Oleh:

Siti Masfiah, SKM, M.Kes, M.A

Kesehatan Masyarakat – UNSOED

SISTEM PELAYAN KESEHATAN DI

INDONESIA

OUTLINE

• Definisi Pelayanan Kesehatan

• Jenis Pelayanan Kesehatan

• Sistem Pelayanan Kesehatan di Indonesia

• Stratifikasi Pelayanan Kesehatan

• Masalah Pelayanan Kesehatan di Indonesia

DEFINISI PELAYAN KESEHATAN

• Prof. Dr. Soekidjo Notoatmojo:

Sub sistem Yankes tujuan utamanya adalah pelayanan preventif dan

promotif dengan sasaran masyarakat.

• Levey & Loomba (1973):

Upaya yang diselenggarakan sendiri/bersama dalam suatu organisasi untuk

memelihara dan meningkatkan kesehatan, mencegah dan menyembuhkan

penyakit serta memulihkan kesehatan perorangan, keluarga, kelompok atau

masyarakat.

Acuan Depkes RI (2009)

JENIS PELAYANAN KESEHATAN

• Pelayanan Kedokteran:

• Medical Services

• Solo prectice/bersama-sama

• Tujuan: menyembuhkan penyakit, memulihkan kesehatan

• Sasaran: perorangan dan keluarga

• Pelayanan kesehatan Masyarakat

• Public health services

• Pengorganisasian secara bersama-sama

• Tujuan: memelihara dan meningkatkan kesehatan, mencegah penyakit

• Sasaran: kelompok, masyarakat

Onset of

Disease

Early

Detection

Onset of Signs/

Symptoms

Exposure

Primary

Prevention

A B C

Secondary

Prevention Preclinical

Tertiary

Prevention Clinical

D1. Cure

D2. Control

D3. Disability

D4. Death

LEVELS OF PREVENTION

Copyright 2008, The Johns Hopkins University and Henry Taylor

DEATH ONSET HEALTHY

Do not SICK APPROACH : PREVENTION – PROMOTION TARGET : UN-SICK PEOPLE/COMMUNITY GOAL : HEALTHY PEOPLE IN A HEALTHY ENVIRONMENT THROUGH : -HEALTHY PUBLIC POLICY -BEHAVIOR CHANGE -Preventive & Promotive based HEALTH SERVICES MEASUREMENT : HEALTH INDICATORS -HDI ????? -QLI ??????

SICK/ILL APPROACH : CURATIVE –

MEDICINE/DOCTOR TARGET : SICK PERSON

INDIVIDUAL GOAL : CURED PERSON THROUGH : -TREATMENT/DRUG

-TECHNOLOGY BASED

MEDICAL SERVICES MEASUREMENT : INDICATORS

-MORTALITY

-MORBIDITY

MEDICINE AND PUBLIC HEALTH MEDICAL VS PUBLIC HEALTH SERIVCES

SICK/ILL

ONSET

MEDICINE AND PUBLIC HEALTH

Do not SICK HEALTHY

HEALTHY

HEALTHY

By DECREASING MORTALITY AND MORBIDITY MEANS INCREASING HEALTH ???

HEALTHY DEATH DEATH DEATH DEATH

MEDICAL VS PUBLIC HEALTH SERIVCES

SICK/ILL Do not SICK

DEATH ONSET HEALTHY

MEDICINE AND PUBLIC HEALTH

•

•

•

•

•

•

•

•

Patient Practitioner Chief complaint History & Physical Laboratory tests Clinical Diagnosis Treatment plan Home monitoring and

follow-up testing

• Follow-up visit

•

•

•

•

•

•

•

•

A defined population A health system Community perceptions Professional opinions Epidemiologic analysis Community Diagnosis Interventions Monitoring efforts

• Modification of all the

above steps.

MEDICAL VS PUBLIC HEALTH SERIVCES

9

• Sistem : Tatanan, komponen, interaksi,

interdependensi, tujuan

Input Output Proses

Feed back

Sistem Pelayanan Kesehatan

SYSTEM

Systems have structure, defined by parts and their

composition;

Systems have behavior, which involves inputs,

processing and outputs of material, energy or

information;

Systems have interconnectivity: the various parts of

a system have functional as well as structural

relationships between each other.

System(s) have by itself function(s) or group of

Functions

CARDIOVASCULAR SYSTEM

(Government)

Services PROVIDER PROVIDER PROVIDER

CLIENTS CLIENTS CLIENTS

PUBLIC HEALTH SYSTEM REGULATOR

HEALTH OF COMMUNITY

PUBLIC HEALTH SYSTEM

Public Health Structure Four governmental levels :

Local/District Health Office/Departments

State / Province Health Office/Agency •

Bureau for Public Health,

Health Care Authority

Federal / National Government • Ministry of Health, CDC, EPA, ?

International Health Agencies • WHO, UNICEF, etc

PUBLIC HEALTH STRUCTURES

HEALTH DEPARTMENT (Depkes)

Ministry of Health

Central Level

Provinced Health Office (Dinkes)

Provincial level

District Level Health Office

District Level

Sub district Level Health Centre

Village Level

MINISTRY OF HEALTH FROM CENTRAL TO PERIPHERAL LEVEL

Sub Health Centre (Pustu)

Village Midwife Clinic (Polindes) Integrated Health Post(Posyandu)

REFERRAL SYSTEM

Health Department/Provinced

Health Office (Depkes/DKP)

District Level Health Office

Primary Health Care

Village Midwife Clinic &

Integrated Health Post

Central or Province Hospital

District/city Hospital, Clinic,

Private Practitioner

Primary Health Care, Midwife,

General practitioner

Village Midwife Clinic,

Integrated Health Post &

Village Health Post

Health Centre Unit Public Health Unit

Health

Foundation

3rd level

Health Foundation

2nd level

Health Foundation

Ist level

Community

HOUSEHOLD

Maximal Type of Regional Health Office Structure

Minimal Type of Regional Health Office Structure

Province Health

Office

Regional Health

office Primary

Health Care

Posyandu

(Integrated Service

Post)

PDAM Social Office

Dispenda

BKKBN

Education Office

Public Works

Religion Office

Regional

Legislative council

BAPPEDA

Tourism Agency

POM Institution

Industry and Trade

Office

Department of Hygiene

And funeral

Walikota/major central statistics

agency

Traditional

medicine Private Hospital

Non government

Organization

Private

doctor/midwife

Regional

AIDS control

RSUD Regional Health

Laboratory

Relationship Between Regional Health Office and other Department

TYPES OF HEALTH WORKER

(PP NO 32 TAHUN 1996 )

1) Health personnel consist of: a. medical personnel; b. nursing personnel; c. pharmacy personnel; d. community health workers; e. energy malnutrition; f. Therapy of physical strength; g. Technicians medical personnel.

2) Labor includes medical doctors and dentists

3) Labor nursing include nurses and midwives.

4) Energy pharmacy involves pharmacists, pharmaceutical analyst and assistant pharmacist.

5) Power epidemiology public health include health, medical entomologist, microbiologist health, health extension workers, health administrators and sanitarian.

6) Energy includes nutritionists and nutrition dietitian.

7) Power of therapy include physical therapist, speech therapist and Occupational Therapy .

8) Labor radiographer technician include medical, radioteraphist , dental technician, technician elektromedist, health analyst, refractionis optisien, otorik prosthetic, technicians transfusions and medical recorder.

HEALTH FINANCING

There are generally five primary methods of funding

health care systems:

direct or out- of- pocket payments,

general taxation to the state, county or municipality,

social health insurance,

voluntary or private health insurance, and

donations or community health insurance.

PUBLIC HEALTH FINANCING

TERIMAKASIH