HEALTH PROMOTIONin

Health Disaster Management

Presented by: Yayi Suryo PrabandariDepartment of Health Behavior, Social Medicine &

Environment Health Graduate Program of Public Health @2017

Faculty of Medicine - Universitas of Gadjah MadaBased on chapter book “Health Promotion in Emergency Situation”

written by M. Agus P., & Yayi SP, Guest lecture at University of Groningen presented by Yayi

Topik hari ini

• Indonesia sebagai negara dengan toko serba ada bencana

• Promosi kesehatan – pengingatan kembali

• Konsekuensi kesehatan masyarakat dalam bencana

• Respon kesehatan masyarakat dalam bencana

• Peran promosi kesehatan dan profesi promosi kesehatan dalam penatalaksanaan bencana

• Contoh program promosi kesehatan untuk bencana di Indonesia

Indonesia tercinta : negara penuh

dengan Hazard bencana

Indonesian Archipelago

Indonesia terdiri : 33 propinsi, 349 kab and 91 kotamadya

Ring of fire sebaran gunung berapi di Indonesia

Kecuali Kalimantan, semua pulau berisiko terkena

gempa

Indonesia :

Ring of Fire

Indonesia: earthquake islands

Indonesia – toko serba ada bencana

Bencana yang mungkin terjadi di Indonesia

Natural disaster Man made disaster Lainnya

Gempa bumi Konflik KLB

Erupsi gunung berapi Terorism Kekeringan

Banjir Polusi lingkungan

Longsor Kecelakaan industri

Badai Kecelakaan transportasi

Angin topan dan putingbeliung

Tsunami

Promosi Kesehatan

Pengingatan

The Fundamental Conditions and

Resources for Health

Peace, shelter, education, food, income, a stable eco-system, sustainable resources, social justice and equity.

(prerequisite of health):

Improvement in health requires a secure foundation in these basic prerequisites

Promosi Kesehatan

• WHO menyebutkan bahwa promosi kesehatan merupakan proses untuk mendorong orang meningkatkan kontrol dan mengembangkan kesehatannya.

Promosi Kesehatan =Pendidikan kesehatan +

kebijakan

Promosi kesehatan adalah proses advokasi kesehatan yang dilaksanakan untuk meningkatkan kemungkinan:

– personal (individu, keluarga & masyarakat),

– swasta (profesional dan bisnis) serta

– pemerintah (nasional, propinsi, lokal)

untuk mendukung praktek kesehatan positif menjadi norma sosial.

Sehat, kualitas hidup, sejahtera

secara menyeluruh

TUJUAN

PROMOSI

KESEHATAN

Promosi Kesehatan

Sebelum 2016

• A = advokasi

• B = bina suasana

• G = gerakan pemberdayaan masyarakat

Pasca Shanghai

Declaration (2016) & SDG

3 Pilar Promosi Kesehatan

• Health literacy

• Good governance

• Healthy in all setting

Promosi kesehatanPerubahan yg direncanakan untuk

kesehatan yang berhubungan dengan

gaya hidup dan kondisi fisik melalui

perubahan individu dan lingkunganTingkat

populasi

Kondisi

kehidupan

Lingkungan fisik

dan psikososial

Aksi politik

Organiasi

masyarakat

Pengem-

bangan

masyarakatPeningkatan kesehatan individ dan

kesejahteraan:

Menjadi individu, keluarga,

sekolah, tempat kerja, pelayanan

kesehatan & masyarakat

Tingkat

Individual

Perilaku

Pilihan

Gaya hidup

Pendidikan

kesehatan

Pemasaran sosial

Komunikasi

INTERAKSI

PROMOSI

KESEHATAN*

*Adapted from O’Neill & Stirling, 2007, cit. Fertman & Aleensworth, 2010

Health Promotion Cycle

Community Analysis

Targeted assessment

Evaluation Program Plan Development

Implementation

Perjalanan Promosi kesehatan

Ottawa Chatter for HP (WHO, 1986)

• Develop healthy public policy

• Develop personal skills

• Strengthen community action

• Create supportive environments

• Reorient health service

Jakarta Declaration on leading HP (WHO,

1997)

• Promote social responsibility of health

• Increase investment for health developments in all sectors

• Consolidate and expand partnerships for health

• Increase community capacity and empower individuals

• Secure an infrastructure for health promotion

Bangkok Declaration 2005

• Promote social responsibility for health

• Increase investment for health development

• Consolidate and expand partnerships for health

• Increase community capacity and empower the individual health promotion I carried out by and with people

• Secure an infrastructure for health to secure an infrastructure for health promotion, new mechanisms of funding it locally, nationally and globally must be found

Nairobi Declaration 2009

• S t r e n g t h e n l e a d e r s h i p a n d

w o r k f o r c e s

• M a i n s t r e a m h e a l t h p r o m o t i o n

• E m p o w e r c o m m u n i t i e s a n d

i n d i v i d u a l s

• E n h a n c e p a r t i c i p a t o r y p r o c e s s e s

• B u i l d a n d a p p l y k n o w l e d g e

Helsinki Statement - 2013We, the participants of this conference

• Prioritize health and equity as a core responsibility of governments to its peoples.

• Affirm the compelling and urgent need for effective policy coherence for health and well-being.

• Recognize that this will require political will, courage and strategic foresight.

Helsinki Statement - 2013

We call on governments

to fulfil their obligations to their peoples’ health and well-being by taking the following actions:

• Commit to health and health equity as a political priority by adopting the principles of Health in All Policies and taking action on the social determinants of health.

• Ensure effective structures, processes and resources that enable implementation of the Health in All Policies approach across governments at all levels and between governments.

• Strengthen the capacity of Ministries of Health to engage other sectors of government through leadership, partnership, advocacy and mediation to achieve improved health outcomes.

• Build institutional capacity and skills that enable the implementation of Health in All Policies and provide evidence on the determinants of health and inequity and on effective responses.

• Adopt transparent audit and accountability mechanisms for health and equity impacts that build trust across government and between governments and their people.

• Establish conflict of interest measures that include effective safeguards to protect policies from distortion by commercial and vested interests and influence.

• Include communities, social movements and civil society in the development, implementation and monitoring of Health in All Policies, building health literacy in the population.

Shanghai Declaration 2016

• We recognize that health and wellbeing are essential to achieving sustainable development

• We will promote health through action on all the SDGs

• We will make bold political choices for health

• Good governance is crucial for health

• Cities and communities are critical settings for health

• Health literacy empowers and drives equity

•

Kerangka untuk PromosiKesehatan (Keleher, MacDougall & Murphy, 2007)

Prevensi

penyakit

Strategi

Komunikasi

Edukasi

kesehatan dan

pemberdayaan

Pengembangan

kesehatan dan

komunitas

Perubahan

infrastruktur

dan sistem

Primer

Sekunder

Tersier

Informasi

kesehatan

Kampanye

perubahan

perilaku

Pengetahuan

Pemahaman

Pengembangan

keterampilan

Keterlibatan

Pengembangan

komunitas

Kebijakan

Legislasi

Perubahan

organisasi

Lini bawah Lini atas

INTERVENSI

Pelayanan

primerPendekatan gaya hidup dan

perilaku

Pendekatan ekologis

Konsekuensi kesehatanmasyarakat

dalam bencana

Apa yang terjadi dalam bencana?

• 1. Kehilangan nyawa, luka-luka

• 2. Kerusakan berat pada infrastruktur

• 3. Adanya penyintas dan cerai berainya keluarga

• 4. Kesulitan ekonomi

• 5. Masa berkabung dan kemarahan yang intens

Kehilangan nyawa dan luka-luka• Kebutuhan kesehatan dan sosial yang segera

• Trauma psikologis

• Luka atau cidera yang tidak mendapatkan pengobatan yang adekuat

• Nutrisi yang tidak optimal dan seimbang mengandalkan pada bantuan

• Kehilangan nyawa akibat cidera

• Kecacatan permanen

Kerusakan infrastruktur

• Tidak hanya fasilitas kesehatan yang rusak, namun infrastruktur yang lain (sanitasi, air minum dsb)

• Pelayanan untuk keluarga juga terkena jasa penitipan anak dsb

• Risiko adanya epidemik

• Akses terbatas pada populasi yang terkena bencana (rusaknya jalan – keamanan)

Penyintas• Habitat baru

• Ketegangan atau hambatan untuk mendapatkan hak sipil ataupun fasilitas yang diperlukan sebagai anggota masyarakat

• Pasien penyakit kronis akan rentan

• Orang tua dan anak-anak (terutama balita) kurang mendapatkan nutrisi yang tepat dan seimbang

• Perasaan tidak aman

• Kehilangan harga diri

• Pengungsian

Masa yang berat utk Ekonomi

• Kehilangan kesempatan untuk berwirausaha

• Pelepasan terhadap bantuan

• Peningkatan ketergantungan

• Rentan terhadap penyakit dan sakit

• Dapat tergiring ke arah perlaku anti sosial dan kejadian

Masa berkabung dan kemarahan

• Rentan secara psikologis dan emosional

• Dapat menghasilkan perilaku aneh

• Muncul ketidakpuasan/ketidak senangan dengan pemerintah atau organisasi pemberi bantuan lainnya

• Sebagian mendapatkan informasi yang tidak benar dari media massa

Peran promosi kesehatan dan profesional promkes dalam

bencana

What happened in this situation?

Rehabilitation

Preparednessss Response

Event

Impact &

Damage

Mitigation

LESSON

LEARNED

Health

Promotion?

Where?

Phase of Emergency Situation (Oxfam, 2005)

• High risk situation

• Medium risk

• Health maintenance

Nine Contextual Determinant of Health Population in Emergency Situation

• Geography

• Political structure and governance

• Community socioeconomic status

• Distribution relative of income and wealth

• Culture

• Health and social infrastructure

• Physical environment

• Social environment

• Civil Society

Where is the place of health promotion in emergency situation?

IDP (internally displacement

person/penyintas) health issues

Surveillance

Mental Health

Hospital, Medical

Services, Rehabilitation

Child, Maternal,

Reproductive

Immunization

Information and Supply Management

Health

Promotion

Water Sanitation

Food & Nutrition

Communicable Disease

Stages after events up to

disaster

Hazard

Risk

Impact

Damage

Disaster

Event

PreventionModification

Absorb

capacity

Buffering

capacity

Vulnerability

Response

ResilianceBuffering

capacity

Health Promotion

Cycle

Community Analysis

Targeted assessment

Evaluation Program Plan Development

Implementation

Disaster Phases:

•Preparedness

•Response

•Mitigation

•Recovery

• Rehabilitation

Health promotion cycle and

disaster phases

Risk & Emergency

Preparedness

Event

Assessment

& Analysis

Planning &

Objective SetImplementationMonitoring

Evaluation

&

Impact

measuremen

t

Sayangnya terkadang bencana tidak mengikuti alur linier

• Rehabilitation

• Recovery

• Adaptation

• Acute phase

• Emergency / disaster

Pentingnya Promkes dlm Bencana• Menekankan dampak kesehatan masyarakat

• Dalam konteks pengelolaan kedaruratan atau bencana, Promkes melibatkan diri melalui bekerja dengan masyarakat untuk mencegah, mempersiapkan dan respon terhadap bencana untuk mengurangi risiko, meningkatkan resiliens dan mitigasi dampak bencana terhadap kesehatan

• Pemberdayaan masyarakat merupakan dasar dalam situasi tersebut

Pentingnya Partisipasi Masyarakat dalam bencana

Persiapan kedaruratan:

• Partisipasi dalam mengukur risikodan kerentanan

• Meningkatkan kesadaran akan tandalingkungan (hazard) dan keamanan

• Memperkuat organisasi danpenerimaan masyarakat

• Peningkatan kesadaran danpelatihan adalah hal yang utama

Respon dan pemulihanterhadap kedaruratan

• Partisipasi dalam faserespon

• Menekankan padajaminan peningkatan dankeberlangsungankesehatan lingkunan

Persiapan(Preparedness)

Respon (Response) Pemulihan (Recovery)

Mengorganisasikanmasyarakat agar merekasadar sehat dan keamanan

Memberikan informasi “how to” (bagaimana caranya) danmempromosikan kesadaran

Secara bertahapmengintegrasikan aksi untukkondisi yang stabil

Mendefinisikan populasiberisiko dan tingkatrisikonya

Menekankan pada konsekuensikondisi dan memberikanrekomendasi tindakan

Melakukan assessment padapopulasi yang membutuhkanpelayanan jangka panjang

Merancang informasi risikodidasarkan karakteristikindividu

Menyesuaikan aktivitas promosikesehatan sesuai dengankeadaan dan kelangkaan

Menekankan bahwamembangun kembali proses adalah “fokus sehat’

Membantu masyarakatuntuk mengembangkanpersepsi risiko

Kebutuhan untuk menyelesaikanmasalah psikososial dalamsituasi tersebut

Menggunakan pesandidasarkan masalah ataupraktek dalam masapemulihan

Adaptasi metode untukkebutuhan yang aktual danpotensial

Identifikasi pesan dan metodekomunikasi yang spesifik padasituasi tersebut

Dukungan rehabilitasipsikologis jangka panjang

Mempromosikan praktekhidup sehat dalampengembangan komunitas

Memberikan panduan danpelatihan dalam aksi

Fokus pada persiapan danpencegahan bencana

Pertanyaan pada mitigasi• Manakah praktek atau tindakan yang menempatkan risiko

untuk kesehatan?

• Manakah kelompok masyarakat yang paling rentan?

• Apa yang harus dilakukan agar masyarakat mengadopsi praktek/tindakan yang aman?

• Siapa yang akan menjadi sasaran program?

• Bagaimana caranya berkomunikasi dengan mereka?

Koordinasi: sulitkah?• Duplikasi atau menyia-siakan sumber yang langka

• Terkadang masyarakat tidak diassess : kebutuhannya berdasarkan kebutuhan mereka sendiri, dan bukan kebutuhan yang nyata

• Tidak ada informasi yang non sintesis

• Agenda instansi donor?

• Bagaimana dengan partai politik yg memanfaatkan kejadian bencana?

• Pemerintah menggantungkan pada organisasi yang membantu dalam bencana

Peran profesi promkes• Mengelola data dan informasi untuk keefektifan

program promkes

• Hygiene dan sanitasi (air, perumahan dan sanitasi)

• Promosi kesehatan mental

• Imunisasi (KIA)

• Prevensi epidemik

• Merawat pasien penyakit kronis

• Menghitung kecenderungan

LAMPIRAN:

Contoh Promkes dalam Bencana

Health Promotion Program at

Nias Island – 6 months after

Earthquake

NiasCoordinates: 1°6′N 97°32′E1.1°N 97.533°E

Area: 4,771 km2 (1,842 sq mi)

Highest point: unnamed (800 m (2,600 ft))

Province: North Sumatra

Regencies: Nias, South Nias

Population: 639,675

Density: 134.08 /km2 (347.3 /sq mi)

Ethnic groups: Malay, Batak, and Chinese

People in Nias

• The theory of cultural dissemination states Nias's ancestors came from Yunan, in the south of China, about 3.500 years ago.

• Material culture -- such as sword hilts and coffins -- and their traditional architecture, which is dominated by dragon-head motifs.

• Nias Island represents the glory of the megalithic age from Indonesia's perspective. • Areas in Nias Island are dominated by large stones portraying their cultural

civilization which take the form of menhirs, dolmens, stone coffins, monuments, statues from the megalithic age and house ladders.

• Rituals and traditions involving stones have been passed down from generation to generation as well as working in a group

• Stone is symbolizes the religious, social, eternal, devotional and conceptual values within the Nias people.

Nias Island after Earthquake

· A great earthquake was noted at 23:09:36 hrs, local time at epicenter, on Monday, March 28, 2005.The magnitude was 8.7 on the Richter scale and located in NORTHERN SUMATRA, INDONESIA.The epicenter was located 90 km south of Sinabang with 30 Km Depth 2.065 N 97.010 E

After earthquake

Government officials update figures:

• Deaths tolls at 532, with 422 in the Nias District, and 113 from South Nias.

• 1125 seriously injured persons and 928 minor injury cases.

• The number of temporary displaced has been put at 19,016 while the number of permanently displaced has been put at 35,235 (houses destroyed)

Community Analysis*

Targeted assessment

Evaluation Program Plan Development

Implementation

50

*conducted by UGM and Nias district health office officers

** based on the conceptual framework by Dignan & Carr

Need Assessment Result• Several diseases were found at Gunung Sitoli

community:– ARI (Acute Respiratory Infection)

– Skin diseases

– Musculoskeletal diseases

– Dyspepsia

– Hypertention

– Malaria

– Diarrhoea.

The children had higher risk for the diseases.

The people’ hygiene practice was poor.

They never washed their hand after defecating.

Need Assessment Result

• Several health promotion programs have been done by UNICEF and Indonesian Health Office since the disaster. An (NGO) has made printed media health messages i.e. poster and banner.

• The basic problem was water supply.

• Vector borne diseases were a serious problem

after the earthquake

Aim

• To facilitate sufficient and feasible health information and education for people in the disaster area

• To overcome the health problem, particularly hygiene and sanitation, mother and child health, and infectious disease prevention.

Activities

• Capacity building for sustaining the health promotion delivery (through training for trainers)

• Advocacy to the local authority (to assess the continuity of the program)

• Developing health education media

• Distribution and delivering mass media (printed and electronic media)

• Traditional performance art (for implementing mass health promotion)

Expected outcome

• The increasing knowledge and attitude toward healthy environment, including hygiene and sanitation, infectious disease prevention, as well as mother and child health care after the health promotion activities

• The change of health behavior practice of Nias people after disaster.

Training

• Development training module

• Training for trainer

• Training for health promotion officer

Media Development

The health promotion poster : before (left) and after pre

testing (right)

Poster

Flip Chart

Pre test of media

Advocacy

Head of Nias Health Office

Head of Nias Development planning board (Bappeda)

Head of communicable disease division (Seksi P2M)

Head of Gunung Sitoli Sub Distric

Head of Ilir Village

Head of Pasar Gunung Sitoli Village

Traditional Performance Art

Maena Dance Competition

Banner

Distribution of Message

Health education delivery• Place:

– Integrated health post (Posyandu)– Community houses– Religious places– Village meeting halls

• Topics:– Environmental health– Maternal and child health

• Sources– Community leader– Spiritual leader

• Media: – Radio– Poster

The result after the implementation

(evaluation phase)• An increasing practicing in using toilet among women, other than man

(other places to defecate sea shore, pig pen), as well as using water for cleaning (other than leaves & coconut peels)

• Women give more attention on healthy behavior practices of their children other than men

• Women showed an increasing knowledge toward healthy behavior after the program, but men demonstrated an increasing attitude toward healthy behavior

Lesson learnt• Involving local people (DHO and health cadres/lay person) on

health program plays as an important factor in facilitating health program in Nias

• The use of traditional culture (Maena dance) as a health promotion media can be seen as an alternative to deliver health message

• Involving men in family health is challenging need to explore in where and when men can be involved in the family health responsibility (without breaking the culture and norm)

• Nias District Health Office should conduct follow up of the existing program by guiding cadres and midwifes and always empower community and spiritual leaders to elevate the community health status (particularly there were few NGOs still working in the areas and BRR/Rehabilitation & Reconstruction Body of Aceh and Nias is the coordinator)

Promoting Community Health

through Capacity BuildingRehabilitation and Health System Improvement in

Eastern and Central District of Nanggroe Aceh

Darussalam Province

ACEH:

Area : 57,365.57 km2 (22,149 sq mi)

Population : 3,930,000 (2000)

Density : 68.5 /km2 (177 /sq mi)

Ethnic groups : Acehnese (50%), Javanese (16%), Gayo Lut (7%), Gayo Luwes (5%), Alas (4%), Singkil (3%), Simeulu (2%)

Religion: Islam (98.6%), Christianity (0.7%), Hinduism (0.08%), Buddhism (0.55%)

Languages: Indonesian (official), Acehnese

Maternal and infant mortalityMalnutrition

Transmitted disease malaria, DHF, ARI

Chronic diseases cardiovascular, stroke Community

Behavior Smoking habitNon compliance of using helmet

Health promotion program NOT OPTIMAL

CAPACITY BUILDING OF HEALTH PROMOTER

IMPLEMENTATION OF DESA SIAGA/Alert village

•Building capacity of health promoter and community regarding health promotion strategy and technqiue through training from the level of

– District

– Primary Health Care,

– Village (Poskesdes)

in 10 districts in NAD.

•Training for health promotion officers in district health office and Primary Health Care

•Training of health promotion for Midwifes and cadres

•Supervising the implementation of health promotion in village level

•Evaluating the health promotion implementation

PROGRAM EXECUTION

Internal – External Environmental

Assessment(Underpining & Understanding Environment)

HP training for DHO

and Puskesmas officer

Implementation Health Promotion at

Village and sub village level

PROGRAM PLANNING

(Goal, Criteria, Activities)

Advocacy to policy

maker at district level

Formative

Evaluation

Summative Evaluation

N

e

x

t

S

t

a

g

e

HP training for Midwife

and cadre

Support

and

Supervise

Reinforcement

Problem Based

Discussion

Reinforcement

Community

Action plan

Conceptual Framework*

*Based on the

IDM concept

• Finalizing the plan and need assessment (Health Promotion need assessment and training need assessment-collaboration between UGM and PHO & DHO).

• Program implementation that consist of first stage training (district health officer and Primary health care officer) and second stage (midwife and cadre).

• An independent activity by cadre, midwife, Primary Health Care oficer and district health officer with supervision from UGM

• Evaluation

1 IntroductionAll about project descriptionThe descriptions of health promotion program situation

2 The roles of health promoter and community empowerment.

3 Need assessment

4 Advocacy : one strategy to influence public policy

5 Presentation technique

6 Basic concept of targeted assessment in health promotion needassessment

7 Health promotion program plan.

8 Health promotion program Implementation

9 Health promotion program evaluation Basic concept of health promotion program evaluation Health promotion program measurement.

10 Follow-up plan

PHO AND DHO TRAINING

1 Introduction

2 Advocating : Strategy

3 Advocating : communication

4 Lobbying and Negotiation

5 Presentation Technique

6 Public Speaking

7 Effective meeting

8 Development of Traditional media to health promotion and creativity

9 Community empowerment

0

2

4

6

8

10

pre test 2.7 2.775 2.35 3.65 3.15 2.95 3.59 4.8

postest 6.185 6.46375 5.5175 6.4825 5.43 5.23 6.73 7.8

Pertemuan

Efektif

Public

SpeakKreativitas Presentasi

Pemberday

aanKomunikasi Lobi Nego

Strat

advokasi

No Village District Health Promotion Programs

1 Rantau Panjang East Aceh Posyandu (integrated health post) Revitalization

2 Oulee Blang East Aceh Elderly integrated health post (posyandu lansia)

3 Bies Penantan Central Aceh Posyandu Lansia dan malnutrition

4 Desa Tebuk Central Aceh Family healthy behavior

5 Marlempang Aceh Tamiang a.Smoking cessationb.Tabulin (Tabungan Ibu Bersalin) (pregnantmother saving)

6 Banai Aceh Tamiang Collective periodically toilet

7 Mupakat Jadi Bener Meriah a.Pregnant mother savingb.Health fundsc.Village ambulance

8 Blanpulo Bener Meriah a.Health fundsb.Village ambulance

9 Salang alas South-East Aceh School health promotion

10 Terutung Pedi South-East Aceh Garbage management

Health Promotion Program Carried out by Midwifes and Health Cadres, supervised by PHO, DHO & UGM

Health promotion delivery

• Place:– Integrated health

post/Posyandu

– Group praying

– Home visit

• Resources:– Midwifes

– Health cadres

The result after the implementation (evaluation phase)

• There was an elevating of knowledge among men and women in the intervention areas

• The practicing of eating healthy food, smoking behavior and helmet wearing were better in the intervention areas compared to the control areas

Lesson learnt

• Districts in Aceh have different characteristics (different DHO & health cadres impact on the results

• Implementing training is challenging due to the several numbers of training carried out by NGOs

• Years in conflict impact on Aceh people to obtain new things

• Community partisipation can be done through intense approach (but still challenging)

Assist Integrated Community Partisipation on Health Program After Earthquake in

Jogjakarta

Area : 185.80 km2 (1,230 sq mi)

Population : 3,121,000 (2003)

Density : 979.7 /km2 (2,537 /sq mi)

Ethnic groups : Javanese (97%), Sundanese (1%)

Religion: Islam (91.8%), Christianity (7.9%), Hinduism (0.2%), Buddhism (0.1%)

Languages: Indonesian (official), Javanese

Assessment (health, etc)

• Carried out by several NGO’s, universities finally coordinate by the PHO of Yogyakarta offices (health) & National Coordination of Emergency

• Cases (health)

– Fracture

– Tetanus (Infection generally occurs through wound contamination and often involves a cut or deep puncture wound)

– ARI

Phase of Emergency Situation (Oxfam, 2005)

• High risk situation – Emergency response

• Medium risk– Assisting existing Primary

health care & temporary clinics

• Health maintenance– Coordinating integrated

health post (local community, NGO, universities & academies)

The different of refugee camps in Aceh & Jogjakarta

• Aceh • Jogjakarta

Lesson learnt- Learning about people in the disaster area plays important role

in the humanitarian action (Aceh = Nias = Jogjakarta)- Aceh disaster after this disaster, Indonesian gov, NGO has

experience on how to coordinate the humanitarian action and its impact to the surrounding community

- Nias disaster has learned from Aceh emergency response- Jogja disaster:

- although the government not “really ready” to that situation, the coordination was better that Aceh case (has had experience)

- The government of Jogjakarta province allow the NGO to work in the disaster area in the maximum of 6 months time

ACKNOWLEDMENT•NOHA• WHO• Gitec

•Health Providers, Cadres, Community and Spiritual leaders in Nias, Aceh &

Jogjakarta Provinces•Nias District Health Office

•North Sumatra, Aceh & Jogja Provincial Health Office

Thanking for your attention