Transition to comprehensive sexual and reproductive health services in the era of climate disaster threats in Indonesia : analysis of policy gaps in the reproductive health sector in Indonesia's national health crisis response guidelines

Abstract

The Indonesian health sector faces unprecedented challenges as the frequency and intensity of natural disasters such as floods and droughts increase due to climate change. These disasters disproportionately disrupt sexual and reproductive health (SRH) services, threatening the well-being and rights of women, adolescents, and other vulnerable groups. In response, Minister of Health Decree No. HK.01.07/Menkes/1502/2023 established the National Guidelines for Health Crisis Management, marking an important step toward strengthening disaster response for SRH. However, critical policy gaps remain, particularly the limited distribution of reproductive health kits (RH Kits) and the absence of mechanisms to empower communities to assess their own SRH needs during crises. A comprehensive policy analysis shows that current protocols, which limit the distribution of RH Kits to major disasters, are not aligned with international best practices such as the Minimum Initial Service Package (MISP). These global standards advocate for flexible and context-sensitive SRH interventions from the onset of a humanitarian emergency, regardless of its scale. Additionally, the absence of community-based self-assessment training results in delays and low effectiveness in the delivery of SRH services, particularly in Indonesia's vast and disaster-prone regions. This study recommends two transformative policy and program shifts to address these challenges. First, Indonesia needs to adopt a more detailed disaster classification system, enabling the deployment of tailored and timely Reproductive Health Kits (RH Kits) for minor, moderate, and major events. Second, the country should institutionalize community-based self-assessment training, leveraging local leaders, peer educators, and digital tools to empower individuals and families to identify and communicate their SRH needs quickly. This strategy requires strong multi-stakeholder collaboration, sustainable resource allocation, and continuous monitoring and evaluation to ensure effectiveness and sustainability. Implementing these recommendations will not only improve the timeliness and equity of SRH service provision during disasters but also strengthen Indonesia's commitment to health equity, gender rights, and international humanitarian standards. By integrating flexibility, inclusivity, and community participation into health crisis management, Indonesia can become a regional leader in climate-resilient public health, ensuring that no one is left behind as climate risks increase.