GLOBAL WORKSHOP of PUBLIC HEALTH IMPROVEMENT
INTERNATIONAL URBAN TRAINING CENTRE (IUTC) Gangwon Province, South Korea
June 27 to July 1, 2022
The Program of Water, Sanitation and Hygiene in Health Care Facility or WASH in HCF under the Ministry of Health, the Republic of Indonesia, contributing to the Improvement of Public Health in Indonesia: A Case Study in Metro Municipality, the Province of Lampung.
Gressando, Yulian1
Abstract
Background
Indonesia is located in a strategic position, a tropical country just over the Equator, and is flanked by two oceans, i.e. Indian and Pacific Oceans, as well as two continents, i.e. Asia and Australia continents.
The current population of Indonesia is 279,084,067 as of Monday, June 6, 2022, based on Worldometer elaboration of the latest United Nations data2, while the area of case study is situated in Metro Municipality, the Province of Lampung, with the total area of 73.21 km23 (7,321.4 Ha) and with the total population of 172,208 inhabitants4. The economic growth of Metro prior to pandemic was higher than the Province of Lampung and Indonesia, namely 5.57%, 5.26%, and 5.02%
respectively. However, due to Covid-19. they dramatically dropped down to -1.79%, -1.67%, and - 2.07% in 2020. Then restored back to 2.91%, 2.79%, and 3.69% in 2021. Metro Human Development Index (HDI) is categorized high, also again compares to the Province of Lampung and National one, respectively 77.49%, 69.9% and 72.29%.
In view of public health issue, the case study is highlighting the critical factor of providing good access to Water, Sanitation, and Hygiene in Health Care Facility (WASH in HCF), especially the Primary Health Care (PHC). Global evidence shows that clean birth practices associated with reduced risks of all causes, including sepsis neonatal deaths5. Safe and health delivery, infection prevention and control (IPC), and best quality of care could be improved through better access and services of WASH in HCF.
It is also part of SDGs and quality Universal Health Coverage6. Public Health related Issues
The mortality rate for sepsis in Indonesia is quite high, which is greater than 50% for sepsis in general.
Sepsis is also the cause of 20% of patient deaths in hospital each year7,8. On the other side, Indonesia
1 Individual Consultant of YKU INDONESIA - NGO
2 Source: https://www.worldometers.info/world-population/indonesia-population/
3 RPJMD -- Metro Municipality 5-Year Planning of 2022-2026.
4 Indonesia Central Bureau of Statistics, 2021.
5 “Clean Birth and Postnatal Care Practices to Reduce Neonatal Deaths from Sepsis and Tetanus: a Systematic Review and Delphi Estimation of Mortality Effect.”, Blencowe et al, 2011.
6 WASH in HCF for better care services, WHO-UNICEF JMP Global Baseline Report, 2019
7 Hari MS, Harrison DA, Rubenfeld GD, Rowan K. Epidemiology of sepsis and septic shock in critical care unit:
comparison between sepsis-2 and sepsis-3 populations using a national critical care database. British Journal of Anaesthesia. 2017;119(4):626-636
8 Gauer R. Early recognition and management of sepsis in adults: the first six hours. Am Fam Physician.
2013;889(1):44-53
is the 7th largest number of neonatal deaths in the world (WHO 2020)9. Therefore, in the effort of addressing public health issues, Indonesia has stated a strong global commitment during 72nd World Health Assembly, 2019, in supporting Sustainable Development Goals (SDGs) 2030, including WASH Program, following Presidential Regulation No. 59 Year 2017 regarding the implementation towards SDGs in Indonesia.
In order to achieve SDGs, Indonesia conducts a comprehensive assessment, develops and implements a WASH Roadmap according to the national context, establishes and implements minimum WASH standards, and sets health policy targets and integration of clean water, sanitation, and hygiene indicators as well as IPC to improve the public health in general.
Policy Framework
Indonesia already has a lot of related regulations regarding public health in general as well as Health Care Facility at national and Metro Municipality to address the issues on public health. The policy direction of the 2019-2024 National Planning is to increase access and quality of health services towards Universal Health Coverage (UHC) by strengthening PHC services and increasing promotive and preventive efforts, supported by innovation and the use of technology. The strategy is to improve maternal, child, family planning, and reproductive health; acceleration of community nutrition improvement; increasing disease control, strengthening the movement for healthy living; and improvement of health services and drug and food control 10.
WASH in HCF: Pilot Program in Metro Municipality
Water, Sanitation, and Hygiene (WASH) in Healthcare Facility (HCF) is aimed at providing a safe and accessible water supply; clean and safe sanitation facilities; hand hygiene facilities at points of care and at toilets; and appropriate waste disposal systems. A pilot program is being conducted in Metro Municipality with the support of SNV (INGO) and YKWS (Local LGO), as one of efforts in developing a Road Map of WASH in HCF Program in Indonesia. Five (5) main indicators are used, i.e. access to water, accessible toilet for all, good hygiene facility and behaviours (includes hand washing with soap/HWWS and menstrual hygiene management/MHM), safe medical waste management, and environmental cleaning11. The pilot is conducted in four (4) Metro PHCs utilizing public involvement and community development approaches
A Theory of Change (ToC) was also developed to be then derived into program indicators 12. A WASH Working Group (WASH WG) is established in each PHC where the members comprise of PHC staffs and community groups includes woman, youth, religious, disability, and mass media groups. Each WASH WG conducted a kind of social audit inside and around the PHC using a modified WASH FIT, a tool that was introduced by WHO and contextualised into Metro local conditions.
Interesting findings have been recorded by YKWS’ baseline survey (quantitative and qualitative methods) in May 202113, whereas in terms of water access is that 4 PHCs are in good condition. There is relatively no water scarcity challenge in the PHCs, even though in terms of water quality still needs to be improved. The prototype of inclusive sanitation facility (toilet) in 4 PHCs are yet to be developed.
HWWS facilities and behaviour are good, however, MHM is relatively new issue to the WASH WG.
Medical waste is also facing a challenge as it is still much depending on the third party in regular waste collection of PHC. For the environmental cleaning, 4 PHCs still need to develop the SOP and provide regular trainings to the health workers, though the cleanliness of PHC is in good conditions.
9 https://www.who.int/news-room/fact-sheets/detail/levels-and-trends-in-child-mortality-report- 2021#:~:text=Globally%202.4%20million%20children%20died,in%20child%20survival%20since%201990.
10 Indonesia RPJMN or Middle Term Planning 2019-2024
11 WASH FIT, WHO. https://www.who.int/publications/i/item/9789240043237
12 YKWS Project Document, 2021.
13 Baseline Report, YKWS, 2021
Best Practice and Learning
Having completed one (1) year of technical assistance and advocacy to Metro Municipal Government, the pilot program noted important outputs to note. The Mayor of Metro buys-in the program and with the strong commitments to replicate WASH in HCF Program in all PHCs in Metro in 2022 onwards.
Through social audit process, PHCs have been starting since the end of 2021 to improve WASH facilities and services for having a universal PHC to give access for all, no one left behind.
Concluding Remarks
The initiatives are significantly contributing to the improvement of public health issues. WASH WGs are learning a lot regarding public health and they are able to act as health champions in the community. WASH FIT Tool is recognized and modified, as well as would be contributed to accreditation and other public health programs of MoH to support public health policy in Indonesia.
ANNEX
Baseline Results:
Indicator 1: Water Resources Indicator 2: Toilet
Indicator 3: Hygiene Facility and Behaviour
Indicator 4: Waste Management
Indicator 5: Environmental Cleaning
