How ASIK Identifies One of the Reasons for Low Immunization Coverage in Indonesia

The COVID-19 pandemic has affected healthcare service delivery in Indonesia, including child immunization, thus impacting national immunization coverage. Through Sehat IndonesiaKu (ASIK), the Ministry of Health (MoH) of the Republic of Indonesia strives to digitize children’s immunization records by name and address to increase immunization coverage to reach pre-pandemic levels or even better before pre-pandemic levels.

**Thoriqul Aziz**, Data Analyst from Primary Healthcare Service Tribe at the Digital Transformation Office (DTO) MoH Indonesia, shares his experience in utilizing ASIK data to optimize the achievement of Complete Basic Immunization (CBI) coverage in Indonesia.

The COVID-19 Pandemic and its Impact on the CBI Coverage

Based on **immunization data from MoH Indonesia**, the coverage of Complete Basic Immunization (CBI) in children aged 0–11 months has significantly decreased since the beginning of the COVID-19 pandemic. It has dropped from 84.2 percent in 2020 to 79.6 percent in 2021.

The survey conducted by the MoH Indonesia and UNICEF in 2020 showed that, besides the shortage of healthcare workers and the suspension of healthcare services in some areas due to the pandemic, the reluctancy of the parents and caregivers to bring their children for immunization because of the risk of COVID-19 transmission was also attributed to the low immunization coverage during COVID-19.

Basic immunization for children aged 0–11 months is mandatory and has become a priority to develop immunity while promoting optimal growth and development during the first 1000 days of their lives. MoH Indonesia aims to achieve CBI coverage of 33.3 percent by April 2023 and 100 percent nationwide this year.

As a response, on May 18, 2022, Minister of Health Budi G. Sadikin launched the National Children’s Immunization Month (Bulan Imunisasi Anak Nasional/BIAN) as well as ASIK as a platform to record child immunization data and early detection of non-communicable diseases (NCDs).

The utilization of ASIK is expected to enhance the efficiency of child immunization data recording through digitization, optimize human health resources with a focus on service delivery, and provide high-quality health data by name and address that is integrated with the SATUSEHAT Platform.

ASIK also serves as a tool to support the implementation of BIAN and to achieve full coverage for CBI across all regions in Indonesia this year. In turn, this can drive the formulation of data-driven decision-making.

CBI Coverage Data in ASIK 2023

Based on the recorded data from ASIK, the national coverage of CBI for the period of January-March 2023 is 3.1 percent, with a total of 4.2 million children. It is far from the target of 33.3 percent, predicted because many infants (94.3 percent) have not received the complete basic immunization yet.

DTO conducted an analysis on two aspects, namely the adherence to vaccine administration protocols by healthcare workers and the infants’ demographic data as vaccine recipients.

According to the perspective of health workers, as many as 98.3 percent of the vaccine has been given ideally based on the child’s age range to receive the vaccine.

Based on the analysis of demographic data of 1 April 2023, the majority of infants (67 percent) recorded in ASIK were less than 9 months old. Most of the infants have not received the measles-rubella vaccine (MR), reaching 1.7 million children. MR vaccine is only given to infants at the age of 9 months old.

If the infants were younger than 9 months old when recorded, it is considered as not having complete basic immunization yet. This is the reason why the ‘incomplete vaccine’ rate is reaching 94%.

So, if the data that has been input into the system is an infant who is less than 9 months old or an infant who has not been able to receive the MR vaccine, then the baby will not get IDL status. This is also one of the factors in the high number of cases of ‘lack of vaccine’ reaching 94 percent.

To increase the CBI coverage in 2023, our finding is reported to the Directorate General of Disease Control and Prevention of MoH Indonesia, to be further socialized and advised to the Public Health Centre (Puskesmas) and Integrated Healthcare Center (Posyandu) in Indonesia, so that the child immunization record for 9 months old infants is in accordance with the month of the vaccine given.

About Sehat IndonesiaKu (ASIK)

ASIK is the first app to record and monitor individual-based healthcare services anytime and anywhere which are conducted outside the healthcare facilities. Through this app, the immunization record by healthcare workers and cadres becomes more structured and efficient and will be integrated into the SATUSEHAT Platform.

The development of ASIK is the result of collaboration between the Data and Information Technology Center and Digital Transformation Office (Pusdatin-DTO), the Directorate General of Public Health, and the Directorate General of Disease Control and Prevention. More than 90 percent of Puskesmas in Indonesia have been integrated with ASIK for recording National Children’s Immunization Month (BIAN) and NCDs data.