Indonesian Experiences In Resolving the Inequality of Health

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Indonesian Experiences

In Resolving the Inequality

of Health

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MENTERI KESEHATAN REPUBLIK INDONESIA

Prof. Dr. dr. Nila F. Moeloek, Sp.M (K)

Bappenas_Indonesia Development Forum Jakarta, 10 Agustus 2017

Indonesian Experiences

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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

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The Public Health Development Index of 2013

0 .65 0 3 0 .60 8 5 0 .60 8 1 0 .57 5 7 0 .57 3 3 0 .56 8 2 0 .56 3 1 0 .55 3 5 0 .54 6 2 0 .54 5 8 0 .54 4 9 0 .54 2 7 0 .54 1 5 0 .54 1 1 0 .54 0 4 0 .53 6 3 0 .53 4 3 0 .53 2 8 0 .53 0 1 0 .5 2 4 4 0 .52 3 6 0 .51 6 1 0 .51 4 5 0 .51 0 8 0 .50 5 3 0 .50 5 1 0 .49 8 5 0 .49 6 6 0 .49 6 0 0 .49 3 7 0 .48 8 9 0 .48 5 7 0 .46 2 2 0 .43 8 7 0.0000 0.1000 0.2000 0.3000 0.4000 0.5000 0.6000 0.7000 BA LI DK I J AK AR TA K EP U LAU AN R IA U K ALIM A NT AN TIM U R DIY B A N TEN JAW A T ENG A H RIA U SU MAT ER A BA RA T JAW A B AR A T LA MP U N G SU LAWE SI U TAR A SU MAT ER A U TA RA JAW A T IM U R IND ONES IA BA NG K A B ELITU N G JAM BI BE NG K U LU SU MAT ER A S ELA TAN SU LA WE SI SE LA TAN NU SA TE N G G A RA BA RA T SU LAWE SI TEN G G A RA K ALIM A NT AN BAR AT G ORO N TA LO K ALIM A NT AN TEN G AH AC EH SU LAWE SI BAR AT P AP U A B AR AT MA LU KU U TAR A MA LU KU SU LAWE SI TEN G AH K ALIM A NT AN SE LAT AN NU SA TE N G G A RA TIMU R P AP U A I n e q u a l i t y

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PREVALENCE TREND OF NUTRITION STATUS

OF UNDER FIVE YEARS OLD

(2014-2016 NUTRITION STATUS MONITORING)

MENTERI KESEHATAN REPUBLIK INDONESIA 19,3 28,9 11,8 5,5 18,8 29 11,9 5,3 17,8 27,5 11,1 4,3 0 5 10 15 20 25 30 35

Gizi Kurang Pendek Kurus Gemuk

2014 2015 2016

Prevalence of under two years old stunting: 21.7%

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EPIDEMIOLOGICAL TRANSITION

Emerging and Re-emerging of Diseases

Increase in deaths due to non communicable diseases

Causes of Burden of Diseases, 1990 - 2015

Ceder a 7% Penya kit Tidak Menu lar … Penya kit Menu lar 56% Ceder a 8% Penya kit Tidak Menu lar … Penya kit Menu lar 43% Cedera 9% Penya kit Tidak Menu lar … Penya kit Menu lar 33% 1990 2000 2010 2015

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… Peny akit Men ular 30%

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0 10 20 30 40 50 60 70 80 90 Male Female

LIFE EXPECTANCY ACROSS PROVINCES, INDONESIA (2014)

68 ,9 y rs 7 2 ,6 yr s Lif e Expe ct an cy (Y rs ) Ja va Island N T T & N TB M alu ku & P ap u a MENTERI KESEHATAN REPUBLIK INDONESIA

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Components of Inequality

Inequality of: • Infrastructure • Workforce • Financial capacity • Governance capacity (Decentrali-zation) 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 • Respon-siveness • Financial protection MENTERI KESEHATAN REPUBLIK INDONESIA

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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 3. National

Health Insurance

Program • Benefits • Financing system: insurance–gotong royong mutual shared principle • Quality Control & Cost

Control

Membership KIS

D T P K

HEALTHY FAMILY

• Continuum of care

throughout the life cycle • Health risk – based

intervention

Pillar 2. Healthcare

Strengthening

Program

• Improving access, particularly at primary level

• Referral system optimalization • Quality improvement

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HOSPITAL

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.

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).

MENTERI KESEHATAN

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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.

Nusantara Sehat:

ensuring no one is left behind

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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

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

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

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Family participate in Family Planning (KB)

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)

1 Hypertension patients are treated

regularly

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

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**Kepmenkes HK.02.02/MENKES/390/2014 dan HK.02.02/MENKES/391/2014

Referral

Hospital National Province

Class A 12 2 Class B 2 15 Class C -- 3

Total 14 20

RSU H Adam Malik

RSU Dr. M.Jamil

RSU Dr. Mohammad Hoesin

RSU Dr. Cipto Mangunkusumo

RSU Dr Hasan Sadikin RSU Dr. Soetomo RSU Dr. Kariadi

RSUP Dr. Sarjito

RSUP Sanglah Denpasar RSU Dr Sudarso PTK

RSUD H A WahabSjahranie

RSU Prof.Dr. R.D Kandou

RSU Dr W Sudirohusodo

RSU Jayapura RSU Dr. Zainoel Abidin

RSUD Kep. Riau

RSUD Arifin Achmad RSUD Raden Mattaher

RSU Dr. Ir. Soekarno RSUD Dr. M. Yunus

RSU Dr. H. Abdul Moelok RSU Tangerang

RSUD Tarakan

RSUD Dr. Doris Sylvanus RSUD Ulin

RSU Sorong RSU Dr. Hasan Busor RSU Prof. Dr. Aloei

RSUD Mamuju RSU Kendari

RSU Dr. M Haulussy

RSU Prof. Dr. WZ Johanes RSUD Prov NTB

TOTAL REGIONAL REFERRAL HOSPITAL: 110

CLASS A 2 RS

CLASS B 58 RS

CLASS C 46 RS

CLASS D 4 RS

NATIONAL REFERRAL HOSPITAL PROVINCE REFERRAL HOSPITAL

NATIONAL, PROVINCE, AND REGIONAL REFERRAL HOSPITAL

MENTERI KESEHATAN

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1 kab, 1 RS, 2 peserta 2 kab, 2 RS, 2 peserta 4 kab, 5 RS, 6 peserta 2 kota, 2 RS, 2 peserta 2 kab, 2 RS, 2 peserta

SPECIALISED DOCTORS COMPULSORY SERVICES

(WKDS)

Perpres Nomor 4 Tahun 2017 Wajib Kerja Dokter Spesialis

3 kab, 3 RS, 3 peserta 1 kab, 1 RS, 1 peserta 3 kab, 3 RS, 3 peserta 1 kota, 1 RS, 1 peserta 3 kab, 3 RS, 3 peserta 4 kab, 4 RS, 5 peserta 4 kab, 4 RS, 4 peserta 2 kab, 2 RS, 2 peserta 2 kab, 2 RS, 2 peserta 2 kab, 2 RS, 2 Peserta 1 kab, 1 RS, 3 Peserta 1 kab, 1 RS, 1 Peserta 3 kab, 3 RS, 3 Peserta 4 kab, 4 RS, 4 Peserta 3 kab, 3 RS, 4 Peserta 1 kab, 1 RS, 1 Peserta 2 kab, 2 RS, 3 Peserta 7 kab, 8 RS, 8 Peserta 1 kab, 1 RS, 1 peserta MENTERI KESEHATAN REPUBLIK INDONESIA

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Provider Amount Primary Health Facilities (FKTP) 20.696 Hospital (FKRTL) 2.097 Apotik 2.131 Optik 972 Lab 333 Total 26.229

HEALTH FACILITIES THAT PROVIDE JKN

National Health Insurance

(JKN) MENTERI KESEHATAN

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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

Increasing Healthy Life Education Increasing Environment Quality Increasing Prevention

and Early Detection of Disease Provision of Healthy Foods

and the Acceleration of Nutrition Improvement Improving Healthy

Lifestyle Behaviour Improving

Physical Activities

Regulation of Ministry of Home Affair No. 32/2017 about Establishing 2018 Work Plan of

Local Government

• 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

Circular Letter of Ministry of Home Affair No. 440/2797/SJ

about

Supporting on Implementation of Presiden Instruction 1/2017

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COLLABORATION FOR

Community Action to Healthy Life (GERMAS)

Gerakan

Memasyarakatkan Makan Ikan

Promosi makan sayur dan buah dalam negeri

Jalur Sepeda dan Pejalan kaki

Sarana aktivitas fisik di pemukiman dan TTU, Ruang terbuka hijau

Meningkatkan pelayanan Promprev

Cukai dan pajak rokok, minuman beralkohol

Koord dan Fasilitasi Pemda

Partisipasi perempuan untuk deteksi dini PTM, KIE

Kampanye Gemar Olah Raga, Sarana Olah Raga Keamanan PJAS, Keamanan mutu pangan olahan

Konseling pra nikah, Poskestren UKS, Sekolah Ramah Anak, Aktivitas Fisik

Keamanan dan mutu pangan segar

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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.

LEGAL BASIS

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.

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Antenatal health services according to the standard

Maternal healthcare according to the standard

Neonatal healthcare according to the standard

Children under five healthcare according to the standard

Health care for students of primary education according to the standard

Productive adults healthcare according to the standard

1 Elderly healthcare according to the

standard

Hypertension disease health services according to the standard

Diabetes disease health services according to the standard

Mental disorders health services according to the standard

Health services for people suspected of TB according to the standard

Health services for people suspected of HIV according to the standard

6 7 8 9 10 11 12 3 4 5 2

MINIMUM SERVICE STANDARD ON HEALTH IN THE PROVINCE OF DISTRICT/CITY

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FAMILY APPROACH

2

Posyandu POSBINDU _PTM Poskestren

Health Centre 3 HEALTHY COMMUNITY MOVEMENT MINIMUM SERVICE STANDARD in DISTRICT AND PROVINCE 1

HEALTHY INDONESIA THROUGH

FAMILY–BASED APPROACH

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23 MENTERI KESEHATAN