Indonesian Experiences In Resolving the Inequality of Health
MENTERI KESEHATAN
REPUBLIK INDONESIA
Prof. Dr. dr. Nila F. Moeloek, Sp.M (K)
Bappenas_Indonesia Development Forum
Jakarta, 10 Agustus 2017
MENTERI KESEHATAN
REPUBLIK INDONESIA
Indonesian Experiences In Resolving the Inequality of Health
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
The Public Health Development Index of 2013 0
.65
03
0.6
08
5
0.6
08
1
0.5
75
7
0.5
73
3
0.5
68
2
0.5
63
1
0.5
53
5
0.5
46
2
0.5
45
8
0.5
44
9
0.5
42
7
0.5
41
5
0.5
41
1
0.5
40
4
0.5
36
3
0.5
34
3
0.5
32
8
0.5
30
1
0.5
24
4
0.5
23
6
0.5
16
1
0.5
14
5
0.5
10
8
0.5
05
3
0.5
05
1
0.4
98
5
0.4
96
6
0.4
96
0
0.4
93
7
0.4
88
9
0.4
85
7
0.4
62
2
0.4
38
7
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0.1000
0.2000
0.3000
0.4000
0.5000
0.6000
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Inequality
Sumber Data :IPKM 2013, Kemenkes RI
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%
EPIDEMIOLOGICAL TRANSITION
Emerging and Re-emerging of Diseases
Increase in deaths due to non communicable diseases
Causes of Burden of Diseases, 1990 - 2015
Cedera
7%
Penyakit
Tidak Menular …
Penyakit
Menular
56%
Cedera
8%
Penyakit
Tidak Menular …
Penyakit
Menular
43%
Cedera 9%
Penyakit
Tidak Menular …
Penyakit
Menular
33%
1990 2000 2010 2015
Measurement of disease burden using Disability-adjusted Life Years (DALYs)
loss of lives due to morbidity and premature deaths
Cedera
13%
Penyakit
Tidak Menula…
Penyakit Menular 30%
0
10
20
30
40
50
60
70
80
90
Male
Female
LIFE EXPECTANCY ACROSS PROVINCES, INDONESIA (2014)
68
,9 y
rs
72
,6 y
rs
Life
Exp
ecta
ncy
(Yr
s)
Java
Isla
nd
NT
T &
NTB
Mal
uku
& P
apu
a
MENTERI KESEHATAN
REPUBLIK INDONESIA
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
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
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
REPUBLIK INDONESIA
ENHANCING ACCESS OF HEALTH SERVICES
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 MENTERI KESEHATAN
REPUBLIK INDONESIA
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
DEFINITION OF FAMILY APPROACH
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
12 INDICATORS OF HEALTHY FAMILY
**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
REPUBLIK INDONESIA
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
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
REPUBLIK INDONESIA
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
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
MENTERI KESEHATAN
REPUBLIK INDONESIA
MINIMUM SERVICE STANDARD
STANDAR PELAYANAN MINIMAL (SPM) MENTERI KESEHATAN
REPUBLIK INDONESIA
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.
MENTERI KESEHATAN
REPUBLIK INDONESIA
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
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
23
MENTERI KESEHATAN
REPUBLIK INDONESIA