By Mr. Gde Yulian Yogadhita, Dr. Bella Donna, Gadjah Mada University, Indonesia
As many countries around the globe are preparing to face the second, or even third, wave of the pandemic, our greatest challenge today is to prevent this from happening. The biggest concern for many governments, including Indonesia’s, is the potential massive mobility of people from the large urban centers to their hometowns during the holy month of Ramadhan. The total estimated number of people moving to celebrate the Hari Raya or Eid Festival, is up to 23 million people each year and it is continuously growing as the transportation and technology is also evolving. The Gadjah Mada University’s Center of Health Policy and Management conducted a research back in 2020, just before the Ramadan holy month last year, analyzing the opinion of the community regarding social restriction policies and empowerment in preventing COVID-19. As far as social restrictions are concerned, at a micro level these were focusing on maintaining physical distance up to 1.5 meters; at a macro one, staying at home or reducing mobilities. The research has also measured the local communities’ understanding of government guidelines about community empowerment, focusing on households and villages. The study included health data collection, information on risk factors and community deliberation activities using online questionnaires in order to introduce better COVID-19 prevention measures.
The questionnaire targeted two main regions: Yogyakarta, a small city situated at a rural area; and the grater Jakarta area (Jakarta and its surrounding cities such as Bogor Depok Tangerang and Bekasi which are commonly known as Jabodetabek area). The results showed that the percentage of citizen involvement in health data collection through community centers in Yogyakarta, Jakarta, and Greater Jakarta area (Bodetabek) was at low levels. The percentage of community involvement in deliberation activities with community members (organizing COVID-19 prevention activities) was also still low. However, the percentage of involvement of Yogyakarta residents was higher than Jakarta and greater Jakarta urban areas. Eventually, this study showcased how well and to what extend the community understood the Ministry of Health guidelines on community empowerment about COVID-19 prevention when the partial lockdown (large scale social restriction along with a provincial based lockdown in high populated areas) took place.
The research also highlighted that the community leaders were active in providing information about COVID-19 to residents of Yogyakarta, Jakarta, and greater Jakarta (Bodetabek) area. Around 73% of the respondents stated that the community leaders did provide them with information at village and household level, to the community regarding COVID-19 information in Yogyakarta, Jakarta, and greater Jakarta (Bodetabek) area, including social media and print media. However, the information that has been provided was not strong enough to persuade the community to self-isolate at home. Around 65% of the respondents stated that the social restrictions policy did not interfere with their everyday routine. For instance, people continued to follow their usual routines in order to meet primary, daily needs for the family, (e.g., groceries, health care/services) instead of using remote services such as telemedicine or home visits by their family doctor. In general, the main reason respondents would leave their household was to work and exercise.
Another interesting point was that Yogyakarta and the greater Jakarta area attempted different social restriction policies. Jakarta officially adopted “large scale social restriction, also known as PSBB, while Yogyakarta did not officially declare a similar social restriction policy. Instead, the latter regulated a partial, sectoral, policy to restrict the movement and activity of targeted population, such as students, small scale enterprises, public transportation, as well as religious activities. As a result, the patient visits, both patients under surveillance (now known as suspect) and positive confirmation patients in Greater Jakarta and Yogyakarta, remained high. This situation is related to the fact that community’s discipline towards the implementation of social restriction policies is still not optimal.
In another research based on data collected between March and May 2020, results shown that the large-scale social restriction policy (partial lockdown) did not have a significant effect on reducing the number of COVID-19 cases in four provinces: Banten, West Java, East Java and DKI Jakarta. According to the above research, this policy has not been effective in reducing the mobility from outside the Jakarta area. Population movements from Bekasi (West Java Province) to Jakarta and from Banten to Jakarta after the implementation of the Jakarta PSBB policy, had a small effect in ameliorating the situation. The daily mobility analysis showed that a significant decrease in community mobility occurs only on weekends. The Jakarta Provincial Transportation Agency’s report used in the study also indicated that the number of vehicles entering Jakarta from West Java and Banten during the second PSBB period was still high. The main concern was those restrictions, social and business policies, impose short-term, and possibly medium-term, financial burdens, especially for those who are not contractually employed, and need to continue working to ensure their income. However, financial compensation was indeed expected for losses occurred due to the implementation of the public health protocols.
Between March and July 2020, thanks to the policies enacted by the federal and local government the number of suspected and infected COVID-19 patients visiting the hospitals drastically decreased, giving local governments time to prepare to improve and increase the capacity of healthcare services. Of course, other matters still need to be studied to extrapolate data regarding the social restriction policy, such as economic, social, and cultural issues. It is necessary to maintain strict supervision, especially when transitioning from the large-scale social restriction policy into the previous policy status. As the central government and local governments have considered and implemented many strategies to overcome COVID-19 (also known as 3T: test-trace-treatment most of the community still did not adhere to the restrictions regarding the fulfillment of their daily needs. On the contrary, there were still few policies regulating companies regarding in-person work. In other cases, this could not be implemented due to the nature of the job (e.g., factories).
According to the WHO SEARO situation report of May 2021 (see figure 1) the result of the current research can be generalized. In Indonesia, restrictions regarding the workplace and the use of public transport are still at a low level, while at the same time, the compliance of the stay-at-home policy, is the lowest amongst the eleven countries in Southeast Asia. Nonetheless, the gathering restrictions index is at the highest-level. From the research conducted it was also found that the central government and local government (provincial government of Yogyakarta and grater Jakarta) regulate many policies, around 241 policies in the first seven months in 2020, while half of them were related to social restrictions. However, according to the survey, community involvement is in discordance with the social restriction policy implementation, so even though the policy reaches the community, the public does not yet understand its meaning.
As a result, it is imperative that government and local government policies cannot be communicated by low level officials, such as the village’s community leader. The policies issued should reach the village level and should be communicated to the community. The lack of communication and understanding of the rules is also showcased by the large number of people who are still violating in house restrictions, doing activities on the grounds of supporting their family’s needs. These results are also discussed in the research conducted on the knowledge, attitudes, and skills of the local communities in preventing COVID-19 in the province of DKI Jakarta. The results of this study indicated that 83% of respondents have good knowledge about the prevention of COVID-19, 70.7% of respondents are adopting the appropriate behaviors, still, new cases of COVID-19 every day increase by about a thousand cases in mid-2020. This shows that there is still room for improvement to deal with COVID-19 in the community level. The application of the new normal must be balanced with high compliance from the community in preventing COVID-19.
The New Normal Adaptation Process must be consistently implemented starting from wearing masks, maintaining distance, washing hands, not making physical contact with others, and increasing endurance through nutritional intake and exercise. The goal is to adopt a bottom-up approach by the federal government and local governments through community empowerment efforts and education. These interventions are based on theories that increase public knowledge and awareness of certain health risks resulting in positive behavior change. As a result of the community’s non-compliance, which was caused due to inadequate policy information and understanding of diseases, an increase in the number of case visits to health facilities has been reported. Legal Policies for Handling the COVID-19 Pandemic in Indonesia have not been implemented properly as mandated by the laws and regulations. There are still many individuals who violate the social restriction activities despite the existence of law enforcement and administrative sanctions that can be imposed.
Under such circumstances, the Central and Local Governments should ensure the disclosure of public information in real terms to be able to find out the chain of the spread of the virus. They must be able to guarantee and ensure that especially the middle and lower classes are able to fulfill their needs. the dignity of the people and the need for public roles in terms of protecting, reminding each other and helping one another. in a study, conducted last year shows that the social restriction policies issued by the federal government and local governments of Yogyakarta and DKI Jakarta were able to reduce the level of patient visits before the Ramadhan month, and it appears that there was no extreme spike that exceeded local health capacity. Thus, as long as there has not been a surge in patient visits with the implementation of social restriction policies, this can provide sufficient time for local governments to prepare for an outbreak by improving or increasing the capacity of health services. From the lessons learned from the previous year, where the spikes of increasing cases always occurred after long weekend holidays. This year, the local government has not applied provincial-scale, large social restriction to limit the mobility of people within the province. Instead, a massive blockade took place in coordination between the central and local government to prevent mobility between provinces. (HERE- para conclusion needed) As mentioned in this article, the above policy was not only ineffective in reducing the transmission, but also impacting the local economies severely. An intra-provincial social restriction might be a better solution, so the respective province can be localized and solve their own problems and the central government will have a better perspective on what to prioritize in which province.
About the Authors
Dr. Bella Donna, M. Kes, is a medical doctor holding a degree from the Faculty of Medicine, Methodist University of Indonesia, Medan. She continued her studies at the Postgraduate Program of Specialization in Health Service Policy and Management at Public Health Department, Medical faculty of Gadjah Mada University. In 1994 she provided medical service at the Kelayang Health Center, Riau Province. In 1999 she moved to Waena Community Health Center, Papua Province and in 2002 she moved to Kraton Yogyakarta Community Health Center. Currently, she, is working with WHO and the Indonesia’s Ministry of Health’s Crisis Management Center. She is also part of the International Training Consortium Disaster Risk Reduction (ITC-DRR) Facilitator to improve the health system in the country specializing in emergency and disaster management, preparedness, and mitigation. She is also contributing to governmental, local, or central, research, serving at the same time as a facilitator in various capacity building activities and seminars.
Mr Gde Yulian Yogadhita is a pharmacist graduated from the Pharmacy Faculty, Gadjah Mada University. He currently holds a master’s degree in epidemiology from the University of Indonesia. His thesis was focusing on road traffic injury epidemiology. In 2006, he began his career in the World Health Organization as an emergency supply assistant focusing on analyzing and disposing the inappropriate medical donation during disasters. During his engagement in WHO Indonesia, he was also acting as a national consultant for emergency field operations and injury prevention. He remained heavily involved in managing the local health cluster coordination and EMT-emergency medical team deployment in numerous disasters in Indonesia and abroad. Since April 2020 he is working as a researcher and consultant at the Center for Health Policy and Management, Faculty of Medicine Public Health and Nursing at Gadjah Mada University, Yogyakarta.
