Indonesian Experiences In Resolving the Inequality of Health

Indonesian Experiences In Resolving the Inequality of Health

MENTERI KESEHATAN REPUBLIK INDONESIA

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

0.2000

0.1000

0.0000 0.5363 0.5343 0.5328 0.5301 0.5244 0.5236 0.5161 0.5145 0.5108 0.5053 0.5051

BANGKA BELITUNG JAMBI BENGKULU SUMATERA SELATAN SULAWESI SELATAN NUSA TENGGARA BARAT SULAWESI TENGGARA KALIMANTAN BARAT GORONTALO KALIMANTAN TENGAH ACEH

PAPUA

NUSA TENGGARA TIMUR

0.4387

0.4622

0.4857

0.5404

INDONESIA

KALIMANTAN SELATAN

0.5411

JAWA TIMUR

0.4889

0.5415

SUMATERA UTARA

SULAWESI TENGAH

0.5427

SULAWESI UTARA

0.4937

0.5449

LAMPUNG

MALUKU

0.5458

JAWA BARAT

0.4960

0.5462

SUMATERA BARAT

MALUKU UTARA

0.5535

RIAU

0.4966

0.5631

JAWA TENGAH

PAPUA BARAT

0.5682

BANTEN

0.4985

0.5733

DIY

SULAWESI BARAT

0.5757

KALIMANTAN TIMUR

0.6081

0.3000

KEPULAUAN RIAU

0.4000 0.6085

0.5000

DKI JAKARTA

0.6000 0.6503

0.7000

BALI

The Public Health Development Index of 2013

Sumber Data :IPKM 2013, Kemenkes RI

I n e q u a l i t y


PREVALENCE TREND OF NUTRITION STATUS OF UNDER FIVE YEARS OLD (2014-2016 NUTRITION STATUS MONITORING)

35

28,9 29

30

27,5

Prevalence of under two years old stunting: 21.7%

25

20

19,3 18,8

17,8

15

11,8 11,9 11,1

10

5,5 5,3 4,3

5 0

Gizi Kurang

Pendek

Kurus

Gemuk 2014

2015

2016

EPIDEMIOLOGICAL TRANSITION Increase in deaths due to non communicable diseases Causes of Burden of Diseases, 1990 - 2015 1990

2000 Ceder a 7%

Penya kit Menu lar 56%

Penya kit Tidak Menu lar…

2010 Ceder a 8%




2015 Cedera 9%


Peny akit Men ular 30%

Cede ra 13% Peny akit Tidak Men ula…

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

72,6 yrs

68,9 yrs

Maluku & Papua

80

NTT & NTB

90

Java Island

LIFE EXPECTANCY ACROSS PROVINCES, INDONESIA (2014)


Life Expectancy (Yrs)

70 60 50 40

Male

30

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

MoH Strategic Plan 2015-2019

Pillar 1. Health Paradigm Program • Health mainstreaming in the development • Promotive – Preventive as the main pillar in health programmes • Community Empowerment

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

COMMUNITY HEALTH CENTER

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).

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 Planning (KB)

Hypertension patients are treated regularly

Women give birth in health facility

Severe mental disorders are not abandoned

Babies get complete basic immunization

No family members smoke

Babies are exclusively breastfed for 6 months

Families have access to clean water

Growth of children under five is monitored monthly

Families have access or use healthy latrines

Pulmonary TB patients are treated appropriately (standard treatment)

Whole family is member of National Health Insurance

NATIONAL, PROVINCE, AND REGIONAL REFERRAL HOSPITAL


RSU Dr. Zainoel Abidin

RSUD Tarakan

RSU H Adam Malik

RSU Prof.Dr. R.D Kandou

RSUD Kep. Riau RSU Dr Sudarso PTK RSU Dr. M.Jamil RSUD Arifin Achmad

RSU Sorong RSU Dr. Hasan Busor RSUD H A WahabSjahranie RSU Prof. Dr. Aloei

RSUD Dr. Doris Sylvanus

RSUD Raden Mattaher RSUD Dr. M. Yunus

RSU Dr. Ir. Soekarno RSU Dr. Mohammad Hoesin

RSUD Mamuju RSU Kendari RSUD Ulin RSU Dr. M Haulussy RSU Dr W Sudirohusodo

RSU Dr. H. Abdul Moelok RSU Tangerang RSU Dr. Kariadi RSU Dr. Cipto Mangunkusumo RSU Dr Hasan Sadikin RSU Dr. Soetomo RSUD Prov NTB RSUP Dr. Sarjito RSUP Sanglah Denpasar

NATIONAL REFERRAL HOSPITAL PROVINCE REFERRAL HOSPITAL

RSU Prof. Dr. WZ Johanes

RSU Jayapura

Referral Hospital

National

Province

Class A

12

2

Class B

2

15

Class C

--

3

Total

14

20

TOTAL REGIONAL REFERRAL HOSPITAL: 110 CLASS A

2 RS

CLASS B

58 RS

CLASS C

46 RS

CLASS D

4 RS

**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

1 kab, 1 RS, 1 Peserta



2 kota, 2 RS, 2 peserta

1 kab, 1 RS, 3 Peserta 4 kab, 4 RS, 4 Peserta

2 kab, 2 RS, 2 peserta3 kab, 3 4 kab, 5 RS, 6 peserta


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, 4 Peserta 1 kab, 1 RS, 1 Peserta





National Health Insurance (JKN) HEALTH FACILITIES THAT PROVIDE JKN

Provider

Amount

Primary Health Facilities (FKTP)

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

Increasing Prevention Improving Healthy Provision of Healthy Foods and Early Detection Lifestyle Behaviour and the Acceleration of Disease of Nutrition Improvement

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

Increasing Environment Quality

Increasing Healthy Life Education

• 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

Jalur Sepeda dan Pejalan kaki

Partisipasi perempuan untuk deteksi dini PTM, KIE Kampanye Gemar Olah Raga, Sarana Olah Raga Keamanan PJAS, Keamanan mutu pangan olahan

UKS, Sekolah Ramah Anak, Aktivitas Fisik

Sarana aktivitas fisik di pemukiman dan TTU, Ruang terbuka hijau

Meningkatkan pelayanan Promprev Cukai dan pajak rokok, minuman beralkohol

Konseling pra nikah, Poskestren Keamanan dan mutu pangan segar


MINIMUM SERVICE STANDARD STANDAR PELAYANAN MINIMAL (SPM)

LEGAL BASIS 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 standard

7

Elderly healthcare according to the 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

2

MINIMUM SERVICE STANDARD in DISTRICT AND PROVINCE

FAMILY APPROACH

Health Centre

Posyandu

POSBINDU PTM

Poskestren

3 HEALTHY COMMUNITY MOVEMENT


23

Indonesian Experiences In Resolving the Inequality of Health

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