DEALING WITH BIOLOGICAL MASS

CASUALTY INCIDENT IN INDONESIA

NEEDS AND REQUIREMENTS
Dr. Ina Agustina Isturini
Ministry of Health of Republic of Indonesia

NCT CBRNe ASIA 2014 CONFERENCE

Phnom Penh, 15 October 2014

Health status

HDI : 0,629 (moderate)

<5 yr malnutrition : 17,9%
IMR: 32/1.000 live birth
MMR: 228/100.000 live birth
Life expectancy at birth : 72

Location: South East Asia.

Land area : 1.922.570 km2
Water area: 3.257.483 km2
34 Provinces, 497 districts/cities.
Population is about 237.000.000 people
Ethnic Groups & Languages:
About 300 tribes, 726 different languages and dialects

Indonesia located on boundaries of

4 moving Tectonic Plates,
On daily basis affected by average of
5 Earth quakes (> 5 RS)

Ring of Fire
where 129 active volcanoes
are located

DISASTER IN INDONESIA
NATURAL DISASTER
Earth quakes, Tsunami Volcano, Eruption,
Flood, Drought, Typhoon, Landslide etc.

NON NATURAL DISASTER

Technologi , Fire , Epidemic

Pandemic, etc.

SOCIAL DISASTER
Conflict, Terror, Bomb, etc

Frequency : almost everyday, Death : 900 / year, Severe Injured :

1.900/year, IDPs : 300.000 / year
(Center for Health Crisis MoH, 2008 2013)

Health Crisis Information and Coordination System

DISASTER
Prevention
Mitigation
Preparedness
and readiness
Pre-disaster

Daily IEMSS

Emergency
Response

Quick
response
Life saving
Limb saving

Disaster IEMSS

Rehabilitation
Reconstruction

SAFE
COMMUNITY
Post Disaster

Daily IEMSS

Human Resources

Prevention

Trained
communities,
paramedic

Ambulance
officers

Doctors
and nurses

Specialists
(doctors &
nurses)

COMMUNICATION

Quick Response
Safe-Healthy
Community

TRANSPORTATION

( Comm.Prepardness )

Patient

Ambulance

Comm. Health
Centers

Hospital
Class C
In-Hospital

Pra Hospital
Public Safety Center
(AGDT 119, 110/112,113)

Center for Health Crisis Management

Ministry of Health
Republic of Indonesia

Hospital
Class B/A
In-Hospital

Inter-Hospital
Hospital Network
AGDT 118/119

9 REGIONALS & 2 SUB REGIONALS

OF THE MINISTRY OF HEALTH
Regional
North
Sumatera

Regional
South
Kalimantan

Regional North
Sulawesi

Sub Regional
West Sumatera

Sub Regional
Papua

Regional
South
Sumatera

Regional
Bali

Regional
DKI Jakarta,
Regional
Central
Java

Regional
East Java

Regional
South
Sulawesi

Every year, there are about 300.000 IDPs

because of disaster
Many point of entries (27 international
airport, 41 international seaport and 6
cross border)
Bioterrorism and bioweapon threat

Cholera
Plague
Polio
Diphteria
Rabies
Malaria
Avian influenza
Anthrax

Leptospirosis
Hepatitis
New Influenza A
(H1N1)
Meningitis
Yellow fever
Chikungunya

+ 70% of EID (Emerging Infectious Diseases) are Zoonotic

60

120%

50

100%

40

80%

30

60%

20

40%

10

20%

0%
2005

2006

2007

2008

2009

Confirmed cases

2010

2011

Death

CFR

2012

2013

Objective :
Preventing the entry of new biological threat
that potentially epidemic/pandemic to
Indonesia;
To decrease the fatality rate and
transmission;
Reducing the impact.

a.

Indonesia has achieved the implementation of

minimum core capacities required for
International Health Regulation (2005)

b.

Maintenance and operational of these core

capacities are essential to detect, verify, assess
and respond any public health events of
national and international concern including to
biological threats (infectious, zoonotic, food
safety).

Review and revise policy and regulation regularly.

Now in process of revision of the existing Health

Quarantine Law.
Enacted many decrees, regulations, guidelines
and procedures related to epidemic/pandemic at
various level and also related to terrorism
Coordination intersector, cross sector and
regional from primary level (subdistrict/ village),
intermediate level (province/district) and national
level.

COORDINATION
Intersector :
Government
institution, Private
agencies. Military,
NGO

Regional :
ASEAN, WHO, FAO,
UNOCHA, Bilateral,
USAID.AUSAID

Cross Sector
Health
Agriculture
Internal Affairs
Security
Education
National Agency for Disaster
Management
National Agency for Counter
Terrorism
National Commision for zoonotic
control
Research and Technology
Communication and information
Transportation,
Environment
Army.
Tourism
Finance
National Planning Agency
Indonesia Red Cross, etc

President
COORDINATING MINISTER
Steering
component

Executing
component

NATIONAL

Governor
Senior Official

PROVINCE

Steering
component

Executing
component

REGENT/
MAYOR
Senior Official

DISTRICT/MUNICIPALITY

Steering
component

SUB DISTRICT

PUBLIC HEALTH OFFICE

Executing
component

ALERT VILLAGE

Establish National Outbreak Command Post

which is led by CDC MoH and Health Crisis
Information Operational Unit which is led by
Center for Health Crisis MoH 24 hours for
event based surveillance
Implementation of the Early Warning Alert
Response System (EWARS) up to Health
Center/Sub-district level and at Point of Entry
(23 priority diseases).
Establish Rapid Response Team in district
province and national level, for investigating and
confirming outbreaks.

Risk mapping
Develop plan and simulation :
Up to 2013 Contingency Plan toward potential

PHEIC have been developed and tested at 35

PoEs including table top exercise and
simulation.
In 2008 (Bali) and 2009 (Makassar), Indonesia
conducted the simulation of The Containment
of Pandemic Influenza Epicenter.
Hospital disaster plan.

Assigned 100 referral hospitals : free of charge for

suspects and confirmed cases. 10 of them is

equipped with negative pressure isolation room
Stockpiling of drugs and supplies at all levels.
Availability and mobilization of logistics (drugs,
PPE, supplies).
Preparing infrastructure to produce vaccine
Assigned 14 PoEs as designated Points of Entry (7
Sea Ports, 6 Airports, 1 Ground Crossing) which is
has capacity as IHR implementation

14 designated Point of Entries (PoEs)

In Indonesia
LAGOI
SEAPORT

HANG NADIM
AIRPORT

HARBOUR
BAY
SEAPORT

ENTIKONG
LAND
BORDER

SEKUPANG
SEAPORT

Indonesias PoE:
27 internasional airport,
41 internasional seaport
6 official land border

POLONIA
AIRPORT
BELAWAN
SEAPORT
TANJUNG
PRIOK
SEAPORT

SOEKARNO
HATTA
AIRPORT

TANJUNG
PERAK
SEAPORT
JUANDA
AIRPORT

NGURAH RAI
AIRPORT

SOEKARNO
HATTA
SEAPORT

HASANUDIN
AIRPORT

Mechanismes for effective risk

communication during a public health
emergency have designated under the
collaboration between Ministry of Health and
Ministry of Communication and Information
Socialization of the mechanisme to all
networking at all levels

Human resources mapping

Equitable distribution of the qualified human resources
Establish Rapid Response Team and National CBRNe
Instructor Team.
Education and Trainings :
FETP (Field Epidemiology Training Program) Master
Degree
Short courses training
Risk communication training
On job training
CBRNe for terrorism attact Training
Laboratory biosafety training
Laboratory Management Training
Rapid response team training

Assigned 2 national reference + 42 regional

laboratories for suspect epidemic/pandemic
case.
Assigned 7 forensic laboratories (Police
department) for criminal case
Development of Laboratory Information
System
Dissemination of emergency standard
operational procedures

Limited budget to reference laboratories for

confirmation EWAR system
Data source for monitoring and evaluation
(cases and program) need more coordination
and analysis.
Limited trained human resources
Limited research
Geographical difficulties and uneven of
resources

Strengthening Coordination and

Communication with each relevant
stakeholders at all levels
Continuing advocacy and socialization
Strengthening development of contingency
plan including the table top exercise and
simulation
Capacity building

Dr Sri Henni Setiawati, MHA (senior advisor to

Minister of Health on the Protection of Health Risk
Factor )
Dr Nirmal Kandel, WHO representative to Indonesia
Legislation and regulation in Indonesia
Adisasmito, W., B.M. Hunter, et al. (2011). Pandemic
Influenza and Health System Resource Gaps in Bali :
An Analysis Through a Resource Transmission
Dynamics Model. Asia-Pacific Journal of Public
Health XX(X).
All individuals, who are directly or indirectly
contributed in pandemic preparedness and response
in Indonesia

Thank you