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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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