27 May 06 Earthquake in Jogjakarta Province

Jogjakarta before May 27, 2006 Earthquake

• Center for students and healthcare innovation• Human Development Index ranked the third in Indonesia• Life expectancy in 2002, 73 years (67.8 national)• Infant mortality rate in 2004, 23.3/thousand life birth (35

national)• Population and health care services ratio in 2004, 25,000

(39,000 national)• Nine years School Participation Rate 93% in 2004

(above national rate, and equal rate for boys and girls)• High school transition rate is 43.6% (8.6% national, and

6.9% Central Java)

Bantul area

Bantul and Jogja areas

Chaos, in fear of tsunami

Damages of schools and offices

Staying in the open in fear of aftershock

Hospital and clinics were full of patients

Trying to find what’s remained from the destroyed houses

Health facilities

• Hospitalization and treatment was free for badly injured victims (in public or private hospitals and clinics)

• Health Centers were free for everybody • Many temporary clinics from various NGO’s and

foundations were built close to the affected areas

• Many medicines were distributed without the coordination with health office/authorities

Relief and emergency supports

• Food• Tents• Medicines (hospitals and temporary clinics)• Ambulance, transport (hospital – home)• Clothes• Water and sanitation• School equipments, stationary• Debris cleaning, etc.

NGO’s

• International, regional, national, and local NGOs took part in the emergency and recovery activities – Providing food, temporary shelter, building field

hospital, delivering health services, etc.• No complete data on all NGO’s working in the

area, or on what activities being conducted (partial information existed)

• Most of them working in the areas close to epicenter

Bakornas (National Disaster Management Coordinating Board)

• Ministry of Social affairs and health• Coordinating Minister for people’s welfare• Ministry of Education• Ministry of Settlement and infrastructure• Ministry of Internal affairs

Satkorlak Gempa (Provincial Coordinating Unit for the management of disaster)

• Satlak (District unit for disaster management)• Provide information on numbers, areas

affected, damages and losses, and supports needed

• Advising on urgent humanitarian needs• Coordinating supports and emergency needs

Damage and Loss in Social Sector (in Billion Rp)

Social SectorEffect Owner

Damage

Loss

Total

Private

Government

Education 1.683 0,561.73

9 585 1.154

Health and Family Planning 1.525 0,211.54

6 996 550Facility for the Poor and Vulnerable 44 0,1 44 34 10

Religious and Cultural center 654 0,0 654 498 156

Total 3.906 0,773.98

2 2.113 1,870

% for total damage and loss all sectors 17 1,2 14

Damage and Loss in The Health Sector (in Billion Rp)

District Damage Loss Total

D.I.Yogyakarta Province 1,408,059 14,636 1,444,695

Sleman 198,237 1,487 199,724

Bantul 418,380 4,449 422,829

Gunung Kidul 169,115 1,147 170,262

Yogyakarta 604,400 7,420 611,820

Kulon Progo 17,927 0,133 18,060

Central Java Province 101,969 6,004 107,973

Klaten 15,291 0,403 15,694

Other District 86,678 5,601 92,279

Total 1,510,028 20,640 1,530,668

Health Facilities Affected by the Earthquake

From 117 healthcare center in Jogjakarta Province• 45 destroyed• 22 severely damaged• 16 low damaged

From 324 sub-healthcare center in Jogjakarta Province• 73 destroyed• 35 severely damage • 42 low damage

From about 6.000 private practitioners, 1.631 were affected (practices or houses)

Government support

• Living cost as much as Rp 90,000 per head per month for 3 months (Aug – Oct)

• Rice distribution as much as 10 kg per head per month for 3 months (Aug – Oct)

• Rp 15 millions for each household with complete house damage (started November 2006)

• Temporary houses (plywood, temporary roofing, nails and hammers, etc)

Mechanism to get support

• Untuk living cost dan dana rekonstruksi RT melakukan pendataan terhadap semua semua kerusakan

• Untuk dana reskonstruksi data dari RT kemudian dilakukan verifikasi oleh perangkat (Kelurahan) dan aparat (polisi/tentara) untuk klasifikasi tingkat kerusakan kerusakan (berdasarkan prosentase kerusakan bangunan). Dari hasil verifikasi itu ada yang mengalami perubahan kategori (dari berat menjadi sedang atau dari sedang menjadi ringan). Hasil verifikasi diajukan ke pemerintah kota dan selanjutnya ke pusat. Daftar nama penerima bantuan dana rekonstruksi (klasifikasi rusak berat) turun dan di tingkat kelurahan nama-nama tersebut dibagi dalam pokmas-pokmas. Kemudian daftar calon penerima bantuan disosialisasikan ke masyarakat dan warga membentuk kepengurusan pokmas (ketua dll) kemudian melengkapi persyaratan dan dana disalurkan ke masing-masing pokmas

• Untuk bantuan lainnya ada yang dengan sistem langsung: para dermawan langsung menyerahkan bantuan ke posko ataupun ke warga

• Mekanisme lainnya: warga mengajukan permohonan bantuan kepada para dermawan (bisa perorangan ataupun dikoordinir dalam posko dengan sepengetahuan RT/RW, Kelurahan)

The study1. To describe health-seeking behavior following

the earthquake;2. To assess the role of the private health sector in

the field area short- and medium-term after the earthquake;

3. To assess the local distribution of the impact4. To identify lessons learnt and recommendations

for disaster preparedness, including the role of the private sector vis-a-vis government and NGO sectors.

The StudySetting:Urban poor neighborhood in Tegalrejo and Badran

(baseline data existed)Urban poor neighborhood in Umbulharjo and

Kotagede (severely and less affected or damaged houses)

Methods:• In-depth interview: families and private

practitioners • Survey: 200 families

In the research areas

Tegalrejo: 8 houses completely damaged

Umbulharjo

• Completely damage: 165

• Moderately damage: 84

• Low damage: 141

What were they doing on 27 May 2006?

• 6.2 Richter Scale earthquake (5.58am): people were at home, some have been waken up some were still sleeping

• People thought that Mount Merapi was erupted, but from the radio, people aware of the earthquake

• People left their houses during the rumor of tsunami• In the first week, households activities were carried out

outside the house, and in couple weeks activities were done inside the house during the day but still outside during the night; in fear of aftershock

• Aftershock frequently happened in the first month (June), and less frequent in the 2nd-3rd months

Urban poor neighborhoodTegalrejo/JetisHouses were mostly rented

on monthly/ weekly bases

Houses are too packed to each other, and no open space at all

Occupation: small trader, becak driver, scavengers, singing beggar, labors

Umbulharjo/KotagedeHouses were mostly owned

by the families or rented on yearly bases

Many open spacesOccupation: small trader,

becak driver, home industry, big scavengers, industrial and agricultural labors, backyard farmers

Social impact• No jobs for several days for certain families, but for

several others; income had increased for several days• Stronger group solidarity among those affected (groups

of families cooked and ate together, hanging around up to late night) conflict rise when the affected families did not receive enough attention from the local authorities

• Some who had only rented house were given opportunity to own a house

• Some of those who illegally occupied the land were legally given the right to register and own the land (umbulharjo) better houses

Health problems: both areas

• Physical health problems were mostly on direct impact of having day and night activities outside the house like cold, flu, “masuk angin,” fever, cough, and head ache. Injuries were more prevalent in Umbulharjo

• Psychological problems: fear of harsh sounds (car, train), easy to get startled, never wanted to be left alone even going to the bathroom, anxious

• Other problems: no appetite to eat, constipation, fatigue, always sweating, shivering

Health seeking behaviorTegalrejoHealth center staff went out

to the area to identify those who are injured free services

For common health problems, they went to small kiosk and health center

UmbulharjoPeople went to a newly

formed of Pos Kesehatan (health post) and to health center for mild injuries as well as to hospital in search of treatment free

Mostly, they went to available health resources (individual medical clinic, maternity clinic, private nurses, etc.) free up to 1 week-2 months

Private Practitioners in the SettingTegalrejo

None was personally affected by the earthquake

Most practitioners were busy helping people in their official setting or other health center

Most fully private practitioners conducted “business as usual” after office hours

Some gave free treatment or discounted fee to the patients (1 week – 1 month)

Umbulharjo

Some were directly and personally affected by the earthquake (damage of the clinic, house, and get injured) HC was completely damaged

All was busy helping people in the health center

No private business at all in 1-2 months because their private clinics were turned to a POSKO

Practicing Nurse (SH)

• Health center nurse • Practicing in the poor area since 2002 and

also in the private hospital• Helping people affected by earthquake

through delivering free services during private practices for one month, but also involved in health care center

• Setting up in-patient clinics in his home• Done amputations for earthquake victim

Local Institution and Social Mobilization

• Coordinating post (POSKO) were existed in many places in the neighborhood, to distribute and manage logistic supports

• Rukun Tetangga/RT: association of 25-50 households based have been existed; the head of the RT will identify the damage houses (mild, moderate, severe damages)

• Rukun Warga/RW: association of 3-6 RTs (accept the result of the identification)

Local Institution and social mobilization

• Head of Village/Kampong and Head of sub-district would verify the reports

• The list of those who will receive the government support will be released along with the suggestion of forming a community group. Only those belong to a community group (POKMAS) who will receive government support

the district hired a facilitator for every 10-15 POKMAS• Government support as much as Rp 15 millions for each

household with complete house damage (November 2006), Rp 4 millions with moderate damage, and Rp 1 million for light damage (not implemented)

• Variation based on local arrangement existed (1-4 million reductions)

Emergency and recoveryTegalrejo• Political parties,

individuals and churches, NGO

• RT/RW had not activity, because damage was not obvious

• POKMAS was not existed

Umbulharjo• Government, political

parties, individuals, NGO, mass media

• RT/RW were very active in writing proposals, asking for supports

• POKMAS were very active

Flow of government support• Verification team district level

(polcei/army, technical team)

• Sub-district

• Urban village

• RT/RW

• community

The Family of Sari• Sari is 45, single mother of one child, has lived in a semi-concrete

house that she inherited from her mother 22 years. She works as a labor in a small mineral-water company.

• After the earthquake she suffered from asthma, her childhood health problem.

• She visited health center every week and to drug store for her asthma. She used the insurance to consult health center but has to find other resources for the store medicine. Actually the drug from the health center was ok for her condition, although the medicine from the drug store was better because she felt a lot better after taking the medicine.

• However, she could not frequently go to the health center due to the office hour, as well, she feels not comfortable because nurses usually teased her for not paying the treatment because she used a health card

Family of Sari

• One year post disaster, she is still living under the tent

• She did not know that those whose house are severely damaged could get 15 million rupiah for reconstruction support

• She is not also included in the POKMAS, therefore she could not receive any help

• She did not know that the government had announced the name of those who would receive moderate and small supports from the government

Differences in social impact and management of government support (last

march 2007)Tegalrejo• People did not work

or find work for several days to one month

• No government support but those who directly affected got some support from NGO, religious and political party

Umbulhario

• Some people still lived in tents or temporary shelter

• Some people did not work 2- 4 months

• Some have not finished in reconstructing or rebuilding their houses because of limited funds

• Many have not received government support although their names were already listed and verified,

• Fund reduction by local authority was prevalent

Discussion

• Interruption of safe water and sanitation (?)

• Population displacement• Access for health care (?)• Routine health program• Equitable social mobilization