Building and analyzing an innovative community-centered dengue-ecosystem management intervention in Yogyakarta, Indonesia

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Susilowati Tana*1 , SittiRahmah Umniyati2 , Max Petzold3 , Axel Kroeger4,5, Johannes Sommerfeld4

ABSTRACT

Background and Objectives: Dengue is an important public health problem in Yogyakarta city, Indonesia. The aim of this study was to build an innovative community-centered dengue-ecosystem management intervention in the city and to assess the process and results. 

Methods: For describing the baseline situation, entomological surveys and household surveys were carried out in six randomly selected neighborhoods in Yogyakarta city, documents were analyzed and different stakeholders involved in dengue control and environmental management were interviewed. Then a community-centered dengue-ecosystem management intervention was built up in two of the neighborhoods (Demangan and Giwangan) whereas two neighborhoods served as controls with no intervention (Tahunan and Bener). Six months after the intervention follow up surveys (household interviews and entomological) were conducted as well as focus group discussions and key informant interviews. 

Findings: The intervention results included: better community knowledge, attitude and practices in dengue prevention; increased household and community participation; improved partnership including a variety of stakeholders with prospects for sustainability; vector control efforts refocused on environmental and health issues; increased community ownership of dengue vector management including broader community development activities such as solid waste management and recycling.

Conclusion: The community-centred approach needs a lot of effort at the beginning but has better prospects for sustainability than the vertical ‘‘top-down’’ approach.

OPINION

In this article shown that in-depth interviews with city government officers showed the following: Although there are defined community structures with leaders, volunteers and assemblies (forums) the 3M campaign (see introduction) is often not implemented by community members and is therefore limited in scope. The community sees dengue control as a government responsibility, and has limited knowledge about mosquito breeding places. The most common community education programme is to show banners and distribute leaflets at community health centres and district health offices but such one-way communication is not very effective and is limited in coverage. These promotion efforts have resulted in increased community knowledge about dengue vector control but not in improved behavior concerning source reduction.
Outcomes of the intervention included: increased community knowledge, attitude and practices in dengue prevention; increased household and community participation; prospects for sustainability and continued partnership; routine community vector control efforts refocused on environmental and health issues.
It can be seen that the community-centred multistakeholder approach needs more efforts at the beginning but has better prospects for sustainability than the vertical ‘‘top–down’’ approach, which achieves high coverage levels at the start but needs a maintained effort on the side of the public control services.