Tag: health surveillance

Indonesia Kicks Off the First Phase of Blood Lead Surveillance Piloting

The implementation of the first phase of blood lead surveillance (BLS) piloting in Indonesia, as part of the Strengthening Health Systems to Reduce Lead Exposure project, has reached a significant milestone. Following extensive preparations since April 2024—including numerous technical meetings with the Blood Lead Surveillance (BLS) Working Group and coordination with relevant stakeholders—the Ministry of Health of Indonesia, in collaboration with Yayasan Pure Earth Indonesia, Vital Strategies, and the Research Center for Public Health and Nutrition (PRKesmaszi) of the National Research and Innovation Agency (BRIN), officially kicked off the first phase of BLS piloting in Indonesia.

“The first phase of BLS piloting will take place throughout 2025 in twelve selected districts/cities across six provinces: East Java, Central Java, South Sumatra, Lampung, Bali, and West Nusa Tenggara, as well as a pre-survey location in Tangerang Regency. The piloting surveillance includes blood lead levels (BLL) testing in children and identification of lead exposure sources through home-based assessments, which will involve sampling dust, soil, and water, as well as measuring lead levels in everyday items,” said Alfi Sina Vinci, Program Coordinator of the project, at the kickoff event held on December 13, 2024 in Jakarta.

Solidifying Commitment in A Growing Collaboration 

The kickoff represents a tremendous commitment to the effort to reduce childhood lead exposure in Indonesia. The Institute for Health Metrics and Evaluation (2019) estimates that more than 8 million children in Indonesia have blood lead levels exceeding 5 micrograms per deciliter (µg/dL) which is the World Health Organization’s (WHO) recommended threshold for action. WHO emphasizes that no safe level of lead exposure exists, as even relatively low levels can harm children’s health and impair cognitive development.

“Therefore, it is imperative for us to protect our children from lead exposure. It aligns with our effort to realize our vision of Golden Indonesia 2045,” stated dr. Anas Ma’ruf, MKM, Director of Environmental Health, Directorate General of Disease Prevention and Control, Ministry of Health of the Republic of Indonesia said in his opening remarks.

Since April 2024, the BLS Working Group, led by the Directorate of Environmental Health, has held a series of meetings and received extensive input to develop the BLS piloting work plans. These plans encompass study design, location selection, methodology, laboratory partnerships, and communication strategies. As the initiative progressed, the Working Group expanded. In early December 2024, the Research Center for Public Health and Nutrition (PRKesmaszi) of BRIN officially joined as the Principal Investigator for the BLS piloting.

“The role aligns with the duties and functions of BRIN in research, development, assessment, and application, to provide evidence-based recommendations for national development,” said Dr. Wahyu Pudji Nugraheni, SKM., M.Kes., Head of PRKesmaszi – BRIN. 

Mobilizing Resources for the BLS Piloting

The first phase of BLS Piloting will involve eleven BRIN researchers, 1,618 children aged 12–59 months (accompanied by their parents/guardians), 65 health workers, 65 enumerators, and 130 health cadres from selected locations. “PRKesmaszi – BRIN, Yayasan Pure Earth Indonesia, and Vital Strategies will provide technical support and assist community health centers in the selected locations, ensuring effective field implementation,” said Budi Susilorini, Country Director of Yayasan Pure Earth Indonesia, in her progress report at the event.

In addition to data collection, the first phase of BLS Piloting also includes capacity-building activities for stakeholders and public education on the dangers of lead exposure. Later stages will involve communicating test results to participants, developing policy recommendations, and disseminating findings to stakeholders.

“The BLS Working Group will later discuss strategies for disseminating the surveillance results across the six provinces. These findings will serve as a baseline for the Ministry of Health in making policies and determining the next steps to address the health impacts of lead exposure in Indonesia,” added Edwin Siswono, Epidemiologist at Vital Strategies.

Watch the highlight of the event in this video:

Learn more about the implementation of the Strengthening Health Systems to Reduce Lead Exposure project in Indonesia.

New Report: Analysis of the capacity of the healthcare system of the Kyrgyz Republic to monitor lead concentrations

Read the full capacity assessment report.

To analyze the capacity of the healthcare system of the Kyrgyz Republic to monitor the concentrations of lead and other heavy metals in blood, urine and other media and existing regulatory legal acts as well as to provide recommendations for changes. The study was conducted in coordination with international project experts and using questionnaires developed by them.

Analysis of the capacity of the healthcare system of the Kyrgyz Republic to monitor lead concentrations (Desk review report) was prepared for the project Strengthening Health Systems to Reduce Lead Exposure. This report serves to justify the project and to inform decision-makers about the subsequent implementation of monitoring lead levels in children’s blood and determining priority actions to establish a sustainable monitoring, prevention, and treatment system for heavy metal poisoning, including lead.

Lead is a toxic element that even in small concentrations can have serious negative effects on human health, especially vulnerable groups such as children. Research indicates that exposure to lead can lead to developmental delays, reduced cognitive abilities, behavioral problems, and other adverse health outcomes (Lanphear et al., 2005; Canfield et al., 2003). However, despite the well-known risks associated with lead, many countries, including Kyrgyzstan, lack comprehensive monitoring and prevention programs for lead poisoning, particularly among children. This is due to insufficient data on the scale of the problem at the national level and a lack of awareness among the population and decision-makers about the importance and urgency of this issue.

Conducting this study will help fill the gaps in knowledge regarding current levels of lead in children’s blood in Kyrgyzstan and identify the main sources and pathways of lead exposure in children. The data obtained will serve as a basis for developing targeted public health programs aimed at reducing lead exposure and preventing its negative health consequences for children. This, in turn, will contribute to improving quality of life, reducing
healthcare costs, and enhancing public well-being.

To conduct monitoring of lead and other heavy metals concentrations in blood, urine, and other mediums, and to determine priority actions and effectively utilize existing resources, a situational analysis of the healthcare system’s potential in the Kyrgyz Republic was conducted.

Acknowledgements

We are grateful to the Ministry of Health, the Ministry of Natural Resources, Ecology, and Technical Supervision of the Kyrgyz Republic, as well as to the staff of centers and laboratories, including private ones, for their active support in conducting the assessment of the healthcare system’s potential in the Kyrgyz Republic for monitoring the concentration of lead and other heavy metals in blood.

The funder had no role in the capacity inventory design, data collection, analysis, and report preparation.

AUTHORS

  • Ainash Sharshenova, Doctor of Medical Sciences, Professor, International School of
  • Medicine, International University of Kyrgyzstan
  • Indira Zhakipova, Civil Society Association ECOIS-BISHKEK
  • Kubanych Almerekov, Civil Society Association ECOIS-BISHKEK
Read the full report

Indonesia: Collaboration + Synergy = The Key

“The Strengthening Health System to Reduce Lead Exposure” Program in Indonesia

For non-profit organizations, collaboration is crucial in reaching organizational goals and creating a positive impact on the communities. In addition, synergy can make combined efforts accomplish more. Pure Earth has been partnering with governments, communities and industry leaders to identify and implement solutions in order to stop toxic exposures, protect health, and restore environments. The organization – collaborating with various global and local stakeholders – also specifically works to sustainably address the root causes of lead and mercury pollution.

In regards to health surveillance, conducting baseline Blood Lead Level (BLL) testing and analysis is crucial to understand prevalence, severity and sources of lead exposure. In 2023, with a grant from Takeda Pharmaceutical Limited (Takeda), Pure Earth launched “Strengthening Health Systems to Reduce Lead Exposure” program, a partnership between Pure Earth, Vital Strategies, and the Ministries of Health in Colombia, Indonesia, Kyrgyzstan, Maharashtra, India, and Peru to strengthen each country’s national healthcare system to better prevent, identify, and treat lead exposure.

Started in April 2024 until present, Yayasan Pure Earth Indonesia (PE Indonesia) and Vital Strategies (VS) have been in discussion with the Ministry of Health (MOH) of the Republic of Indonesia in designing and implementing the new national program to identify, monitor and reduce lead exposure. The working plan is still being developed together by the working team. Quite many inputs came up from the members of the working team, which consists of members from various institutions, including PE Indonesia, VS and directorates (Dit) under MOH, such as Environmental Health as the Coordinator, Public Health Governance (Takelkesmas), Center for Health Development Policy (BKPK), Data and Information Center (Pusdatin), as well as cross-sectoral government agencies, i.e. Central Bureau of Statistics (BPS) and many more. The last technical coordination meeting was just held on June 24, 2024, where small group meetings will be carried out to finalize and agree on the working plan.

Surveillance as one of the instruments in public health has a role in producing information from the data collected, hence stakeholders can determine effective and efficient policies (Groseclose, 2017). BLL Surveillance (SKTD) is expected to be a tool in monitoring children’s BLL nationally in Indonesia, so that policies in controlling lead exposure can be established effectively.

In the context of the implementation of the “Strengthening Health System to Reduce Lead Exposure” program, SKTD piloting activities will be carried out to obtain data on the prevalence of BLL in Indonesian children as reference material in efforts to strengthen the health system in Indonesia. The piloting activity will be carried out in two stages, the first phase of which is planned to be carried out in the second semester of 2024 with the aim of monitoring BLL in children in Indonesia and understanding the increasing prevalence of BLL in children, evaluating the capacity of existing resources, and testing the feasibility of implementing national BLL. Meanwhile, the second phase is planned to be implemented in 2026 with the aim of initiating the integration of SKTD into periodic active surveillance.

New Report: Childhood Lead Exposure Prevention: Assessment of Blood Lead Surveillance Capacity in Maharashtra, India

Read the full capacity assessment report.

As an essential step toward establishing such a system at the state level in Maharashtra, we conducted a capacity assessment to evaluate existing laboratory capacity and health system structure and provide recommendations for capacity strengthening and surveillance options best suited for Maharashtra. This capacity assessment report evaluated the policy landscape, public health infrastructure laboratory capacity to initiate and support a statewide childhood lead surveillance system, which will be fulfilled in close collaboration with the Public Health Department (PHD), Government of Maharashtra.

Preventing exposure to lead (Pb) is particularly important for health, because neurological and behavioral impacts caused by lead exposure among children are generally irreversible. Blood lead surveillance is a critical component of a comprehensive lead poisoning prevention program, as effective and comprehensive prevention begins with information obtained from surveillance. Unfortunately, at present, very few countries in Asia have established blood lead surveillance due to a lack of awareness and resources.

In India, a recent National Institution for Transforming India (NITI) Aayog—Council of Scientific and Industrial Research (CSIR) report has highlighted the importance of establishing blood lead surveillance that can generate high-quality local data to help understand lead exposure and health burden among Indian children. This may be implemented effectively at the state level, starting in states including Maharashtra, where there is demonstrated government commitment to addressing environmental health issues. Statewide childhood blood
lead surveillance typically involves monitoring blood lead levels (BLLs) among children and collecting other information that may indicate risks and sources of lead exposure.

Acknowledgements

Vital Strategies and Pure Earth gratefully acknowledge the support of the Public Health
Department of the Government of Maharashtra in this assessment. Commissioner of Health Services cum Mission Director National Health Mission gave his input and connected us with concerned senior health officials. We thank the officials from the State Family Welfare Bureau, State Health Systems Resource Centre, State Surveillance Unit, and State Public Health Laboratory for providing us with valuable insights who work under the leadership of the Director of Health Services. The assessment was made possible by the generous support received from Takeda Pharmaceuticals.

Contributors:

  • Yatin Pimplé, Vital Strategies
  • Yi Lu, Vital Strategies
  • Sumi Mehta, Vital Strategies
  • Dan Kass, Vital Strategies
  • Lavanya Nambiar, Pure Earth
  • Debanjana Choudhari, Pure Earth

The views expressed in this report are those of the contributors and do not necessarily reflect
those of the funders or the Public Health Department of the Government of Maharashtra.

Read the full report