Pelsa Facilitator Manual/id

Pedoman Fasilitator

Pedoman ini ditujukan kepada Koordinator dan pelatih lainnya yang bertanggung jawab untuk menghubungkan, merekrut, mengelola dan mempertahankan jaringan pelapor berbasis desa yang kuat. Pelsa memainkan sebuah peranan yang sangat penting dalam rantai informasi kita dan menawarkan pelaporan yang lebih cepat terhadap penyakit dan respon yang lebih efektif dari staf dinas.

Tujuan dari pelatihan Pelsa ini adalah untuk;

• mengajarkan alat-alat baru untuk digunakan saat melaporkan penyakit dan menciptakan kesempatan untuk melatih keterampilan yang baru,
• meningkatkan kepercayaan diri dan keterlibatan Pelsa,
• memotivasi dan menginspirasi praktik-praktik yang baik,
• memberikan penghargaan dan pengakuan,
• memperkuat ikatan antara Pelsa dan staf Dinas.

Latar Belakang

Pelsa telah dipilih oleh masyarakat sekitar mereka, dengan atau tanpa bantuan dari staf veteriner kabupaten, untuk menjadi seorang pelapor desa (pelsa) dan berkontribusi dalam meningkatkan kesehatan ternak di daerah mereka, dengan memastikan agar masalah kesehatan segera dilaporkan dan membantu staf dokter hewan untuk merespons secara efektif.

Pelsa memainkan peran yang sangat penting dalam sistem kesehatan hewan di Indonesia. Mereka adalah orang yang paling dekat dengan komunitas, juga dengan ternak dan para pemiliknya. Pelsa adalah titik bantuan pertama bagi komunitas mereka dan garis pertahanan pertama dalam melindungi komunitasnya.

Pelsa berperan sebagai penghubung yang sangat dibutuhkan antara peternak dengan layanan kedokteran hewan dan memudahkan paravet untuk merespons secara efisien.

Materi pelatihan ini mencoba untuk mendukung para koordinator untuk mengembangkan keterampilan Pelsa, juga kepercayaan diri dan akurasi mereka dalam mengenali dan melaporkan tanda-tanda penyakit di dalam populasi ternak lokal dengan menggunakan iSIKHNAS.

Di akhir pelatihan, Pelsa diharapkan dapat:

• Mengetahui dan mensosialisasikan peran mereka serta membangun hubungan yang baik dengan masyarakat
• Mengenali tanda-tanda klinis penyakit-penyakit hewan yang lazim dan/atau penting
• Mengenali beberapa sindrom yang menjadi karakteristik penyakit-penyakit menular yang penting (prioritas)
• Menggunakan iSIKHNAS untuk kegiatan-kegiatan pelaporan penyakit
• Mengetahui siapa yang dihubungi saat memerlukan bantuan.

Dua pendekatan

Untuk Pelsa berpengalaman (dan Koordinator berpengalaman!)

• Pelatihan setengah hari - pelaporan iSIKHNAS

Untuk staf baru

• Pelatihan satu hari - Mengenali Tanda-Tanda Penyakit dan pelaporan iSIKHNAS

Pelatihan Pelsa Setengah Hari

Jadwal Pelatihan

Waktu	Sesi	Topik
Pagi	1	Peran dan tanggung jawab Pelsa (Pelapor Kesehatan Hewan Desa) dan Mengenali permasalahan kesehatan
	2	Mengenali dan Melaporkan masalah-masalah kesehatan
	3	Skenario Pelaporan
	4	Dukungan, Umpan Balik dan Wisuda

Pelatihan Pelsa Satu Hari Penuh

Jadwal pelatihan

Time	Session	Topic
Morning	1	Role and responsibilities of Pelsa (Village Animal Health Reporter)
	2	Creating good linkages in the community
	3	Recognising health problems
	4	Recognising health problems
Afternoon	5	Reporting health problems
	6	Scenarios
	7	Support and Feedback
	8	Graduation

Persiapan dan logistik

• Pendaftaran pengguna baru
  • Registration of new users using a spreadsheet
  • Registration of new users using SMS or website
• Manajemen Pelatihan dengan situs iSIKHNAS
• Pencetakan
• Upacara penghargaan atau Wisuda

Materi-Materi

• Powerpoint dan alat bantu lain
• Grafik-grafik dan dukungan visual lainnya
• Contoh-contoh dan skenario kesalahan

Sesi 1: Peran dan Tanggung Jawab

Pelsa harus dapat;

• Mengenali tanda-tandan penyakit hewan: Mereka hendaknya dapat mengenali saat hewan menunjukan tanda-tanda yang dapat berarti bahwa mereka sedang menderita dari suatu penyakit, dan mampu menggunakan kosa kata standar dan kode-kode asosiasi dalam menjelaskan tanda-tanda dan sindrom tersebut.

• Melaporkan tanda-tanda penyakit hewan: Pelsa mengirimkan laporan kasus hewan yang sakit kepada layanan veteriner melalui SMS khusus, singkat dan terkode. Hal ini akan langsung mengirimkan peringatan kepada staf Dinas setempat yang bertanggung jawab atas area tersebut bahwa ada hewan di desa tempat tugas Pelsa yang bersangkutan yang menunjukan tanda-tandan penyakit. Dokter hewan atau paramedik veteriner setempat selanjutnya dapat merespon kepada peringatan tersebut dengan menelepon Pelsa dan menanyakan pertanyaan-pertanyaan lebih lanjut guna menentukan apakah mereka harus melakukan kunjungan atau apakah mereka dapat menyarankan suatu pengobatan tertentu melalui telepon.

• Jadilah sebuah penghubung kepada layanan veteriner yang terpecaya: Beberapa warga desa mungkin merasa malu atau tidak nyaman untuk menghubungi langsung layanan veteriner kabupaten tempat mereka berada. Namun karena Pelsa adalah anggota masyarakat asli yang terpercaya, banyak warga desa yang bersangkutan akan merasa lebih nyaman berbicara dengannya. Ini berarti bahwa akan lebih banyak kasus penyakit yang dilaporkan di desa-desa yang memiliki Pelsa dibandingkan dengan yang tidak memilikinya. Tentunya hal ini tidak berarti bahwa desa-desa yang memiliki Pelsa memiliki lebih banyak penyakit, maksudnya hanyalah lebih banyak kasus yang dilaporkan. Seiring dengan Pelsa yang semakin dikenal dan dihargai atas pekerjaan yang mereka lakukan di lingkungan masyarakat sekitar tempat mereka berada, akan lebih banyak orang yang mau menggunakan layanan mereka. Hal ini akan memantapkan hubungan antara masyarakat dan layanan veteriner agar tetap kuat dan efektif.

• Jadilah sumber informasi untuk masyarakat: Sebagai orang penghubung lokal bagi desa mereka, Pelsa dapat memberikan informasi dari Dinas setempat ke masyarakat. Hal ini termasuk pula pemberitahuan tentang kasus-kasus penyakit hewan atau adanya wabah di wilayah mereka, atau rincian tentang program vaksinasi yang akan datang. Pelsa bisa juga berpartisipasi dalam kegiatan-kegiatan terkait program vaksinasi atau surveilans, pemutakhiran data populasi dan melaporkan hasil-hasil dari beragam kasus termasuk jika ada seekor hewan yang telah pulih dari permasalahan yang dilaporkan.

Session 2 : Community linkages

Background

Livestock play multiple roles in people's lives. These include:

• Food and nutrition: animals are a very important source of food [protein]
• Social functions: animals may raise the social status of their owners. They may contribute to gender balance by affording women the opportunity to own livestock. In some communities, animal have a role in cultural or religious practices.
• Contribution to crop production: animals provide draught power and their manure contributes to soil fertility
• Income generation and wealth accumulation: animals may enable saving of wealth, providing security and playing a role as a ‘bank account’ and ‘insurance policy’
• Economic role: animal production may be an important part of the local and regional economy
• Livestock and the environment: livestock production is a part of sustainable land use, although animal production can have both positive and negative impact on the environment
• Risk buffer: in some communities, animal production provides alternative streams of income that buffers against the risks of crop failures.

The health of animals is vitally important to people's lives. Here are some effects of sickness and disease in animals;

• increase the likelihood of poverty for individual farmers and their families,
• threaten food security locally and sometimes more widely,
• negatively affect local economies because people have less money to spend, or local industries start to fail,
• impact the availability of draught power for cropping,
• can be difficult and costly to treat or cure, and to control,
• reduce production of animal products such as milk, eggs, meat,
• can be a direct risk to human health,
• increase the risk of follow-on effects from all of the above.

It is important to get help or advice about animal health problems promptly. The longer the time between first noticing a disease problem and getting help or advice for it, the greater the risk animals and the livestock owning community are at to the above problems. Prompt reporting of problems to get advice about how to deal with it is important. Some problems appear very routine and mundane but even by reporting the problem farmers can help the veterinary services to respond better and find improved solutions for all farmers with the same problem in their livestock.

What stops people from reporting?

• Don't know where to report
• Don't know why to report
• Don't know how to report
• Don't have faith in veterinary services
• Worry about the costs
• Don't care
• Try to treat by themselves
• Don't recognise the signs of disease
• Don't recognise the urgency or importance
• Worry that the vet services will cull their animals
• Take a wait and see approach and sometimes win and sometimes lose

Pelsa can help to break down some of these hurdles or barriers and make it more likely problems of disease will be reported. Pelsa are a vital link between the community and the veterinary services. Pelsa

• are a trusted member of the community,
• have training in signs recognition and the language to describe problems,
• have experience in seeing cases,
• have knowledge of how to report quickly and simply,
• can help provide a continued link, pass on advice and offer assistance with treatments suggested by the vet services,
• can determine if a problem appears to be of higher priority than others,
• can observe problems even when the farmer has not and suggest a problem is reported,
• can be a useful source of information, warnings, and advice to the community,
• understands that reporting disease can bring benefit to the community as well as to the individual farmer.

Pelsa can increase their network in their community by

• being easily and readily available,
• being open, friendly and helpful,
• being responsible and trustworthy,
• caring about the people and animals who live together,
• having a charged mobile phone with pelsa,
• wanting to improve in skills and knowledge about animal health,
• knowing when to listen and when to call for help.

Session 3 : Recognising signs of disease

What are signs?: Signs are changes in an animal that are caused by disease and that people can detect. Clinical signs are things that the observer can directly see or measure, such as swollen joints, runny nose, or diarrhoea.

Recognising signs of good health

Animals cannot tell us if they are feeling sick or healthy, but we can observe signs that suggest that they are healthy. These include:

• bright, alert, responsive
• able to stand, walk and run properly
• eat, drink and defecate normally
• good body condition/weight
• glossy coat and feather and complete/intact
• normal social interactions and behaviour

Recognising signs of disease

Signs of disease are changes in an animal that are caused by disease and that people can detect. Signs are things that the observer can directly see or measure, such as swollen joints, runny nose, or diarrhoea.

How to look over an animal?

• Head - Look for changes or things which don't seem normal - eyes, ears, mouth, tongue, teeth, neck
• Skin - Look for unusual patches, sores, redness, swelling, signs of rubbing or irritation
• Limbs - Look for cuts, injury, swelling, unusual walking, other abnormalities
• Excretions - Look at urine, faeces, blood, nose running, mouth drooling, other unusual fluids
• Behaviour - Is the animal lying down and can't get up, aggressive, agitated etc

What are common local signs of disease?

• Group activity to list as many common signs as they can think of/have seen
• Ordering them by how 'common' they are
• Agreeing on the words used for the signs
• Talking about differences and similarities

What is a syndrome?

Example of a cold in a human - runny nose, cough, weakness, lethargy, elevated temperature, etc. All the signs together point to a 'syndrome' which may or may not be a cold but could be. The collected signs describe what might be the problem.

Defined priority syndromes is a way of detecting important problems but why are some diseases considered more important than others?

• risk to human health (like rabies or anthrax)
• risk of being very infectious (like AI)
• risk of being exotic disease that we don't have (and don't want) (like FMD)
• risk of huge losses (like AI or hog cholera)
• risk of significant production losses (like brucellosis)

The role of a Pelsa involves determining if a problem is a likely to be a routine disease or a priority disease by reporting the signs or syndrome the Pelsa can observe. Priority syndrome reports will get a faster response from the veterinary services because of the possibility it is a report of a significant or important disease and will require a more thorough investigation.

iSIKHNAS uses codes to abbreviate the signs and the syndromes so that they are easier and quicker to report. iSIKHNAS interprets the codes and 'translates' them into real information. This is what we are going to learn about in the next sessions.... how to report a problem using iSIKHNAS coded SMS messages.

Remember that when you report a problem to iSIKHNAS the report is used in two ways for two different purposes.

1. to alert the veterinary services in your area that there is a health problem
2. to add to the national data about all animal disease. Our decision makers need this data in order to help all the farmers in your area to improve the health of all livestock.

So when reporting to iSIKHNAS Pelsa need to be encouraged to send accurate and complete information.

Session 4 : Reporting disease

A pelsa may hear about a health problem in the animal population in their area in a variety of ways. Perhaps a farmer will contact the Pelsa directly, perhaps she will hear about it indirectly through someone else in the village or the pelsa may come across the problem himself while walking around the village or during the course of a normal day's activity. As soon as the Pelsa hears about a new case they should try to visit the farmer and the animal if possible. Pelsa should talk to the farmer and ask him about the 'history' of the problem - when he noticed it first, if it has got worse, whether other animals are affected etc. These details will help to answer questions the dinas staff may ask the Pelsa after it is reported. Pelsa should look carefully at the animal and remember their training in signs recognition.

The next thing you need to do is to report the problem. Pelsa must decide if the problem is a 'General' problem (Tanda Umum) or a 'Priority Syndrome' (Sindrom Prioritas). If the pelsa thinks the case meets any of the Priority Syndrome descriptions then she should send an SMS using the P message format. Otherwise he should send an SMS message to iSIKHNAS using the U message format including the main signs that can be seen.

General signs report

U [sign,sign...] [species] [number of animals] {location} 

Priority syndrome report

P [syndrome] [species] [number of animals] {location} 

Remember that the information Pelsa send in each new report is used in two ways for two different purposes.

1. to alert the veterinary services in the area there is a health problem
2. to add to the national data about all animal disease. Our decision makers need this data in order to help all the farmers in your area to improve the health of all livestock.

General signs reports

U [sign,sign...] [species] [number of animals] {location} 

• Use CKT [name of sign] to look up a general sign codes.

• Use Kode SP to look up species codes.

• Use CKL [name of location] to look up the location code for a village.

The U report allows you to report the individual signs of disease that you see in the animal. You may see several signs and you should report the most significant signs. You can report several signs. Remember to separate the signs with a comma.

Pelsa are provided with training on how to look for and recognise a list of common, easily observable signs. Each sign on this list has been given an easy code to make reporting easier.

Use this list to report the signs you see as accurately as you can. Remember, the information is important and useful so try to be as accurate as you can. Don't be lazy and use "Tanda Lain"!

When you register as a Pelsa your location is also registered. All of your messages will include the details of your location automatically so most of the time most Pelsa will never have to report their location. This {location} part of the message format is optional and only used by some people who have a larger area of responsibility than a single village.

Remember that the information you send in each new report is used in two ways for two different purposes.

1. to alert the veterinary services in your area there is a health problem
2. to add to the national data about all animal disease. Our decision makers need this data in order to help all the farmers in your area to improve the health of all livestock.

Reports of General Signs of disease whilst important are much less likely to be disease of significance to the whole community. The veterinary staff will respond to these messages as soon as they can. Staff will likely call you to get more details and offer advice for treatment. Sometimes they will visit the animal to investigate further. P messages received by the iSIKHNAS system will receive a faster response by the veterinary services because they may be diseases which could be dangerous to humans, or which spread quickly or which IF they get into Indonesia could be economically catastrophic for the country. Most P reports will ensure a visit by veterinary staff.

Training Notes

• This message allows for more than one sign to be entered - multiple entries need to be separated by a comma
• Signs recognition practice may be necessary or an activity to focus staff and perhaps look at how easy and intuitive the codes are.
• Repeat the importance of making the clear decision for every case - Is this a Priority Syndrome/Important disease? (if yes, send a P, if not send a U message). This step is about discounting the possibility of an important disease before reporting a General signs case. Priority syndrome awareness raising will be important.
• Pelsa are not being asked to give a diagnosis. Dinas staff should contact the Pelsa (usually by telephone) and provide a Differential Diagnosis - the equivalent of a "best guess", or an opinion using experience and training to whatever level a person has, not necessarily a vet. A differential diagnosis can also be adjusted, changed or reversed when new information becomes available which helps to refine the opinion. When looking at a differential diagnosis, the confidence you have about it comes from knowing more about the person who gave the opinion. iSIKHNAS provides this information because all records are linked to the person who reported them. A Definitive Diagnosis however is provided by a vet with the help of laboratory test results and other evidence and is obviously most reliable and final.
• Pelsa should be discouraged from using 'other signs', ‘tanda lain’. These are unhelpful. Where there are multiple signs, Pelsa may just choose the most important, significant or prominent signs.
• Codes for specific signs can be queried using CKT [nama tanda]. Sign codes can be found by CKT [freetext] query which allows users to query the code for signs which start with similar letters or match the freetext entry. Eg CKT kembung returns kembung KBG and other options with similar letter configurations.
• When to use optional location code – pelsa with several villages.
• Location codes are gradually being updated and will soon be able to be managed locally.
• Remember: Different message formats for AH staff and Pelsa reporters - no diagnosis for pelsa.
• 100% response rate should be the target for dinas staff – mostly by telephone perhaps.

List of general signs for the U (Tanda Umum) report

Code	Sign
OBT	Obstipasi
NSA	Mual
TL	tanda lain
AU	Anuria
PU	Poliuria
DVU	Distensi VU
EPT	Epistaxis
PA	Kelainan perilaku
GG	gila galak
LP	lumpuh
LMH	Lemah
LTA	Lethargy
MN	Mata bernanah
MPC	Mata peka cahaya
MBA	Mata berair
RDT	Radang Telinga
OTA	Telinga berair
AL	Liur berlebihan
KRM	Keropeng mulut
PFA	Polifagia
MTH	Muntah
PBS	Perut Busung
MC	mencret
GT	gatal
LB	luka berdarah
KBE	Kulit Berketombe
KBA	Kulit Berkerak
PC	pincang
SB	sendi bengkak
LK	luka pada kaki
BT	batuk
HB	hidung beringus
BSN	Bersin
PLU	Pollakiuria
PDA	Polidipsia
SU	Stranguria
PR	prolaps rahim
KG	keguguran
DK	kesulitan lahir
KP	Kematian Pedet
KLP	Kelainan Pedet
AES	anestrus
KBR	Kawin Berulang
BRT	Berahi tenang
AZO	Azotemia
MT	mati mendadak
SM	sakit akut
PK	peningkatan kematian
DM	demam
RB	rahang bawah bengkak
BP	busung papan pada dada

Priority Syndrome reports

P [syndrome] [species] [number of animals] {location}

• Use Kode SIN to look up a syndrome code

• Use Kode SP to look up species codes.

• Use CKL [name of location] to look up the location code for a village.

P messages do not use the General Signs codes. P messages use only the Sindrom Prioritas 3-letter codes which represent descriptions of syndromes which look similar to important or priority disease. Syndromes are used to describe a specific set of signs which if seen together in particular species could be one of these important diseases. You are not being asked to diagnose a case but to simply be on the alert to the possibility of these priority diseases being present in your area every time you see a sick animal. It is better to be alert and on the lookout in order to protect your community from the consequences of a serious outbreak which could have been prevented early.

P messages received by the iSIKHNAS system will receive a faster response by the veterinary services because they may be diseases which could be dangerous to humans, or which spread quickly or which IF they get into Indonesia could be economically catastrophic for the country. Most P reports will ensure a visit by veterinary staff. General signs reports are very important too of course but much less likely to be disease of significance to the whole community. The veterinary staff will respond to these messages as soon as they can. Staff will likely call you to get more details and offer advice for treatment. Sometimes they will visit the animal to investigate further.

Remember that when you register as a Pelsa your location is also registered. All of your messages will include the details of your location automatically so most of the time most Pelsa will never have to report their location. This {location} part of the message format is optional and only used by some people who have a larger area of responsibility than a single village.

List of Priority Syndrome codes for the P (Sindrom Prioritas) report

Kode	Nama	Description	Spesies
BBK	Benjol Benjol Kulit	digunakan untuk melaporkan kecurigaan terhadap penyakit Lumpy Skin Disease	sapi, kerbau
DMB	Demam pada babi	Demam tinggi, konjungtivitas dan peningkatan kematian pada babi	babi, Babi Liar
GGA	Gila galak	Perubahan tingkah laku menjadi lebih agresif atau depresif,dan hipersalivasi	Anjing, Kucing, kuda, Ruminan, Primate, Musang
IDK	Ingusan dan Diare pada Kambing	Leleran hidung dan diare pada ruminansia kecil	ruminan kecil
KBS	Keringat Berdarah Sapi	keringat berdarah, kehilangan nafsu makan, demam, lethargi, diare pada sapi bali	sapi bali
KGS	Keguguran atau sendi membengkak	Keguguran pada trimester ke 3 atau sendi membengkak	Ruminan
MBG	Sempoyongan (Mubeng)	digunakan untuk laporan kecurigaan terhadap penyakit Surra	equine, ruminan besar
MBK	Mata Merah dan Bengkak	Digunakan untuk melaporkan kecurigaan terhadap African Horse Sickness	kuda
MMU	Mati meningkat pada unggas	Kematian meningkat pada ayam kampung dan unggas lain. Burung:kematian mendadak dalam waktu 2 hari dengan atau tanpa gejala klinis layer:kematian diatas 1% dalam waktu 2 hari berturut-turut.	ayam, itik, puyuh, entog, Belibis, angsa, Burung Pipit, Bebek, Bebek Peking
MTD	Mati mendadak	Kematian mendadak dan keluar darah pada lubang kumlah	Ruminan, babi, kuda
NGK	Ngorok	Sindrom untuk pelaporan kecurigaan SE	sapi, kerbau
PLB	Penyakit luar biasa	Penyakit yang sangat menular (cepat menyebar) norbiditas mortalitas tinggi tanda-tanda penyakit yang tidak biasa zoonosis	Ruminan, Burung, Monogastric
PLL	Pincang, air liur dan lepuh	Pincang, air liur berlebihan, dan lepuh pada mulut / kaki / puting	Ruminan, babi

Training Notes

• Priority codes and definitions – There are six defined syndromes but should also be referred to as a tool for reporting important disease, not just listed priority diseases
• There is one additional undefined Priority syndrome where signs don’t fit into the syndrome description but reporter feels urgent response is required (if suspected to be zoonotic, highly contagious, high mortality etc)
• Positive Consequences - Those who report P should be thanked for staying alert, even if their report turns out to be false alarm, as it will in many cases, at least it shows reporter is alert and conscious of importance of distinguishing important from routine disease. Reporters should never be afraid to report a P message but overuse will of course have possible negative consequences - "fatigue" may develop and future true priority cases may be ignored. Remember: Most "P" cases will be negative for the priority or important disease - the importance lies in our vigilance in looking out for these diseases.
• Pelsa are not being asked to give a diagnosis - just to alert dinas to what they see.
• 100% should be visited quickly, after an initial telephone call to ask for further details
• Repeating sequence (species, number of animals) for multiple species with similar syndrome
• Pelsa should be encouraged to memorise their village code or keep it in a handy place on their phone.
• Additional Priority Syndrome has been added which allows Pelsa to report urgent looking case (zoonosis, high morbidity/mortality or contagious) without having a clear syndrome is an alert for unknown or exotic disease. This is like a "Red button" to ask for help when they are concerned.