REFORMASI KURIKULUM PENDIDIKAN KESMAS; sebuah langkah awal meningkatkan derajat kesehatan masyarakat
Prof. Dr. Veni Hadju Fakultas Kesehatan Masyarakat Universitas Hasanuddin IPHSS, Depok, 14 Juli, 2011.
Sistematika Penyajian Pendahuluan Masalah Kesehatan di Indonesia Kompetensi dan Tantangan Tenaga Kesehatan Reformasi kurikulum Penutup
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ADANYA GAP DALAM SDH (TINGKAT PENDIDIKAN, PENDAPATAN, GENDER, KESULITAN MEDAN GEOGRAFIS, TERSEDIANYA AIR BERSIH, KEBERSIHAN & KESEHATAN LINGKUNGAN) DAN PELAKSANAAN SISTEM KESEHATAN
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s u lu t
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R ia u
75.0
b ali
b ab e l k a ltim or
k e pri
d ki
100.0
Poverty by Province
Percent of population in quintile 1 and 2 Susenas 2007 DHS-1
DHS-2
Non DHS
50.0
National Average
25.0
DISPARITAS STATUS KESEHATAN DAN GIZI MENURUT PROPINSI, 2007 Indikator Rata-rata Terendah Tertinggi Nasional AKB
34
AKI
228
TFR
2,6
Gizi Kurang
18,4
Sumber data
DIY (19); NTB (72); SDKI Jateng(28) Sulbar (74) 2007
SDKI 2007 DIY (1,8)
NTT (4,2)
SDKI 2007
DIY (10,9)
NTT (33,6)
Riskesda s 2007 6
Pola penyebab kematian pada semua Umur No 1 2 3 4 5 6 7 8 9 10
Penyebab Kematian (n=4014) Stroke Tuberculosis Hypertensive diseases Cedera Perinatal condition Diabetes Mellitus Neoplasm malignant Diseases of the liver Ischaemic heart diseases Chronic lower respiratory diseases
% 15.4 7.5 6.8 6.5 6.0 5.7 5.7 5.1 5.1 5.1
Proporsi penyebab kematian kelompok umur 0-6 hari dan 7-28 hari No
0-6 hari (n=142)
%
7-28 hari (n=39)
%
1
Respiratory disorders
35.9 Sepsis neonatorum
20.5
2
Premature
32.4 Congenital malformations
18.1
3
Sepsis of newborn
12.0 Pneumonia
15.4
4
Hypothermia of newborn
6.3 Respiratory Distress
12.8
Syndrome 5
Haemorrhagic disorders and
5.6 Premature
12.8
neonatal jaundice 6
Postmature
2.8 Neonatal jaundice
2.6
7
Congenital malformation
1.4 Birth trauma
2.6
8
Tetanus
2.6
9
Nutritional deficiency
2.6
Proporsi penyebab kematian pada umur 29 hari-4 tahun No
29 hari-11 bulan (n=173)
%
1-4 tahun (n=103)
%
1
Diarrhoea
31.4 Diarrhoea
25.2
2
Pneumonia
23.8 Pneumonia
15.5
3
Meningitis/encephalitis
9.3 Symptoms and signs, NEC
4
Diseases of the digestive
6.4 Meningitis/encephalitis
8.8
5.8 Dengue haemorrhagic fever
6.8
10.7
system 5
Congenital malformation of the heart and hydrocephalus
6
Sepsis
4.1 Measles
5.8
7
Tetanus
2.9 Drowning
4.9
8
Malnutrition
2.3 Tuberculosis
3.9
9
Tuberculosis
1.2 Malaria
2.9
Proporsi penyebab kematian pada umur 5 tahun ke atas menurut tipe daerah No
Perkotaan (n=1515)
%
Perdesaan (n=1966)
1 2 3 4
Stroke Diabetes mellitus Hypertensive diseases Tuberculosis
5
Ischaemic heart diseases
Stroke Tuberculosis Hypertensive diseases Chronic lower respiratory diseases 6.5 Malignant neoplasm
6 7
Malignant neoplasm Diseases of the liver
5.8 Diseases of the liver 5.5 Ischaemic heart disease
6.0 5.6
8
Symptoms and signs, NEC Other heart diseases Chronic lower respiratory
5.3 Symptoms and signs, NEC
5.4
5.1 Other heart diseases 4.7 Diabetes mellitus
4.7 4.4
9 10
19.4 9.7 7.5 7.3
% 16.1 9.1 8.3 7.1 6.6
Proporsi penyebab kematian pada umur 5 tahun ke atas berdasakan jenis kelamin No 1 2 3 4 5 6 7 8 9
Laki-Laki (n=1960) % Perempuan (n=1522) % Stroke 17.4 Stroke 17.7 Tuberculosis 9.5 Hypertensive diseases 9.5 Hypertensive diseases 6.8 Carcinoma malignant 8.7 Ischaemic heart diseases 6.8 Diabetes mellitus 8.0 Chronic lower respiratory 6.7 Tuberculosis 6.9 diseases Diseases of the liver 6.6 Chronic lower 5.7 respiratory diseases Diabetes mellitus 5.6 Ischaemic heart 5.1 diseases Other heart diseases 4.9 Others heart diseases 4.9 Carcinoma malignant 4.8 Diseases of the liver 4.7
Peringkat Penyebab Kematian PM Dan PTM Pada Semua Umur No
Penyakit menular (n=1080)
%
Penyakit tidak menular (n=2285)
%
1
Tuberculosis
27.8
Stroke
26.9
2
Diseases of the liver
19.1
Hypertensive diseases
12.3
3
Pneumonia
14.4
Diabetes mellitus
10.2
4
Diarrhoea
13.2
Carcinoma malignant
10.2
5
Typhoid
6.0
Ischaemic heart diseases
9.3
6
Malaria
4.0
Chronic lower respiratory diseases
9.2
7
Meningitis/Encefalitis
3.0
Other heart diseases
7.5
8
Dengue haemorrhagic fever
2.1
Gastric and duodenal ulcer
3.4
9
Tetanus
1.9
Congenital malformation
1.0
Septicaemia
1.2
Malnutrition
0.4
10
Hipertensi: Prevalensi & Cakupan Tidak 68,3 %
Tidak 76,1% Hipertensi 31.7%
Terdiagnosis/Minum Obat 23,9% Cakupan: Proporsi kasus terdiagnosis atau minum obat
Hipertensi:Ekonomi & Cakupan Nakes 35,0%
30,5%
30,9%
31,6%
7,0%
7,4%
31,9%
33,0%
30,0% 25,0% 20,0% 15,0% 10,0%
6,7%
8,0%
8,7%
5,0% 0,0% Kuintil1
Kuintil2
Prevalensi
Kuintil3
Kuintil4
Didiagnosa Nakes
Kuintil5
Hipertensi: Prevalensi & Umur % 80,0
Laki-laki
Perempuan
Total
70,0 60,0 50,0 40,0
30,0 20,0 10,0 0,0 15-17 tahun
18-24 tahun
25-34 tahun
35-44 tahun
45-54 tahun
55-64 tahun
65-74 75+ tahun tahun
Prevalensi DIABETES dan TGT 10,2%
Sudah Terdiagnos
(1.5%)
5,7% 84,1%
Belum terdiagnos
(4.2%)
Tdk DM
TGT
DM
TGT: Provinsi
DM & TGT: Umur persen 25,0
TGT
TDM
19,4
20,0 15,0 10,0
5,3
5,0 65.1-70
55.1-60
45.1-50
35.1-40
25.1-30
15-20
umur
0,0
DM & TGT: IMT TGT DM 25 20
14,5
15
10 5
10,7
8,1 3,2
6,4
8,1
0
18.5 - < 23
23 - < 25
25-40 P < 0,0001
ANALISIS AKAR MASALAH 1. Tingkat pendidikan dan pengetahuan masyarakat 2. Kondisi lingkungan dan letak geografis 3. Kualitas petugas dan kerjasama antar SDM Kesehatan 4. Kebijakan dan perhatian pemerintah 5. Partisipasi dan kepedulian masyarakat 6. Kerjasama dan keterikatan antar sektor
KOMPETENSI DAN TANTANGAN TENAGA KESEHATAN
What is a competency? “A complex set of measurable behaviors made up of knowledge, skills and attitudes that can be shown to predict and measure effective performance.”
Skills
Knowledge
Experience
Source: Nelson JC, The Public Health Competency Handbook: Optimizing Individual & Organizational Performance for the Public’s Health, Atlanta, GA: Centre for Public Health Practice of the Rollins School of Public Health, 2002
Attitudes Values
24
Importance of competency: Competency Skills
Knowledge
Experience
Attitudes Values
Performance Behavior Uses advanced problem-solving skills to analyze performance problems, and take timely corrective actions to address problems.
Outcome Performance problems are addressed successfully and in a timely manner, ensuring achievement of objectives.
Competencies predict behavioral actions which, in turn, predict job performance outcome. 25
Tingkat kompetensi yang dicapai KREATIF MENGEVALUASI
MENGANALISA MENSINTESA MENGAPLIKASIKAN
MEMAHAMI MENGINGAT
EXECUTIVE SUMMARY
HEALTH PROFESSIONAL EDUCATION QUALITY PROJECT
EQUILIBRIA ASSOCIATED with HEALTH FAMILY •Spouse •Children •Parent •Etc
Leisure activity
THE INDIVIDUAL • Genes •Learning •Handicaps •Personality •Expectation •Self-image
SOCIAL FACTORS •Neighborhood •Housing •Poverty •Culture •Education
WORK •Fatigue •Boredom hazards •Unemployment •Retirement
Environmental Hazards/disease •Infection •Injure •Cancer •Degeneration •Smoking •Overeating •Alcoholism
Marital Status, Marital Quality, and Atherosclerotic Burden in Postmenopausal Women Psychosomatic Medicine 65:952–962 (2003) LINDA C. GALLO, PHD, WENDY M. TROXEL, MS, LEWIS H. KULLER, MD, DRPH, KIM SUTTONTYRRELL, DRPH, DANIEL EDMUNDOWICZ, MD, AND KAREN A. MATTHEWS, PHD From SDSU/UCSD Joint Doctoral Program in Clinical Psychology, San Diego State University (L.C.G.), the Department of Psychology (W.M.T.), and the Graduate School of Public Health (L.H.K., K.S.T), University of Pittsburgh, and the Departments of Psychiatry (K.A.M.) and Medicine (D.E.), University of Pittsburgh School of Medicine,
Hasil Penelitan
A: Average IMT (in mm) according to marital status/quality grouping at the first scan (N 372). B: Average change in IMT (in mm) across 3 years (N 203) according to marital status/quality grouping.
– Beratnya 1:200 miliar gram – Lebarnya 1:500.000 mm – Panjangnya bisa mencapai 3 m Mengandung 3 miliar informasi (kode genetik) Begitu kecilnya DNA itu, jika seluruh penduduk bumi dikumpulkan DNA nya hanya sebesar 1 butir beras DNA yang mikroskopik menyimpan informasi genetik yang luar biasa banyaknya.
BERPIKIR POSITIF MEMBANGUNKAN GEN-GEN BERMANFAAT Berpikir positif
Berpikir negatif
Gen positif aktif
Gen negatif aktif
Mengurangi proses entropi
Peningkatan proses entropi
PEMIKIRAN GENETIK
• Berpikir (+) > sulit pada keadaan musibah
REFORMASI KURIKULUM
European Public Health Core Competencies:
HEALTH PROMOTION AND PREVENTION
METHODS IN PUBLIC HEALTH
SOCIAL ENVIRONMENT AND HEALTH
CROSSDISCIPLINARY THEMES
HEALTH POLICY, MANAG EMENT AND ECONOMICS
PHYSICAL, CHE MICAL AND BIOLOGICAL ENVIRONMENT 35
The Public Health Net
International Standard of Excellence
Morality Ethics Knowledge Intellectual skills Relationship between responsibility and personnel Analysis Communication Information technology
Prince Mahidol Philosophy True success is not in the learning but in its application to the benefit of mankind
PENUTUP Masalah kesehatan di Indonesia masih begitu besar dengan berbagai hambatan dan keterbatasannya. Diperlukan Reformasi Kurikulum yang akan menghasilkan Nakes Kesmas dengan kompetensi yang baik dan kinerja yang optimal. Derajat kesehatan masyarakat dapat ditingkatkan melalui kerjasama lintas disiplin dan komprehensif.
