On 6 October, a district animal health officer was conducting active surveillance at a poultry market in Indonesia following a recent avian influenza event.
During the visit, the officer collected a sample for laboratory testing. Four days later, the sample tested positive for highly pathogenic avian influenza (HPAI), a severe form of avian influenza that can spread rapidly among poultry, cause widespread bird deaths, and cross the species barrier to infect people, with potentially severe consequences for human health.
That potential for animal outbreaks to threaten human health makes rapid action and information sharing across sectors essential. In Indonesia, avian influenza is a priority disease, with confirmed cases prioritized for rapid joint follow-up by animal and human health authorities.
With the positive laboratory result in hand, the animal health officer updated the existing case record in iSIKHNAS, Indonesia’s animal health reporting platform, with the confirmed HPAI result. The confirmed case triggered an alert to the District Agriculture and Livestock Office, which officially verified the case within two days.
But the information did not stop with the animal health sector. Because iSIKHNAS had recently been integrated with SIZE, Indonesia’s One Health platform, notification of the verified case was immediately shared with the District Health Office. By the next day, 13 October, a joint team of animal and human health officers, together with the local market management team, was carrying out a coordinated response at the poultry market. The team disinfected the market and briefed traders on measures to reduce the risk of further spread among poultry and people.
Just 10 days earlier, human and animal health teams had been practicing this kind of coordinated response.
Why animal and human health data need to meet
Many infectious diseases can move between animals and people, including avian influenza, rabies, leptospirosis, and anthrax, among others. An animal health worker may therefore detect a potential threat before it appears in the human health system.
That is the heart of One Health: recognizing that the health of people, animals, and ecosystems are interconnected, making collaboration across sectors essential.
Indonesia already has dedicated surveillance systems for these sectors. The Ministry of Agriculture uses iSIKHNAS (Sistem Informasi Kesehatan Hewan Nasional) for animal health reporting; the Ministry of Health uses SKDR (Sistem Kewaspadaan Dini dan Respons), also known as EWARS (Early Warning, Alert and Response System), for early warning of potential outbreaks in people; and the Ministry of Forestry uses SehatSatli (Sistem Informasi Kesehatan Satwa Liar) for wildlife health information.
To bring this data together, the Coordinating Ministry for Human Development and Cultural Affairs (Kemenko PMK) developed SIZE (Sistem Informasi Zoonosis dan Emerging Infectious Diseases) as a shared platform for information on zoonotic and emerging infectious diseases. In SIZE, officers across sectors can access the same case information, coordinate follow-up, and record their response. SIZE can then send response information back to each source system, helping every sector see what has happened.
How the four systems connect. SIZE receives cases from iSIKHNAS, SKDR, and SehatSatli, alerts users across sectors, records the response, and sends it back to each source system. Graphic: STRIDES.
Making the connections work
Making these connections work required more than linking the systems technically. The systems needed to support reliable data exchange and address differences in how each system recorded diseases, dates, case status, and locations. Without consistent data definitions, information can be difficult to compare, and cases may be missed or counted more than once.
This is where STRIDES (Strengthening Infectious Disease Detection Systems) comes in. The STRIDES Activity is funded by the U.S. government, led by FHI 360 with core partners PATH and Black & Veatch. Through this project, PATH is working alongside government counterparts and system developers to connect Indonesia’s disease surveillance systems and strengthen how information moves across them.
The STRIDES team brought system managers and developers together to establish shared data standards, develop a common variable map, and then test the connection and use of these systems.
From September 30 to October 2, human and animal health officers from Sukoharjo and other districts gathered to practice cross-sector response supported by Indonesia’s One Health data platforms. Through a series of simulated cases, multi-sectoral teams practiced moving from notification to field response and recording their actions. They also tested the newly established connections across Indonesia’s human, animal, and wildlife surveillance systems.
With these connections in place, data can now move automatically between SIZE and the three connected surveillance systems, giving officers across sectors a shared source of information to review cases, coordinate follow-up, and make decisions.
Participants check their phones during a cross-sector response simulation through SIZE in Surabaya, Indonesia, held 30 September to 2 October 2026. Photo: STRIDES/Yaumil Ikhsan.
Turning connected data into action
The Sukoharjo experience showcased the system's practical benefits. The report moved from iSIKHNAS to SIZE automatically, without needing to be re-entered. It provided a structured record with a case number, diagnosis, report date, location, and reporter details that officers across sectors could use as a shared starting point for coordination and follow-up. It also underscored that connected systems are only part of the equation. Timely reporting, clear roles and workflows, and officers who know how to act on an alert remain essential to turning shared information into action.
On October 27, 2026, Indonesia took the connection between its four One Health data systems from pilot testing to national implementation, paving the way for more districts to benefit from the kind of coordinated, cross-sector response seen in Sukoharjo.
STRIDES will build on this foundation by supporting routine use of SIZE and iSIKHNAS among district coordinators, field animal health officers, and communities, while strengthening the translation of surveillance data into action. This will include developing visualizations and actionable dashboards that help users identify patterns, interpret disease surveillance data, and inform decisions and follow-up actions.
The Sukoharjo experience offers a powerful reminder: Disease threats do not stay within one sector. The information needed to detect and respond to them cannot either.
By connecting information and strengthening collaboration across human, animal, and wildlife health, Indonesia is building the foundations for faster, better-informed, and more coordinated responses to emerging health threats.
This article was developed with contributions from Saldi Yusuf and Joko Daryono.
