Strengthening government’s response to COVID-19 in Indonesia: A modified Delphi study of medical and health academics

  1. Yodi Mahendradhata
  2. Trisasi Lestari
  3. Riyanti Djalante

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Abstract

The Indonesian government has issued various policies to control COVID-19. However, COVID-19 new cases continued to increase, and there remain uncertainties as to the future trajectory. We aimed to investigate how medical and health academics view the Indonesian government’s handling of COVID-19 and which areas of health systems need to be prioritized to improve the government’s response to COVID-19. We conducted a modified Delphi study adapting the COVID-19 assessment scorecard (COVID-SCORE) as the measurement criteria. We invited medical and health academics from ten universities across Indonesia to take part in the two-round Delphi study. In the first round, participants were presented with 20 statements of COVID-SCORE and asked to rate their agreement with each statement using a five-point Likert scale. All participants who completed the first cycle were invited to participate in the second cycle. They had the opportunity to revise their answers based on the previous cycle’s results and ranked a list of actions to improve government response. We achieved a moderate consensus level for five statements, a low consensus level for 13 statements and no consensus for two statements. The prioritization suggested that top priorities for improving the government’s response to COVID-19 in Indonesia encompass: (1) strengthening capacity to ensure consistent, credible and targeted communication while adopting a more inclusive and empathic communication style to address public concerns; (2) ensuring universal access to reliable COVID-19 testing by expanding lab infrastructure, facilitating operational readiness, and scaling up implementation of proven alternative/complementary tests to RT-PCR; and (3) boosting contact tracing implementation capacity and facilitating contact tracing for all positive cases, involving key stakeholders in further development of the existing contact tracing system (i.e. PeduliLindungi) as well as its evaluation and quality assurance. Ultimately, our study highlights the importance of strengthening health system functions during the pandemic and improving health system resilience for dealing with future public health emergencies.

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  1. Version published to 10.1371/journal.pone.0275153
  2. ScreenIT

    SciScore for 10.1101/2020.11.09.20228270: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementConsent: Research Ethic: Informed consent was required before a participant could start filling the online questionnaire.
    IRB: The study was reviewed and granted ethical approval by the Medical and Health Research Ethics Committee Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada/Dr. Sardjito General Hospital (Protocol ID KE/FK/0743/EC/2020).
    Randomizationnot detected.
    Blindingnot detected.
    Power AnalysisThe Delphi group size depend on group dynamics for arriving at consensus among experts rather than on statistical power [13].
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Notwithstanding, our Delphi process had key limitations. Firstly, the scope of the work precluded inclusion of academics beyond medicine and health (e.g. economics, public policy, public administration) and non-academics (e.g. public health practitioners, clinical practitioners, policy makers, community leaders) in the process. Seeking opinions from a broader category of participants, would have been preferable had time and the need to ensure expertise of participants not been such pressing factors. Secondly, the statements assessed here were all developed based on expert opinions [5]. As the output and recommendations from a Delphi process can only be as robust as the statements that are assessed, higher levels of evidence and further experiences should be incorporated as they become available to ensure that the recommendations remains relevant.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a protocol registration statement.

    About SciScore

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  3. Version published to 10.1101/2020.11.09.20228270v1 on medRxiv