A journey to improve the healthcare WASH and waste management information system in Indonesia

Inadequate and unequal access to water, sanitation, and hygiene (WASH) coupled with ineffective waste management in healthcare facilities, can fuel the transmission of infectious diseases like COVID-19, disproportionately affecting vulnerable populations. The implementation of a routine monitoring system, however, provides healthcare providers and policymakers with the tools to enact robust control measures that shields patients, healthcare workers, the community, and the environment from harm.

Health officers from all Indonesian provinces participated in a capacity building on healthcare waste management and the Water, Sanitation and Hygiene (WASH) information system (SIKELIM), Bandung 22-24 June 2022. Credit: PIAREA/Ryco

In 2021, 27 % of Indonesian healthcare facilities met waste management standards, a rise from 19% the previous year. Despite this, a glaring disparity persist between regions (ref: Health profile, MoH 2021. Urban areas take the lead, bolstered by superior facilities, equipment, and staff. This potent mix empowers them to manage medical waste effectively.

The MOH and WHO staff visited Puskesmas Sukarasa, a pilot site in Bandung City on May 5, 2023. They engaged in a guided discussion to devise an improvement plan based on the findings reported through SIKELIM. Credit: PIAREA/Icha

Rural regions, on the other hand, struggle. Inadequate resources and infrastructure thwart attempts to establish efficient waste management systems. And if this was not enough, the terrain conspires against them. Remote location, hostile landscape, and scant waste collection networks muddle the disposal of medical waste in rural healthcare facilities, amplifying the disparity in waste management performance.

Notably, provinces such as Lampung (78%), Banten (63%), and Central Java (50%) lead the pack in compliance rates, while Gorontalo (0.9%), North Maluku (1.3%), West Papua, and Aceh (1.7%) trail at the bottom. Addressing this uneven landscape is crucial to ensure equal access for WASH services and waste management across Indonesia.

MoH, PHO and WHO conducted spot check to the waste storage at a Puskesmas in Pangkal Pinang Province, 4 May 2023. Photo Credit: WHO/Itsnaeni Abbas

WHO Indonesia has been supporting the development and socialization of the WASH-waste management information system (SIKELIM) since 2021. This support persisted through 2022–2023, pivoting its focus on two key aspects. Firstly, the organization held capacity-building workshops targeting Provincial Health Officers (PHOs) and the MOH team. Held between 22 and 26 August 2022, the workshop aimed to build understanding about health care waste management, the SIKELIM, and tools for enhancing WASH in health care facilities (WASH-FIT).

Secondly, WHO facilitated a pilot of the COVID-19 Healthcare Waste Management and WASH FIT Information System across five provinces—Banten, Jogjakarta, Greater Jakarta, West Java, and Bangka Belitung Islands—between March and May 2023.

The second phase yielded key outcomes. Knowledge among PHO staff regarding WASH services and medical waste management saw a significant jump—from 54% in the pre- to 81% in the post-workshop test. A preliminary plan was then drafted to further circulate SIKELIM and implement WASH FIT across 38 provinces. Impressively, by March 2023, 74% of healthcare facilities (HCFs) reported their WASH services statuses via SIKELIM, also enabling the collection of data on COVID-19 waste generation.

"In today's interconnected world, healthcare service quality is of growing concern to facility users. Acting on SIKELIM’s findings shows our dedication to WASH, waste, and environmental health, thereby enhancing health facilities’ reputation and building trust among patients, employees, and the community," said Dr Anas Ma’ruf. MKM, Director of Environmental Health at MoH. His comment were made during a capacity-building workshop for SIKELIM and WASH FIT in Bandung.

Ms Yuntina Erdani, a representative from West Java Provincial Health Office, delivered remarks in the orientation of SIKELIM-WASH FIT. Bandung 22 May 2022. Credit: PIAREA/Ryco

During the pilot implementation on 5 June 2023, Mr Anhar Hadian, SKM, Head of the Bandung Health Municipality Office, articulated his vision. He suggested, "Linking SIKELIM with the Ministry of Environmental and Forestry’s waste transport system (SIRAJA) would be advantageous. Such a connection would permit end to end process monitoring, from waste generation at health facilities to disposal at treatment plants, thus ensuring regulatory compliance."

Public access to SIKELIM data foster awareness about the importance of regular WASH practice and effective waste management in bolstering public health. It enlightens individuals about disease prevention, hygiene practices, and the hazards linked to substandard WASH or mishandled health care waste. Moreover, the community benefits from a transparent lens into current data on local WASH services and waste management, enhancing their understanding of essential services quality and availability. This transparency promotes accountability and strengthens trust between service providers and the public.

sikelimkemkes.id  

The Ministry of Health plans to integrate SIKELIM with the hazardous and non-hazardous information system (SIRAJA), overseen by the Ministry of Environment and Forestry, facilitating smoother coordination. Employing data gathered through SIKELIM for policy refinement, WHO will support the Ministry of Health in crafting a technocratic paper, serving as a background study for the impending strategic planning period of 2025-2029. In addition, an accredited training curriculum is on the horizon, courtesy of the Ministry of Health, ensuring continuous training in WASH for healthcare facilities.

These activities were carried out between July 2022 and June 2023 with the generous support from DFAT.

Written by Indah Deviyanti-National Professional Officer Environmental Health and Climate Change