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8/3/2019 Hospitals Safe From Disasters Document 11
http://slidepdf.com/reader/full/hospitals-safe-from-disasters-document-11 1/5
1
REGIONAL ISSUES AND CHALLENGES IN KEEPING
HEALTH FACILITIES SAFE FROM DISASTER
HEALTH FACILITIES SAFE FROMDISASTERS
INDONESIA COUNTRY REPORT
By
Dr. Lucky Tjahjono : Crisis Center, MOH
Dr. Wuwuh Utaminingsih : Dit. Basic Medical Care, MOHDr. R. Suhartono, Emergency Unit, Ciptomangonkusumo Hospital
Drg. Maria Sidangdoki, National Coordination Board forDisaster Management
2
The Geographic Nature of Indonesia
Indonesia located on 4 movingtectonic plates,
has daily, average of5 Earth quakes (> 5 RS)
and Ring of Firewhere 126 active volcanoes
Around the country
3
Earthquake & Tsunami
Volcanoes Eruption
Floods
Flash floods & Landslides
Conflict – Social unrest
Bomb Blast
Industrial Accident
Transportation Accident Cyclone
Hazards
Earthquake
Infectious Diseases
Black Outs 4
Hazard Mapping, Indonesia
NAD
2,3,4,5,6,7,13
,14
N. Sumatra
3,4,7,14
W Sumatra
1,2,
3,4,8,11,14
Bangka Belitung
3,14
S. Sumatra
3,4,14
Riau
3,5,7,8,14
Kep Riau
14
3Lampung
2,3,14
Bengkulu
2,4,14
Jambi
3,14
Jakarta
3,4,6,7,9, 14
W, Java
2,3,4,5,6,7,11
,14
Banten
2,3,5,12,14
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
NTT
1,3,6,9,11,2,13,4,5,
14
W. Kalimantan
1,3,8,4,6,10,9,5,11,
13,14
S. Kalimantan
3,10,5,13,14
C. Kalimantan
6.10,8,9,3,11,7,
14
E. Kalimantan
3,10, 8,9,5,14
N. Sulawesi
1,3,8,2,4,11,13,14
S. Sulawesi
3,4,6,7,13,14
C. Sulawesi
2,3,6,9,7,13,14
S.E Sulawesi
3,6,14
Gorontalo
3,14
Maluku
2,3,6,7,9,11,13,14
N.Maluku
2,4,6,7,9,13,14
Papua
2,3,4,6,7,9,11,13,
14
Type of Emergency and Disaster1. Volcano 5. Hurricane 9. Disease outbreak 13. Tsunami
2. Earthquake 6. Conflict 10. storm 14. Transportation
3. Flood 7. Terrorism 11. Drought Accident4. Landslide 8. Environment Pollution 12. Industrial Accident
5
Indonesia National Hazards Risk
Geographic size : 1.890.754 Km²33 provinces, 349 districts, 91 city, 5.263 sub districts,
62.806 villages, and 7.123 sub villages.Population size : 217.072.346 peoples
6
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MOH Emergency Preparedness and Response Programme
Supported by WHO and Partner Agencies
8
Regional Crisis Center of SumateraUtara (NAD, SUMUT, RIAU, KEPRI,SUMBAR)
Regional Crisis Center of SumateraSelatan (SUMSEL, JAMBI, BENGKULU,BABEL)
Regional Crisis Center of DKI Jakarta (JAKARTA,LAMPUNG, BANTEN, JABAR, KALBAR)
Regional Crisis Center of JawaTengah (JATENG,YOGYAKATA)
PPK Regional Jawa Timur(JAWA TIMUR)
Regional Crisis Center ofBali (BALI, NTB, NTT)
Regional Crisis Center of KalimantanSelatan (KALSEL, KALTENG, KALTIM)
Regional Crisis Center of Sulawesi
Utara (SULUT, GORONTALO,MALUT)
Regional Crisis Center of Sulawesi Selatan(SULSEL, SULTENG, SULTRA, SULBAR,MALUKU, PAPUA BARAT, PAPUA)
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
(BLS)
Layman
(MFR, CSSR)
Police
Fire Brigade
Security Guard
Civil Defense
Scouts
Red Cross
(Paramedic ,
CSSR)
118
Emergency
Ambulance
ServiceE.D. I .C .U Wa rd
Access
Emergency
Telephone Number
110,113,118
Pre-Hospital Phase
Public
Health
Center
Rehabilitation
DISASTER
Hospital Phase
• HOPE• Emergency Nurse(BTLS, BCLS, BNLS, BPLS)• Emergency physician(ATLS, ACLS, ANLS, APLS)• Surgeon(ATLS, BSS, DSTC, PeriOPE CC)• Emergency and Disaster management
(Basic, Master Degree Courses)
DISASTER MANAGEMENT
CAPACITY BUILDING HRCAPACITY BUILDING HR
NUMBER OF GENERAL HOSPITALS
Public
MOH, Prov./ Distric
Police/ ARMY
Others Department
452
112
78
35.6
8.8
6.2
Total 642 40.6
Privates 626 49.4
TOTAL Public & Private 1268
Hospital Quantity Percentage(%)
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Hospital Distribution
Hospital Quantity Percentage (%)
General Hospital 995 78,5
Mental Health Hospital 51 4
Leprosy Hospital 22 1,7
Tuberculosis Hospital 9 0,7
Delivery Hospital 56 4,4
Eye Hospital 10 0,8
Other specialized hospital 125 9,9
NONO MANAGEMENTMANAGEMENT HOSPITALHOSPITAL
CLASSESCLASSES
TOTALTOTAL
A A BB CC DD11 M.OHM.OH 55 88 -- -- 1313
22 PROVINCEPROVINCE 11 3030 1010 22 4343
33 DISTRICT/CITY DISTRICT/CITY -- 3737 224224 7373 334334
INDONESIA INDONESIA 66 7575 234234 7575 390390
PUBLIC HOSPITAL DISTRIBUTION
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
4 stars4 stars RS TIPE ARS TIPE A
3 stars3 stars RS TIPE BRS TIPE B
2 stars2 stars RS TIPE CRS TIPE C
1 star1 star RS TIPE DRS TIPE D
Classi f ica t ion :lass i f i ca t ion :
Has internal &
externaldisaster plan
Only has internal
disaster pan
HOSPITAL
DISASTER PLAN
Tert
Secd
PrimHealth Centers / Puskesmas
Case Example
TSUNAMI NADTSUNAMI NAD
Total collapsedTotal collapsedJOGJAKARTA EARTHQUAKEJOGJAKARTA EARTHQUAKE
MMediumedium damagedamage
BENGKULU EARTHQUAKEBENGKULU EARTHQUAKE
MMinimalinimal damagedamage
•Mortality•Hospitalloaded with
dead body
•Injured patient•Capacity over loaded•Limited human resources
•Psychological effect•Fieldhospitalestablished
Disaster Management Mechanism
Disaster Plan(Contingency Operation Plan)
Training of Hospital Staff
Training of Medical Professions
Drills and Simulations
Disaster Management CommitteeMultispectral
Provincial Crisis CenterEmergency Operation Unit
10 - Regional Crisis Centers(Hospital –Public Health – University)
Emergency operation Unit
Standard Operation Procedures (SOP)
Crisis Center, MOHEmergency Operation Unit
District Crisis CenterEmergency Operation Unit
National Coordination Board forDisaster Management
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19
Crisis Center
Central Operation UnitMoH,
Crisis Center
Central Operation UnitMoH,
Early warning Information
Coordination
Resource MobilizationReview, monitoring
1983
Operator Radio MedikJatim pada akhir 1984
Tahun 1995 s/d 2008
Antenna HF-SSB National-Wide
Challenges
Challenges faced to improve the stateof preparedness in health facilities
Decentralized administrativepolicy and structure – down todistrict 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 nosystematic link
Transfer of health staff dependsmore on local authorities.
Hospitals, most of the time overloaded with day to day patientsespecially with road trafficaccidents and seasonal diseases.
Emergencies and disastersaffecting different districts on
weekly basis.
Health Sector and Cluster Structural andMethodology used in Indonesia
Heath Sector / ClusterGeneral Coordination
Sub – Groups Coordination andpresentation•Immunization•Child, reproductive and maternal•Water and Sanitation•Surveillance and outbreak control•Mental Health•Mobile Clinics
•Field Hospitals•Hospital care•Supplies
HealthEmergencyInformationOperation
Center
Government CoordinationMeeting
UN ClusterCoordination Meeting
OperationalMapping
Building codes
Indonesian standardbuilding codes.
Hospital buildingcodes – Higherstandards.
Guidelines available. Applications of BC
varies as weakness inmonitoring andenforcement system.
Location of hospitalschallenged byurbanization.
Disaster Risk Reduction
Risk = Hazard x Vulnerability
---------------------
Capacity
Hazard
Vulnerability
Capacity
Risk
GlobalWarming
ClimateChanges
DevelopmentVs
Developing
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Disaster Risk Reduction
Assessment for bothinternal and externaldone to all hospitals in2007.
Hazard / Vulnerability /Capacity assessmentand mapping
SOP, Check List andmonitoring toolsdevelopment in process.
Integrating data toEmergency InformationSystem in process.
Capacity building of human resources inprocess through ITC-DRR.
Recommendations Health facility preparedness
strengthen through EPR programmeroad map – Regional Crisis Centers,SOP and ITC-DRR.
Follow up on assessment findings,socialized central - local authoritiesand private sector to supportnecessary preparedness andmitigation interventions.
Strengthen Health Engineeringcapacity.
Support for Health centersassessment and mapping.
Strengthen emergency informationsystem.
Strengthen emergency operationunits.
Strengthen health centers capacity,responsibility and services to reducethe over load of hospitals.
Learn form experiences, use goodmodels and strengthen overall EPRprogramme.
Strengthen capacity of hospitalassessment soon after emergency ordisaster stricks.
Strengthen law enforcement.
Super Thanks for Your Support !