global health and physician responsibilty
TRANSCRIPT
Global Health and Physician ResponsibilityVIERA WARDHANI
Meet your new partner Viera Wardhani
Department of Public Health, FKUB
Postgraduate Program in Hospital Management
Why?
We all live in the same word
We are all member of a single humanity inside our heart we all speak the same, we all love our children and our parents, we all live in the same world…….(Mac Forne Malne)
We all live in the same world
If civilization is to survive we must cultivate the science of human relationship the ability of all people all kind to live together in the same world at peace (Franklin D Rosevelt)
Global Health Challenges
Tujuan Pembelajaran
Menjelaskan isi MDG dan Post MDG yang terkait dengan bidang kesehatan
Menyebutkan indikator dan target pencapaian MDG dan Post MDG yang terkait dengan bidang kesehatan
Menjelaskan pencapaian indikator dan target pencapaian MDG bidang kesehatan di Indonesia dibandingkan dengan negara ASEAN
Menjelaskan permasalahan dalam pencapaian indikator dan target pencapaian MDG bidang kesehatan
Mengidentifikasi peran dokter dalam sistem pelayanan kesehatan untuk menjamin pencapaian MDG dan agenda post MDG
Menjelaskan tantangan AFTA 2015 dan UHC dalam bidang kesehatan dan peran aktif dokter.
What is MDG and current state achievement
Topic 1-2
Why MDG
What is MDG
4. Reducing Child Mortality
Indicator 1997 Target 2007 Comments
Under five mortality rate/1000
81 32 40
Infant mortality rate/1000
57 19 32
Child Mortality Health
Neonatal death causes
Infant mortality causes
U-5 Mortality causes
5. Improving maternal health
Indicator 1990 Target 2007 Comments
Maternal mortality rate per 100.000
390 110 300
Birth helped by trained nurse
40.7% 100% 72.4
Married women age 15-49 using contraception
50.5% 100% 57.9
MMR Trend
Cause MMR
Three delay model
Making Pregnancy Safer Messages
All pregnancy is intended (wanted)
All delivery is helped by trained health care attendance
All pregnancy complication
managed with an adequate health
1
2
3
6. Combating HIV/AIDS and other Diseases (TB, Malaria)
Indicator 1997 Target 2007
Prevalence of HIV/AIDS
Control the spread
5.6
Case of Malaria/1000
8.5
Tuberculosis prevalence /100.000
786 262
Why HIV Epidemic?
PerempuanLaki-laki
3,1 Juta Pria membeli Sex
(2-20% dari Pria Dewasa)
1,6 Juta menikah
dg pria risiko tinggi
230.000penasun
800,000GWL
230,000Wanita
Pekerja seks
Anak-anak
Jumlah Penduduk Indonesia: 240 juta
ASEAN Human development index Rank
Country ASEAN rank
HDI Income category
GDP
Group Rank Index
Singapore High High 25 0.992 High 29.663
Brunei High High 30 0.894 High 28.161
Malaysia Upper med High 63 0.811 Upper med 10.882
Thailand Upper med Medium 78 0.781 Lower med 8.672
Philippine Medium Medium 90 0.711 Lower med 5.137
Vietnam Medium Medium 105 0.733 Low 3.071
Indonesia Medium Medium 107 0.738 Lower med 3.843
Laos Lower med Medium 130 0.601 Low 2.039
Cambodia Lower med Medium 131 0.598 Low 2.727
Myanmar Lower med Medium 132 0.583 Low 1.027
ASEAN Human development index Rank
Thai Mal Phil Indo Vietn. Cam Lao Myan.
Poverty A A A ?
Hunger A A A
Primary education
A A
Gender disparity
A A A
Under 5 M A A
MMR A A
HIV/AIDS A A
Infectious disease
A A
Environment ? ?
Safe water, sanitation
A A A
What are the remaining global problems?SUSTAINABILITY AND GOOD GOVERNANCE
From MDGs to Sustainable Development Goals
8 GOALS MDGs
12 GOALS SDGs
Comparing MDGs and SDGs
MDGs 2000 - 2015
1. Menanggung Kemiskinan dan Kelaparan
2. Mencapai Pendidikan dasar untuk semua
3. Mendorong Kesetaraan Gender dan Pemberdayaan Perempuan
4. Menurunkan Kematian Anak
5. Meningkatkan Kesehatan Ibu
6. Mengendalikan HIV dan AIDS, Malaria & Penyakit Menular Lainnya (TB)
7. Menjamin Kelestarian Lingkungan Hidup
8. Mengembangkan Kemitraan Pembangunan Tingkat Global
POST 20151. Mengakhiri Kemiskinan
2. Memberdayakan Anak Perempuan, Kaum Perempuan & Pencapaian Kesetaraan Gender
3. Meningkatkan Mutu Pendidikan & Penerapan Belajar Seumur Hidup
4. Menjamin Hidup Sehat
5. Menjamin Ketahanan Pangan & Gizi Baik
6. Menjamin Tersediannya Akses Air Bersih & Sanitasi
7. Membangun Ketahanan Energi Berkelanjutan
8. Menciptakan Lapangan Kerja, Penghidupan Berkelanjutan, & Pertumbuhan Berkeadilan
9. Mengelola Aset Sumber Daya Alam secara Berkelanjutan
10. Meningkatkan Penyelenggaraan Pemerintahan yang baik dan efektif
11. Menjamin Kehidupan Bermasyarakat yang Aman dan Damai
12. Menciptakan Lingkungan Global yang Kondusif sebagai Katalisator Pembiayaan Jangka Panjang
Two Important Keys
Good governance
Sustainability
AFTA Challenges and Universal Health Coverage
AFTA challenges
Global Standard
Free Trading
Global Competition
Universal Health Coverage & Sustainable Development
Health enables sustainable development
Health is a Right
Health is socially determined
Health contributes to growth & development
Increase access to health services
Improve level & distribution of
health
Outcomes
Better health for citizen
Improve country competitiveness
Inclusive & sustainable growth
Healthy population mean higher labor productivityHigher return to household from labor market participation
75% of health outcome is highly depend on working and living condition
The right of everyone to enjoy the highest attainable standard of physical and mental health is globally recognized
The contribution of health sector
Post 2015 Development Agenda : Wellbeing for All
Sustainable wellbeing for all: poverty eradication, education, nutrition, environment, security, etc
Healthy lives at all stages: child survival, maternal survival, MDG6, adolescent health NCD burden reduction
Universal Health Coverage; health promotion, prevention, treatment, financial risk protection
Health Sector
Other Sector
UHC Means
All people can access the health service they need without incurring financial hardship
AccessFinancial protection
Road map of Indonesian universal health coverage
(UHC)
20% 50% 75% 100%
20% 50% 75% 100%
10% 30% 50% 70% 100% 100%
`Perusahaan 2014 2015 2016 2017 2018 2019
USAHA BESAR 20% 50% 75% 100% USAHA SEDANG 20% 50% 75% 100% USAHA KECIL 10% 30% 50% 70% 100% USAHA MIKRO 10% 25% 40% 60% 80% 100%
2012
2013
2014
2015
2016
2017
2018
2019
Pengalihan Peserta JPK Jamsostek, Jamkesmas, Askes
PNS, TNI Polri ke BPJS Kesehatan
Perluasan Peserta di Usaha Besar, Sedang, Kecil & MikroPenyusunan Sisdur
Kepesertaan dan
Pengumpulan Iuran
Pemetaan Perusahaa
n dan sosialisasi
Pengukuran kepuasan peserta berkala, tiap 6 bulan
Integrasi Kepesertaan Jamkesda dan askes komersial ke BPJS Kesehatan
Pengalihan Kepesertaan TNI/POLRI ke
BPJS Kesehatan
Kajian perbaikan manfaat dan pelayanan peserta tiap tahun
Sinkronisasi Data Kepesertaan: JPK
Jamsostek, Jamkesmas dan Askes PNS/Sosial -- NIK
Penduduk yang dijamin di berbagai skema 148,2 jt jiwa
111,6 juta peserta dikelola BPJS Keesehatan
60,07 Juta pst dikelola oleh Badan Lain
257,5 juta peserta (semua
penduduk) dikelola BPJS Keesehatan
Tingkat Kepuasan
Peserta 85%
KEGIATAN: Pengalihan, Integrasi, Perluasan
73,8 juta belum jadi peserta
90,4juta belum jadi peserta
Perpres Dukungan
Operasional Kesehatan bagi
TNI Polri
86,4 juta PBI
3572%
(2013)
National Health Security System
Regulator
BPJS
Participants
Health facilities
Paym
ent p
reem
ie M
edica
l ser
vices M
OU
Claim order
Claim paym
entAccess to Health service
Health Services
National policy for regulation and implement
Regulation for , health personal, medical equipment,
medicine formularies etc.
Regulasi Pricing of health services/provider (TARIF)
Kendali
Bia
ya &
kualit
as
Yanke
s
Government
Sistem Rujukan
Pembayar tunggal, regulasi, kesetaraan
PrimarySecondary Referral
Tertiary Referral system
2014 20202015 2019
Keep in mind