Indonesian Experiences In Resolving the Inequality of Health

Indonesian Experiences In Resolving the Inequality of Health

Indonesian Experiences In Resolving the Inequality of Health Prof. Dr. dr. Nila F. Moeloek, Sp.M (K) Bappenas_Indonesia Development Forum Jakarta, 10 Agustus 2017

ARCHIPELAGO CONSISTS OF 17.504 ISLANDS WHICH SPANS FROM SABANG TO MERAUKE HEALTH WORKERS ARE NOT YET EQUALLY DISTRIBUTED, CONCENTRATED MOSTLY IN SUMATRA AND JAVA ISLAND NUTRITION PROBLEM STILL DOMINATED BY STUNTING

0.6503 BALI 0.6085 DKI JAKARTA The Public Health Development Index of 2013 0.6081 KEPULAUAN RIAU 0.5757 KALIMANTAN TIMUR 0.5733 DIY 0.5682 BANTEN 0.5631 JAWA TENGAH 0.5535 RIAU 0.5462 SUMATERA BARAT 0.5458 JAWA BARAT 0.5449 LAMPUNG 0.5427 SULAWESI UTARA 0.5415 SUMATERA UTARA 0.5411 JAWA TIMUR 0.5404 INDONESIA 0.5363 BANGKA BELITUNG 0.5343 JAMBI 0.5328 BENGKULU 0.5301 SUMATERA SELATAN 0.5244 SULAWESI SELATAN 0.5236 NUSA TENGGARA BARAT 0.5161 SULAWESI TENGGARA 0.5145 KALIMANTAN BARAT 0.5108 GORONTALO 0.5053 KALIMANTAN TENGAH 0.5051 ACEH 0.4985 SULAWESI BARAT 0.4966 PAPUA BARAT 0.4960 MALUKU UTARA 0.4937 MALUKU 0.4889 SULAWESI TENGAH 0.4857 KALIMANTAN SELATAN 0.4622 NUSA TENGGARA TIMUR 0.4387 PAPUA 0.7000 0.6000 0.5000 0.4000 0.3000 0.2000 0.1000 I n e q u a l i t y 0.0000 Sumber Data :IPKM 2013, Kemenkes RI

PREVALENCE TREND OF NUTRITION STATUS OF UNDER FIVE YEARS OLD (2014-2016 NUTRITION STATUS MONITORING) 35 30 25 20 19,3 18,8 17,8 28,9 29 27,5 Prevalence of under two years old stunting: 21.7% 15 10 5 11,8 11,9 11,1 5,5 5,3 4,3 0 Gizi Kurang Pendek Kurus Gemuk 2014 2015 2016

EPIDEMIOLOGICAL TRANSITION Increase in deaths due to non communicable diseases Penya kit Menu lar 56% Causes of Burden of Diseases, 1990-2015 1990 2000 2010 2015 Penya kit Tidak Menu lar Ceder a 7% Penya kit Menu lar 43% Penya kit Tidak Menu lar Ceder a 8% Penya kit Menu lar 33% Penya kit Tidak Menu lar Cedera 9% Peny akit Men ular 30% Emerging and Re-emerging of Diseases Measurement of disease burden using Disability-adjusted Life Years (DALYs) loss of lives due to morbidity and premature deaths Cede ra 13% Peny akit Tidak Men ula

Life Expectancy (Yrs) Java Island NTT & NTB Maluku & Papua 68,9 yrs 72,6 yrs MENTERI KESEHATAN LIFE EXPECTANCY ACROSS PROVINCES, INDONESIA (2014) 90 80 70 60 50 40 30 Male Female 20 10 0

Components of Inequality Inequality of: Infrastructure Workforce Financial capacity Governance capacity (Decentralization) Inequality of: Access to health services Readiness of health facilities Health services quality Inequality of: Health services coverage Public health intervention (promotive & preventive) Inequality of: Health status Responsiveness Financial protection

Pillar 1. Health Paradigm Program Health mainstreaming in the development Promotive Preventive as the main pillar in health programmes Community Empowerment MoH Strategic Plan 2015-2019 Pillar 2. Healthcare Strengthening Program Improving access, particularly at primary level Referral system optimalization Quality improvement Continuum of care throughout the life cycle Health risk based intervention HEALTHY FAMILY Pillar 3. National Health Insurance Program Benefits Financing system: insurance gotong royong mutual shared principle Quality Control & Cost Control Membership KIS D T P

ENHANCING ACCESS OF HEALTH SERVICES HOSPITAL 1. The amount of hospitals in Indonesia is 2598. Currently, developing 104 Regional Referral Hospital. 2. Establishing 23 Pratama Hospital. 3. Strengthening 4 Province Hospital as National Referral Hospital. 4. 2017 : Planning to establish 3 new vertical hospital in Tahap perencanaan pembangunan 3 RS Vertikal baru di Eastern Indonesia (Maluku, Papua, NTT). COMMUNITY HEALTH CENTER 1. The amount of Community Health Center in Indonesia is 9754. 2. Establishing 24 Community Health Center in border areas. 3. Establishing 362 Community Health Center in remote areas.

Nusantara Sehat: ensuring no one is left behind 1.462 371 Throughout 2015-2016 deployed 1462health professionals In 371 Public Health Centers situated at borders, islands and most remote areas Under a special task force team Called Nusantara Sehat.

DEFINITION OF FAMILY APPROACH The Family Approach is one of methods held by Community Health Center to increase the coverage of the target and to get closer or to improve access to health services by visiting the family Objectives of Family Approach: 1. Improving family access to comprehensive health services 2. Supporting the achievement of Minimum Service Standard of Districts/Cities and Provinces 3. Support the implementation of National Health Insurance 4. Supporting the achievement of Healthy Indonesia program A service approach that integrates individual health efforts (UKP) and community health efforts (UKM) on an ongoing basis, with family targets, based on data & information from family health profiles

12 INDICATORS OF HEALTHY FAMILY 1 Family participate in Family Hypertension patients are treated Planning (KB) regularly Women give birth in health facility Babies get complete basic immunization Babies are exclusively breastfed for 6 months Growth of children under five is monitored monthly Pulmonary TB patients are treated appropriately (standard treatment) Severe mental disorders are not abandoned No family members smoke Families have access to clean water Families have access or use healthy latrines Whole family is member of National Health Insurance

NATIONAL, PROVINCE, AND REGIONAL REFERRAL HOSPITAL Referral Hospital National Province RSU Dr. Zainoel Abidin RSU H Adam Malik RSU Prof.Dr. R.D Kandou RSUD Kep. Riau RSU Sorong RSU Dr Sudarso PTK RSU Dr. Hasan Busor RSU Dr. M.Jamil RSUD H A WahabSjahranie RSU Prof. Dr. Aloei RSUD Arifin Achmad RSUD Dr. Doris Sylvanus RSUD Raden Mattaher RSUD Mamuju RSUD Ulin RSU Kendari RSU Jayapura RSUD Dr. M. Yunus RSU Dr. Ir. Soekarno RSU Dr W Sudirohusodo RSU Dr. M Haulussy RSU Dr. Mohammad Hoesin RSU Dr. H. Abdul Moelok RSU Dr. Cipto Mangunkusumo RSU Dr Hasan Sadikin RSU Tangerang RSU Dr. Kariadi RSUP Dr. Sarjito RSUD Tarakan RSU Dr. Soetomo RSUD Prov NTB RSUP Sanglah Denpasar RSU Prof. Dr. WZ Johanes Class A 12 2 Class B 2 15 Class C -- 3 Total 14 20 TOTAL REGIONAL REFERRAL HOSPITAL: 110 CLASS A CLASS B CLASS C CLASS D 2 RS 58 RS 46 RS 4 RS NATIONAL REFERRAL HOSPITAL PROVINCE REFERRAL HOSPITAL **Kepmenkes HK.02.02/MENKES/390/2014 dan HK.02.02/MENKES/391/2014

SPECIALISED DOCTORS COMPULSORY SERVICES (WKDS) Perpres Nomor 4 Tahun 2017 Wajib Kerja Dokter Spesialis 2 kab, 2 RS, 2 peserta 2 kota, 2 RS, 2 peserta 2 kab, 2 RS, 2 peserta 1 kab, 1 RS, 1 Peserta 2 kab, 2 RS, 2 Peserta 1 kab, 1 RS, 3 Peserta 4 kab, 4 RS, 4 Peserta 4 kab, 5 RS, 6 peserta 2 kab, 2 RS, 2 peserta 3 kab, 3 RS, 3 peserta 2 kab, 2 RS, 3 Peserta 3 kab, 3 RS, 3 Peserta 1 kab, 1 RS, 2 peserta 1 kab, 1 RS, 1 peserta 1 kota, 1 RS, 1 peserta 3 kab, 3 RS, 3 peserta 3 kab, 3 RS, 3 peserta 4 kab, 4 RS, 5 peserta 7 kab, 8 RS, 8 Peserta 4 kab, 4 RS, 4 peserta 1 kab, 1 RS, 1 peserta 2 kab, 2 RS, 2 peserta 1 kab, 1 RS, 1 Peserta 3 kab, 3 RS, 4 Peserta

National Health Insurance (JKN) HEALTH FACILITIES THAT PROVIDE JKN Provider Primary Health Facilities (FKTP) Amount 20.696 Hospital (FKRTL) 2.097 Apotik 2.131 Optik 972 Lab 333 Total 26.229

GERMAS (Community Action to Living Healthy) is a systematic and planned action undertaken jointly by all nation components with awareness, willingness, and ability to behave healthily to improve the quality of life PRESIDENT INSTRUCTION: NUMBER 1 / 2017 Improving Physical Activities Improving Healthy Increasing Prevention Provision of Healthy Foods Lifestyle Behaviour and Early Detection and the Acceleration of Disease of Nutrition Improvement Increasing Environment Quality Increasing Healthy Life Education Regulation of Ministry of Home Affair No. 32/2017 about Establishing 2018 Work Plan of Local Government Circular Letter of Ministry of Home Affair No. 440/2797/SJ about Supporting on Implementation of Presiden Instruction 1/2017 Circular Letter of Governor of East Java, Central Java, Jambi, DIY, West Nusa Tenggara and Bali in 2017 Governor Instruction of Kepulauan Riau No.1/2017

COLLABORATION FOR Community Action to Healthy Life (GERMAS) Koord dan Fasilitasi Pemda Gerakan Memasyarakatkan Makan Ikan Promosi makan sayur dan buah dalam negeri Partisipasi perempuan untuk deteksi dini PTM, KIE Kampanye Gemar Olah Raga, Sarana Olah Raga Keamanan PJAS, Keamanan mutu pangan olahan Jalur Sepeda dan Pejalan kaki Sarana aktivitas fisik di pemukiman dan TTU, Ruang terbuka hijau Meningkatkan pelayanan Promprev Cukai dan pajak rokok, minuman beralkohol UKS, Sekolah Ramah Anak, Aktivitas Fisik Konseling pra nikah, Poskestren Keamanan dan mutu pangan segar

LEGAL BASIS MINIMUM SERVICE STANDARD STANDAR PELAYANAN MINIMAL (SPM) Law of The Republic of Indonesia Number 23 of 2014 About Local Government, Article 18, Act (2) and (3) that state Implementation of Basic Services to the Mandatory Government Affairs relating to fundamental services referred to in paragraph (1) based on the minimum service standards set by the central government and further provisions on minimum service standards set by government regulation. The Mandatory Government Affairs relating to Basic Services including: 1. Education; 2. Housing and residential areas; 3. Health; 4. Paece, public order, and the protection of society; 5. Public works and spatial planning; 6. Social.

MINIMUM SERVICE STANDARD ON HEALTH IN THE PROVINCE OF DISTRICT/CITY 1 Antenatal health services according to the 7 Elderly healthcare according to the standard standard 2 Maternal healthcare according to the standard 8 Hypertension disease health services according to the standard 3 Neonatal healthcare according to the standard 9 Diabetes disease health services according to the standard 4 Children under five healthcare according to the standard 10 Mental disorders health services according to the standard 5 Health care for students of primary education according to the standard 11 Health services for people suspected of TB according to the standard 6 Productive adults healthcare according to the standard 12 Health services for people suspected of HIV according to the standard

HEALTHY INDONESIA THROUGH FAMILY BASED APPROACH 1 MINIMUM SERVICE STANDARD in DISTRICT AND PROVINCE Health Centre 2 FAMILY APPROACH 3 HEALTHY COMMUNITY MOVEMENT Posyandu POSBINDU PTM Poskestren

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