development of national policy on health for adaptation to climate change in indonesia

Development of National Policy on Health for Adaptation to Climate Change

in Indonesia

dr Wan Alkadri, SS , MScDirector Environmental Health

Ministry of Health Indonesia

OUTLINE

• Background

• Initiate adaptation strategy in Indonesia

Identification on impact of climate change on health, Hazards, Vulnerability, and Adaptive Capacity

• Policy, Strategy and Institutional Framework

Background

Republic of Indonesia

• Population of 236.4m, 57% in villages (SCB, 2007)

• 17,508 islands over 3.977 miles

• GDP per capita US$ 3.843 (UNDP,2007/8)

• Human Development Index ranking 107 (UNDP 2007/8)

• 45.2% (105.3m) poor and vulnerable poor (World Bank 2007)

• In 2001 implemented a Decentralization policy.

• In 2007 administratively; into 33 provinces, 444 districts

• Climate Change now become an important issue in Indonesia and is mainstreamed in National Development Plan.

• Ministry of Health has been developing a National Policy and strategy on Health for Adaptation to Climate Change.

• With other sectors, health adaptation strategy will be implemented under National Development Plan 2010-2029

Roadmap of CC on Health Sector & other sectors

into National Development Plan

Roadmap Perubahan Iklim 2010-2030 sektor

KESEHATAN

Roadmap Perubahan Iklim 2010-2030 sektor lainnya

Cross-cutting issues

Scientific Basis Analysis

Regions (7)

Climate Change Issues

Findings,

GIS based

informationSector issues

Framework Institutional Policy and Program

Development of adaptation strategy on health should be based on Scientific basis analysis, regional differences and cross cutting

issues

• Identifying future potential impact• Indentifying vulnerability aspects on health towards

climate change impact. • Indentifying hazard and adaptive capacity on Climate

Change• Identifying policy, strategy and program for

integrated adaptation on health towards climate change

Scope in developing a roadmap climate change on health :

Vulnerable & Adaptation Framework

Matrix as a tool to develop Adaptation Strategy

No Regions H V R

Recommendation for

adaptation strategy

Program and Activity Recomendation2010-2014

2015-2020

2021-2025

2025-2030

1 Sumatera

2 Jawa, Madura, Bali

3 Kalimantan

4 Sulawesi

5 Kep. Nusatenggara

6 Kep. Maluku

7 Papua

Note:H = Hazard, V = Vulnerability, R = Risk

The analysis has covered the time period as follows :

• baseline, compiled and analysis data from 1961 –1990 (30 years)

• current time (1991 – 2008)

• near future (2009 – 2029)

• and projection (2029 -2100)

Papua

7 REGIONS

Sumatera

Maluku

Nusa Tenggara

Sulawesi

Kalimantan

Jawa, Madura, Bali

The impact of climate change on health-hazard & vulnerability, and adaptation

capacity

1. Vector borne diseases (malaria, dengue, filariasis, chikungunya, Schistosomiasis )

2. Water borne disease (Diarrhea, Cholera, Thypoid)

3. Air borne disease (Acute and chronic respiratory disease, cardiac diseases)

4. Malnutrition5. Injuries

The impact of climate change on Health

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INSIDENS

YEAR

DENGUE INSIDENS & CASE FATALITY RATE (CFR) IN INDONESIA , TH 1968-2007

INSIDENS

CFR

CFR

Vector borne diseasesDENGUE

Vector borne diseases

Schistosomiasis

Schistosomiasis Prevalency on human cases in year 2000-2008

2001 2002 2003 2004 2005 2006 2007 20081 Lindu, Kab. Donggala 0,36 0,75 0,64 0,17 0,66 5,2 1,36 2,192 Napu-Besoa, Kab. Poso 1,22 1,02 0,76 0,71 1,02 1,55 1,21 2,443 Bada, Kab. Poso ( new foci) *) 0,84

No Districts Year

No Districts2007 2008

Tikus Keong Tikus Keong

1 Lindu, Kab. Donggala 0,51 0,6 1,04 0,22

2 Napu-Besoa, Poso District 0,73 1,8 2,54 10,5

Schistosomiasis Prevalency in animal in year 2007-2008 di Napu-Besoa, Lindu

2006 2007 2008until september

Number of events 162 205 326

Died 7.618 766 281Victims with

severe injuries 30.243 2.861 2.435

Victims with light injuries

260.376 350.116 67.507

Missing 313 142 7Total 298.550 353.885 70.230

Displaced 2.485.963 808.778 214.852

* Source : MOH, Crisis Center

Health Hazard Factors

Hazards on health

• Increase in temperature

• Rainfall variability

• Sea level rise

• More intense & extreme weather events (Floodings and landslides)

• Water shortage

• Drought

• Air Pollution

Change of Mean TemperatureYear = 2000

Source: Susandi, 2006

oC

Change of Mean TemperatureYear = 2010

Source: Susandi, 2006

oC

Change of Mean TemperatureYear = 2020

Source: Susandi, 2006

oC

Change of Mean TemperatureYear = 2030

Source: Susandi, 2006

oC

Risk on water shortage in 2005

Risk on water shortage in 2015

Risk on water shortage in 2025

Risk on water shortage in 2030

Risk of drought in 2005

Risk of drought in 2015

Risk of drought in 2020

Risk of drought in 2030

Health Sector’s Vulnerability Concerns

Vulnerability

1. Poor and vulnerable to poverty especially in urban area2. Coastal Community (65% Population in Java Island life in

coastal area)3. Elderly and children, 4. Traditional Community 5. Farmers, 6. Small islands Population (17.500 islands, Indonesia

archipelago)7. Peopel wih water hardship, poor sanitation and hygiene 8. Poor Health system (facility, services, and community

participation)9. Ecosystem and disease (vector distribution and transmission)10.Marine ecosytem

Health Adaptive Capacity and Challenges

Health System conditions and challenges

• Disparities in Health Service Status • Double burden of diseases • Communicable diseases (new emerging and re-

emerging diseasesw)• Inadequate and poor health-services

(performance and quality)• Inadequate healthy behavior • Degrading environmental health conditions • Insufficient numbers of health officers• Drug stock (poor stockpiling of drugs)

Hospitals Distribution in 2008

Integrated Community Health Post (Posyandu) Distribution in 2008

Immunization coverage rate in 2008

DISASTER REGIONAL CENTER

Medan

Palembang

Jakarta

Semarang

SurabayaDenpasar

Banjarmasin MakassarManado

Jayapura

Padang

National Policy, Strategy and Program towards climate change impact on health

Adaptation Framework will take followings in to the considerations:

Categorize burdens to health system that are likely to be imposed due to CC

Develop guidelines and regulation on Health Sector adaptation to CC

Raise Health Sector and the other sectors awareness on building adaptive capacity to CC

Strengthen local government capacity and empowering community

Action planning on Health Sector’s adaptation to CC

Start implementing simple adaptive approach in Health Sector and developing monitoring information system

Genetic Study :1. Human genetic susceptibility2. Virulensi disease agent/parasite, microbe/virus

HEALTH ROADMAP 2010-2014Hazard & Vulnerability Mapping : 1. Climate and incidence

Correlation analysis2. Study o f vulnerability

to disease

Disaster’s preparedness :1. Floods, fire 2. Evironment, physic,

biology, social

2. Behavior change studies

Non-Diseases1. Environment Change Study2. Behavior change studies

Epidemic/Pandemic preparedness:1. Health Resource Evaluation 2. Organization & Coordination 3. Policy making

Early Warning :1. Vector Borne2. Water Borne3. Air Borne4. Non Transmitted

Diseases5. Disaster &accident

Ou tbreaks Investigation : 1. General investigation 2. Spécial Investigation

(outbreak, etc)3. Environment investigation

Health adaptation strategy development :1. Workshop & Seminar2. Adaptation Formulation3. Advocacy & Socialization4. selection of candidate vaccine

Case Study & management:1. Case Study2. Case Management3. Improving surveillance

• Strengthening Disease Surveillance

• Health Emergency• Healthy drinking water• Integrated vector

management

Pilot Project :1. Adaptation Testing/Trial2. Coordination cross-program

& cross-sector 3. Community Empowering

Objectives :1. Health Adaptation

to disease prevention & control

2. Early Warning System

3. Improving community capacity, etc

Political Commitment :Advocacy

Improving community involvement :1. IEC moduls, materials2. Campaign & Health

Promotion 3. Community

Empowerment

1. Improving EH Capacity Building

2. Public Health Policy, Healthy City, Healthy Industry, Healthy Housing

3. Organization/Institution

Basis Saintifik Rekomendasi untuk Alternatif Strategi

Adaptasi

Prioritas Program

Bahaya Kerentanan Potensi Dampak 2010 – 2014 2015 – 2019 2020 – 2024 2025 – 2029

Perubahan pola curah hujan akibat perubahan variabilitas iklim alamiah (El-Nino [EN], La-Nina [LN]).Proyeksi EN dan LN (Sofian, 2009):.

Terdapatnyapulau-pulau kecildi sebelah baratdan timurSumatra

Banyak terdapatsistem muarasungai, lagun danrawa di pesisirtimur.

40% area rawa di Indonesia terdapat di Sumatera

Informasi kerentanan dan risiko di sektor kesehatan dan adaptasi berkenaan perubahan iklim masih minim

Terjadi perubahan ekosistem di pesisir dan pedalaman MALARIA

Peningkatan curahhujan pada batasnormal akanmeningkatkanjumlah habitat baruuntuk larva yang berarti juga akanterjadi peningkatanpopulasi vector dengan peningkatansurvival vector, vector’s biting rate, pathogenisitas danincubation rate

Pembangunan sadar penyakitbersumberbinatang

Upayapengendalianpenyakitbersumber vektor/ binatang secaraREESA (Rational, Efficient, Effective, Sustainable, Acceptable)

Penggunaanberbagai metodepemberantasanuntuk memutusrantai penularanserta keterpaduandengan berbagaisektor & program terkait

Komitmen Politik Departemen kesehatan

Advokasi dan Sosialisasi

Manajemen data, kajian, analisis serta penelitian tentang bahaya, kerentanan, dan risiko serta dampak perubahan iklim terhadap malaria

Pemetaan daerah rawan malaria akibat perubahan iklim di Sumatera

Pemetaan vektor kerentanan terhadap insektisida pada tingkat Kabupaten di Sumatera

Pemetaan habitat perkembangbiakan vektor malaria di wilayah endemis malaria di Sumatera

Pengembangan model intervensi KIE dan partisipasi masyarakat tentang pengendalian malaria

Peningkatan Kapasitas Pengelola Program

Penguatan managemen kasus dan pengendalian vektor

Penigktan Kapasitas Pengelola Program

Pengendalian faktor risikor penularan malaria meliputi : pengelolaaan habitat perkembangbiakan akibat perubahan & meningkatkan kepedulian masyarakat dalam pencegahan dan pengendalian mlaria .

Institutional Framework• Indonesia has ratified UNFCC’s Framework with Law No.

5 /1994

• There exists a Government Regulation No. 46/2008 about National Council on Climate Change, and Minister of Health as a member.

• National Cross-sector Working Group on Climate Change. Leaded by Minister of Environment with members : MoForestry, MoEnergy, MoAgricultural, MoHealth, National Planning, MoPublic Works and Universities.

• National Team on Climate Change Planning, PPN Minister/BAPENAS No. 204/M.PPN/10/2008

• Communication Forum for Climate Change Impact on Health, MOH as a chairperson

There exist national action plan on Climate Change; however health sector needs are inadequately addressed

Ministry of Health is in process of developing health sector policy and strategy on Climate Change

Ministry of Health is undertaking vulnerability assessment and evidences on Climate Change effects to health

Ministry of Health is socializing the issue of Climate Change at Central and Provincial levels

Ministry of Health is promoting exchange of ideas and sharing knowledge at inter-country level

Current National Efforts:

thank you