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Indonesias Health care

Challenges

Prof.Dr.Ridwan Amiruddin, SKM.M.Kes., Msc.Ph.

Faculty of Public Health, Hasanuddin University
Indonesia

Email: ridwan.amiruddin@gmail.com
Mobile: 08164384965

International seminar Manado, 3 Sept

 POPULATION QUALITIES

1. MMR : 359/100.000 lb
2. IMR : 34 per 1.000 lb
3. 60% Only elementary school
4. HDI rank 108 from 188 countries (2009) and numer 6
from 10 ASEAN countries
5. LE: 68/72 Tahun
6. Poverty : 31,02 million (13,3% population)) *BPS 2010
7. Unemployed: 7,14% from 116,5 M workforce(BPS, Agustus 2010)

International seminar Manado, 3 Sept 2016

 Current issues in Public Health

1. Population Transition---InfantGeriatri

2. Rural----Urban----Megapolitan

3. Communication & Globalization

4. Change in Disease Pattern(Triple Burden of the

Disease:DM; Atherotrombosis; Psychiatri(fear and anxiety);
Geriatri; Celebrity; NCD; Emerging of New Infectious
Disease(eg. Bird Flu)

5. Disaster Epidemiology

6. Life Style Problem: Smoking; Sedentary Life Style; Practice

Healthier Life Style

7. Nano; Genom; Moleculer and Proteomic

8. IT: e-medicine;e-prevention ; chips; robot
9. One Health
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 Public Health Challenges

Emerging Diseases (SARS, Pandemic Flu)

Re-emerging Diseases (XDR-TB)
Food Safety
Bioterrorism
Natural Disasters
Obesity
Aging Population
Health Disparities
Global Warming

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 Health Care Crisis

Aging Population
Re-emerging Diseases
Emerging Diseases
Obesity
Health Disparities
Access to Quality Health Care
Health Insurance Costs
Uninsured and Underinsured

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 Source: WHO statistics 2008

International seminar Source: W.H.O. Statistics

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Indonesias Health System Challenges
Stagnating Health Outcomes

Geographic Inequalities

Under-funding

Inefficiencies (low utilization)

Financially Unsustainable

Limited Health Insurance Coverage

Weak Stewardship

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INDONESIAS HEALTH INDICATOR

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Particular challenges remain in MDG
related areas

Maternal
mortality

Geogra
Child
phical
malnut
dispari
rition
ties

Female
literacy and
access to
clean water

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NUTRITIONAL STATUS INDICATORS

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BURDEN OF DISEASE

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 WHO (2007):
Health System
Buildiing Blocks
Goals / Outcomes
1. SERVICE DELIVERY

IMPROVED HEALH
(level & equity)
2. HEALTH WORKFORCE ACCESS
COVERAGE

3. INFORMATION RESPONSIVENESS

SOCIAL & FINANCIAL RISK

4. MEDICAL PRODUCTs, PROTECTION
VACCINES & TECHNOLOGY
QUALITY
SAFETY
IMPROVED EFFICIENCY
5. FINANCING

6. LEADERSHIP/GOVERNANCE

FoCOS

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 HOW TO EMPOWER NATIONAL HEALTH SYSTEM
(Perpres No 72/2012)

Health management

RENSTRA
Penguatan Fungsi Pemantapan Perencanaan SDM
Dinkes Fungsionalisasi KF-PTK
Workforce
Peningkatan kemampuan SDM Puskesmas

PhARMACY

Services delivery Health status

RESEARCH

Akreditasi Puskesmas
COMMUNITY Permenkes 75/2014
EMPOWERMENT Pengembangan Sistem Rujukan
Penguatan UKBM

fINANCIAL

PHA/DHA SUPPORTING DIMENSION SERVICES DIMENSION

Sosialisasi tarif baru INA CBG

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 Jiw
a
ISP
A
DIAR K
Ca
E Vit B
A
TB EPI
C
Vit
HIV
A KL

Sbaya-Kupang

Full AC
RPJMN
Renstra
RPJMD
Renstra

Vertical vs System Approach

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 NATIONAL ISSUE for Health Care
UNFINISHED ISSUE NEW STRATEGIES DESIGN STRATEGIES
ISSUE ISSUE 2015-2019

1. Reduce IMR and 1. Prepare universal 1. Improve MCH status

MMR health coverage 2. Improve community
2. Reduce nutrition (2019), nutrition status
deficient 2. Epidemiology 3. Double burden of
3. ReduceTFR (fertility) transition disease
4. Control of TB, 4. Available pharmacy
3. Increasing
Malaria, HIV/AIDS, 5. National health
prevalence NCD
DBD insurance
(stroke,
5. Health finance 6. Health promotion and
cardiovascular, )
6. Increase Promotif community
and Preventif 4. Nutritional deficient; empowerment
7. Increase clean Child stunting 7. Manajement and
water and sanitation 5. Number and quality health financing
8. Increase Health og health workforce. 8. Limited Human
promotion resources

source: Bappenas
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 How to empower National Health System
(Perpres No 72/2012)

BUILDING BLOCKS
HEALTH SYSTEMS.
COMMITMEN
LEADERSHIP and SYSTEM THINKING

HEALTH SYSTEMS STRENGTHENING

BASED ON PRIMARY HEALTH CARE

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PRIMARY HEALTH CARE
PHC 3 Dimension:
1. Approach Dimension:
1) Universal Coverage (Equity)
2) Self Help and community
participation
3) Collaboration cross sector
4) Use available technology
2. Dimension Health services:
1) Primer
2) Secunder
3) Tertier
3. Dimension Program
1) Health promotion
2) Disease control
3) Nutrition
4) Clean water
5) MCH & FP
6) Immunisation
7) Endemic disease control
8) Curative and accident
9) Pharmacy

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 Conceptual Model of a
Comprehensive Integrated
Health System
 Continuum Of Care
Upaya promotif
Lansia

dan preventif di
Pelayanan bagi anak
hulu sama
SMP/A & remaja Kualitas
pentingnya Degenerasi
dengan yang
dihilir Pelayanan bagi
anak SD Kespro remaja
Konseling: Gizi
HIV/AIDS,
Pelayanan bagi NAPZA dll
balita Fe
Pelayanan bagi
Penjaringan
Persalinan, nifas bayi Bln Imunisasi Anak
& neonatal Sekolah
Upaya Kes Sklh
Pelayanan PMT
Antenatal
Pemantauan
pertumbuhan &
Pelayanan perkembangan
PUS & WUS PMT
ASI eksklusif
Imunisasi dasar
lengkap
P4K APN (MAK III) dan KF Pemberian makan
Buku KIA Inisiasi Menyusu Dini Penimbangan
ANC terpadu Vit K 1 inj Vit A
Kelas Ibu Hamil Imunisasi Hep B MTBS
Konseling Rumah Tunggu
Fe & asam folat
Kespro Kemitraan Bidan Dukun
PMT ibu hamil
Pelayanan KB
TT ibu hamil KB International
pasca persalinanseminar Manado, 3
KIE Kespro PONED-PONEK Sept 2016
Catin
Increase health status

Increase Nutritional
status

Communicable disease
control, NCD and env.

Empower Health
system

Health access

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 PHC ISSU
Recruitment health workforce.
staff Competence of staff

Village Budget allocation to community empower.

Finacial

Public Health focus; curative vs health promotion

Management

Cultu Local culture to support reducing IMR and MMR

re
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COMMUNITY HEALTH SERVICES
COMMUNITY PARTICIPATION;

FP PROGRAM(KB)

Economic Creative PROGRAM (NUTRITION PROGRAM)

1000 DAY EARLY LIFE

TB CONTROL

LEPROSY CONTROL

HEALTH SCHOOL CADRE

ALERT Brigade Siaga 115

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 Ex. PHC ANALISIS

factors Analysis supporting and

weakness
Man Available of midwifery and cadre
Staff low competence
money Budget allocation 7-8%
Other resources
Material Available PHC per sub district
Innovative program
Machine Base on application software
Method Base on capacity
Networking with stakeholders;
cadre
etc

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 SWOT PHC IN SERVICES
DELIVERY
Health workforce available; nurse,
Cadre per village
Strength Available of Disease control guideline
Many program to support Public health
Financial support

Less Knowledge and concern

population (-)
Weakness Less optimalization Program.
Health Workforce distribution
Less supporting infrastructure

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 SWOT PHC delivery

Decentralization

Opportunities Local govt supporting.

Networking and stakeholders.
Financial supporting village.

Local cultural; early marriage, decision

Threats base on family structure
Instability policy

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 Rebalancing Health Priorities

General Targeted Primary Secondary Tertiary

protection protection prevention protection protection

Affected people
Safer without Affected people
Vulnerable complications
Healthier with
people (undiagnosed complications
People asymptomatic)

Death from
Complications

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 Traditional Healthcare
Affected People
Safer without Affected People
Vulnerable complications
Healthier with
People (undiagnosed complications
People asymptomatic)

Traditional Healthcare

Disease Care

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 Traditional Public Health
Affected People
Safer without Affected People
Vulnerable complications
Healthier with
People (undiagnosed complications
People asymptomatic)

Public Health System

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 Need to Rebalance Health Priorities

Affected People
Safer without Affected People
Vulnerable complications
Healthier with
People (undiagnosed complications
People asymptomatic)

Public Health Network Healthcare Delivery System

Health Protection: Health Promotion, Disease Care

Prevention, and Preparedness

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 Rebalancing Health Priorities

General Targeted Primary Secondary Tertiary

protection protection prevention protection protection

Affected people
Safer without Affected people
Vulnerable complications
Healthier with
people (undiagnosed complications
People asymptomatic)

Death from
Complications

International seminar
 Traditional Healthcare
Affected People
Safer without Affected People
Vulnerable complications
Healthier with
People (undiagnosed complications
People asymptomatic)

Traditional Healthcare

Disease Care

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 Traditional Public Health
Affected People
Safer without Affected People
Vulnerable complications
Healthier with
People (undiagnosed complications
People asymptomatic)

Public Health System

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 Need to Rebalance Health
Priorities
Affected People
Safer without Affected People
Vulnerable complications
Healthier with
People (undiagnosed complications
People asymptomatic)

Public Health Network Healthcare Delivery System

Health Protection: Health Promotion, Disease Care

Prevention, and Preparedness

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 The Quality of Care

Safe; avoiding injuries to patients

Effective; providing scientific-base
cervices.
Patient centered; providing care that
is respectful
Timely; reducing waiting time
Efficient; avoiding waste; equipment,
supplies; idea, energy.
Equitable; gender, ethnic,
socioeconomic status, geographic.
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 Recommendation to improving
Quality of Care
Improve training quality within certification
system
Clear responsibilities and assignment
Change the national education system from
a certification-based system to a
competency-based system.
Shift home-based deliveries to institution-
based deliveries.
Reduce the inequity in the distribution of
specialists and skilled birth attendants.

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 Recommendation for Public health
improvement

Empower public health education

Continuing collaboration
international community
Budget for education and health
Disease control
Continuing research for health
services

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 PUBLIC HEALTH RESPONSIBILITY

Prevention epidemic & distribution of

disease
Community protection from envy hazard
Prevention accident
Promotion and health behavior
Rapid Response toward disaster
Ensure health services available, quality,
and accessible.

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Thank you