Idea Transcript
Ministry of Health of the Republic of Indonesia
POLICY AND STRATEGY OF NATIONAL HEALTH DEVELOPMENT: DEVELOPMENT INDONESIAN INDONESIA N PERSPECTIVE Prof. Nila Farid Moeloek 47th Asia Pacific Academic Consortium for Public Health (APACPH) Conference Bandung 21 October 2015 Bandung , 21 October 2015 1
Outline • Introduction • MDGs Progress of Asia Pacific Countries • H Health lth Development D l t Strategy: St t Indonesian’s Perspective • Role of Academia in Health Development
Introduction
Economic growth
Infants: Breastfeed Imunisation
Human p Development
Children & Youth: Children Character under 5: Building Nutritiion Sexual & Reproductive Character health Building
Youth & Young adults:
Senior Citizens: Adults: Social Productivity Security
Education Innovation Creativity Job creation
UNIVERSAL HEALTH COVERAGE UNIVERSAL HEALTH COVERAGE Food Food ( sea, land)
Energy gy Water Housing and g (sanitation and healthy (fossil, UNIVERSAL HEALTH COVERAGE irigation ) environment renewable))
Access
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(Health & Education)
Maternal Deaths
Unsafe Ab ti Abortion
Unmet need of FP Contraception
Deliveries assisted by non trained health personnel
Causes beyond health:
Infrastructure Energy, Transportation Transportation,
Safe drinking Water,
Indirect causes: Anemia, worm infestation and under nutrition under-nutrition
Culture.
Health at the heart off sustainable t i bl d development l t • Better health is central to human well ‐being. • It It makes makes an important contribution to contribution to economic
Three Dimensions off S Sustainable t i bl Development D l t ECONOMY Jobs Assets Investment Wealth Creation
ENVIRONMENT Climate Cli Water Natural Resources Biodiversity
Sustainable
Economy
Social
E i Equity
Sustainable Development Healthy
Environment
Health & Safety
Skilled Workforce pp g Supporting Communities
SOCIETY
Investing in health is not only the right thing to do, but the smart thing to do
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Investing in Nutrition for Human Development
• The Copenhagen Consensus 2012: • World World economists identified that economists identified that “Investing in Community Nutrition” is the most smart way to address the top 10 world’s challenges
• Investing in nutrition can help to cut off poverty cycle and increase GDP between 2 – 3% per year. p y • For every dollar invested in nutrition will be returned about 30 dollar in improvement of health, education, and economic productivity •
Source: SUN Movement Secretariate, 2013 9
Why y Invest in Health? Health used to b viewed as an end product of the growth process: h
New thi N thinking ki iis that th t health enhances economic growth
Health
Improves political stability, investment climate, and productivity Reduces medical spending R d Reduces ffertility tilit Increases labor supply and female labor force participation c eases saving sav g Increases Increase in the years of healthy life expectancy
Economic Growth
Children Development Paradigm (1 000 days (1.000 d off first fi t lif life)) 270 days Pre conception
730 days afterbirth
Knowledge
Knowledge
• Family Planning • Birth problems • Access to health and facility • Nutrition in fetal • Health Insurance
• Family Planning • Breast feeding • Child health • Immunization • Child Psychomotoric • Healthy and clean env’t
Negative behavior
SUSTAINABLE IMPACT OF ECONOMIC DEVELOPMENT O
‘Cost of Value’ ‘Intangible Intangible Cost Cost’
WHY MDGs??? 1. Eradicate 1 Eradicate extreme poverty and hunger and hunger
4. Reduce child
mortality mortality
7. Ensure environmental environmental sustainability
2. Achieve universal primary education
5.Improve maternal health
8. Global p partnership p for development
3 Promote gender 3. P d equality & empower women p
6. Combat HIV/AIDS, Malaria, and other disease d th di
POST 2015 ‘poverty’
Fundamental Aspects of SDGs Fundamental Aspects of SDGs 5 Fundamentals of Sustainable Development f S t i bl D l t
People
Peace
Planet FUNDAMENTALS
Partnership
Prosperity
Translated into 17 goals as SDGs Translated into 17 goals as SDGs
MDG Progress in Asia Pacific Region MDG Progress in Asia Pacific Region
Asia‐Pacific Economies Economies on‐ and off‐track f MDG for MDGs
Source: Asia Pacific MDGs Reports 2014/2015
Asia-Pacific Country groups on and off track for MDGs on-
Source: Asia Pacific MDGs Reports 2014/2015
Common challenges among C h ll Asia Pacific countries
Asia‐Pacific Country Progress of reducing the incidence of Maternal Mortality of reducing the incidence of Maternal Mortality
Source: Asia Pacific MDGs Reports 2014/2015
Asia and Pacific share of the developing world’s deprived people
Source: Asia Pacific MDGs Reports 2014/2015
CHALLENGES !!! Agenda of 2015 MDGs
+
Agenda of 2030 for SDGs
Health Development Strategy: H lth D l t St t Indonesia s Perspective Indonesia’s Perspective
CHALLENGES IN HEALTH DEVELOPMENT
• ↙ number of death Attainment of number of poor MDGs and • ↙ number of poor population SDGs • ↙ number of morbidity
Implementation • ↗ access to services of National • Systematic Services Health Insurance • Efficient & Effective Services
Healthy Indonesia
STRONG RELEVANCE OF SDGs and INDONESIAN LEADERS VISION Goal 17, 16, 10, 3
All goals
Goal 1-11 1 11 All goals Goal 4, 2, 3, 6
Goal 1-10 Goal 1 1,2,3,4,5,8,9,12 2 3 4 5 8 9 12 Goal 3,4,11 Goal 17, 16, 10, 5
Population Pyramid of Indonesia 2012 Male
BPS, Susenas 2012
1971
Female
DEMOGRAPHIC BONUS
2030
Bonus demografi dan jendela peluang
Majority: Productive age
90
Demographic Bonus Bonus Demografi
80 70 60
Muda
40 30 20
Lansia
10 0
19950 19955 19960 19965 19970 19975 19980 19985 19990 19995 20000 20005 20010 20015 20020 20025 20030 20035 20040 20045 20050
Persentasee
50
Window of J d l Jendela opportunity peluang
Year Tahun
determining Indonesia’ss Indonesia opportunity to be to be developed country
INTERLINKAGES ACROSS SECTORS FOR HEALTH SECTOR DEVELOPMENT FOR HEALTH SECTOR DEVELOPMENT
Burden of Diseases in Indonesia 1990
Injuries
2010
2000 Infectious Diseases
Injuries
7%
Infectious Diseases
Injuries
Infectious Diseases
9%
8%
33%
37%
43%
56% 49%
NCDs
Source: IHME 2010
NCDs
58%
NCDs
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PROGRAM OF HEALTHY INDONESIA 1
2
3
Healthy Paradigm
Strengthening of Health Care of Health Care
JJ K N
Program: • Mainstreaming health in national development • Promotion ‐ Prevention as a main pillar of health efforts. • Community Empowerment
Program: • Improving access, esp. Improving access esp Primary Care • Strengthening Referral System • Improving Quality of Services Adoption of continuum p of care approach Health risk based intervention
Program: • Benefit • Financing System: insurance – principle of “gotong gotong royong royong” • Quality Assurance and Cost Containment T • Target: • PBI & Non‐PBI • ID Card KIS
DIRECTION OF HEALTH DEVELOPMENT RPJMN I 2005-2009
RPJMN II 2010-2014
RPJMN III 2015-2019
RPJMN IV 2020-2024
U i l Universal Coverage
Curative
Supporting efforts
Healthy Community Community, Self Reliance and equal
EQUITABLE ACCESS
QUALITY IMPROVEMENT
STRENGTHENING HEALTH CARE HEALTH CARE SERVICES
STRENGTHENING REFFERAL SYSTEM
STAKEHOLDERS ENGAGEMENT
EMPOWERMENT OF SUB NATIONAL LEVEL 30
Primary Healthcare Services Possible Intervention Models for Indonesia POSSIBLE PHC MODELS
Remote, Bord ers, Islands
Model 1 Model 1
Papua and West Papua
Urban/Cities
Rural locations in not‐so remote areas
Model 2
Model 3
Model 4
STRENGTHENING HEALTH CARE IN REMOTE AND BORDERS ISLANDS “Nusantara Nusantara Sehat Sehat” •Team‐based interventions in p primary health care facilities y •48 Districts, 120 health cent
Remote and b d borders islands
Year
Prov.
District Puskesmas
HRH
2015
16
44
120
960
2016
17
54
130
1.040
2017
18
59
140
1.120
2018
19
64
150
1 200 1.200
2019
20
69
160
1.28032
National Referral Hospital & Provincial Referral Hospitals P i i lR f l H it l
33
INTEGRATION FROM SOME HEALTH INSURANCE SCHEMES TO JKN (1JANUARI 2014)
Askes (PNS, PNS pension) Jamsostek (Formal sector worker) Jamkesmas (poor population) Jamkesda TNI/Polri
16,3 Million
8,1 MIllion
86,4 MIllion
4,2 Million
4,5 Million
Pool single, single payer: National Health Insurance (JKN), managed by BPJS Kesehatan
All Indonesian have the right to have JKN in order to achieve Universal Health Coverage in 2019. JKN is a big leap to budget pooling
EXPANSION OF MEMBERS IN 2015 & MEMBERSHIP PROJECTION 2014 2014-2019 2019 Membership
Members
PROJECTED NUMBER OF POPULATION & Proyeksi Jumlah Penduduk dan Target Peserta JKN 2014‐2019 TARGET OF JKN MEMBER 2014 2019 TARGET OF JKN MEMBER 2014‐2019
Supply Side Readiness
Tahun %‐peserta 2014 51% 2015 60% 2016 70% 2017 80% 2018 90% 2019 95%
2014 2015 2016 2017 2018 2019 Penduduk (Jiwa) 252,164,800 255,461,700 258,705,000 261,890,900 265,015,300 268,074,600 Peserta JKN(Jiwa) 128,000,000 153,277,020 181,093,500 209,512,720 238,513,770 254,670,870 35
CONTINUUM OF CARE
IBU HAMIL, BERSALIN, DAN NIFAS • Kes. reproduksi • Konseling gizi HIV/AIDS dan NAPZA • Tablet Fe • Konseling Kespro • PKRT
P4K Buku KIA ANC terpadu Kelas Ibu APN RTK Kemitraan Bidan Dukun • KB PP • PONED/ PONEK • • • • • • •
• ASI eksklusif • Imunisasi dasar lengkap • Pemberian makan • Timbang Ti b • Vit A • MTBS
SDIDTK Imunisasi Gizi Kolaborasi PAUD BKB PAUD, BKB, dan Posyandu • Deteksi dan Simulasi kognitif • • • •
• UKS • Imunisasi anak anak sekolah • Penjaringa n anak usia sekolah • PMT
• Kesehatan reproduksi • Konseling gizi HIV/AIDS HIV/AIDS dan NAPZA • Tablet Fe • Konseling Kespro p • PKRT
• • • • •
• Posyandu Lansia KB bagi PUS • Peningkatan Kualitas Hidup PKRT Mandiri Deteksi PM • Perlambatan dan PTM Proses Kesehatan OR Degeneratif dan kerja i l Brain Healty Life Style
“Family Family Approach” Approach Puskesmas Posyandu
Family
Family
Posbindu PTM
Family
Poskestren
Family
Family
PRIORITY a. Improving Maternal and Child Health ( to reduce MMR and IMR)) b. Improving nutrition Status c. Prevention and Control of CDC, esp. , p HIV// AIDS, Tuberkulosis & Malaria) d. Prevention and Control of NCDs (Hypertension, Diabetes Mellitus, Obesity & Cancer)) 38
The Role of Academia The Role of Academia
SYNERGY AND HARMONIZATION SYNERGY AND HARMONIZATION
Government
Shared Social Value Of Communities
Private Sector
Civil Society and academia d i
R l off A Role Academia d i • To provide inputs for the development of national policy p y on health development p • To conduct surveys and researches for policy development • To improve the quality of HRH, which have more public bli h health lth orientation. i t ti • To strengthen networking among the education institutions and governments
What next ? Continue to keep the momentum of MDGs until the final stage
“no one left behind”
MDGs
2015
Pasca‐2015
Sustainable Development
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"The biggest enemy of health in the developing world is in the developing world is poverty." Kofi Annan Kofi Annan
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