Development National Policy on Health for Adaptation to Climate Change in Indonesia
dr Wan Alkadri, SS , MSc Director Environmental Health Ministry of Health Indonesia
OUTLINE • Background • Methodology for vulnerability and adaption assessment on health and Climate Change, The Impact of climate change on health Hazards Vulnerability Adaptive Capacity • Strategy Adaptation in Indonesia
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 has been mainstreamed in National Development Plan. • Ministry of Health has been developing a National Policy on Health for Adaptation to Climate Change. • With other sectors, health adaptation strategy will be implemented in a National Development Plan (National Development Plan 2010-2029)
Methodology for vulnerability and adaption assessment on health and Climate Change
Relation Roadmap of CC on Health Sector & Roadmap of Climate Change
with Development Planning Roadmap Perubahan Iklim 2010-2030 sektor KES EHATAN
Roadmap Perubahan Iklim 2010-2030 sektor lainnya
CC Roadmap development method 7 regions
Findings, GIS based
Climate Change Issues
Sector issues
Cross-cutting issues
Scientific Basis Analysis
information
Framework Institutional Policy and Program
7 REGIONS Sumatera
Kalimantan Papua
Sulawesi
Maluku Nusa Tenggara
Jawa, Madura, Bali
CLIMATE CHANGE AND HEALTH IMPACT Social conditions Environmental conditions
Health system conditions
(‘upstream’ determinants of health)
Direct exposures
*
(temperature, preci pita tion, sea level rise, extreme events)
Climate change
Indirect exposures
Health impacts
(changes in wa ter, air, food quality; vector ecology; ecos ys tems , agri culture, indus try and settlements )
Social & economic disruption
*
Modifying influence
Confalonieri, Menne et al, 2007
Vulnerable & Adaptation Framework
Hazard, vulnerability and risk analysis on health sector • • • •
The analysis used time periodic as follows : baseline, compiled and analysis data from 1961 –1990 (30 years) current time (1991 – 2008) near future (2009 – 2029) and projection (2029 -2100)
The impact of Climate Change on health, hazard, vulnerability and adaptation capacity
The impact of climate change on Health KASUS MALARIA DI JAWA BALI THN 19891989-2007
Vector borne diseases
0.9
MALARIA
0.8 0.7
Hubungan antara Kasus, An. aconItus, An. maculatus dan C. hujan Desa Wadaslintang th. 2001
0.6 0.5 0.4
60
0.3 0.2
50
0.1
40
0
1989 1990 1991 1992 301993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Insidens Malaria 0.21 0.17 0.14 0.12 0.19 0.17 0.07 0.08 0.12 20
0.3 0.52 0.81 0.62 0.47 0.22 0.11 0.23 0.19 0.16
10 0
C-hujan
JAN PEB MAR APR MEI JUN
JUL AGT SEP OKT NOP DES
Maculatus Aconitus Kasus
Vector borne diseases DENGUE
Water borne diseases Diarrheal 6000000
Sumber: Lap Subdit Diare
5000000 4000000250000
2004
3000000
2005
2006
200000
2000000 1000000
150000
0 '81 '83 '85 '87 '89 '91 '93 '95 '97 '99 '01 '03 '05 '07
100000
50000
Sumber: Lap STP. P2PL
0 Jan Feb Mar apr Mei Jun Jul
Ags Sep Okt Nop des
Hazards
Hazards on health • • • • • • •
Increase in temperature Rain fall variability Sea level rise More intense extreme events Water shortage Drought Air Polution
Change of Mean Temperature
Source: Susandi, 2006
Year = 2000
oC
Change of Mean Temperature
Source: Susandi, 2006
Year = 2010
oC
Change of Mean Temperature
Source: Susandi, 2006
Year = 2020
oC
Change of Mean Temperature
Source: Susandi, 2006
Year = 2030
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
Vulnerability
Vulnerability 1. Poor and vulnerable poor especially in urban area 2. 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. Poor water supply, sanitation and hygiene 8. Poor Health system (facility, services, and community participation) 9. Ecosystem (vector distribution and transmission)
Population growth and distribution projection in 2010
Population growth and distribution projection in 2020
Adaptation to Climate Change
Health System conditions and challenges • • • • • • • •
Disparities of Health Status Double burden diseases Communicable diseases Poor health services performance and quality Health behavior Bad environmental health condition Numbers of health officer Drug stock
DISASTER REGIONAL CENTER Medan Padang
Banjarmasin
Makassar Manado
Palembang Jakarta Semarang
Denpasar Surabaya
Jayapura
Hospitals Distribution in 2008
Posyandu Distribution in 2008
Immunization coverage rate in 2008
National Policy, Strategy and Program towards climate change impact on health
Matrix as a tool to develop Adaptation Strategy N o
Regions
1
Sumatera
2
Jawa, Madura, Bali
3
Kalimantan
4
Sulawesi
5
Kep. Nusatenggara
6
Kep. Maluku
7
Papua
H
V
Note: H = Hazard, V = Vulnerability, R = Risk
R
Recommendati on for adaptation strategy
Program and Activity Recomendation 20102014
20152020
20212025
2025-2030
HEALTH ROADMAP 2010-2014
Hazard & Vulnerability Mapping : 1.Climate and incidence Correlation analysis 2.Study o f vulnerability to disease
Early Warning : 1.Vector Borne 2.Water Borne 3.Air Borne 4.Non Transmitted Diseases 5.Disaster &accident
Non-Diseases 1. Environment Change Study 2. Behavior change studies Risk factors : 1.Floods, fire 2.Evironment, physic, biology, social
Ou breaks Investigation : 1.General investigation 2. Spécial Investigation (outbreak, etc) 3.Environment investigation
1. Early warning system 2. Adaptation intervention strategy
Epidemic/Pandemic preparedness: 1.Health Resource Evaluation 2.Organization & Coordination 3.Policy making
Vulnerability Adaptation
1.
2.
Political Commitment : Advocacy
3.
Improving community involvement : 1.IEC moduls, materials 2.Campaign & Health Promotion
Case Study & management: 1. Case Study 2. Case Management 3. Improving surveillance
Health adaptation strategy development : 1. Workshop & Seminar 2. Adaptation Formulation 3. Advocacy & Socialization 4. selection of candidate vaccine Genetic Study : 1. Human genetic susceptibility 2. Virulensi disease agent/parasite, microbe/virus
Strengthening Disease Surveillance Health Emergency Healthy drinking water Integrated vector management
Adaptation : 1. Adaptation Testing/Trial 2. Coordination cross-program & cross-sector 3. Community Empowering
Objectives : Health Adaptation to disease prevention & control Early Warning System Improving community capacity, etc
1. Improving EH Capacity Building 2. Public Health Policy, Healthy City, Healthy Industry, Healthy Housing 3. Organization /Institution
Basis Saintifik Bahaya
Perubahan pola curah hujan akibat perubahan variabilitas iklim alamiah (El-Nino [EN], La-Nina [LN]). Proyeksi EN dan LN (Sofian, 2009):.
Kerentanan
Potensi Dampak
Terdapatnya pulau-pulau kecil di sebelah barat dan timur Sumatra
Terjadi perubahan ekosistem di pesisir dan pedalaman MALARIA
Peningkatan curah Banyak terdapat hujan pada batas sistem muara normal akan sungai, lagun dan meningkatkan rawa di pesisir jumlah habitat baru timur. untuk larva yang berarti juga akan 40% area rawa di terjadi peningkatan Indonesia populasi vector terdapat di dengan peningkatan Sumatera survival vector, vector’s biting rate, Informasi pathogenisitas dan kerentanan dan incubation rate risiko di sektor kesehatan dan adaptasi berkenaan perubahan iklim masih minim
Rekomendasi untuk Alternatif Strategi Adaptasi
Pembangunan sadar penyakit bersumber binatang
Prioritas Program 2010 – 2014
Komitmen Politik Departemen kesehatan
2015 – 2019
2020 – 2024
2025 – 2029
Pemetaan daerah rawan malaria akibat perubahan iklim di Sumatera
Pengembangan model intervensi KIE dan partisipasi masyarakat tentang pengendalian malaria
Penigktan Kapasitas Pengelola Program
Advokasi dan Upaya Sosialisasi Pemetaan vektor pengendalian kerentanan penyakit Manajemen data, terhadap bersumber vektor/ kajian, analisis insektisida pada binatang secara serta penelitian tingkat Kabupaten REESA (Rational, tentang bahaya, di Sumatera Efficient, Effective, kerentanan, dan Sustainable, risiko serta dampak Pemetaan habitat Acceptable) perubahan iklim perkembangbiakan terhadap malaria vektor malaria di Penggunaan wilayah endemis berbagai metode malaria di pemberantasan Sumatera untuk memutus rantai penularan serta keterpaduan dengan berbagai sektor & program terkait
Pengendalian faktor risikor penularan malaria meliputi : Peningkatan pengelolaaan Kapasitas habitat Pengelola Program perkembangbiakan akibat perubahan & Penguatan meningkatkan managemen kasus kepedulian dan pengendalian masyarakat dalam vektor pencegahan dan pengendalian mlaria .
Institutional Framework • Indonesia has ratified UNFCC’s Framework with Law No. 5 /1994 • 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. Lead 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
thank you
