Strengthening Border Health Security Through Digital Surveillance: Evaluation of the Satu Sehat Health Pass System in Indonesia

Abstract

Background: The increasing volume of international travel has heightened the risk of cross-border transmission of infectious diseases, necessitating effective surveillance systems at points of entry. In response to the global mpox outbreak and other emerging public health threats, Indonesia implemented the Satu Sehat Health Pass (SSHP), a digital health declaration platform for international travelers. This study evaluated the performance of the SSHP surveillance system at Sultan Hasanuddin International Airport, Makassar, Indonesia. Methods: A mixed-method surveillance system evaluation was conducted from September 2024 to April 2025 using the Centers for Disease Control and Prevention (CDC) surveillance evaluation framework. Quantitative assessment examined sensitivity, positive predictive value (PPV), representativeness, data completeness, and timeliness using secondary surveillance data from 113,051 international travelers. Qualitative assessment explored simplicity, flexibility, acceptability, stability, data quality, and usefulness through in-depth interviews and focus group discussions with surveillance stakeholders. Results: During the study period, 627 (0.55%) travelers were classified as high-risk or symptomatic by SSHP. The sensitivity of self-reported SSHP screening was 63.2%, while the PPV was 4.94%. Health officer assessment demonstrated superior performance, with sensitivity of 73.0% and PPV of 90.3%. Representativeness was satisfactory, with approximately 98% completeness for demographic variables. However, 81% of records contained incomplete or invalid telephone numbers, limiting follow-up investigations. The system showed good timeliness, with notifications transmitted within 24 hours. Qualitative findings indicated that SSHP was useful, flexible, and acceptable, but challenges remained regarding data quality, interoperability, and operational stability during peak travel periods. Conclusion: SSHP contributes to the early detection and monitoring of infectious disease risks among international travelers. Nevertheless, improvements in data validation, traveler compliance, system integration, and infrastructure support are needed to optimize surveillance effectiveness and strengthen border health security in Indonesia.

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