DIGITAL PUBLIC HEALTH AND CLIMATE ADAPTATION IN INDONESIA’S 3T REGIONS: A FISHBONE ANALYSIS

Abstract

Climate change increases environmental health risks, particularly in remote and underserved settings where access to healthcare services and institutional resources is limited. Digital public health offers potential opportunities to strengthen surveillance, risk communication, and public health responses. However, implementation requires consideration of workforce readiness, environmental conditions, and health-system governance. This study aimed to identify and synthesize contextual factors potentially influencing the development of digital public health for climate change adaptation using an adapted 6M Fishbone analytical framework. A qualitative document-based multiple-case analysis was conducted using three purposively selected published contexts: digital health cadre capacity building in Waingapu, community behavior and environmental conditions following a filariasis elimination programme in Southwest Sumba, and tropical disease policy implementation in West Papua and Central Maluku. Directly reported findings were distinguished from the authors' interpretations and mapped onto six Fishbone domains: Man, Method, Machine, Material, Measurement, and Environment. The selected studies respectively reported improvements in health cadre knowledge following education, limited sustained behavioral and environmental changes, and governance and resource-related implementation constraints. The Fishbone synthesis identified contextual considerations for the prospective development of digitally supported surveillance and environmental health responses. However, none of the three studies directly evaluated the effectiveness of digital interventions for climate change adaptation. Climate-responsive digital public health development requires an integrated consideration of human capacity, implementation processes, infrastructure, resources, monitoring systems, and environmental context. The findings provide exploratory implementation hypotheses rather than causal evidence or nationally representative conclusions.