The Geographic Nature of Indonesia

REGIONAL ISSUES AND CHALLENGES IN KEEPING HEALTH FACILITIES SAFE FROM DISASTER

HEALTH FACILITIES SAFE FROM DISASTERS

INDONESIA COUNTRY REPORT
By Dr. Lucky Tjahjono : Crisis Center, MOH Dr. Wuwuh Utaminingsih : Dit. Basic Medical Care, MOH Dr. R. Suhartono, Emergency Unit, Ciptomangonkusumo Hospital Drg. Maria Sidangdoki, National Coordination Board for Disaster Management
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Indonesia located on 4 moving tectonic plates, has daily, average of 5 Earth quakes (> 5 RS) and Ring of Fire where 126 active volcanoes Around the country
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Hazards

Hazard Mapping, Indonesia

NAD 2,3,4,5,6,7,13 ,14 W. Kalimantan 1,3,8,4,6,10,9,5,11, 13,14 C. Kalimantan 6.10,8,9,3,11,7, 14 S. Kalimantan 3,10,5,13,14 E. Kalimantan 3,10, 8,9,5,14 Gorontalo 3,14 N. Sulawesi 1,3,8,2,4,11,13,14 C. Sulawesi 2,3,6,9,7,13,14 S. Sulawesi 3,4,6,7,13,14 S.E Sulawesi 3,6,14 N.Maluku 2,4,6,7,9,13,14 Papua 2,3,4,6,7,9,11,13, 14 Maluku 2,3,6,7,9,11,13,14 NTT 1,3,6,9,11,2,13,4,5, 14 Jakarta 3,4,6,7,9, 14 W, Java 2,3,4,5,6,7,11 ,14 C. Java 1,2,3,4,5,9,11 ,12,14 Jogyakarta 1,11,14 E. java 1,2, 3,5,6,7,9 ,11,12,13,14, Bali 2,3,4,6,7,9,14 NTB 3,6,2,9,4,5,11,7,1 4

Earthquake & Tsunami Floods Earthquake Volcanoes Eruption

N. Sumatra 3,4,7,14 W Sumatra 1,2, 3,4,8,11,14 Bangka Belitung 3,14 S. Sumatra 3,4,14

Flash floods & Landslides Conflict Social unrest

Bomb Blast

Riau 3,5,7,8,14

Kep Riau
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3 Lampung 2,3,14
Bengkulu 2,4,14 Jambi 3,14

Transportation Accident

Cyclone Infectious Diseases Black Outs

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Banten 2,3,5,12,14

Type of Emergency and Disaster

1. 2. 3. 4. Volcano Earthquake Flood Landslide 5. Hurricane 6. Conflict 7. Terrorism 8. Environment Pollution 9. Disease outbreak 10. storm 11. Drought 12. Industrial Accident 13. Tsunami 14. Transportation Accident

Industrial Accident

Indonesia National Hazards Risk

Geographic size : 1.890.754 Km 33 provinces, 349 districts, 91 city, 5.263 sub districts, 62.806 villages, and 7.123 sub villages. Population size : 217.072.346 peoples
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MOH Emergency Preparedness and Response Programme Supported by WHO and Partner Agencies

Regional Crisis Center of Sumatera Utara (NAD, SUMUT, RIAU, KEPRI, SUMBAR) Regional Crisis Center of Sumatera Selatan (SUMSEL, JAMBI, BENGKULU,
BABEL)

Regional Crisis Center of Bali (BALI, NTB, NTT) Regional Crisis Center of Kalimantan Selatan (KALSEL, KALTENG, KALTIM) Regional Crisis Center of Sulawesi Utara (SULUT, GORONTALO, MALUT) Regional Crisis Center of Sulawesi Selatan
(SULSEL, SULTENG, SULTRA, SULBAR, 8 MALUKU, PAPUA BARAT, PAPUA)

Regional Crisis Center of DKI Jakarta (JAKARTA,

LAMPUNG, BANTEN, JABAR, KALBAR)

Regional Crisis Center of Jawa Tengah (JATENG,YOGYAKATA) PPK Regional Jawa Timur
(JAWA TIMUR)

REGIONAL CRISIS CENTER ROLES:

a. The center of health operational support b. The center of health support control c. The center of health referral d. The center of health information / Media Center

CAPACITY BUILDING HR CAPACITY BUILDING HR

(MFR, CSSR) (BLS) Layman Police Fire Brigade Security Guard Civil Defense Scouts Red Cross (Paramedic , CSSR) 118 Emergency Ambulance Service
HOPE Emergency Nurse (BTLS, BCLS, BNLS, BPLS) Emergency physician (ATLS, ACLS, ANLS, APLS) Surgeon (ATLS, BSS, DSTC, Peri OPE CC) Emergency and Disaster management (Basic, Master Degree Courses) DISASTER MANAGEMENT

NUMBER OF GENERAL HOSPITALS

Hospital
Public

Quantity

Percentage(%)

E.D.

I.C.U

Ward

MOH, Prov./ Distric Police/ ARMY Others Department

Rehabilitation

452 112 78 642 626

35.6 8.8 6.2 40.6 49.4

DISASTER

Access Emergency Telephone Number 110,113,118

Total Privates TOTAL Public & Private

Public Health Center

1268

Pre-Hospital Phase

Hospital Phase

Hospital Distribution
Hospital Quantity Percentage (%)

PUBLIC HOSPITAL DISTRIBUTION

NO MANAGEMENT
1 2 3 M.OH PROVINCE DISTRICT/CITY INDONESIA

HOSPITAL TOTAL A CLASSES D B C

5 1 6 8 30 37 10 224 2 73 13 43 334 390

General Hospital Mental Health Hospital Leprosy Hospital Tuberculosis Hospital Delivery Hospital Eye Hospital Other specialized hospital

995 51 22 9 56 10 125

78,5 4 1,7 0,7 4,4 0,8 9,9

75 234 75

Health Human Resources

Total number of Health Staff: Total number of Specialist: Total number of General practitioners: Total number of Nurses: Total number of Midwives: Total number of Paramedics: Total number of support staff: Total number of engineers:

Type of Hospitals Emergency Units

Based on: Infrastructure Human resources Medical equipment Quality control

HOSPITAL DISASTER PLAN

Classification : 4 stars RS TIPE A 3 stars RS TIPE B 2 stars RS TIPE C 1 star RS TIPE D

Health Centers / Puskesmas

Tert

Has internal & external disaster plan

Secd Prim

Only has internal disaster pan

Case Example
Mortality Hospital loaded with dead body TSUNAMI NAD Total collapsed BENGKULU EARTHQUAKE Minimal damage Psychologi cal effect Field hospital established Injured patient Capacity over loaded Limited human resources

Disaster Management Mechanism

National Coordination Board for Disaster Management Crisis Center, MOH Emergency Operation Unit Disaster Management Committee Multispectral

Disaster Plan (Contingency Operation Plan)

10 - Regional Crisis Centers

(Hospital Public Health University)

Standard Operation Procedures (SOP)

JOGJAKARTA EARTHQUAKE Medium damage

Emergency operation Unit Training of Hospital Staff Provincial Crisis Center Emergency Operation Unit Training of Medical Professions District Crisis Center Emergency Operation Unit

Drills and Simulations

Early warning

Information

1983

Operator Radio Medik Jatim pada akhir 1984

Crisis Center Central Operation Unit MoH,

Antenna HF-SSB National-Wide

Review, monitoring

Coordination Resource Mobilization

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Tahun 1995 s/d 2008

Challenges
Challenges faced to improve the state of preparedness in health facilities Decentralized administrative policy and structure down to district level 446 Districts. Weak in role and responsibility of Provinces (33 Provinces) Hospitals under control of Province and District Authorities Governors Hospital (T-S-P) have no systematic link Transfer of health staff depends more on local authorities. Hospitals, most of the time over loaded with day to day patients especially with road traffic accidents and seasonal diseases. Emergencies and disasters affecting different districts on weekly basis.

Health Sector and Cluster Structural and Methodology used in Indonesia

Government Coordination Meeting Heath Sector / Cluster General Coordination Operational Mapping Health Emergency Information Operation Center Sub Groups Coordination and presentation Immunization Child, reproductive and maternal Water and Sanitation Surveillance and outbreak control Mental Health Mobile Clinics Field Hospitals Hospital care Supplies UN Cluster Coordination Meeting

Building codes
Indonesian standard building codes. Hospital building codes Higher standards. Guidelines available. Applications of BC varies as weakness in monitoring and enforcement system. Location of hospitals challenged by urbanization.

Disaster Risk Reduction

Risk
Hazard

Capacity

Global Warming Climate Changes

Development Vs Developing Vulnerability

Risk = Hazard x Vulnerability --------------------Capacity

Disaster Risk Reduction

Assessment for both internal and external done to all hospitals in 2007. Hazard / Vulnerability / Capacity assessment and mapping SOP, Check List and monitoring tools development in process. Integrating data to Emergency Information System in process. Capacity building of human resources in process through ITCDRR.

Recommendations
Health facility preparedness strengthen through EPR programme road map Regional Crisis Centers, SOP and ITC-DRR. Follow up on assessment findings, socialized central - local authorities and private sector to support necessary preparedness and mitigation interventions. Strengthen Health Engineering capacity. Support for Health centers assessment and mapping. Strengthen emergency information system. Strengthen emergency operation units. Strengthen health centers capacity, responsibility and services to reduce the over load of hospitals. Learn form experiences, use good models and strengthen overall EPR programme. Strengthen capacity of hospital assessment soon after emergency or disaster stricks. Strengthen law enforcement.

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