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
Climate Change Issues
Sector issues

Findings, GIS based information

Cross-cutting issues

Framework Institutional Policy and Program

Scientific Basis Analysis

7 REGIONS
Sumatera Kalimantan Papua

Sulawesi

Maluku
Nusa Tenggara

Jawa, Madura, Bali

CLIMATE CHANGE AND HEALTH IMPACT

Social conditions Environmental conditions
(upstream determinants of health)

Health system conditions

Direct exposures
(temperature, preci pita tion, sea level rise, extreme events)

Climate change

Indirect exposures
(changes in wa ter, air, food quality; vector ecology; ecos ys tems , agri culture, indus try and settlements )

Health impacts

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 MALARIA

0.9 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0

50 40 60

Hubungan antara Kasus, An. aconItus, An. maculatus dan C. hujan Desa Wadaslintang th. 2001

1989 1990 1991 1992 301993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 0.3 0.52 0.81 0.62 0.47 0.22 0.11 0.23 0.19 0.16

Insidens Malaria 0.21 0.17 0.14 0.12 0.19 0.17 0.07 0.08 0.12 20
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 5000000 4000000 250000 3000000 2000000 1000000 0 '81 '83 '85 '87 '89 '91 '93 '95 '97 '99 '01 '03 '05 '07
Sumber: Lap Subdit Diare

2004

2005

2006

200000

150000

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

Year = 2000

oC

Source: Susandi, 2006

Change of Mean Temperature

Year = 2010

oC

Source: Susandi, 2006

Change of Mean Temperature

Year = 2020

oC

Source: Susandi, 2006

Change of Mean Temperature

Year = 2030

oC

Source: Susandi, 2006

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 Surabaya Denpasar 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
1 2 3 4 5 6 7

Regions
Sumatera Jawa, Madura, Bali Kalimantan Sulawesi Kep. Nusatenggara Kep. Maluku Papua

Recommendati on for adaptation strategy

Program and Activity Recomendation 20102014 20152020 20212025 2025-2030

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

Hazard & Vulnerability Mapping : 1.Climate and incidence Correlation analysis 2.Study o f vulnerability to disease

HEALTH ROADMAP 2010-2014

Non-Diseases 1. Environment Change Study 2. Behavior change studies Risk factors : 1.Floods, fire 2.Evironment, physic, biology, social 1. Early warning system 2. Adaptation intervention strategy

Early Warning : 1.Vector Borne 2.Water Borne 3.Air Borne 4.Non Transmitted Diseases 5.Disaster &accident

Ou breaks Investigation : 1.General investigation 2. Spcial Investigation (outbreak, etc) 3.Environment investigation

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

Vulnerability Adaptation

1.

2. Improving community involvement : 1.IEC moduls, materials 2.Campaign & Health Promotion 3. 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 Adaptation : 1. Adaptation Testing/Trial 2. Coordination cross-program & cross-sector 3. Community Empowering

Political Commitment : Advocacy

Objectives : Health Adaptation to disease prevention & control Early Warning System Improving community capacity, etc

Case Study & management: 1. Case Study 2. Case Management 3. Improving surveillance

Strengthening Disease Surveillance Health Emergency Healthy drinking water Integrated vector management

1. Improving EH Capacity Building 2. Public Health Policy, Healthy City, Healthy Industry, Healthy Housing 3. Organization /Institution

Basis Saintifik Bahaya Kerentanan Potensi Dampak

Rekomendasi untuk Alternatif Strategi Adaptasi

Prioritas Program 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):.

Terdapatnya pulau-pulau kecil di sebelah barat dan timur Sumatra

Terjadi perubahan ekosistem di pesisir dan pedalaman MALARIA

Pembangunan sadar penyakit bersumber binatang

Komitmen Politik Departemen kesehatan

Pemetaan daerah rawan malaria akibat perubahan iklim di Sumatera

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, vectors biting rate, Informasi pathogenisitas dan kerentanan dan incubation rate risiko di sektor kesehatan dan adaptasi berkenaan perubahan iklim masih minim

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

Pengembangan model intervensi KIE dan partisipasi masyarakat tentang pengendalian malaria

Penigktan Kapasitas Pengelola Program

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 UNFCCs 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