Surge in demand for health services: evaluating health system impact and capacity to respond in countries with limited resources


Support by the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ)

Indonesia is a lower middle income country in Southeast Asia with over 17,000 islands and more than 200 million inhabitants. The country is at the center of many recent geological catastrophes including the 2004 Tsunami and the 2006 Yogyakarta earthquake. It has also witnessed 9 SARS cases and the highest number of human cases of avian influenza and total deaths. Indonesia’s size, demographics, and decentralised health system poses significant challenges to operationalising pandemic preparedness plans. Additionally, devolved governance arrangements to district level increase the difficulty in effectively implementing coordinated pandemic response and mitigation activities.Indonesia is chosen as a pilot study country for this research study because of its diversity and potential threats from pandemic and other natural and non-natural disasters. 

The health system capacity is relatively similar to other developing countries with high variations at the district and province levels. The country is also investing in national health facility survey (RISFASKES 2011) which can serve as a useful input for further elaborative assessment in additional dimensions of health system capacity. We plan to conduct the study of the surge capacity of health service system in two purposively selected provinces namely Bali and West Sumatra.

This project will provide new knowledge and information in regard to health system surge capacity which is currently very limited even at the international level. It will enable disease modelers and health system planners to better understand the existing capacity and potential resource mobilization needs. For example, we have previously developed a resource-linked mathematical model for simulating pandemic influenza scenarios. The results from an evaluation of surge capacity in Indonesia could inform analyses using this model, or subsequent extensions of the model, to generate more robust estimates of where, and in which resource types, gaps are most severe.It will also inform policy makers to be able to make evidence based policy decision on resource reallocation across geographical and administrative boundaries within a region or a country. The national pandemic preparedness plan as well as national disaster preparedness plan can be improved by taking into account the surge capacity of health facilities for pandemic and disaster responses.


Project Leader: Samantha Watson 

Email: Samantha.Watson@lshtm.ac.uk

 Key outputs

Outputs from this project would include, but may not be limited to, the following:

  • Literature review on surge capacity: previous concepts, and experiences from real-life public health emergencies

  • A new conceptual and analytical framework and user-friendly policy tool for defining and evaluating health system surge capacity in terms of aggregate health outcomes, disaggregated outcomes by age, and health equity

  • Report on the existing surge capacity of the health system in Bali and West Sumatra

  • Policy recommendations, strategies, and new models of care for enhancing surge capacity and response in Bali (and elsewhere)

  • Research skills capacity development in Indonesia academic institutions

  • User friendly software for resource needs and gaps projection according to various scenarios based on local parameters

  • Knowledge and skills amongst policy makers of health systems research, its potential and limitations through ongoing dialogue with policy-makers.

 Project Collaborators include:  

London School of Hygiene & Tropical Medicine



The Faculty of Public Health University of Indonesia