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Volume'3,'No.'2,'December'2021'
e-ISSN:
2797-6068
'''dan'p-ISSN:
2777-0915
EVALUATION AND IMPLEMENTATION OF SURVEILLANCE
SYSTEMS DURING THE COVID-19 PANDEMIC AT THE PADANG
CLASS II PORT HEALTH OFFICE WORKING AREA OF
MINANGKABAU INTERNATIONAL AIRPORT
Yulia Astuti
1
, Aria Gusti
2
, Magdalena
3
Andalus University
1,2
, Padang Class II Port Health Office
3
E-mail: [email protected]
1
, [email protected]
2
,
[email protected]
3
Keywords
Evaluation of
Surveillance
system, Covid-19
Pandemic, Port
Health Office,
International
Airport Work Area
Article Info
Accepted:
November, 24
th
2021
Revised:
December, 4
th
2021
Approved:
December, 13
rd
2021
Abstract Covid-19 has been declared a global
pandemic by the World Health Organization. In addition,
it has been declared a national disaster by the President
of Indonesia. One of the efforts to prevent disease entry
in an area is through surveillance activities, one of which
is carried out at the Port Health Office of the
Minangkabau International Airport Working Area. This
research used qualitative research with a case study
approach which will be carried out in February-March
2021. Information is obtained from the Surveillance
section of the BIM Wilker Port Health Office. The
variable in this study is the surveillance system during
the Covid-19 pandemic, surveillance management
activities are carried out using a systems approach
consisting of input, process, and output. The instruments
used in this study were interviews, cameras, tape
recorders, and writing instruments. Data analysis was
carried out through gap analysis. In the implementation
of the input, process, and output processes, it is
necessary to add personnel and increase knowledge in
the implementation of data processing, analysis, and
interpretation to provide information to the public in a
surveillance system. Conclusions from the field study in
the implementation of the surveillance system during
the Covid-19 Pandemic at BIM Padang have been
running but have not met the surveillance system
approach. Efforts should be made to disseminate
Yulia Astuti, Aria Gusti, Magdalena
Evaluation and Implementation of Surveillance Systems during the Covid-19
Pandemic at the Padang Class II Port Health Office Working Area of Minangkabau
International Airport 84
information, socialize and provide human resources and
training to improve the capacity of officers.
Introduction
Minang Kabau International Airport (BIM) is one of the international airports on
the island of Sumatra. This airport is one of the air entrances in Indonesia from
several other countries such as China, and Malaysia, and other countries. This
has led to very strict inspections to control transnational diseases. Disease
control in the BIM work area is carried out routinely by the Class II Padang Port
Health Office (KKP).
During the Covid-19 pandemic, supervision of the entrance to the departure
and arrival of passengers is even stricter to help the government break the
chain of the Covid-19 pandemic in Indonesia, especially in West Sumatra
Province. The Port Health Office opens a health document inspection counter in
the form of validation of Covid-19 test results with rules and conditions
applicable at the departure gate and checking e-HAC at the arrival gate for each
passenger as one of the surveillance activities for monitoring the health of
passengers who will travel or enter BIM Airport (Dabachine, Taheri, Biniz,
Bouikhalene, & Balouki, 2020).
Coronavirus Disease 2019 (COVID-19) is an infectious disease caused by Severe
Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) (Acter et al., 2020).
SARS-CoV-2 is a new type of coronavirus that has never been previously
identified in humans (Ashour, Elkhatib, Rahman, & Elshabrawy, 2020). There are
at least two types of coronavirus that are known to cause diseases that can
cause severe symptoms such as Middle East Respiratory Syndrome (MERS) and
Severe Acute Respiratory Syndrome (SARS) (McIntosh & Perlman, 2015).
Common signs and symptoms of COVID-19 infection include symptoms of acute
respiratory distress such as fever, cough, and shortness of breath. The average
incubation period is 5-6 days with the longest incubation period being 14 days.
In severe cases of COVID-19, it can cause pneumonia, acute respiratory
syndrome, kidney failure, and even death.
The increase in the number of cases took place quite quickly and spread to
various countries in a short time (Onder, Rezza, & Brusaferro, 2020). As of
March 6, 2021, WHO reported 115,653,459 confirmed cases with 2,571,823
deaths worldwide (Case Fatality Rate/CFR 2.2%) with 222 infected countries and
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187 local transmission countries where CRF data were compared as of July 2020
CFR. 4.6% has decreased. As of March 6, 2021, the country with the highest
number of confirmed cases of Covid-19 was the United States with a total of
28,468,736 cases, while for the Covid-19 case in ASEAN, Indonesia became the
country with the highest confirmed cases of 1,373,836, followed by the
Philippines with 587,704 cases and Malaysia. 310,097 cases. The state of
Indonesia itself began reporting its first case on March 2, 2020. Cases are
increasing and spreading rapidly throughout Indonesia. As of July 9, 2020, the
Ministry of Health reported 70,736 confirmed cases of Covid-19 with 3,417
deaths (CFR 4.8%). As of March 6, 2021, the number of COVID-19 cases in
Indonesia that have been examined amounted to 7,420,374 with confirmed
Covid-19 cases totaling 1,373,836 cases, 1,189,510 people recovered, 37,154
deaths with a CRF of 2.7%.
As explained that at KKP Class II Padang where the Quarantine Control and
Epidemiological Surveillance Section has the task of preparing planning
materials, monitoring, evaluating, compiling reports, and coordinating the
implementation of quarantine, disease epidemiological surveillance, potential
disease outbreaks, new diseases, and emerging diseases (Agustina, Afidah, &
fadhilah Hasanah, 2021). The data generated in a surveillance system is used to
know the picture of the health of a population, take policies that can be applied
in the population, both regarding behavior patterns and disease prevention,
monitor and evaluate health programs implemented in the community conduct
further research related to surveillance data, and identify problems that exist in
the population calls.
The scope of surveillance activities itself is quite broad, ranging from early
detection of extraordinary events/epidemics, prevention of infectious diseases,
to prevention of chronic (non-communicable) diseases that can be carried out
within the period of changing behavior patterns to the onset of the disease
(Peckham, 2016). Surveillance can be used to collect data on various elements
of the disease chain, starting from behavioral risk factors, preventive actions, as
well as program evaluation and unit costs (Haddix, Teutsch, & Corso, 2003). In
other words, a surveillance system is needed to get an overview of the disease
burden of a community, including the number of cases, incidence, prevalence,
case-fatality rate, mortality and morbidity rates, treatment costs, prevention,
epidemic potential, and information on the emergence of new diseases.
Yulia Astuti, Aria Gusti, Magdalena
Evaluation and Implementation of Surveillance Systems during the Covid-19
Pandemic at the Padang Class II Port Health Office Working Area of Minangkabau
International Airport 86
Regulation of the Minister of Health Number 45 of 2014 issued by the Ministry of
Health of the Republic of Indonesia surveillance management activities is carried
out using a systems approach consisting of inputs, processes, and outputs. The
input approach can be broken down into 5M (man, money, method, material,
market) while the process and output can be adjusted to the needs of
management (Hardin & McCool, 2015).
To produce good output, it is necessary to strengthen in carrying out good input
activities as well. Input is an element that is needed in carrying out the program
which will later be processed to produce output. According to the concept
expressed in management by Harrington Emerson in Phiffner John F and
Presthus Robert V, input is composed of 5M (man, money, method, material,
market). Man is a human resource owned by the organization.
In human resource management activities, it is an element that has an
important role because management will emerge when every human resource
gathers and interacts with each other to achieve the goals determined by the
organization. Money and Materials are tools used to achieve organizational
goals and have an important role in this. The method is a technique or method
used to achieve organizational goals. The parts of the surveillance system
approach are as follows:
Input
1. Man (Human Resources)
Human resources in the field of health called health workers are everyone who
dedicates themselves to the health sector and has knowledge and skills through
education in the health sector which for certain types requires the authority to
carry out health efforts as quoted from Law number 36 of 2014 (Koblinsky et al.,
2006). Government the central or local government procures and improves the
quality of health workers by providing education and training. From the results of
reviewing the guidelines for implementing a health surveillance system, the
human resources for implementing an epidemiological surveillance system
consist of epidemiologists (S1, S2, S3), trained surveillance staff, health unit
managers with an epidemiological orientation, functional ethnology department,
sanitarian functional position, laboratory human resources, other human
resources related to functional epidemiology.
2. Money
In carrying out the surveillance program the funds used can come from the
APBD, APBN, Block Grants, and aid funds such as those from NGOs (Rokx, 2009).
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In allocating funds to conduct surveillance programs, each agency has a role in it.
3. Method
There are two methods or approaches that are commonly used in
surveillance activities as written in the Minister of Health Regulation number 45.
The first is to use the active surveillance method, namely activities carried out by
officers directly in the field to record and collect data. Second, passive
surveillance, namely surveillance activities carried out by relying on reports from
interested parties. In this surveillance activity at the entrance, KKP receives
reports from notifications from other affected countries and other regions.
4. Material
The facilities and infrastructure used to support an activity or program are
elements of the material (Scheckler et al., 1998). Facilities can include moving
objects such as ambulances and infrastructure including immovable objects such
as isolation rooms, ATK, PPE, surveillance data collection forms, thermal
scanners, communication tools, and others.
5. Market
The target or market in Covid-19 surveillance activities at the entrance is
travelers, namely crew or personnel and passengers, especially those from
affected regions or countries, and other areas entering West Sumatra via
domestic flights.
Process
The process carried out is how surveillance activities are carried out to carry
out continuous monitoring of all passengers and flight crews before leaving the
airport where activities in finding Covid-19 cases at the entrance or arrival
include carry out monitoring of travelers; personnel or crew, and passengers,
especially those coming from the affected region or country (Khanh et al., 2020).
Monitoring is carried out through a thermal scanner or infrared thermometer,
monitoring signs and symptoms, or conducting additional health checks.
Examination of health documents on travelers. If an indication of high
temperature is found from the results of the detection of a thermal scanner or
infrared thermometer, the person will be separated for further interviews
(Itasari, 2020). If it is found that a traveler has a fever and shows symptoms of
pneumonia on the transportation equipment based on the report of the
transportation equipment personnel, the KKP officer will check the
transportation equipment using standard PPE. The treatment given to travelers is
by the conditions and criteria of the case, and the procedures for handling cases
(Makurumidze, 2020). Take action according to SOP for goods and transportation
equipment.
Yulia Astuti, Aria Gusti, Magdalena
Evaluation and Implementation of Surveillance Systems during the Covid-19
Pandemic at the Padang Class II Port Health Office Working Area of Minangkabau
International Airport 88
Output
The results of surveillance activities for each activity have their results.
However, in general, the results of epidemiological surveillance activities
produce information that can be disseminated to the wider community.
Research Method
The method used is taken from the Regulation of the Minister of Health Number
45 of 2014 issued by the Ministry of Health of the Republic of Indonesia where
surveillance management activities are carried out using a systems approach
consisting of input, process, and output. The input approach can be broken
down into 5M (man, money, method, material, market) while the process and
output are expected to produce information that is disseminated to the public
and can be used as a reference in making a policy and as a guide in planning a
program in the future.
Result and Discussion
Epidemiological surveillance at KKP Class II Padang BIM Working Area is carried
out through input, process, and output stages. The description of these stages is
as follows:
1. Inputs
a. Man (power)
The surveillance staff at Class II Padang Port Health Office in the BIM Working
Area consists of 10 people who are in the Quarantine Control and
Epidemiological Surveillance (PKSE) section consisting of State Civil Apparatus
(ASN) and Non-ASN with educational backgrounds of D3 Health, S1 Public Health,
and S2 Health.
In carrying out surveillance activities at the airport, they are also assisted by
officers from the Environmental Risk Control (PRL) section and the Health Efforts
and Cross-regional (UKLW) section so that the number of personnel at the Class II
Padang Port Health Office in the BIM Work Area is 22 people who are in the
implementation of this activity. Surveillance in 2020 at Wilker BIM consists of
two shifts, morning and evening, but in February 2021, surveillance work
activities at Wilker BIM will be divided into three shifts, morning, afternoon, and
night.
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Table 1. Availability of Human Resources in Class II KKP
Power Type
Amount
available
Standard
Adequacy
Yes
No
1
1
2
V
2
7
4
V
V
3
1
4
-
V
4
6
1
V
-
b. Money
Available in the form of an existing budget in the KKP originating from the State
Budget of the Ministry of Health, Directorate General of P2P as stated in the
Padang Class II KKP activity budget plan for 2020-2024 with measurable targets
and targets so that surveillance activities at Wilker BIM are expected to be
carried out properly and as expected in prevention and control of Covid-19. The
total budget and achievements of the 2020 PKSE Section Budget are as follows:
Table 2. PKSE Section Budget Achievement in 2020
c. Method
Surveillance methods are carried out actively and passively. The implementation
of surveillance at the Wilker Airport KKP actively observes passengers who want
to depart by checking the results of the Rapid Test which are still valid for
PROGRAMS/ACTI
VITIES/ OUTPUT
THE FINANCIAL YEAR 2020
INDICATOR
BUDGET
TARGET
ACHIEVEMENT
ALLOCATION
REALIZATI
ON
Health
Quarantine
Service
719 Service
719 Service
170,340,000
156,314,9
60
Total
719 Service
170,340,000
156,314,9
60
Yulia Astuti, Aria Gusti, Magdalena
Evaluation and Implementation of Surveillance Systems during the Covid-19
Pandemic at the Padang Class II Port Health Office Working Area of Minangkabau
International Airport 90
departure according to the applicable provisions where the results of the Covid-
19 test are negative, where if an antigen test is carried out, the validity period of
the test is 2 x 24 hours from the results a negative test comes out, but if the test
is PCR, the negative test result is valid for 3 x 24 hours. Furthermore, on arrival,
an e-HAC scan check is carried out as an effort to prevent Covid-19 for all
passengers where one e-HAC application can be used for ten passengers.
Furthermore, at Arrival, passenger supervision is also carried out with a Thermo
scanner to check the body temperature of passengers on arrival.
Picture 1. HAC Data Collection Distribution 2020
d. Material
In the form of facilities and infrastructure used to support an activity. Facilities
can include moving objects such as ambulances and infrastructure including
immovable objects such as isolation rooms, ATK, PPE, surveillance data collection
forms, thermal scanners, communication tools, and others in the form of
equipment used in the implementation of surveillance activities at the airport.
complete, it is just that there are some tools whose usability is still not optimal,
such as a thermal scanner on arrival as an automatic tool to check body
temperature.
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Picture 2. Quarantine & SE. Control Section Equipment
e. Market
As a marker, all travelers, both passengers, and all crew members are the object
of surveillance at the Wilker Padang KKP. During the pandemic period, there are
no flights from abroad so only domestic flights so that in monitoring for
passengers only passengers from within the territory of Indonesia.
Picture 3. Distribution of Domestic Passenger Arrivals in 2020
The number of domestic passenger arrivals at the port/airport in the Padang
Class II KKP Work Area in 2020 Wilker BIM was 609,831 people (90.14%) and the
rest were at other wilkers so that the highest number of passenger arrivals was
at BIM. When compared to the arrival of domestic passengers in 2019, which
was 1,352,471 people, there was a fairly large decrease of 675,949 people
(49.98%).
Kd Barang Nama Barang
Baik
Rusak
Ringan
Rusak
Berat
1 3.09.04.03.004.3.2015 GPSMAP 64S GARMIN 1
Teluk Bayur Seksi PKSE
V
2 3.09.04.03.004.001.2013 eTrex 10 GARMIN 1
Teluk Bayur Seksi PKSE
V
3 3.09.04.05.012.3.2020
Barcode ICV 1 Teluk Bayur Seksi PKSE
V
4 3.09.04.05.012.4.2020
Barcode ICV 1 Teluk Bayur Seksi PKSE
V
5 3.09.04.05.012.5.2020
Barcode ICV 1 Teluk Bayur Seksi PKSE
V
6
3.09.04.05.012.6.2020
Barcode ICV 1 Teluk Bayur Seksi PKSE
V
7 3.10.01.02.009.1 2018
Tablet SAMSUNG 1 Wilker BIM Seksi PKSE
V
8 3.10.01.02.002.2015 Laptop ASUS 1
Wilker BIM Seksi PKSE
V
9 3.09.04.03.004.2015 GPSMAP GARMIN 1
Wilker BIM Seksi PKSE
V
10 3.09.04.09.078.1.2018 Thermal Scanner DELL 1
Wilker BIM Seksi PKSE
V
11 3.10.10.02.01.009.3.2018
Printer Thermal
Scanner
1 Wilker BIM Seksi PKSE
V
12 3.09.04.09.078.2.2019
Thermal Scanner APC 2 Wilker BIM Seksi PKSE V
1 camera
tidak bisa di
operasikan
13 3.09.04.05.012.1.2019
Barcode ICV 1 Wilker BIM Seksi PKSE
V
14 3.09.04.05.012.2.2019
Barcode ICV 1 Wilker BIM Seksi PKSE
V
Ket
No
Uraian BMN
Merk / Type
Jumlah
Lokasi
Penanggung
jawab
Kondisi
Teluk Bayur Bungus Muara Sikakap BIM
Tdk Terjangkit
4.349 18.541 27.220 9.478 320.062
Terjangkit
1.515 - - 5.588 289.769
Jumlah
5.864 18.541 27.220 15.066 609.831
∑ = 676.522
Yulia Astuti, Aria Gusti, Magdalena
Evaluation and Implementation of Surveillance Systems during the Covid-19
Pandemic at the Padang Class II Port Health Office Working Area of Minangkabau
International Airport 92
2. Process
a. Data collection
Data collection is carried out by surveillance officers to aircraft passengers by
direct observation and supervision of the arrival of domestic flight passengers
because since Covid-19 there are no longer international flights at KKP wilker
BIM. Data collection is carried out by officers using an inspection form that is
filled in by the supervising officer based on interviews with passengers or carried
out by each passenger through the eHAC Application. For e-HAC data itself, every
month it is always different from the result of the number of passengers that
should be. Where the number of Passenger data should be the same as the
number of eHAC, so there is always a lack of passenger eHAC data.
b. Data processing.
Data that has entered the system will be sent to the Ministry of Health and will
be processed directly in the system. However, the data processing carried out by
the KKP itself has not been processed properly so that it cannot represent a good
surveillance system.
c. Analysis and interpretation
the analysis has also not been carried out properly because the data is not
processed properly. This is due to the absence of special and trained personnel in
processing and analyzing surveillance data.
3. Output
The output of epidemiological surveillance activities produces information that
can be disseminated to the general public that can be easily understood and can
also be used as a reference in the success of a program as well as a reference by
policy makers in planning further programs.
Picture 4. BIM Working Area Polyclinic VisitBy Age Group January 2021
Source: Padang MPA Class II Data
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From the results obtained during field studies at KKP Padang, the BIM work area,
it can be described for the personnel themselves, according to the standard for
routine epidemiological surveillance activities, but if it is based on the KMK
standard No. 1116 of 2003 as table 1 (one) where personnel/resources are still a
problem where there are personnel who have met the standards and some have
not. KKP Padang has 4 (four) wilkers, it is necessary to add surveillance personnel
as well as at the Padang BIM Wilker so that all surveillance activities can be
carried out because based on the results of interviews since the Covid-19
pandemic, the BIM Wilker KKP officers are more focused on validating Covid 19
test results on departure and e-HAC scans at the arrival of passengers so that
other surveillance activities at BIM are disrupted. Furthermore, the addition of
work shifts from two to three consisting of morning, afternoon, and evening
shifts will certainly also affect the implementation of surveillance activities.
To solve the problem of manpower, it is necessary to increase the number of
personnel, either by adding personnel with a contract system and also by
proposing the acceptance of civil servants at KKP Padang. In addition,
surveillance personnel needs training in increasing the ability to carry out a
surveillance activity so that the expected results for the success of the
surveillance system can be carried out so those surveillance activities can assist
in the implementation of control programs and the implementation of vigilance,
preparedness for the possibility of outbreaks in the work area. BIM KKP Class II
Padang.
Availability of the existing budget in the KKP originating from the State Budget of
the Ministry of Health, Directorate General of P2P as stated in the Padang Class II
KKP activity budget plan for 2020-2024 with measurable targets and targets so
that it is hoped that surveillance activities at Wilker BIM can be carried out
properly and as expected in prevention and control of Covid-19. And for the
budget available to carry out surveillance programs and other programs at the
Padang KKP there is an increase from 2020 to 2021. The budget is very
supportive in carrying out surveillance activities and other activities. The RAK has
also been provided to increase the capacity of the apparatus in adding insight
and skills to carry out surveillance activities.
Yulia Astuti, Aria Gusti, Magdalena
Evaluation and Implementation of Surveillance Systems during the Covid-19
Pandemic at the Padang Class II Port Health Office Working Area of Minangkabau
International Airport 94
Surveillance methods in the KKP are carried out actively and passively, manually
and electronically (by utilizing an android smartphone). On departure with
validation of the Covid-19 test results with applicable terms and conditions,
where the validity period of negative antigen and PCR test results is 2 x 24 hours
for negative test results for antigens, and 3 x 24 hours for negative PCR test
results, however online is sometimes constrained by a signal so sometimes it
takes longer.
In the form of facilities and infrastructure used to support an activity. Facilities
can include moving objects such as ambulances and infrastructure including
immovable objects such as isolation rooms, ATK, PPE, surveillance data collection
forms, thermal scanners, communication tools, and others in the form of
equipment used in the implementation of surveillance activities at the airport.
complete, it's just that there are some tools whose usability is still not optimal,
such as a thermal scanner on arrival as an automatic tool to check body
temperature.
As a marker, all travelers, both passengers, and all crew members are the object
of surveillance at the Wilker Padang KKP. During the pandemic period, there are
no flights from abroad so only domestic flights so that in the monitoring for
passengers only passengers from within the territory of Indonesia. The target for
BIM surveillance activities on passengers is only at the airport after they leave
the airport, it is no longer the responsibility of the BIM wilker surveillance officer
so that the monitoring is only limited to the airport. If there is a positive case
from a new traveler, there will be a notification report to the West Sumatra
Provincial Health Office.
Data collection is carried out by surveillance officers to aircraft passengers by
direct observation and supervision of the arrival of domestic flight passengers
because since Covid-19 there are no longer international flights at KKP wilker
BIM. Data collection is carried out by officers using an inspection form that is
filled in by the supervising officer based on interviews with passengers or carried
out by each passenger through the eHAC Application. For e-HAC data itself, every
month it is always different from the result of the number of passengers that
should be. Where the number of Passenger data should be the same as the
number of eHAC, so there is always a lack of passenger eHAC data.
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Data is an important variable in epidemiological surveillance activities,
completeness, and accuracy of data are very important in processing data.
Accurate data will produce a good outcome in evaluating a surveillance activity.
Data that has entered the system will be sent to the Ministry of Health and will
be processed directly in the system. However, the data processing carried out by
the KKP itself has not been processed properly so that it cannot represent a good
surveillance system. This is due to officers who have multiple tasks so that they
cannot complete report data on time, and also the expertise of surveillance
officers needs to be honed again in processing surveillance data so that it
becomes a report that can be needed and reliable in taking every appropriate
step.
The analysis has also not been carried out properly because the data is not
processed properly. This is because there are no special and trained personnel in
processing and analyzing surveillance data so that all existing data is the
responsibility of only one person where the surveillance officer only needs to
submit reports every day.
Epidemiological surveillance activities produce information that can be
disseminated to the general public that can be easily understood and can also be
used as a reference in the success of a program as well as a reference by
policymakers in planning further programs. For Covid-19 epidemiological
surveillance, data that has been received by the TC-19, All Record system can be
accessed through the One Health Data Dashboard application. Dissemination can
be by issuing or making a Surveillance Bulletin which contains information to the
public about the activities carried out by the KKP wilker BIM at the air entrance
for monitoring diseases entering the Indonesian Territory.
Evaluation of surveillance activities during departure validation and e-HAC checks
for passenger arrivals at the Class II Padang Port Health Office, BIM Work Area, is
important because Covid-free documents from hospitals and laboratories are
very vulnerable to being faked as well as upon arrival in filling out e-mails. HAC
can also be a possibility that the data is not filled incorrectly. For e-HAC scan data
itself, every month there is always the same number of passengers reported by
the airport authority, even though the number of e-HAC scans should be the
same as the number of passengers reported. This means that there is a system
weakness in conducting surveillance of passengers, so it is necessary to pay
attention to all parties to find a solution so that the number of passengers
reported is the same as the number of e-HAC scans.
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Evaluation and Implementation of Surveillance Systems during the Covid-19
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International Airport 96
Conclusion
In all surveillance systems that are carried out in the process of input, process,
and output, it is very important to follow up on officers who have dual duties,
due to inadequate personnel, furthermore, there are still some surveillance
officers who are still in general functional positions of Epidemiology, and
officers who have not mastered the processing system in processing, analyzing
and interpreting data in reporting, being slow in completing monthly reports,
and annual reports, so that it will be late in disseminating information and in
taking a policy in a surveillance system so that additional personnel and capacity
building of officers are needed through training/training in processing, analyzing
and interpreting surveillance data.
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