Gates Foundation Visit to Garut

Gates Foundation Visit to Garut: Appreciation for the Synergy of Puskesmas, Pustu, Posyandu, and the Health Office in Strengthening Data-Driven and Digitally Enabled Primary Health Services

Garut, April 22, 2025 — Yayasan Institut Pengembangan Suara Mitra, also known as the Summit Institute for Development (SID), in collaboration with the Gates Foundation and the Ministry of Health of the Republic of Indonesia, conducted a field visit to Karangpawitan Community Health Center (Puskesmas) and the Garut District Health Office in West Java. The aim of this visit was to monitor, strengthen, and support the implementation of the Digitally Enabled District (DED) program. The DED program is designed to enhance Garut’s digital capacity in delivering health services and making data-informed decisions for health-related programs.

Through this visit, the Gates Foundation and the Ministry of Health conveyed their appreciation for SID’s dedication and success in supporting Garut District in building and integrating digital technology into the primary healthcare system, utilizing the Fast Healthcare Interoperability Resources (FHIR) data exchange standard, and promoting data use for action in Garut. Local health workers, community health cadres, and stakeholders in Garut demonstrated how digital technology has improved collaboration at the village and sub-district levels, significantly impacting the broader health system in Indonesia.

Appreciation for Local Partners

During the visit, the Summit Institute for Development extended its heartfelt appreciation to all field partners for their exceptional commitment:

• Karangpawitan Puskesmas, as the key partner in primary health data integration and inter-facility coordination.

• Situjaya Pustu, for actively providing direct services across all age groups in the village.

• Tunas Harapan Posyandu, as the frontline of community health services, especially in maternal and child monitoring.

• Garut District Health Office, for its role in formulating supportive local health policies and ensuring cross-sectoral coordination for program integration and sustainability at the facility level.

FHIR-Based Data Exchange Ecosystem at District Level

FHIR, developed by HL7 (Health Level Seven International) and endorsed by the WHO, is now used globally. Indonesia has adopted FHIR at the national level as part of its digital health transformation, particularly in the development of the SatuSehat platform—an integrated national health data ecosystem that securely, rapidly, and systematically connects patient data from all health service facilities.

The DED program plays a pivotal role in helping Garut develop a district-level data exchange ecosystem through the establishment of an FHIR server. This facilitates secure, real-time integration of health data from various non-FHIR-compliant platforms used in primary care services—such as SIMPUS, ASIK, e-Kohort, ePPGBM, SMILE, and KuApps (BidanKu and KaderKu apps)  – FHIR-compliant applications for recording and reporting maternal and child health data outside of health facilities. With a local FHIR server, Garut has greater control over its health data infrastructure, ensuring higher security and accessibility, and paving the way for more integrated healthcare delivery.

Data for Action through the Local Monitoring Dashboard (PWS)

The PWS Dashboard is a visual platform for monitoring community health conditions at the local level (village, sub-district, district/city), aligned with the national Integrated Primary Health Services (ILP) initiative. It was developed to comply with national ILP dashboard standards and further adapted to meet local needs.

The dashboard provides real-time visibility into health trends, resource distribution, service completeness, outbreak prediction, and optimized care planning. It enhances decision-making and empowers local health managers (e.g., Puskesmas heads) to act swiftly and data-driven.

It enables daily, weekly, and monthly performance evaluations of healthcare services and programs, and includes real-time data on high-risk pregnant women, malnourished children, patients with chronic illnesses, and elderly individuals with limited mobility. Based on dashboard analytics, health workers can prioritize home visits more accurately.

Dynamic Worker Support (DWS) for Accountability in Home and Field Visits

Home visits are a strategic approach to strengthening family- and community-based healthcare. As part of primary healthcare integration, health workers and cadres conduct home visits for patients and families needing further health monitoring.

DWS is a platform that supports scheduling, route optimization, real-time tracking of field workers, practical guidance, and individual performance feedback. Through DWS, village or Pustu coordinators can assign home visit tasks to midwives or health cadres based on their designated service areas, factoring in time efficiency and distance.

On visit days, cadres or health workers use DWS to access their schedules and automatically log arrival and departure times. During visits, they perform basic health checks, provide health education, and collect further data, which is submitted digitally and instantly synced to the central system for visualization on the dashboard.

DWS supports transparent, verifiable tracking and helps optimize field time while preventing potential fraud in home visit reporting.

WhatsApp API and Call Center: Improving Access to Health Information and Service Gap Notifications

In the DED program, digital health innovation extends beyond apps and data systems to include end-to-end services through WhatsApp API and call centers—key bridges between the community and health facilities.

Integrated with the district-level ecosystem, these services automate and personalize WhatsApp messages and calls based on client conditions and deliver them at scale. These tools help disseminate health information, appointment reminders, care gap notifications, and follow-up actions while strengthening the relationship between clients and health workers.

Additionally, they provide easy access to health education and follow-up services via WhatsApp chatbot or the call center, particularly beneficial for those without active internet. With support from trained medical professionals, the WhatsApp API and call center expand outreach, provide education, and accelerate follow-up care to ensure continuity of care.

Strong Synergy Among Puskesmas, Pustu, Posyandu, and the District Health Office in Garut in Advancing Digital, Data-Driven Primary Health Services

During the field visit, the Gates Foundation and the Ministry of Health witnessed firsthand how DED’s digital components have been integrated into the operational system of primary health service delivery—from Puskesmas to Pustu to Posyandu.

H. Ajat Sudrajat Haryadi, S.Kep, Ners., Head of Karangpawitan Puskesmas, explained how health service data from Puskesmas, Pustu, and Posyandu is exported, uploaded to the FHIR server, and visualized on the dashboard. This is made possible through standardized, FHIR-mapped forms implemented within the district’s ecosystem.

“Over the past 1.5 years, we've worked closely with SID, and the results are evident. Our understanding of health digitalization has improved significantly. The PWS dashboard, accessible from Puskesmas to Pustu, helps us understand real-time health conditions in our working area and enables us to make data-driven decisions and act promptly,” shared the Head of Karangpawitan Puskesmas.

Titin Sumarni, SST, SKM, Bdn, M.Kes (ILP Cluster 2 Coordinator), and Ns. Wildan Saeful Majid, S.Kep. (ILP Cluster 3 Coordinator), demonstrated the use of the PWS dashboard in helping health workers make informed decisions and deliver services to the community.

At Tunas Harapan Posyandu, the Gates Foundation and Ministry of Health observed the use of KuApps by midwives and cadres to record and report child and maternal health data. Cadre Dety explained how easy KuApps is to use and how it helps identify pregnant women and children in the Posyandu area.

Because KuApps is FHIR-compliant, data is updated in real-time on the PWS dashboard. Sri Hastuti Wulandari, S.ST, a village midwife in Situjaya, shared how the dashboard helps her identify high-risk pregnancies and facilitates coordination with other village-level stakeholders.

“Data from the field goes straight to the dashboard. We can identify individuals with issues like anemia or hypertension by name and address. In the past, it was manual and difficult to compile. Now, we just type a name or NIK, and everything shows up. It really speeds up follow-up and inter-sector coordination,” said midwife Sri Hastuti.

At Situjaya Pustu, Ucu Maryamah, Amd. Kep, shared how the PWS dashboard is used similarly to Puskesmas but at a smaller scale, covering sub-village or RW areas. The dashboard helps coordinate home visit scheduling for cadres based on risk indicators.

Titin Sumarni added:

“Previously, a cadre could only visit five homes a day due to manual data. Now with the dashboard, they can cover up to ten, thanks to clear and complete target data. Manual summaries used to take two weeks every month. That’s no longer the case.”

Closing Dialogue and Reflections

At the end of the visit, the Gates Foundation team held a valuable dialogue session with health cadres, workers, and local stakeholders. The cadres expressed enthusiasm for the DED program and their commitment to continuing KuApps usage in Posyandu.

In addition, a separate dialogue was held with the Head of the Garut District Health Office and her team at the Garut District Health Office. Dr. Hj. Leli Yuliani, M.M., Head of the District Health Office, expressed her appreciation to SID for supporting Garut District in accelerating health digitalization. She also conveyed her hope for continued assistance and support from the SID team and the Gates Foundation until Garut is able to independently implement new approaches in healthcare services, including the use of information technology to enable more efficient and effective service delivery. It is hoped that through this transformation, the people of Garut will experience improved healthcare quality and the development of a health system that is more responsive to community needs.

The Gates Foundation and Ministry of Health praised the dedication and achievements of Garut as a leading example of how effective collaboration between technology and primary healthcare services can be realized.

Thank you to all stakeholders for your hard work. Let’s continue moving forward together for a better.