Use of community-based surveillance to enhance emerging infectious disease intelligence generation in Indonesia.

Background: Community-based surveillance (CBS) refers to a structured process whereby community members systematically detect and report events of public health significance occurring within their communities. In response to the COVID-19 pandemic, the Government of Indonesia has taken steps to enhance national preparedness for future health threats, focussing on expanding the use of CBS. Given the novelty of CBS's use in Indonesia, we undertook this research to provide evidence-based advice to guide its implementation across the country's diverse communities and operational contexts. Methods: We employed three strategies to gather data: a content analysis of policy documents related to CBS implementation in Indonesia, site visits, and interviews with purposefully selected key informants from the animal, wildlife and human health sectors, planning agencies, village leadership, and inter-government coordination bodies. We conducted additional interviews with staff from the United Nations and donor development assistance agencies involved in CBS implementation in Indonesia. A semi-structured tool guided the interviews, and we analysed the data using an inductive approach. Results: We identified eight policy documents, visited six CBS project sites, and interviewed 120 key stakeholders. Key themes that emerged included the need for greater clarity on the scope, purpose, and function of CBS and how data collected intersect with and is used within Indonesia's broader early warning disease surveillance architecture, a need to harmonisation CBS legislation and implementation guidance across and within ministries, and that ongoing investment in essential health system building blocks - workforce, data systems, and analytical capacity - is required to ensure the scalability and sustainability of CBS across the country. Conclusions: Although CBS holds promise for strengthening public health security in Indonesia, key challenges related to common understanding, workforce capacity, data flow, and system governance must be addressed if the strategy is to make a meaningful contribution. Effective collaboration among government ministries, administrative levels, and community stakeholders is crucial for adapting CBS to balance local and national health security priorities, while ensuring stability, sustainability, and scalability across Indonesia's diverse contexts.