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ADAPTING TO IMPACT OF ADAPTING TO IMPACT OF CLIMATE CHANGE ONCLIMATE CHANGE ON
DENGUE HEMORRHAGIC FEVER DENGUE HEMORRHAGIC FEVER IN INDONESIAIN INDONESIA
Budi Haryanto
DECISION MAKERSDECISION MAKERS
• Minister of Health• Director of the National Planning and
Development Board
TEMPERATURE PROJECTION ON TEMPERATURE PROJECTION ON INDONESIAINDONESIA
24.0
25.0
26.0
27.0
28.0
1950 1960 1970 1980 1990 2000
0C 0C
Year
24.0
25.0
26.0
27.0
28.0
2000 2020 2040 2060 2080 2100
Year
Source: NOAA, 2002 Source: Susandi, 2005
JULY
JANUARY
Jakarta : 1.4°C
Surabaya : 3.29°C
Surabaya : 1.46°C Jakarta : 1.04°C
INCREASING TEMPE- RATURE IN JAKARTA & SURABAYA 1900 - 2000
GLOBAL : 0.7°C/100 years GLOBAL : 0.7°C/100 years
15
RAINFALL TREND RAINFALL TREND IN INDONESIA 1950IN INDONESIA 1950--20002000
1350140014501500155016001650170017501800
1950 1960 1970 1980 1990 2000Year
mm/Year
Source: NOAA-CIRES (2005)
Scatter Diagram HH vs CH Rata-2 Area Bulanan Kota Surabaya (1973-2007)
y = 0.4827x2 + 15.973x ; R2 = 0.8971
050
100150200250300350400450500550600650700
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22HH
CH
(mm
)
Scatter Diagram HH vs CH Propinsi DKI Jakarta tahun 1995-2006
y = 14.005x ; R2 = 0.6859
050
100150200250300350400450500550600650700750800
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29HH
CH (m
m)
RAINFALL AND DHF CASES RAINFALL AND DHF CASES IN DKI JAKARTA 1993IN DKI JAKARTA 1993--20062006
y = 258.62x ‐ 395.27
R2 = 0.3633
‐1000
0
1000
2000
3000
4000
5000
6000
7000
8000
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
DBD‐mar
Linear (DBD‐
Skenario Kasus DBD Kota Surabaya 2007- 2015
y = 360.05x + 894.78R2 = 0.332
y = 1203.6e0.1315x
R2 = 0.2011
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015Tahun
DB
DPREDICTION OF DHF CASES IN SURABAYA 2007PREDICTION OF DHF CASES IN SURABAYA 2007--20152015
Skenario DBD 1995-2015 Prop DKI Jakarta
y = 1618.4x + 1357.5 ; R2 = 0.593
0
5000
10000
15000
20000
25000
30000
35000
40000
45000
199519961997199819992000200120022003200420052006200720082009201020112012201320142015
Tahun
DB
DPREDICTION OF DHF CASES IN JAKARTA 2007PREDICTION OF DHF CASES IN JAKARTA 2007--
20152015
YEAR
Figure 3.Scenario DHF Cases Over Indonesia (1968~2100)
y = 2171.7x - 17241R2 = 0.6596
y = 59.281x1.907
R2 = 0.9085
025,00050,00075,000
100,000125,000150,000175,000200,000225,000250,000275,000300,000325,000350,000375,000400,000425,000450,000475,000500,000525,000550,000575,000600,000625,000650,000675,000700,000
68 73 78 83 88 93 98 0320
08 13 18 23 28 33 38 43 4820
53 58 63 68 73 78 83 88 9320
98Year
DH
F El~Nino Year
Using
data
cases
of
dengue
fever
since
1968‐2007,
scenario
that
cases
of
dengue
fever
in
years
2050
and
2100
in
Indonesia,
up
to
150,000/275.000
and 275,000/675.000
cases.
0
50
100
150
200
250
300
350
400
0.00
10.00
20.00
30.00
40.00
50.00
60.00
70.00
80.00
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20
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20
09
Incidence Rate per 100,000
Year
INCIDENCE RATE & NUMBER OF DISTRICTS/CITIES WITH DHF
IN INDONESIA 1968 - 2008
INSIDENS
KAB/KOTA TERJANGKIT
# Districts/Cities
DHF CASES BY DHF CASES BY CITIES/DISTRICTS IN INDONESIA CITIES/DISTRICTS IN INDONESIA
1968 1968 -- 20082008
MAIN PROBLEMMAIN PROBLEM
Rising of DHF incidence in Indonesia
SCOPING PROBLEMSCOPING PROBLEM
EFFECTS
CAUSES
PROBLEM
Risk of spread
Indonesia International
Reduce productivity
Rising incidence of DHF in Indonesia
Increasing rain fall & temperature
Number of mosquito increased
Increasing breeding places
Inability to control DHF
Lack of capacity in MOH
Many infected persons
Climate change
Putting more people at risk worldwide
Threat tourism
Economic loss
Increase absenteeismFear inCommunity
Morbidity Mortality
lack of health promotion
Improper program implementation
lack of community participation
Lack of SOP
Late diagnosis
‘Carrier’ people movement
Inaccurate diagnosis
Difficult to be tackled
CAUSES
PROBLEM Rising incidence of DHF in Indonesia
Increasing rain fall & temperature
Number of mosquito increased
Increasing breeding places
Inability to control DHF
Many infected persons
Climate change
S O L U T I O N S
Burying, Covering, and Cleaning the potential mosquito breeding places (community & government)
Intensifying control for Aedes’ adult & pupa (comm & govt)
Early warning system information from BMKG sent to government to activate control of breeding places (govt & univ.)
Mitigation to reduce sources of GHG (govt, univ., NGO & comm)
BURYING, COVERING, & CLEANING BURYING, COVERING, & CLEANING MOSQUITO BREEDING PLACESMOSQUITO BREEDING PLACES
WHAT SHOULD DO STAKE HOLDERSTo find potential Aedes’s breeding places at the home yard (can, bottle, etc.)
Individual, household, & community
To burry the removable breeding places Individual, household, & community
To cover the non-removable breeding places Individual, household, & community
To clean or drain clean water which is potential for Aedes’s breeding places
Individual, household, & community
INTENSIFYING CONTROL OF INTENSIFYING CONTROL OF AEDESAEDES’’S ADULT & PUPA S ADULT & PUPA
WHAT SHOULD DO STAKE HOLDERSHealth promotion & education of BCC to community
Local Health Office
Training of eradicating Aedes’s adult (fogging) and pupa surveillance
MOH & Local Health Office
To do fogging properly in the area of new DHF patient living
Local Health Office & Public Health Center
Surveillance of Aedes’s pupa and breeding places Local Health Office & Public Health Center
Community empowerment for combating Aedes’s adult and pupa
Public Health Center & Local Government
EARLY WARNING SYSTEMEARLY WARNING SYSTEM
WHAT SHOULD DO STAKE HOLDERSTo generate collaboration of Early Warning System between MOH & BMKG
MOHBMKG
BMKG to send warning to Local Health Office of the increasing trend of rainfall & temperature within 24 hours
BMKGLocal Health OfficeMOH
MITIGATION TO REDUCE SOURCES MITIGATION TO REDUCE SOURCES OF GREEN HOUSE GASESOF GREEN HOUSE GASES
WHAT SHOULD DO STAKE HOLDERSTo take part to reduce all energy uses as a daily life
Individual, community
To take part to generate ‘green’ environment Individual, community
To take part to act ‘environmental friendly’ behavior
Individual, community
To prioritize climate change on the national development
President, MOH, Bappenas
To involve other sectors and stake holders in implementing national mitigation strategy
Central government, Local government, Civil society, NGOs
CAUSES
PROBLEM Rising incidence of DHF in Indonesia
Number of mosquito increased Inability to control DHF
Many infected persons
Inaccurate diagnosis
‘Carrier’ people movement
Late diagnosis
S O L U T I O N S
Health promotion on recognizing the symptoms of DHF (govt)
Send the DHF suspect to hospital immediately (comm)
Capacity building for medical, health service providers, and laboratories (govt & univ.)
Health promotion on recognizing the symptoms of DHF (govt) and Delay for travelling (comm)
HEALTH PROMOTION ON HEALTH PROMOTION ON RECOGNIZING DHFRECOGNIZING DHF’’S SYMPTOMSS SYMPTOMS
WHAT SHOULD DO STAKE HOLDERSTo develop health promotion materials on DHF symptoms and early prompt treatment for community
MOH, Local health office
To conduct health promotion and education on DHF symptoms and early prompt treatment to community
Local health office, Health center, key persons in community
To use media for disseminating health promotion on DHF symptoms and early prompt treatment to community
MOH, local health office, local government
SEND DHFSEND DHF’’S SUSPECT TO S SUSPECT TO HOSPITAL IMMEDIATELYHOSPITAL IMMEDIATELY
WHAT SHOULD DO STAKE HOLDERSTo identify member of family and neighborhood who having symptoms like DHF
Individual, household, community
To send those who have symptoms like DHF to hospital immediately
Individual, household, community
CAPACITY BUILDING FOR MEDICAL CAPACITY BUILDING FOR MEDICAL HEALTH SERVICES & LABORANTSHEALTH SERVICES & LABORANTS
WHAT SHOULD DO STAKE HOLDERSTo conduct frequent workshop on DHF treatment for medical and health service officers
MOH, local health office, hospitals
To conduct training on Laboratory analysis for DHF
MOH, local health office, hospitals
To standardize the DHF treatment management and laboratory analysis
MOH
HEALTH PROMOTION ON THE SYMPTOMS HEALTH PROMOTION ON THE SYMPTOMS OF DHF & DELAY TRAVELLINGOF DHF & DELAY TRAVELLING
WHAT SHOULD DO STAKE HOLDERSTo conduct health promotion and education on DHF symptoms and early prompt treatment to community
Local health office, health center, local government
To recognize the DHF symptoms and decide to delay for travelling
Individual, community
CAUSES
PROBLEM Rising incidence of DHF in Indonesia
Number of mosquito increased Inability to control DHF
Lack of capacity in MOH
Many infected persons
lack of health promotion
Improper program implementation
lack of community participation
Lack of SOP
S O L U T I O N S
Capacity building for health officers and revitalizing current SOP (govt & univ.)
Capacity building for health officers and supervision (govt & univ.)
Capacity building for health officers, revitalizing program and budget allocation (govt & univ.)
Advocacy, capacity building, political awareness (univ. & govt)
Health promotion & community empowerment (govt & univ.)
CAPACITY BUILDING FOR HEALTH CAPACITY BUILDING FOR HEALTH OFFICERS AND SUPERVISIONOFFICERS AND SUPERVISION
WHAT SHOULD DO STAKE HOLDERSTo conduct training on DHF control management
MOH, Local health office
To facilitate equipments and materials for DHF control implementation
MOH, Local health office
To provide appropriate funding for DHF control implementation
MOH, Local health office, local government
To supervise regularly on DHF control implementation
Local health office
CAPACITY BUILDING FOR HEALTH CAPACITY BUILDING FOR HEALTH OFFICERS & REVITALIZE SOPOFFICERS & REVITALIZE SOP
WHAT SHOULD DO STAKE HOLDERSTo revitalize the current standard operating procedure of DHF program based on empirics, current research, and theories
MOH
To conduct training for the assigned health officers on new SOP of DHF
MOH, Local health office
HEALTH PROMOTION AND HEALTH PROMOTION AND COMMUNITY EMPOWERMENTCOMMUNITY EMPOWERMENT
WHAT SHOULD DO STAKE HOLDERSTo promote and educate community on DHF awareness and prevention through media or other potential ways on local wisdom
Local health office, health center, local government, key persons in the community
To conduct community capacity building on DHF awareness and prevention
Local health office, health center, local government, key persons in the community
To support community participation on DHF awareness and prevention
Local health office, health center, local government
CAPACITY BUILDING FOR HEALTH CAPACITY BUILDING FOR HEALTH OFFICERS, REVITALIZING PROGRAM OFFICERS, REVITALIZING PROGRAM
AND BUDGET ALLOCATIONAND BUDGET ALLOCATION
WHAT SHOULD DO STAKE HOLDERSTo conduct training on health promotion & education among health officers
MOH, Univ., Local health office
To conduct training on health community development among health officers
Univ., Local health office
To evaluate & revitalize DHF eradication program
MOH, Local health office
To implement the revised program & supervise frequently
Local health office, MOH
To provide appropriate budget MOH, Local health office, Local government
ADVOCACY, CAPACITY BUILDING, ADVOCACY, CAPACITY BUILDING, POLITICAL AWARENESSPOLITICAL AWARENESS
WHAT SHOULD DO STAKE HOLDERSTo conduct meeting/workshop on DHF eradication ideas for MOH high level positions
University
To conduct seminar/workshop on DHF current research & prevention for MOH
University
To conduct public hearing/seminar on current status of DHF & its prevention for politicians/parties
University
EFFECTS
IMPACTS
PROBLEM
Risk of spread
Indonesia International
Reduce productivity
Rising incidence of DHF in Indonesia
Putting more people at risk worldwide
Threat tourism
Economic loss
Increase absenteeismFear inCommunity
Morbidity Mortality
Difficult to be tackled
OUTCOME
STAKE HOLDERS RELEVANT STAKE HOLDERS RELEVANT TO THE EFFECTSTO THE EFFECTS
• DHF patients• General population• Tourists• Neighborhood countries
ORGANISATIONAL ORGANISATIONAL STRUCTURESTRUCTURE
MOH & University charts
ORGANISATIONAL ORGANISATIONAL STRUCTURESTRUCTURE
Provincial & city government with health office charts
STAKEHOLDER ANALYSISSTAKEHOLDER ANALYSISPOWER
MOHUniversityLocal Govt.Key personLocal HOMCGA
URGENCY
LEGITIMACY
MOHUniversityLocal Govt.Local HOMCGA
UniversityKey personCommunity
MOHUniversityLocal Govt.Local HO
MOHUniversityLocal Govt.Local HOMCGA
UniversityUniversityKey person
POWER POWER+INTEREST?POWER POWER+INTEREST?HIGH
HIGHLOW
POWER
INTEREST
1. MOH/DG of CDC&EH2. Local government3. Local health office/health
center4. BMKG
1. University2. Key persons in the
community3. Media/Journal
Community
ACTION PLANACTION PLANGOAL
The policy brief adopted by the Indonesia Ministry of Health
OBJECTIVES:• Adopt an evidence-based solution• Develop innovative or solution-oriented research agenda• Strengthen capacity of public health practitioner and
professional • Strengthen knowledge & awareness of academician &
public
OBJECTIVE #1OBJECTIVE #1OBJECTIVE ACTION PLAN
TARGETED STAKE HOLDERS INDICATORS TIME
Adopt an evidence-based solution
To discuss the policy brief approach with the decision makers on a personal meeting
Dit of Env. Health MOHDit of Animal Diseases MOHRC for Health Ecology MOHCenter for CC & Air Pollution MCGA
Decision makers adopt & commit to the approach
2010
To share the policy brief approach on the development of national CC health adaptation process
Dit of Env. Health MOH The team accept & utilize the approach
2010
To disseminate the policy brief approach to potential staff working on CC health adaptation
Dit of Env. Health MOHDit of Animal Diseases MOHRC for Health Ecology MOH
The potential staffs understand the policy brief approach
2010
To advocate a specific decision maker to adapt policy brief approach for other animal diseases related to CC
Dit of Animal Diseases MOH The policy brief approach adapted by Dit of Animal Diseases MOH
2010
To advocate decision makers on the important to develop Early Warning System on climate related diseases
Dit of Env. Health MOHMCGALocal Health Office
The MOU of collaboration Early Warning System signed
2010
OBJECTIVE #2OBJECTIVE #2
OBJECTIVES ACTION PLANTARGETED STAKE
HOLDERS INDICATORS TIME
Develop innovative or solution-oriented research agenda
To suggest potential research for verifying & eradicating DHF causes or other possible CC-related illnesses
RC for Health Ecology MOHCenter for CC & Air Pollution MCGAAcademicians at SPH UI & RCC UI
More research proposals are developed among institutions
2011
To advocate of sharing data support for research on DHF causes and or other possible CC-related illnesses to decision maker
DG of MCGA MCGA shared climate data to MOH & Universities
2010
To share research focus & methods on the development of collaboration research on CC and DHF, Malaria, Diarrhea
Center for CC & Air Pollution MCGA
The team accepted the research focus & methods
2010
OBJECTIVE #3OBJECTIVE #3
OBJECTIVE ACTION PLANTARGETED STAKE
HOLDERS INDICATORS TIME
Strengthen capacity of public health practitioner and professional
To present modification of policy brief on the ongoing CC health adaptation training of MOH
Dit of Env. Health MOHPublic health practitioner & professional
Public health practitioner & professional accept the approach
2010
To adopt the bridging research- policy divide to train the trainer for capacity building
Decision makersPH professionalsPH practitionersAcademicians
The training of trainer conducted at the University of Indonesia
2011
OBJECTIVE #4OBJECTIVE #4OBJECTIVE ACTION PLAN
TARGETED STAKE HOLDERS INDICATORS TIME
Strengthen knowledge & awareness of academician & public
To rewrite the policy brief into a scientific article to publish on an international journal
AcademiciansStudents
Published by international journal
2011
To rewrite the policy brief into a popular article and to publish on a media
CommunityDecision makersPoliticians
Published by national media
2010
POTENTIAL BARRIERSPOTENTIAL BARRIERS• A few number of research available
due to limited number researcher interested in the issue.
• Advocating and influencing policy makers
HERE IT ISHERE IT IS…….!.!