on the ground, District Health Offices (DHOs) in NTT initiated measures to bolster their health teams. With the support from WHO, districts like Manggarai Timur and Malaka transitioned to updated cohort book formats, making it easier to administer catch-up immunizations. Additionally, an innovative system called "My Village, My Home" (MVMH) for tracking and reaching out to defaulter was introduced in Sampang and Indragiri Hilir Districts. To ensure its effective deployment, skill-building sessions were organized, emphasizing the importance of accurate record-keeping, and identifying children in need of catch-up immunization. Vaccination Technical Officers, as an extension of WHO’s presence in the field, are actively monitoring and evaluating field activities while assisting health worker in Puskesmas as part of on-the-job training.
Highlighting the advantages of the MVMH tool, Tsuwaibatul Aslamiyah, a village midwife in Dalpenang, Sampang, remarked, “MVMH makes easy to identify unvaccinated and partially vaccinated children. it increases the acceptance of immunization, even with multiple injections.”
Skill-building in defaulter tracking. All midwives, health promotion and immunization programme officers from 21 Puskesmas across Sampang attended. Credit: WHO/Martina
The head of Puskesmas Betun in Malaka District, NTT province, emphasized the importance of adaptive strategies, asserting, "In our pursuit to enhance immunization rates, we harness diverse tools and insights, not just from our local Puskesmas but also from other levels of governance. Among these instrumental resources is the cohort book methodology, as an asset in recalibrating our action plans for the catch-up immunizations of our children."
The utilization of the cohort book and MVMH for tracking and monitoring children’s attendance in immunization is pivotal in ensuring their complete immunization. it is important to optimize catch-up immunization initiatives. it not only guarantees children's protection from vaccine-preventable diseases but also underscores the shared responsibility of health workers, parents, and the community.
Indonesia is currently undergoing a transformation phase in its immunization reporting mechanism, making the shift from manual to digital integration through the ASIK application and dashboard. In Sampang, the MVMH tool is actively employed to curtail the number of zero doses, necessitating regular monitoring and evaluation. Moreover, there's a robust emphasis on fostering cross-sectoral coordination to amplify defaulter tracking efforts.
This activity was supported by the Government of Australia.
Written by the following WHO Indonesia personnel:
Dewi Ayu Kusumawardhani, Vaccination Technical Officer
Suci Rahmawati, Vaccination Technical OfficerMartina, Vaccination Technical Officer
Olivi Silalahi, National Professional Officer of Routine Immunization