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Primary Submission Category: Place/Communities
Healthcare Deserts Under Water: Community Health Workers, Trust, and Climate-Vulnerable Primary Care in Jakarta
Authors: Clarisza Runtung,
Presenting Author: Clarisza Runtung*
Background:
Jakarta faces an accelerating dual crisis. Rapid coastal land subsidence combined with projected sea-level rise threatens to inundate large areas of the city, while the climate resilience of its primary healthcare infrastructure, anchored by community health centers (puskesmas), remains poorly understood. These risks are not evenly distributed. North Jakarta’s coastal kampung neighborhoods are home to communities with long-standing flood adaptation practices, yet urban planning policies have often labeled these areas informal or illegal and subject to eviction rather than support. Chronic flooding therefore intersects with structural marginalization and shapes who can access care and who remains most vulnerable.
Objectives:
This study identifies “healthcare deserts” in Jakarta, defined as areas where coastal flood exposure and limited primary care access converge, and estimates the population living within these compound vulnerability zones.
Methods:
A descriptive spatial analysis was conducted in ArcGIS Pro using multiple geospatial datasets. Low elevation derived from 8-meter resolution DEMNAS digital elevation models was used as a proxy for chronic flood vulnerability given Jakarta’s extreme rates of land subsidence. Flood-prone zones were overlaid with georeferenced locations of all 315 puskesmas. Two-hour travel-time service area catchments were modeled to identify access gaps where flood exposure intersects with limited primary care reach. Population exposure was estimated using 100-meter gridded population data. Complementary qualitative fieldwork engages residents and kader posyandu (community health workers) through interviews and participatory workshops grounded in radical listening and community partnership.
Results:
Approximately 847,000 residents live within identified healthcare desert zones, and 94 puskesmas face operational risk during flood events. Vulnerability is concentrated in coastal North Jakarta where environmental exposure overlaps with displacement pressure and longstanding spatial inequities.
Conclusion:
Climate-related health system vulnerability in Jakarta is closely linked to spatial inequalities in urban development and service distribution. Integrating spatial analysis with community knowledge, particularly that of neighborhood health workers, can support more equitable and climate-responsive primary care planning in coastal cities. This study contributes to population health science by integrating spatial epidemiology with community-informed perspectives from neighborhood health workers.