Hospitals Safe From Disasters Document 11

8/3/2019 Hospitals Safe From Disasters Document 11

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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

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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,

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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

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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

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MOH Emergency Preparedness and Response Programme

Supported by WHO and Partner Agencies

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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(%)



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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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



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 !

Hospitals Safe From Disasters Document 11

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