POLICY AND STRATEGY OF NATIONAL HEALTH DEVELOPMENT

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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

4

(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

8

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

27

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  

42

"The biggest enemy of health  in the developing world is in the developing world is  poverty." Kofi Annan Kofi Annan

44

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POLICY AND STRATEGY OF NATIONAL HEALTH DEVELOPMENT

Ministry of Health of the Republic of Indonesia  POLICY AND STRATEGY OF NATIONAL HEALTH DEVELOPMENT: DEVELOPMENT INDONESIAN INDONESIA N PERSPECTIVE P...

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