Strengthening Health System Resilience through Community-Based Surveillance Assistance for Tuberculosis Control: A Quasi-Experimental Study in Indonesia
Keywords:
Community-Based Surveillance; Tuberculosis Control; Health System Resilience; Community Health WorkersAbstract
Tuberculosis remains a major public health challenge in high-burden countries, including Indonesia, where delayed case detection and weak contact investigation continue to impede effective disease control. Strengthening health system resilience requires innovative approaches that integrate community participation with supportive and digitally enabled surveillance systems. This study examined the effectiveness of digitally supported Community-Based Surveillance Assistance (CBSA) in improving tuberculosis control at the community level. A quasi-experimental study using a non-randomized one-group pre-test and post-test design was conducted among 30 community health cadres in Kramatmulya Sub-District, Kuningan District, Indonesia. The intervention consisted of structured surveillance assistance, capacity-building sessions, and the use of standardized reporting tools aligned with digital health information systems at primary healthcare facilities. Outcome measures included cadres’ tuberculosis-related knowledge, the number of contact investigations conducted, and sputum referrals for suspected cases. Data were analysed using paired t-tests. The results showed significant improvements following the CBSA intervention. Mean knowledge scores increased markedly after assistance (p < 0.001). The average number of tuberculosis contact investigations conducted by cadres increased significantly (p < 0.05), as did sputum referrals for suspected tuberculosis cases (p < 0.05). These findings indicate that community-based surveillance assistance, supported by structured guidance and system-linked reporting mechanisms, can enhance community capacity for early tuberculosis detection. This study highlights the potential of integrating community empowerment with digitally supported surveillance systems to strengthen health system resilience. Community-based surveillance assistance represents a scalable and sustainable strategy for improving tuberculosis control in resource-limited settings.
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