Evaluasi efektivitas layanan pengujian air minum di BLKM Manado dalam mendukung sistem kewaspadaan dini dan respon (SKDR) kejadian luar biasa penyakit diare

Nolita Sesphana Takaendengan (Program Studi Magister Ilmu Kesehatan Masyarakat, Administrasi Kebijakan Kesehatan, Universitas Sam Ratulangi)
Billy Johnson Kepel (Program Studi Magister Ilmu Kesehatan Masyarakat, Administrasi Kebijakan Kesehatan, Universitas Sam Ratulangi)
Silvya L. Mandey (Program Studi Magister Ilmu Kesehatan Masyarakat, Administrasi Kebijakan Kesehatan, Universitas Sam Ratulangi)
DOI: 10.56922/chi.v3i5.16 Published: 2026-10-26 pp. 492-506
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Background: Diarrheal disease remains a public health problem closely related to drinking water quality and environmental sanitation. In Bitung City, the incidence of diarrhea remains quite high, while microbiological testing of drinking water at the Manado Public Health Laboratory (BLKM) still finds Escherichia coli and total coliform contamination in some samples. This situation highlights the importance of public health laboratories in producing accurate and timely laboratory data to support the Early Warning and Response System (SKDR).

Purpose: To evaluate the effectiveness of drinking water testing services at the Manado BLKM in supporting the SKDR for diarrheal disease.

Method: This study used a quantitative evaluative approach with an Input-Process-Output-Outcome (IPOO) framework. Respondents consisted of BLKM Manado employees in the input and process components, drinking water testing service customers in the output component, and Bitung City Health Office personnel as laboratory data users in the outcome component. Data were collected through questionnaires, documentation, and secondary data from microbiological testing of drinking water at the Manado Public Health Office (BLKM) from 2024 to the first quarter of 2026. Univariate and bivariate analyses using Spearman's correlation and Fisher's exact test were conducted based on respondent characteristics. Service effectiveness was assessed using the Service Effectiveness Index (IEL) based on the IPOO framework.

Results: The study showed that all service components were effective. The availability of laboratory resources supported effective service delivery, while the speed of service and the accuracy of test results received positive feedback from customers. Furthermore, the Bitung City Health Office utilized laboratory test results to support surveillance and decision-making in early warning of diarrheal diseases. The IEL assessment also indicated that the overall effectiveness of the BLKM Manado drinking water testing service was in the effective category.

Conclusion: The BLKM Manado plays a strategic role as a Level 4 Public Health Laboratory in supporting laboratory-based surveillance and strengthening the SKDR for diarrheal diseases by providing quality laboratory data.

Suggestion: It is hoped that the quality of laboratory services will continue to improve through strengthening human resource competencies, facilities, and infrastructure, integrating laboratory data with monitoring systems, and utilizing the Service Effectiveness Index as a continuous evaluation instrument to improve the quality of public health laboratory services.

  1. Adaran, T., Jenrola, O., Jegede, F., Ojo, O., Bakare, A., Omiyale, O., Sanni, O. F., Aliu, O. A., & Owolabi, B. O. (2025). Quality management systems implementation in public medical laboratories; A sustainable approach to health system strengthening in Lagos State, Nigeria. PLOS ONE, 20(6), e0319409. https://doi.org/10.1371/journal.pone.0319409
  2. Andrade, C. (2021). A student's guide to the classification and operationalization of variables in the conceptualization and design of a clinical study: Part 1. Indian Journal of Psychological Medicine, 43(2), 177–179. https://doi.org/10.1177/0253717621994334
  3. Aarsi, A., Oberoi, L., Sidhu, S. K., Sodhi, M. K., & Oberoi, T. (2024). Epidemiology of rotavirus diarrhoea in children and adults presenting with acute gastroenteritis at a tertiary care hospital in Northern India: A cross-sectional study. Journal of Clinical and Diagnostic Research, 18(12), DC01–DC04. https://doi.org/10.7860/JCDR/2024/73022.20385
  4. Centers for Disease Control and Prevention. (2024). About Division of Laboratory Systems. https://www.cdc.gov/laboratory-systems/php/about/index.html
  5. Chebichii, N., Amimo, F., & Onguru, D. (2023). Enhancing water quality surveillance: A comparative analysis of water testing portable microbiological lab and the Colilert Quanti-Tray 2000. African Journal of Health Sciences, 36(3), 244–254. https://doi.org/10.4314/ajhs.v36i3.7
  6. Chen, L., Jiao, J., Liu, S., Liu, L., & Liu, P. (2023). Mapping the global, regional, and national burden of diarrheal diseases attributable to unsafe water. Frontiers in Public Health, 11, 1302748. https://doi.org/10.3389/fpubh.2023.1302748
  7. Creswell, J. W., & Creswell, J. D. (2018). Research design: Qualitative, quantitative, and mixed methods approaches (5th ed.). SAGE Publications.
  8. Dinas Kesehatan Provinsi Sulawesi Utara. (2024). Kasus penyakit menurut kabupaten/kota dan jenis penyakit di Provinsi Sulawesi Utara—Tahun 2024. Open Data Provinsi Sulawesi Utara. https://opendata.sulutprov.go.id/dataset/kasus-penyakit-menurut-kabupatenkota-dan-jenis-penyakit-di-provinsi-sulawesi-utara-2024-id_4drvj
  9. Donabedian, A. (1988). The quality of care. How can it be assessed? JAMA, 260(12), 1743–1748. https://doi.org/10.1001/jama.1988.03410120089033
  10. Fontana, C., Favaro, M., & Pistoia, E. S. (2023). Impact on turnaround time of microbiological samples after laboratory automation. Diagnostics, 13(13), 2243. https://doi.org/10.3390/diagnostics13132243
  11. Hamblion, E., Saad, N. J., Greene-Cramer, B., Awofisayo-Okuyelu, A., Selenic Minet, D., Smirnova, A., Tahelew, E. E., Kaasik-Aaslav, K., Ezerska, L. A., Lata, H., Allain Ioos, S., Peron, E., Abdelmalik, P., Perez-Gutierrez, E., Almiron, M., Kato, M., Babu, A., Matsui, T., Biaukula, V., & Corpuz, A. (2023). Global public health intelligence: World Health Organization operational practices. PLOS Global Public Health, 3(9), e0002359. https://doi.org/10.1371/journal.pgph.0002359
  12. Hidayati, R., Kusmanto, A. S., & Kiswantoro, A. (2023). Development and construct validation of Indonesian students self-confidance scale using Pearson Product Moment. Pegem Journal of Education and Instruction, 13(3), 94–103. https://doi.org/10.47750/pegegog.13.03.11
  13. Hong, M., Shin, E., Kim, J., & Yoo, J. (2024). Laboratory surveillance of waterborne and foodborne infectious disease causing bacteria in the Republic of Korea (2019–2022). Public Health Weekly Report, 17(45), 1941–1955. https://doi.org/10.56786/PHWR.2024.17.45.2
  14. Hyde, E., Bonds, M. H., Ihantamalala, F. A., Miller, A. C., Cordier, L. F., Razafinjato, B., Andriambolamanana, H., Randriamanambintsoa, M., Barry, M., Andrianirinarison, J. C., Andriamananjara, M. N., & Garchitorena, A. (2021). Estimating the local spatio-temporal distribution of malaria from routine health information systems in areas of low health care access and reporting. International Journal of Health Geographics, 20(1), Article 8. https://doi.org/10.1186/s12942-021-00262-4
  15. Indu, P. V., Vidhukumar, K., Chacko, D., Menon, V., Grover, S., & Gupta, S. (2025). Criterion validity, construct validity, and factor analysis: An introductory overview. Indian Journal of Psychiatry, 67(9), 916–921. https://doi.org/10.4103/indianjpsychiatry_911_25
  16. Jang, Y., Lee, H., & Park, H. (2025). Surveillance system for infectious disease prevention and management: Direction of Korea's infectious disease surveillance system. Journal of Korean Medical Science, 40, e108. https://doi.org/10.3346/jkms.2025 40.e108
  17. Kementerian Kesehatan Republik Indonesia. (2023). Peraturan Menteri Kesehatan Republik Indonesia Nomor 2 Tahun 2023 tentang Peraturan Pelaksanaan Peraturan Pemerintah Nomor 66 Tahun 2014 tentang Kesehatan Lingkungan. https://peraturan.bpk.go.id/Details/245563/permenkes-no-2-tahun-2023
  18. Kementerian Kesehatan Republik Indonesia. (2023). Peraturan Menteri Kesehatan Republik Indonesia Nomor 25 Tahun 2023 tentang Organisasi dan Tata Kerja Unit Pelaksana Teknis Bidang Laboratorium Kesehatan Masyarakat. https://jdih.kemkes.go.id/documents/peraturan-menteri-kesehatan-nomor-25-tahun-2023
  19. Kementerian Kesehatan Republik Indonesia. (2025). Pola tren terduga penyakit pada aplikasi SKDR tahun 2024 sampai minggu ke-14 tahun 2025. https://surveilans.kemkes.go.id/assets/publikasi/pola-tren-terduga-penyakitpencernaanpada-aplikasi-skdr-tahun-2024-sd-minggu-ke-14-tahun-2025.pdf
  20. Lee, L. M., Teutsch, S. M., Thacker, S. B., & St. Louis, M. E. (2010). Principles and practice of public health surveillance (3rd ed.). Oxford University Press. https://doi.org/10.1093/acprof:oso/9780195372922.001.0001
  21. Martínez-Mesa, J., González-Chica, D. A., Duquia, R. P., Bonamigo, R. R., & Bastos, J. L. (2016). Sampling: How to select participants in my research study? Anais Brasileiros de Dermatologia, 91(3), 326–330. https://doi.org/10.1590/abd1806-4841.20165254
  22. Mohamad, M. M., Sulaiman, N. L., Sern, L. C., & Salleh, K. M. (2015). Measuring the validity and reliability of research instruments. Procedia - Social and Behavioral Sciences, 204, 164–171. https://doi.org/10.1016/j.sbspro.2015.08.129
  23. Pillai, S. P., & Fox, E. (2025). Laboratory quality management system fundamentals. Frontiers in Bioengineering and Biotechnology, 13, Article 1578654. https://doi.org/10.3389/fbioe.2025.1578654
  24. Wolf, J., Johnston, R. B., Ambelu, A., Arnold, B. F., Bain, R., Brauer, M., Brown, J., Caruso, B. A., Clasen, T., Colford, J. M., Mills, J. E., Evans, B., Freeman, M. C., Gordon, B., Kang, G., Lanata, C. F., Medlicott, K. O., Prüss-Ustün, A., Troeger, C. E., & Cumming, O. (2023). Burden of disease attributable to unsafe drinking water, sanitation, and hygiene in domestic settings: A global analysis for selected adverse health outcomes. The Lancet, 401(10393), 2060–2071. https://doi.org/10.1016/S0140-6736(23)00458-0
  25. World Health Organization. (n.d.). Strengthening public health laboratory services. https://www.who.int/activities/strengthening-public-health-laboratory-services
  26. World Health Organization. (2023). Defining collaborative surveillance: A core concept for strengthening the global architecture for health emergency preparedness, response, and resilience (HEPR). https://www.who.int/publications/i/item/9789240074064