Disaster Preparedness as a Health System Performance Indicator: An RR-Based Pathway Modeling Framework for School-Based Disaster Risk Reduction Program Implementation in Indonesia
Keywords
child disaster vulnerability community health resilience disaster risk reduction health system performance LMIC health system resilience scalable monitoring framework school healthAbstract
Background: Disasters disproportionately affect children, yet school-based preparedness—an essential health system performance domain—remains underdeveloped in many lower-middle-income countries. In Indonesia, child vulnerability is exacerbated by suboptimal implementation of the Disaster Safe Education Units program (SPAB), with limited population-level evidence on its performance gaps. Objective: This study assessed school health preparedness capacity and developed optimized SPAB implementation pathways stratified by education level. Methods: A cross-sectional analysis was conducted using secondary data from the BNPB INARISK registry, covering 1,775 schools in Banten, DKI Jakarta, and West Java. Twelve SPAB indicators across prevention, mitigation, and preparedness-response domains were analyzed. Relative risk (RR) with 95% confidence intervals was calculated for indicator associations. Optimized implementation pathways were constructed using maximum-RR criteria and validated through multivariate ANOVA. Results: Only 48.3% of schools received SPAB socialization. Prevention indicators were notably low: vulnerability assessment (16.4%), structural safety assessment (18.0%), and monitoring (18.9%). Disparities were observed by education level (RR=1.39; 95%CI: 1.23–1.57) and school ownership (RR=1.15; 95%CI: 1.03–1.28). Two four-stage implementation pathways were identified for elementary and secondary schools, with SPAB socialization showing the strongest association with preparedness outcomes (RR=2.06–4.95). Conclusion: Significant gaps persist in school-based disaster preparedness in Indonesia. The proposed RR-based pathway model provides a scalable and replicable framework to strengthen health system resilience and reduce child vulnerability in disaster-prone settings.References
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