Qualitative Study of Effectiveness of Early Warning System and Dengue Fever Case Response in West Tulang Bawang Regency, Lampung, Indonesia

The Early Warning and Response System (EWARS) plays a role in detecting potential outbreaks of infectious diseases through weekly reports. West Tulang Bawang Regency experienced an increase in dengue fever cases in 2024–2025, but the early detection function of the EWARS has not been running optimally as indicated by the still low number of alerts compared to the number of reported cases. This study aims to explore the effectiveness of the EWARS for dengue fever cases in West Tulang Bawang Regency, Lampung, Indonesia. The study used a qualitative approach with a case study method. Data collection was carried out from October to December 2025 in three community health centers with 14 research informants consisting of village cadres, village midwives, community health center surveillance officers, Health Office surveillance officers, community health center heads, and village heads selected using a purposive sampling technique. Data collection was carried out through in-depth interviews, observation, and documentation with thematic data analysis. Input components: training is not evenly distributed, competencies are not in accordance with education, limited funds that are not specifically for EWARS reporting, limited facilities and infrastructure (computers, internet network constraints and disruptions to the EWARS web application system). Process components: tiered data collection from networks, health centers via WA to health offices, health centers do not yet have access to the EWARS web application, manual data entry, data validation for signal verification (alert), data presentation in graphical form, feedback via weekly bulletins in the WA group, monitoring, evaluation and follow-up have been carried out according to procedures. The effectiveness of EWARS for DHF cases in West Tulang Bawang Regency is influenced by limited funding, limited facilities and infrastructure, staff competencies that do not match education, uneven training causes different understanding of staff, implementers do not understand what to report, so that cases that are often reported are cases that are already positive or cases that have been treated in hospitals, this is not in accordance with the principles of EWARS. There is a need to increase human resource capacity, provide adequate facilities and infrastructure, integrate web-based reporting systems at the community health center level and mobile SDKR at the network level, encourage symptom-based reporting and provide funding support.