Healthcare facilities depend on safe water, sanitation and effective waste management to protect patients and staff. Climate change is making this increasingly difficult. Floods, droughts and extreme weather can damage infrastructure and interrupt essential services. They can also increase diseases spread through contaminated water, such as diarrhoea, and diseases spread by insects like mosquitoes, including dengue and malaria. This places health workers and communities at greater risk.
Since 2024, the Ministry of Health, with support from WHO and partners, has been strengthening environmental health in healthcare facilities. The focus has been on ensuring safe water, clean sanitation, good hygiene practices, safe waste handling, preparedness for climate risks and access for people with disabilities.
Practical tools and frameworks such as the Water and Sanitation for Health Facility Improvement Tool (WASH FIT) and Climate‑Resilient and Environmentally Sustainable Health Care Facilities (CRESHCF) guideline were integrated into the national climate resilience and environmental health information system SIKELIM to guide assessment, planning and monitoring. At the same time, health workers and local assessors received practical training, which started at provincial level. The province trainees then trained district health officials, who in turn trained community health centres staff. This enabled solutions to be adjusted to local needs.
At Puskesmas Karangmalang in Semarang, Central Java Province, this training has led to clear changes in daily practice. The health centre regularly checks water quality, keeps toilets clean and easy to use, and encourages regular handwashing to reduce the spread of infection.
Meanwhile, waste management is handled in creative and practical ways. Organic waste from the facility is composted and used as fertiliser for plants around the centre. Some organic waste is processed through maggot cultivation, where larvae break down waste quickly and safely. In addition, recyclable inorganic waste such as cardboard and plastic bottles are collected and sold by the Puskesmas. The proceeds are used to support health insurance contributions for families with limited financial means, contributing both to environmental sustainability and better access to health care.
Through responsible healthcare waste management, Puskesmas Karangmalang is reducing environmental impact and strengthening climate‑resilient health services for the community. Credit: Puskesmas Karangmalang
The facility has also taken steps to prepare for climate risks. Emergency water supplies are stored on site. Water from air‑conditioning units is collected and reused for cleaning and plants. Small absorption holes have been made in the ground to reduce flooding during heavy rain, and solar‑powered lights are used to save energy. Staff take part in emergency drills so services can continue during floods and other weather‑related events. Features such as ramps, handrails, guiding blocks and accessible toilets make sure people with disabilities can use the health centre safely and with dignity.
These actions are especially important in Semarang, where flooding, land subsidence and rising sea levels regularly disrupt daily life. Health facilities are often damaged, water systems fail and access to care becomes difficult. Warmer temperatures and changing rainfall also increase diseases such as dengue, adding pressure on health services. Puskesmas Karangmalang implemented their interventions as preventive measures to mitigate potential risks and ensure the continuity of health services.
The experience of Puskesmas Karangmalang demonstrates that practical, low-cost improvements can make health care safer, more reliable and fairer even during climate shocks. By protecting water supplies, reducing infection risks and ensuring access for all, health centres can continue serving communities when they are needed most.
Building on this experience, the Ministry of Health plans to institutionalize climate-resilient approaches through national systems, standard guidance and coordinated learning, with priority given to climate‑vulnerable districts. In 2026, WHO will support the Ministry to conduct a national baseline assessment on CRESHCF. Aligned with the National Action Plan on Climate Change Mitigation and Adaptation for Health 2025–2030, these efforts will help strengthen Indonesia’s health system and support healthier, more resilient communities.
Written by Itsnaeni Abbas, National Consultant for Environmental Health, WHO Indonesia