Local leadership drives village health adaptation to climate change in Indonesia

Indonesia, as a vast archipelagic nation with over 17,000 islands and a population exceeding 270 million, faces acute vulnerabilities to climate change. The country is experiencing:

• Rising temperatures and heatwaves
• Unpredictable rainfall and flooding
• Increased prevalence of vector-borne diseases such as dengue and malaria
• Water scarcity and sanitation challenges in rural and coastal areas

These environmental shifts are directly impacting public health, particularly in underserved and remote communities. The health system must now respond not only to traditional health threats but also to emerging climate-sensitive diseases and disaster-related health risks.

Regional Focus: Jambi Province

Jambi, located on the island of Sumatra, is a predominantly rural province with rich biodiversity and a high dependence on agriculture. It is increasingly affected by:

• Deforestation and land degradation
• Seasonal droughts and floods
• Health risks linked to environmental changes, especially in remote villages

Local governments in Jambi have recognized the urgency of climate-health adaptation and have taken proactive steps to build resilience at the village level.

Alignment with the Belem Health Action Plan

The case study from Jambi contributes to several priority areas of the Belem Health Action Plan, including:

• Strengthening climate-resilient health systems through local leadership and policy integration;
• Promoting community engagement and equity by empowering youth groups, health volunteers, and village task forces;
• Advancing intersectoral collaboration between health, environment, and governance sectors;
• Scaling up local innovations such as the Desa Desi Initiative for broader national impact.

In the Jambi Province, implementation of the aforementioned priority areas included the following key actions:

1. Policy advocacy and political commitment

• The Jambi Provincial Health Office (PHO) has been a pioneer in climate and health initiatives, being among the first to participate in the Training of Trainers (ToT) on health adaptation to climate change, organized by the Ministry of Health with support from WHO in 2018. Since then, PHO Jambi has actively advocated for and implemented health sector adaptation measures across the province.
• PHO Jambi initiated voluntary advocacy efforts to the Governor, district heads (Regents), and mayors.
• These efforts led to the issuance of a Government Decree supporting the Climate-Resilient Healthy Village (Desa Desi) Initiative, formalizing climate-health adaptation at the village level.

2. Identification of vulnerabilities and planning

• In 2022, the initiative began with district-level assessments to identify climate-health vulnerabilities and risk factors.
• Eleven villages were selected as pilot sites based on their exposure and sensitivity to climate-related health risks.

3. Capacity building and institutional strengthening

• In 2023, the PHO conducted training and capacity-building for district and village officials, including health workers and sanitarians.
• Village Health Adaptation Task Forces were established to coordinate local actions and ensure community involvement.

4. Community engagement and participatory planning

• In 2024, the initiative moved into community-led participatory planning, where residents, youth groups (Karang Taruna), and health volunteers (cadres) co-developed local adaptation plans.
• These plans focused on climate-sensitive diseases, especially vector-borne illnesses, and included behavior change communication.

5. Integration into national strategy

• In 2025, the CR Healthy Village program was adopted as a national performance indicator in the Ministry of Health’s Strategic Plan (2025–2029).
• The Ministry issued official guidelines and assessment tools to evaluate village-level climate-health adaptation capacity.

6. Monitoring, Verification, and Reporting (MRV)

• Villages conducted self-assessments using standardized instruments.
• Results were verified by environmental health officers at local health centers (Community Healthcare Center) and uploaded to a centralized reporting system connected to the Ministry of Health.

Several strategies and interventions proved effective in Indonesia's experience, including:

• Voluntary and proactive leadership: The Jambi Provincial Health Office (PHO) initiated climate-health advocacy without external mandates. This voluntary approach built strong political will and ownership at the local level.
• Use of local government budget: Despite limited resources, the PHO utilized existing provincial and district funds to support activities. This demonstrated that impactful programs can begin with modest, locally sourced funding.
• Community empowerment and participation: Mobilizing Karang Taruna (youth groups) and Kader Kesehatan (health volunteers) helped bridge gaps in technical capacity and community outreach. Participatory planning processes increased local ownership and sustainability.
• Capacity building and Task Force formation: Training programs for health workers, sanitarians, and village officials improved technical understanding of climate-health links. Establishing Village Health Adaptation Task Forces ensured coordination and follow-through at the grassroots level.
• Integration into national strategy: Aligning the Desa Desi Initiative with the DEKSI program under the Ministry of Health’s Strategic Plan (2025–2029) provided institutional support and a pathway for scale-up.
• Standardized tools and monitoring systems: The use of assessment instruments and a centralized reporting system enabled consistent monitoring and verification of village-level progress. This helped maintain accountability and informed decision-making.
• Continuous advocacy and training: Even with limited funding, the PHO continued advocacy and training efforts, reinforcing commitment and keeping momentum alive.