Health System:

Improving Performance
Fedri R. Rinawan, dr., MScPH

Department of Public Health

Faculty of Medicine
Universitas Padjadjaran
Curriculum Vitae
Fedri R. Rinawan
Born: 7th February
Address: Jalan Giri sari no.12 Simpay Asih Bandung
Bringing Statistics to Support
Education:
2004 : MD, Faculty of Medicine Universitas Padjadjaran (FK Unpad)
A Quantitative Research
2009 : MSc in Public Health, Universiteit Maastricht, Maastricht, Limburg, The Netherlands
Working :
2004 – 2006 : Mandatory working (PTT) in Malingping, Lebak, Banten Selatan
2007 – 2011 : Researcher of Health Research Unit, as a field doctor in Narcotics Prison
Fedri R Rinawan
Banceuy and HIV-AIDS at-most risk community
2010 : Consultant and Writer on Health Promotion Research of ‘Direktorat Kesehatan
dan Gizi Masyarakat’, Ministry of National Development Planning (BAPPENAS)
Department of Public Health
2007 – now: Emergency Room Doctor in a private hospital

Faculty of Medicine, Universitas Padjadjaran

2010 – now: Lecturer in Department of Public Health, Faculty of Medicine, Universitas
Padjadjaran
2011 – now: volunteer speakers on reproductive health-related themes in one of radio
stations in Bandung
Telp : 0858 143 583 92
Email : fedri_rinawan@yahoo.com ; fedri_rinawan@pubhealth.fk.unpad.ac.id
Meetings
 Meeting 1 (9 September 2011): Health system:
Improving performance
 From the World Health Report 2000
 Meeting II (26 September 2011): Analysis of a
national health system
 Milton I. Roemer
How Health Systems have evolved
 Thousand years ago traditional practices often
integrated with spiritual counseling .
 100 years ago  organized health system in the
modern sense barely existed
 In past decade shift to new universalism (delivery to
all of high-quality essential care ,defined mostly by
criteria of effectiveness, cost and social acceptability.)
How.......................con’t
 It implies explicit choice of priorities among
interventions, respecting the ethical principal
that it maybe necessary and efficient to nation
services, but that it’s inadmissible to exclude
whole group of population;
 The result is increasing demands and pressure
on health systems, including both their public
and private sectors.
What is Health system
 All the activities whose primary purpose to
promote, restore or maintain health
 Three fundamental objectives;
1.improving the health of the population
they serve.
2. responding to people expectations.
3. providing financial protection against the
cost of ill-health.
Health system reform
 During the 20th century there have been 3
generation of Health system (HS) reform;
1.they saw the founding of national HS
and the extension to middle income
nations of social insurance system.
2.they saw the promotion of primary health
care (PHC) as a route to achieving affordable
universal coverage.
Health system reform......con’t
3.they have ideas of responding more to
demand, trying harder to assure access
for the poor and emphasizing financing
including subsidies, rather than just
provision within the public sector .
FUNCTION AND OBJECTIVES
functions objectives
Stewardship ------------ responsiveness

resource----service---------------- health
generating provision status

Financing -------------- fair financing

Meeting II

Analysis of a national health system

Model of National health system

Management

health resources organization service health

needs delivery results

economic
support
 NHS COMPONENTS
MANAGEMENT
MANAGEMENT

RESOURCE
RESOURCE ORGANIZATION
ORGANIZATION OF DELIVERY
DELIVERY OF
PRODUCTION
PRODUCTION OFPROGRAMMES
PROGRAMMES OF SERVICES
SERVICES

ECONOMIC
ECONOMIC SUPORT
SUPPORT
NHS COMPONENTS........CONT
 RESOURCE PRODUCTION:
-manpower -commodities
-Facilities -knowledge
 MANAGEMENT ;
-planning -administration
-regulation -legislation.
 ECONOMIC SUPPORT;
-personal -charity
-insurance -social security
-government -foreign aids
NHS COMPONENTS........CONT
 ORGANIZATION OF PROGRAMMES
- MOH at all level -other public agencies
-voluntary agencies -enterprices
-private market.
 DELIVERY OF SERVICES;
-primary care (preven- -secondary medical care.
tion and treatment) - tertiary medical care
-care of special dis –
order and population
NHS COMPONENTS........CONT

DETERMINANTS AND TYPE OF NHS

 Determinants economic ( GNP per capita) and
political.
 Type of NHS
-based on economic level (affluent and
industrialized; developing and transitional; very poor,
and resources rich)
-based on health system policies (market
intervention) : entrepreneurial and permissive,
welfare-oriented ,universal and comprehensive,
socialist and centrally planned
Thank You