Background: Universal and equitable access to safe and affordable drinking water and adequate sanitation and hygiene in Indonesia are vital to ensure healthy lives and promote well-being for all at all ages. Objectives: To quantify subnational regional inequality in access to improved drinking water and sanitation in Indonesia. Methods: Data about access to improved drinking water and sanitation were derived from the 2015 Indonesian National Socioeconomic Survey (SUSENAS) and disaggregated by 510 districts across the 34 provinces of Indonesia. Two summary measures of inequality, mean difference from mean and weighted index of disparity, were calculated to quantify within-province absolute and relative inequality, respectively. Results: While the majority of Indonesian households had access to improved drinking water (71.0%) and sanitation (62.1%), there were large variations between and within provinces. Access to improved drinking water ranged from 93.4% in DKI Jakarta to 41.1% in Bengkulu, and access to improved sanitation ranged from 89.3% in Jakarta to 23.9% in East Nusa Tenggara. Provinces with similar numbers of districts and similar overall averages showed variable levels of absolute and/or relative inequality. Certain districts reported very low levels of access to improved drinking water and/or sanitation. Conclusions: There are inequalities in access to improved drinking water and sanitation by subnational region in Indonesia. Monitoring within-country inequality in these indicators serves to identify underserved areas, and is useful for developing approaches to improve inequalities in access that can help Indonesia make progress towards the 2030 Agenda for Sustainable Development.

Abstract.Provision of basic water, sanitation, and hygiene (WASH) services in health-care facilities is gaining increased attention, given growing acceptance of its importance to the maternal and newborn quality of care agenda and the universal health coverage framework. Adopting and contextualizing an emerging World Health Organization/United Nations Children’s Fund Joint Program Monitoring service ladder approach to national data collected in 2010/2011, we estimated the national coverage of primary health centers (PHCs) (N = 8,831), auxiliary PHCs (N = 22,853), village health posts (N = 28,692), and village maternity clinics (N = 14,396) with basic WASH services in Indonesia as part of a Sustainable Development Goal baseline assessment. One quarter of PHCs did not have access to a combination of basic water and sanitation (WatSan) services (23.6%) with significant regional variation (10.6–59.8%), whereas more than two-third of PHCs (72.0%) lacked handwashing facility with soap in all three locations (general consulting room, immunization room, and delivery room). More than a half of the three lower health service level facility types lacked basic WatSan services. National health facility monitoring systems need to be urgently strengthened for tracking the progress and addressing gaps in basic WASH services in health facilities in Indonesia.

Since 2002 Indonesia has implemented the Mass Drug Administration (MDA) in regencies/cities that are endemic for lymphatic filariasis. The success of regencies/cities in MDA after 5 years of implementation can be known through the TAS (transmission assessment survey). In 2017 an evaluation study was conducted to determine the failure and success of elimination of filariasis from epidemiological aspects (host, agent, environment) in 12 regencies endemic to zoonotic malayi filariasis who have passed TAS-1, TAS-2, and TAS-3. Evaluation study was carried out using finger blood sampling methods for residents, blood collection in reservoirs (long-tailed monkeys, cats and dogs) and vector mosquito capture. Finger blood test results on residents in 12 regencies: 3 regencies that have passed TAS-1 still found positive microfilaria populations, namely: Pasaman Barat (0.9%), Kuantan Singingi (0.2%), and Hulu Sungai Utara (0 , 2%). As well in the 3 regencies that have passed TAS-3, namely: Bangka Barat (0.6%), Belitung (1.2%), and Kotawaringin Barat (0.8%). Results of blood tests on the reservoir, were found to be positive for B. malayi in house cats in the regencies of Pasaman Barat, Pelalawan, and Kotawaringin Barat; long-tailed monkeys in Belitung and Kotawaringin Barat regencies; and dogs in Kotawaringin Barat regency. The mosquito vectors that were caught and tested positive DNA for microfilaria larvae based on PCR examination were Culex vishnui, Culex quinquefasciastus, Mansonia dives, Mansonia uniformis, Anopheles karwari, Anopheles karwari, Aedes aegypti, Aedes cancricomes, Aedes linneatopenis, and Armigeres kucingensis in the Pesisir Selatan, Pasaman Barat, Kuantan Singingi, Bangka Barat, Belitung, and Hulu Sungai Utara regencies. From the results of the study, even though an area has passed the TAS, transmission of the disease still occurs because of the presence of microfilaria in the reservoir and filaria larvae in mosquitoes. It is recommended that regencies that have passed the TAS continue to carry out active surveillance of vulnerable populations exposed in endemic villages.

Information about the vulnerability of an area due to climate change is one of the supporters on the implementation of the early warning system which is carried out as one of the adaptation activities in health sector in the face of climate change. Health vulnerability assessment research due to climate change was conducted to determine the level of vulnerability and influential indicators for adaptation planning. The study was conducted in the City of Semarang in 2015, to determine indicators of vulnerability for dengue disease due to climate change. Weighting vulnerability indicator variables was done using Principal Component Analysis. The results of the indicators valuation obtained were temperature classification and flood for the exposure component; population density and cases of dengue disease for the sensitivity component; number of health care facilities, number of health workers, clean and healthy living behaviour programme, and healthy houses for adaptive capacity components. The Exposure Index for Dengue Hemorragic Fever (DHF) was found at low and moderate levels, the Sensitivity Index for DHF was at moderate and high levels, while the Adaptive Capacity Index was at very low and low levels. It is necessary to plan and implement proactive policies so as to increase the adaptive capacity of local communities and reduce sensitivity to DHF.