DARIMDG MENUJU SDG

Peran Profesi KesmasAdang Bachtiar

Ketua Umum IAKMI Pusat

2014

Download site: Facebook IAKMI.PUSAT

Born in Cirebon, West JawaDokter from UNIVERSITAS INDONESIAMaster of Public Health (MPH): HARVARD-USADoctor of Science (DSc): JOHNS HOPKINS-USAPost Doctoral in Statistics: UNIV of MICHIGAN-USACurrent Activities:

Indonesian Public Health Association, PresidentGlobal Fund TB at FPH-UI, DirectorHealth Professions Coalition for Anti Smoking (KPK-AR), ChairmanNational Expert Panel on TB, Health Policy SpesialistMoH-Community trial for Mothers’ Compliance Improvement on ARV Treatment, Head of TeamKomnas Penelitian & Pengkajian Penyakit Infeksi (PINERE) Litbangkes -Kemenkes, Expert PanelIndonesian MCH-Nutrition Eval Team-Ministry of Health, Head of TeamDept of Health Policy & Administration, UI, Past Chairman; Advice & examine more than 150 PhD dissertations, in

medicine, dentistry, nursing, public health, regional planningNational Health Research Committee, Expert PanelThe development of RPJMN Kesehatan 2015-2019, Expert PanelThe development of Oral Health Strategic Plan of MoH, Expert Panel

Adang Bachtiar

BERBAGAI KENDALA MENCAPAI MDG• Indonesia memulai lebih lambat daripada banyak negara lain

• Peta jalan efektif belum dijalankan sepenuhnya

• Kendala struktural termasuk dukungan politis di daerah, pertumbuhan

ekonomi dan kapasitas fiskal yang terbatas, serta kapabilitas pelaksana yg

terbatas

• Guncangan ketidakstabilan termasuk keamanan, bencana, ekonomi dan

epidemi penyakit (misal HIV)

KepemimpinanDi Puskesmas

PerencanaanPuskesmas

Pemenuhan Target disesuaikan

kebutuhan (Need) Masy

Kapasitasi SDMPuskesmas

ImplementasiPelayanan di Puskesmas

Pencapaian

Indikator

Puskesmas

Kemampuan SIK utk Added Value

FAKTOR KONTEKSTUAL: SUPRASTRUKTUR-KAWASAN

PEMBANGUNAN-KEMANDIRIAN MASY

.

Time to access 1st ANC

Limited accesibility

56% akses

1st ANC compliance

Mothers w/ =<12 mo. babies

w/ 12-60mos. Babies Total

n % n % n %

Yes 482 37,1 662 38,4 1144 37,9

No 816 62,9 1060 61,6 1876 62,1

DECREASING QUALITY OF MIDWIVES

4th ANC compliance

Mothers w/ =<12 mo. babies

w/ 12-60mos. Babies Total

n % n % n %

Yes 75 5.8 133 7.7 208 6.9

No 1223 94.2 1589 92.3 2812 93.1

PHC SUSTAINABILITY

LOCAL GOVT BUDGETING FOR HEALTH Means (7 provs)

PR.1 Public Health Programs 6.58%PR 1.1 MCH 0.70%

PR 1.2 Nutrition 0.97%PR 1.3 Immunization 0.12%

PR 1.4 TBC 0.06%PR 1.5 Malaria 0.30%

PR 1.6 HIV/AIDS 0.03%PR 1.7 Diarea 0.00%

PR 1.8 Pneumonia 0.01%PR 1.9 Dengue 0.06%

PR 1.10 Other infectious diseases 0.15%PR 1.11 Non-infectious diseases 0.03%

PR 1.12 Family Planning 0.57%PR 1.13 School Health Programs 0.07%

PR 1.14 Reproductive Health 0.01%PR 1.15 Environmental Health 1.20%

PR 1.16 Health Promotion 0.41%PR 1.17 Disaster Program 0.02%

PR 1.18 Surveillance 0.05%PR 1.19 Other Public Health Programs 1.83%

Gani, 2011

MDG ACCELERATION FRAMEWORK (MAF)

• Diagnostic, scaling-up proven interventions

• PHC approach

• Local-level initiative

• Academic-Business-Govt for empowerment

• Protecting public expenditures

• “Mencegah lbh murah drpd mengobati”

FOKUS PENYELESAIAN MDG

• Rencana Aksi Berbiaya di Propinsi dan Kab/Kota

• Fokus pada under-target, termasuk

• Ibu-anak, dengan pendekatan Continuum of Care

• HIV/AIDS

• Monev indikator pencapaian dan akuntabilitas

RENCANA AKSI BERBIAYA

• Mendorong kapasitasi Propinsi dan Kab/Kota untuk capai target prioritas MDG

dg susun Rencana Aksi 2014-2015

• Sinergi Akademisi-Masy tmsk swasta-Pemerintah

• Melalui Musrenbang

• Membangun Task-force

• Indentifikasi sumberdaya masyarakat untuk kesadaran kepentingan

kesehatannya

• Continum of Care

• HIV/AIDS

FOKUS PADA UNDER-TARGET

• Kes Ibu dan Anak

• Menekan jumlah ibu meninggal

• HIV/AIDS

• Berfokus juga pada mereka yang sehat

• Memberdayakan setiap unsur masyarakat untuk mencegah – mengobati dan

rehabilitasi

1991 1995 1999 2003 2007 2012 2014 20150

10

20

30

40

50

60

70

80

68

57

46

35 3432

2423

Target RPJMN

Capaian Target MDGs

SASARAN INDIKATOR STATUS

PENINGKATAN KUALITAS PELAYANAN KESEHATAN IBU DAN BAYI

1. Penurunan tingkat kematian Ibu (AKI)

2. Penurunan tingkat kematian bayi (AKB)

3

3

Target dan Capaian

ANGKA KEMATIAN IBU DAN ANGKA KEMATIAN BAYI

ANGKA KEMATIAN BAYI

Masih tingginya Angka Kematian Ibu dan Bayi (AKI dan AKB) terutama karena : •Cakupan persalinan oleh tenaga kesehatan terlatih sudah mencapai 88,64 persen namun kualitas pelayanan dan kompetensi tenaga kesehatan belum sepenuhnya sesuai standar pelayanan.

•SDKI 2012 melaporkan cakupan imunisasi dasar lengkap meliputi HBV, BCG, DPT, Polio, dan Campak baru mencapai 66 persen, meskipun khusus imunisasi campak sudah mencapai 80,1 persen.

1991 1997 2003 2007 2012 2014 20150

50

100

150

200

250

300

350

400

450

390

334307

228

359

118102

ANGKA KEMATIAN IBU

Target dan Capaian

Target RPJMN

Target MDGs

ImpactOutcome

• Persalinan aman

• KAP ttg persalinan normal dan beresiko

Output

• UKBM yg efektif utk “desa siaga bumil-

bulin-buteki”

• Nakes terlatih siap tugas

• Akses yang membaik

• Prosedur dipatuhi

Process Input

I. Faktor PemungkinANC & Persalinan•Persalinan o nakesPenanganan kompilkasi•UKBM•Sistem transport•Pembiayaan•Donor darah

Ibu dan anak

selamatII. Kebjakan dan advokasi•Kebijakan untuk akses-ketersediaan-mutu-sustain

III. Emergensi Obstertri•PONED dan PONEK•Pelatihan nakes

•Anggaran

•Sarana

•Prasarana

•Transportasi

•SDM

•SPO

•Dukungan politis

Menyelamatkan Ibu dan Anak

FOKUS PDEKOLOGI

SDA dan KapasitasEkologis

FOKUS PD EKONOMI

Sistem2 Ekonomi

FOKUS PDSOSIAL

Modal Sosial &Tujuan Kesejahteraan

Pembangunan Yang Sustainabel

AGENDA PEMBANGUNAN POST 2015

SUMBER DAYA ALAM (DATA DUNIA)

• Sumber air bersih:• 1M penduduk tidak akses air bersih• 2,5M (1/3 total penduduk dunia) tdk miliki sanitasi dasar

• Udara bersih• Hampir semua kota besar tidak miliki udara bersih

• Tanah• Lahan terkontaminasi• Hutan gundul• Desertifikasi (lahan menjadi gersang)

• 50% SDA (fossil fuels, minerals) habis dikonsumsi

DAMPAK KERUSAKAN LINGKUNGAN• Pemanasan global

• Deplesi lapisan ozon

• Kerusakan biodiversitas

• Hujan asam

• Etrofikasi

• Human and eco-toxicity

MASALAH SOSEK (DATA DUNIA)• Jumlah penduduk tidak terkendali:

• Menuju 10M di abad ini

• Ketimpangan ekonomi dan kemiskinan• Proporsi 20% penduduk terkaya miliki 83% pendapatan ekonomi• Sedangkan 20% termiskin miliki 1.4% pendapatan dpl. < $1/hari• Hampir 50% jumlah penduduk (3M) hidup dengan $2/hari• Lebih lanjut: 790juta pendudukan dalam kelaparan dan tidak miliki

pangan yang cukup

AGENDA PEMBANGUNAN POST 2015

Objective Enablers/Pre-requisites

A sustainable Post 2015

Development Agenda 

• Peace and Security• Good Governance and transparency• Strengthened institutional capacity• Strengthened access to justice and

information• Human rights for all• A credible participatory process with

cultural sensitivity• Enhanced statistical capacity to measure

progress and ensure accountability

Objective Enablers/Pre-requisitesA sustainable Post 2015

Development Agenda 

• Growth oriented macro-economic policy • A developmental state• Means of implementation and monitoring• Domestic resource mobilization; • Social inclusiveness and equality• Infrastructure development• Reliable access to energy • Global cooperation and partnerships.

AGENDA PEMBANGUNAN POST 2015

Goal IndicatorsEconomic transformation and inclusive growth

Employment creation Rural development Value addition of primary commodities

and resources Food security Fair trade, markets and regional

integration and investment Prioritize sustainability and support

inclusive green economy initiatives

Goal IndicatorsInnovation and technology transfer  

Quality education at all levels with emphasis on science and technology

Vocational training and adult education Market relevant curricula and placements Technology for sustainable development technology transfer Investment in research and development

Goal IndicatorsHuman development

Gender parity: women and youth empowerment Access to social protection for vulnerable groups Health for all, with special focus on women and

child health Empowerment of elderly and disabled Strengthened capacity to implement disaster risk

reduction and climate adaptation initiatives Adequate shelter and access to water, sanitation

and hygiene 

AGENDA POST-2015 YANG TERKAIT BIDANG KESEHATAN

3. Provide quality education and lifelong journey

3a. Increase by x% the proportion of children able to access and complete pre-primary education

4. Ensure Healthy Lives

4a. End preventable infant and under-5 deaths

4b. Increase by x% the proportion of children, adolescents, at-risk adults and older people that are fully vaccinated

4c. Decrease the maternal mortality ratio to no more than x per 100,000

4d. Ensure universal sexual and reproductive health and rights

4e. Reduce the burden of disease from HIV/AIDS, tuberculosis, malaria, neglected tropical diseases and priority non-communicable diseases

Strategi Diperlukan?BACK TO BASIC

•Sehat merupakan nilai kemanusiaan yg mendasar keberadaannya,

melekat pd setiap insan, melingkupi, mengakar dan merupakan

interaksi dinamis dari berbagai kekuatan sosial yang dihargai

sepanjang sejarah kemanusiaan (Health is seen as embedded in social

relations of power and historically inscribed contexts)

SEHAT HARUS DILIHAT DARI NILAI KATA “SEHAT” SECARA SOSIAL

Labonte, 2005

Stra-1

•Dengan demikian setiap upaya menjaga dan memperbaiki status

“sehat” harus untuk kepentingan masyarakat yang sedang alami

persoalan kesehatan (...should be shaped by the interests of those

communities who carry the greatest burden of disease).

Labonte, 2005

•Cara-cara dalam upaya menjaga dan memperbaiki status “sehat”

tersebut harus melibatkan, mengikutsertakan, memberdayakan

masyarakat dan kelembagaannya sebagai unsur aktif dalam setiap

proses upaya perbaikan (... methods should engage community

constituencies as active agents in the process of research)

Labonte, 2005

• Efektifitas kolektif dalam upaya untuk tetap sehat

• Keberhasilan (perseptif) baik individu, keluarga, organisasi dan masyarakat

luas terkait pengendalian untuk tetap sehat

• Tekanan dan pengaruh sosial yang efektif untuk tetap sehat

• Perubahan dan peningkatan kehidupan keseharian, norma, sumber dan

kondisi sosial untuk tetap sehat

UKURAN KEBERHASILAN PEMBERDAYAANModifikasi dari: Becker, 1992

o Sense of self-worth (berharga-dihargai-menghargai)

o Right to have and to determine choices (pilihan hidup efektif)

o Right to have access to opportunities and resources (meraih cita2)

o Right to have the power to control their own lives (kendali & hak hidup)

o Ability to influence the direction of social change (including family

health) to create a more just social and economic order, nationally and

internationally (kemampuan saling pengaruhi utk lebih baik)

5 KOMPONEN KEBERDAYAAN

Domain Pertama:PERLU KETRAMPILAN

.

.

. 1a.M

onito

r Sta

tus

Kes K

eluar

ga

1b.Diagnosis & Investigasi

2a.Informasi, Kapasitasi,

Pemberdayaan

2b.Mobilisasi A

liansi

3a.K

apas

itas K

ebija

kan

3b.Penegakan Regulasi

4.Penyediaan layanan

5.SDM berkompeten

6.Monev

7.Mgmt System

8.Riset

Libatkan end-user

Kembangkan & diseminasi strategi program

Libatkan stakeholders dlm tiap proses

Tetapkan Goal & tujuan

Rumuskan ProsesKerja

ImplemKeg & Aliansi

Hasil Langsung

(direct)

Outcome (Hasil tdk

lgs)

Domain dampak dari produksi Aliansi:Kapasitasi sisyan kesehatan

Kebijakan kesehatan berbasis dataPerbaikan mgmt program

Peningkatan skills staf

Domain Kedua:Keterkaitan dg Users

Domain Ketiga:ALIANSI MENGELOLA

PENGETAHUAN

4-KapasitasiMengelola

Pengetahuan

1-KapasitasiKebijakan &

Pemograman

3-KapasitasiPartisipasiKel & Masy

2-Kapasitasi Aliansi

Kapasitas Dekonsentrasi

Kapasitasi NSPK

Global Opportunity

Governance

Stewardship

Financial

Capacity building

benchmarking

Standarization

StewardshipGovernance

Financial

Capacity building

Benchmarking

Standards

Kinerja

staf

Kapasitas Otonomi Daerah

Policy Capacity

Hlth Mgtm capacity

HRD capacity

Financial capacity

IS & Knowl mgmtMedia & nerworks

Knowl management & network

International funding

Health Devt Policy & communicationCapacities devt

Modif: Bachtiar 2009

1-Mengelola pengetahuan s/d skala global

Community Empowerment

Global-regional , K

earifan lokal

4-Mengelola Pengetahuan Oleh Kaum Berpengetahuan

PT & ORGANISASI PROFESI

IPTEK

Learning-Knowledge–Innovation

Peran Profesi (bersama PT)

adalah mencipta pengetahuan dan

ketrampilan (KNOWLDEGE

CREATION & PRESERVATION)

sehingga bermanfaat bagi

SEMUA

Suplai YANKES

Modal Sosial Masy

ORGANISASI PELAKSANA (PEM & MASY)

PELKESMAS

Tacit&embedded knowlPeluang & Ancaman

OUTCOME KESEHATAN

DAPAT DIBERIKAN OLEH

“Kaum Berpengetahuan”

Adaptasi dari Hughes-Tuohy 2003 & Hicks & Mishra 1993

KelembagaanALIANSI yg kuat

Sumberdaya ”aksi/power”

MobilisasiSumberdayaKetrampilan

Sumberdaya Pengetahuan

• SOLIDITAS ALIANSI• Advokasi Healthy Public Policy

• Kekuatan politik (pol pressure)•Kekuatan advokasi

•Kapasitasi sistem•Fasilitasi kebijakan•Fasilitasi Perenc&mgmt•Fasilitasi evaluasi

•Kemampuan regulasi&kebijakan•Kemampuan Perenc&mgmt•Kemampuan evaluasi

“MIRACLE” BRANDM MANAGING PUBLIC HEALTH POLICY&

PROGRAM EFFORTS

I INNOVATING APPROACHES – METHODS AND PARADIGM

R RESEARCHING COMPREHENSIVE EVIDENCES

A APPRENTICING (OBSESSION) FOR PERFECTION

C COMMUNITARIAN (LIVE WITH-FROM-TO-BY)

L LEADING FOR A PUBLIC HEALTH VISION

E EDUCATING ALL FOR SELF RELIANCE IN HEALTHY LIFE

Stra-2

PROFESSIONAL VISION

FOR PUBLIC HEALTH GRADUATES

PUBLIC HEALTH GRADUATES MUST HAVE_1

• Knowledge-driven practices

• Adequate knowledge and skills to understand

health problems, at all levels, ie, individual and

community

• Problem-solving attitudes

• Adequate professional skills to solve public health

problems

• Interactive ability

• Adequate softskills for implementing public health

solutions within social economic development

frameworks and perspectives

• Enlightenment capacity

• A comprehensive involvement in social cultural, poltical

and economic development for the sake of people’s health

PUBLIC HEALTH GRADUATES MUST HAVE_2

.

.

SOFTSKILLS

MIRACLE

P.HSKILLS

BASIC PUBLIC HEALTH SKILLS1. Analysis and Assessment

2. Policy development and program planning

3. Communication skills

4. Cultural competency/local wisdom

5. Community dimensions of practice

6. Basic public health sciences

7. Financial planning and management

8. Leadership and systems thinking/total system

Source: IPHA academic draft for PH Competencies, 2011

"TELL ME, I'LL FORGET. SHOW ME,

I MAY REMEMBER. BUT INVOLVE ME AND

I'LL UNDERSTAND."

Confucius, Ancient Chinese Philosopher

Stra-3

A FOUR PHASE EDUCATIONAL MODEL

•PHASE 1 – P.H COMPETENCIES DEVELOPMENT

Depts Participating All PH Departments in the School of PH

Who Participates PH Practitioners, Professors & StudentsWhat 8 PH CompetenciesWhere School and PH fieldsFunding University Funding; Student Tuition

PHASE 1

A FOUR PHASE EDUCATIONAL MODEL

•PHASE 2 – INDIVIDUAL OR GROUP PROBLEM BASED LEARNING

Dept. Related to course topicsWho Practitioners, Profs. & Students

What PH mini case report on PH situation in surrounding

Where In-class and PH “fields”Funds University, Tuition

PHASE 2 PHASE 1

A FOUR PHASE PROCESS MODEL

•PHASE 3 – DESCRIPTIVE & QUALITATIVE INDIVIDUAL RESEARCH

Dept. Related to research topic Other depts within school

Who Practitioners, profs, candidate Practitioners, profs, students

What Translational descrip research

Multi dept contribution to res.

Where Faculty Project location(s) Faculty Project location(s)

Funds Dept funds, Private, Grants University, Tuition, Grants

PHASE 2 PHASE 1PHASE 3

A FOUR PHASE PROCESS MODEL

•PHASE 4 – SUSTAINABLE TRANSLATION & DISTRIBUTION

Dept. Related to research topicWho Practitioners, profs, candidateWhat Thesis exam and publication in journalWhere PH seminarsFunds Dept funds, Private, Grants

PHASE 2 PHASE 1PHASE 3PHASE 4

.

STRUCTURING THE

COLLABORATION

UNIVERSITY ROADMAP

(Continuing) PH

education progr

Impact toHlth System

• Evidence based policy

• Improved Hlth capacity

• Hlth Devt Leadership

• Health systems effectiveness

Internal univ networks

External networks with PH Professions

Globally

External network with donors

External networks with reserachers

MONEV & CONTINUOUS IMPROVEMENT

• Knowledge CreationTranslational research, policy devt

Knowledge brokering and codification

Knowledge warehousingPublications, seminars, workshops

• Knowledge Preservation Knowledge exchange & portal

Policy analysis• Knowledge internalization and

useTeaching/training

Practice guidelines/tools Evaluation studies

EFFECTIVE ALLIANCES:FRAMEWORK USED

Stra-4

Social media & PH education

technology

Strategy & Process for PH

education quality

Social Capital including market

and users

VIRTUALISATIONGLOBAL

HARMONIZATION

PH COMPETENCIES

THE IPHA ACTIONS

• Further actions are planned as follows:

• Strengthening local PH professional

organizations

• Continuing PH Education

• Aliances

• Empowering stakeholders

• Shift the IPHA as holding organization for all

professional health organizations with similar

goal to achive healthy people

CLOSING REMARKS

Membangun Ketahanan Sosial Pasien & Keluarga

O - Output terukur

U - Utamakan budaya sehat-pemulihan & ancamannya

T - Training menuju kemandirian pasien dg fasilitasi UKM-UKP yg terpadu

R - Rancang mobilisasi sumberdaya tmsk jenjang keluarga

E - Eratkan partisipasi semua anggota keluarga, lingk, tempat kerja dll

A - Adopsi dan adaptasi rencana kerja sesuai kebutuhan

C - Cerahkan stakeholders (pasien/kel/dll) mel komunikasi-komunikasi-komunikasi

H – Himpun-pelajari sukses & tahapan2nya untuk adopsi-adaptasi

Being attentive along the journey is as important as the destination