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TOWARDS
HEALTHY INDONESIA 2010
1999
Ministry of Health
Republic of Indonesia.
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With the completion of this Health Development Plan towards Healthy Indonesia
2010, we confer appreciation and thanks to all sides for their attention and helps so far.
This plan is compiled after receiving input from various departments, universities,
experts, professional organizations, NGOs and international agencies. Even though all
related aspects and factors have been attended in this document, none the less there are
still shortcomings. Hence this document still requires revision.
Healthy Indonesia 2010 can only be achieved through the spirit, dedication and
hard work from all of us. Without that, Healthy Indonesia 2010 would be just an empty
slogan with no meaning. With high dedication, spirit and hard work from all of us, Insya
Allah (God willing) civil society that we all wish for, i.e. a social order that is healthy
physically, mentally as well as socially, the modern society that is civilized, faithful,
devout, can be achieved by us.
May the Only God always give His guide and confer strength to all of us in
implementing the health development. Amen.
TABLE OF CONTENTS
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Preface
Analysis of Situation and Trends
Development
Problems
Opportunities
Threats
Strategic Issues
Principles, Vision and Mission of Health Development
Principles of Health Development
Vision of Health Development
Mission of Health Development
Direction, Objectives, Targets, Regulations and Strategies of Health
Development
Direction of Health Development
Objectives of Health Development
Targets of Health Development
Regulations of Health Development
Strategies of Health Development
Programs of Health Development
Principle Programs of Health Development
Prioritized Health Programs
Requirements for Health Resources
Manpower resource
Facility resource
Financial resource
Organization and Motivation in Implementation
General affairs
Organization
Implementation motivation
Intra and Inter-sectoral Co-operation
Cultivation
Supervision, Controlling and Evaluation
Supervision
Model and Mechanism of Supervision
Controlling and Evaluation
Indicators of Health Development
Closure
Lists of Tables and Appendices
Preface
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The national aims of the nation Indonesia as stated in the Preamble of the 1945
Constitution is to protect all the nation of Indonesia and all the territory of Indonesia and
to promote public welfare, to develop the intellectual life of the nation, and to participate
in implementing the world order based on independence, eternal peace and social justice.
In order to achieve the national aims, a planned, comprehensive, integrated, directed and
continuous national development is conducted. The aim of the national development is to
achieve a just and prosperous society with evenly distributed materials and spirituality
based on Pancasila and the 1945 Constitution which is contained in the Unitary State of
the Rep. of Indonesia which is independent, sovereign, unitary, and having people’s
sovereignty within the nation’s living situation that is safe, peaceful, in order and
dynamic as well as within the world’s social environment that is independent, friendly, in
order and peaceful.
To achieve the national development’s aims requires among other things human resource
of integrity, autonomous and qualified. The data from UNDP of year 1997 states that the
human development index in Indonesia is still at the 106 rank out of 176 countries. The
level of education, income and health of Indonesian people is indeed still unsatisfactory.
Recognizing the achievement of the national development’s aims is the will of all the
people of Indonesia, and in order to face the even tighter free competition in the global
era, efforts to increase human resource quality must be implemented. In this case the
roles of health development’s success is very decisive. The healthy people will not only
support the success if the education program, but also push the increase in productivity
and income of the people.
To accelerate the success of health development requires health development policies that
are more dynamic and proactive by involving all the related sectors, the government, the
private, and the society. The success of health development is not only decided by the
performance of health sector alone, but also very much influenced by dynamic interaction
of various sectors. Attempts to make the national development with health concerns as
one of the new missions and strategies must be able to become the commitment of all
sides, beside shifting the old health development’s paradigm into the Health Paradigm.
The existing health development programs so far being implemented has succeeded in
increasing health level of the people significantly, though there are still various problems
and obstacles that will influence health development implementation. To identify the
problems and obstacles requires analysis of the situation and trends in the future. Below
are described the development, problems, opportunities, threats and strategic issues of
health development Indonesia is facing these days.
A. DEVELOPMENT
1. Health Level
Up to now the infant mortality rate (IMR) has been lowered with a lowering rate of on
average 4.1% per annum. While in 1967 the IMR in Indonesia was still ranging 145 per
1000 live births, in 1991 IMR was already 51 per 1000 live births (Supas 1995) (see
tables 1 and 4). The under-five-years death rate (UFDR) (0-4 years) has also been
lowered significantly. In 1986 it was still 111 per 1000 live births, in 1993 it was
lowered to become 81 per 1000 live births. None the less, the differences of IMR and
UFDR between provinces still vary wide. Mean while the MMR has also lowered from
540 per 100.000 live births in 1986 to become 390 per 100.000 live births in 1994 (table
3). In line with this development, life expectancy at birth has also been increased from
average 45.7 years in 1967 to become 64.4 years in 1991 (Supas 1995) (see table 2).
The prevalence of moderate and severe Protein Energy Malnutrition (PEM) among the
under 5 years children has dropped from 18.9% in 1978 to 14.6% in 1995 (Susenas
1995). The total prevalence of (mild, moderate and severe) PEM has dropped from
48.2% in 1978 to 35.0% in 1995 (see table 6). So are the other nutritional problems,
such as blindness due to vitamin A deficiency, iron deficiency anemia, and iodine
deficiency, have shown decrements. The result of xerophthalmia survey done in 1992
concluded that blindness due to vitamin A deficiency was not a community health
problem any more. SKRT (Household Health Survey) discloses the prevalence of
pregnant women suffering from iron deficiency has dropped from 63.5% in 1992 to
50.5% in 1995. Among the pre-school age group, it dropped from 55.5% to 40.5%.
Prevalence of problems due to iodine deficiency (GAKY) has also shown a declining
figure. The total goiter rate (TGR) was 37.2% in 1982 and declined to 27.7% in 1990.
Indonesia has been declared as free from variola by WHO in 1974. Beside that, several
other contagious diseases have been decreased in their morbidities, e.g. framboesia,
leprosy, poliomyelitis, neonatal tetanus and schistosomiasis. While in 1995 there were
still 4 cases of poliomyelitis confirmed laboratorically, in 1997 there was no positive
cases confirmed laboratorically. Neonatal tetanus has been decreased from 3.77 per
10.000 live births in 1990 to become 1.56 per 10.000 live births in 1995. Schistosomiasis
in endemic areas has decreased from 3.48% to become 1.64%. Several contagious
diseases being observed were showing increasing trends of morbidity, such as malaria,
DHF and HIV/AIDS. Annual parasite incidence (API) of malaria decreased from 0.21
per 1000 residents in 1989 to become 0.09 per 1000 residents in 1996 in Java-Bali, then
increased again to 0.20 per 1000 in 1998. Parasite rate (PR) of malaria outside Java-Bali
which was formerly 3.97% in 1995 increased to 4.78% in 1997. Incidence rate of DHF
which was noted as 23.22 per 100.000 residents in 1996 increased to 35.19 per 100.000
residents in 1998. Lung TB is still an illness requiring attention as though its prevalence
has been decreased from 2.9 per 1000 residents in the period 1979-82 to become ca 2.4
per 1000 residents at the end of Pelita VI, though it has not been evenly distributed
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among all the provinces. In certain regions as West Java, Aceh, and Bali, the prevalences
of lung TB were still ranging between 6.5-9.6 per 1000 residents.
At the end of 1999 there were 23 provinces already reporting the existence of HIV, where
14 of them reporting of AIDS. National prevalence of AIDS in Indonesia is 0.11 per
100.000 residents with prominent disparities between provinces. In Jakarta the prevalence
of AIDS is 10 folds higher than the national, i.e. as high as 1,0 per 100.000 people. In
Irian Jaya the prevalence of AIDS is 40 folds higher than national figure, i.e. 4,4 per
100.000 people.
Degenerative diseases and non-contagious diseases also show rising trend. The results
Household Health Survey of 1995 show that 83 per 1.000 people suffering from
hypertension, and ischemic heart disease and stroke are suffered by 3 and 2 per 1.000
people respectively. Emotional mental disturbances among people aged 5-14 years old
and above 15 years old are respectively 104 and 140 per 1.000 people. Blindness is also
rising significantly from 1,2 percent in 1982 to become 1,47 percent in 1995. Traffic
accident in Indonesia in 1994 reaches 34.407 victims, it rises to 49,098 victims by 1997.
Mortality due to traffic accident rises from 3,2 per 100.000 people in 1994 to become 4,1
per 100.000 people in 1997 (see table 8).
2. Facilities
Health development that have been implemented during the last 30 years has succeeded
in preparing health service facilities and infrastructures evenly throughout Indonesia. At
the present time to fulfill basic health service there are 7.243 puskesmas available where
1.676 of them have been up graded to become caring-puskesmas that have in-patient
beds, 21.115 helper puskesmas and 6.849 mobile puskesmas. Hence there are at least one
puskesmas in each sub-district in Indonesia, and more than 40 percents villages have been
served by government’s health service facilities. The ratio of puskesmas to population is
recorded to be 1:27.600 and helper puskesmas to population is 1:9.400.
Beside that, there are also available special Treatment Clinics (Balai Pengobatan) owned
by the government, consisting of 21 units Treatment Clinics for Lung Diseases (BP4), 7
Public Eye Health Clinics (BKMM) and 1 Public Sports Health Clinic.
Beside that there are also various basic health service facilities owned by government’s
sectors outside the health sector, such as the correctional institution, state owned
enterprises (BUMN of the plantation, mining dept.) and so on.
In the private sector, basic health services are arranged in the form of general
practitioners, practicing midwives, private clinics and delivery clinics. The society and
private in the remote areas need much basic health services.
To expand the coverage and reach of puskesmas services various facilities of health
efforts with community’s resources have been developed. Now it has been recorded
243.783 units of posyandu with active cadets total 1.078.208 persons, 20.880 Polindes
(Village Delivery Hut), 15.828 POD (Village Medicine Post) and 1.853 Pos UKK
(Occupational Health Efforts Post).
The even distribution of basic health service facilities is also followed by the increase in
referral health service facilities. At the present there are 4 units of A Class General
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Hospital, 54 units of B Class General Hospital, 213 units of C Class General Hospital, 71
units of D Class General Hospital, 335 units Private General Hospital, 77 units of
Government’s Special Hospital, and 139 units of Private Special Hospital. Total beds are
reaching 120.000 units, so the ratio to residents is 1:1.700. The rate of utilization and the
capability of services of hospitals are increasing from year to year (see table 9).
In order to support the basic and referral health services have been developed 27 Health
Laboratory Offices (BLK), 27 Food and Drugs Supervision Offices (BPOM) and 10
Environmental Health Technique Offices (BTKL). Private laboratory services have also
improved very fast. At present there are registered 599 units private clinical laboratories
distributed among 27 provinces.
3. Health Manpowers
The number and distribution of health manpower have improved significantly enough so
that now there are registered about 32 thousands or so of medical manpower (physician,
specialist, and dentist) and 7 thousands or so of dentists, including specialists, and 6
thousands or so of pharmacists distributed throughout Indonesia. The number and
distribution of nurses and midwives are also improving very fast. There are registered
about 160 thousands or so of nurses with various levels of education. While the number
of midwives is registered 65 thousands persons or so including 52.042 persons in the
villages. Hence it means that nearly all villages in Indonesia have midwives already.
In order to support the development with health paradigm there have also been manpower
in the field of public health. At present there are registered about 11 thousands or so of
public health manpower with various expertise including among them in the nutritional
field about 1.500 persons, and in environmental health about 4 thousands so persons.
The total number of health manpower working in the Ministry of Health and regional
government throughout Indonesia in 1998 is registered about 400 thousands so persons,
where 302.947 persons out of them are central health personnel. While the rest about
90.000 persons more are staffs of regional government.
4. Health Inventories
At present there are 224 units pharmaceutical industries consisting of 4 BUMN (state
owned enterprises), 35 PMA (foreign investments), and 185 domestic private ones. Since
the enforcement of CPOB (good medicine manufacturing practices) in 1996, there are
162 pharmaceutical industries that have had the capability to manufacture medicines
according to CPOB.
Since early 1997 Indonesia has been able to produce generic drugs which are conducted
by 4 BUMN and 60 private owned pharmaceutical plants. The generic drugs have been
more and more accepted by the society.
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In the attempt to cure and improve health a portion of the society use Indonesian
indigenous medicines. Indonesia has the largest biologic varieties in the world with
about 30.000 types of plants. About 940 of them have been known to possess medicinal
effects and about 180 of them have been used in the native medicinal recipes by
Indonesian indigenous medicinal industries.
In 1992 the number of Indonesian indigenous medicinal industries was 449 units
consisting of 429 units of small scale traditional medicine industries (IKOT) and 20 units
of traditional medicine industries (IOT). In 1998 the number of Indonesian indigenous
medicinal industries has increased into 678 consisting of 602 units IKOT and 76 IOT.
Unincluded in the above records are manually mixed ‘jamu’ (Indonesian indigenous
herbs) businesses and ‘jamu’ vendors (see table 11).
The needs for vaccines in order to prevent diseases, among others the BCG, hepatitis,
polio, measles, DPT and tetanus toxoid have been fulfilled from domestic production.
Some of the health inventories such as health instruments have been manufactured
locally, while those using high technologies are still being imported.
5. Health Financing
In the last 30 years the government’s commitment for health financing has increased.
While the health budget in 1987/1988 was 2,32% of total government’s spending, then in
1997/1998 the health budget was 4,55% of total government’s spending.
The funding from private sector primarily the society’s spending is the largest portion of
the health funding. The contribution of private sector and society in funding health is
about 65 percents.
The majority of the society pay for their health still using the ‘fee for service’ model.
Only 14 percents of the society are covered in the health insurance programs. The Public
Health Maintenance Assurance Program (JPKM) which has been developed in all
districts/ municipalities is hoped to be able to rationalize funding from the public as a
base for achieving equality and improving health service quality. The details of JPKM
development result coverage up to the end of 1999 are as the following: (1) civil
servant’s health maintenance and pension revenue of 17,2 millions members, (2)
maintenance for employees and families of 1,6 millions members, (3) private health
maintenance of 600.000 members and (4) health funds of 22 millions members
distributed in about 15.000 villages. Besides, up to recently there are 19 executing bodies
(Bapel) of JPKM having license, and in the context of implementing the Social Safety
Net program in Health Sector there are 326 JPKM executors which are distributed in all
districts/ municipalities.
So far the health development has been built not only upon self strength, but it is also
supported by foreign helps either in the form of off shore loans or grants. To some extent
due to the economic crisis the foreign helps component in the health budget has shown
rising tendency.
6. Policies
The health development which had been done in nearly the last 40 years has undergone
enormous changes and improvements in policies. In Pelita I the policies were more
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In terms of hospital services, since Pelita V and specifically in Pelita VI, much attention
has been put to improve service quality through standardization of services, development
of accreditation instrument and compilation of indicators of hospital instruments’
performance. During this same period decentralization is also implemented, i.e.
delegation of a part of functions to the regions, without being followed by changes in
resources.
During Pelita V the policy on medicines is directed to the use of generic drugs, where all
government’s health facilities are obliged to use generic drugs.
With the issuance of act (UU) number 23 Year 1992 about Health, then a renewal has
happened in the written laws about health development. The act offers a legal base,
direction and various national policies for health development which formerly was based
on the National Health System (SKN). Policies that integrate funding system and health
maintenance system are clearly stated in the act number 23.
In order to protect the society from abuse and misuse of drugs, the act number 5 year
1997 about Psychotropics and the act number 22 year 1997 about Narcotics were issued.
For the sake of consumer protection, it is also enacted the act number 8 year 1999
concerning the protection against pharmaceutical preparations and foods. One of the
aims of the act is to increase the quality of goods and /or services that assure the
continual production of health goods and/ or services, comfortability, safety and survival
of consumers.
The development of state governance at the present time shows a very strong wave of
decentralization. The implementation of act number 22/ 1999 on Regional Government
and the act number 23/ 1999 on Financial Balance between Central and Region will
strongly influence the execution of development including the health development.
Decentralization of health efforts offer authority to the districts and municipalities to self
determine the health development’s priority of the respective regions according to local
capabilities, conditions and needs. As a consequence the success in health development
in the future will depend very much on the capability of the manpower resources in the
regions.
The trends which occur in the world nowadays are the increasing roles of the third party
in regulating health funding through the insurance system, either public or private one.
This condition will also become more flourished in Indonesia in the future when trades
between countries become more free. Hence the policies to be adopted in health
development effort through pre-service payment (pre-paid) system will very strongly
decide the direction of health service conferral to the public more evenly and with more
adequate quality.
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B. PROBLEMS
1. Health Level
Morbidities of some contagious diseases being observed which formerly were declining
or undetected, but recently have shown increasing trends, such as malaria, DHF and HIV/
AIDS. Besides with the increasing openness of Indonesia toward outside world and the
ease in transportation, there is a potential for the occurrence of new contagious diseases
which hitherto have not existed in Indonesia. On the other hand, the degenerative
diseases, non-contagious diseases, and traffic accidents have also shown increasing
trends. The problem of blindness is also rising significantly enough.
2. Cross-Sectoral Cooperation
Health problems are national problems that can not be disconnected from the various
policies of other sectors, hence their solution should involve other sectors as well. The
main issue is how to improve cross-sectoral cooperation more effectively?
The health development so far has not produced optimal results due to the lack of cross-
sectoral supports. There are sectoral programs which have not or not enough health
concerns so that they bring negative impacts to the health of the society. Part of the
health problems are caused by several factors, primarily the environment and behavior,
related closely to various policies and program implementation in sectors outside the
health. For the reason, a very nice cross-sectoral approach is required, so that the related
sectors can always calculate the impacts of their programs toward the public health.
For the same reasons, increase in attempt and management of health services can not be
separated from the roles of other sectors covering funding, regional governance and
development, work force, education, trade, and social and cultural affairs.
Even though the health development policies have been directed to and prioritized on
basic health services, emphasizing more on preventive and instructional health efforts,
but the public perception tends to remain oriented on disease curative and health
rehabilitation. The attempt to increase public awareness to create healthy life style
(Healthy Paradigm) is hard to achieve, as it is not supported by the factors of social
economic, educational level and public cultures.
The healthy life style that has not been well created as stated above is made even worse
by the highly expensive costs spent by patients or their families in order to get cure and
rehabilitation at the health service facilities such as the hospitals. Beside that, the loss in
productivity is another burden that should be born by the patient’s family. In other
words, such model of services is not only inefficient, but also wasting much costs. While
in the other side, the fund from government is declining.
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Beside that, the Indonesian territory which is geographically very wide with varying
tribes, cultures, religions and various communities, has not been given enough
consideration in deciding health policies. So far the decision making in health
development policies is viewed to be strongly centralized with the consequence that part
of the programs are not suitable to the regional or local needs and requirements. As a
result the health development being conducted so far is viewed to be not yet fully
effective and efficient.
As a result of the strong roles of the central government in deciding policies, the mode of
spending given by the central government is based on budget allocation which has been
decided with its detailed activities. The mode of spending like that plus the inadequate
wage system of the civil servants have made it very difficult to produce an appropriate
incentive system for budget efficiency. The matter is worsen by the many regulations
made by the government and applied uniformly, which has abolished the spirit for
competition and obstructed the creation of efficient management model.
Subsidy given by the government for health sector in PJP I (1st phase of long term
development) is only about 2.5% from Gross Domestic Product (GDP) which is far from
the minimum standard recommended by WHO i.e. 5% from GDP. In practice the
relatively small budget subsidized by the government mostly is given in the form of
subsidy to the service provider as regular spending (including wages), development
spending, and operational costs as well as maintenance costs. In other words, the mode
of funding practiced so far is not oriented to the needs of the public and is not directly
directed to subsidy the poor people.
The subsidy given by the government is only 30% of the total health costs. While 70%
of the health costs are still the responsibility of the public, and it is dominated by
individual cash payment system. As a consequence of the above situation is the difficulty
in applying cost control policies and it is also burdening the consumers of health services.
In fact the health costs are inclined to increase even more and become unaffordable when
the mode of payment stated above is still going on.
The mode of policy determination and mode of payment already being applied so far
have brought strong influence on the implementation of health development. The quality
of health service which is good and in line with prevailing standards is hard to find,
especially for the poor people and those living in remote areas.
Beside that, health development implementation is still not yet supported by the
utilization of progresses in applied science and technology. More over, the executors of
health development have not fully applied high level of ethics and morale. As a
consequence of that condition is health development implementation in Indonesia has not
fully implemented professionally.
Even though the number and distribution of health facilities have been regarded adequate,
but from the aspect of service quality the services are still below standard. Other health
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facilities such as hospitals even have not met the minimum requirement yet. In such a
situation, the quality of health services being offered are still far from expectation.
The conducive climate for increased private participation from either domestics or abroad
in offering health services has not been created optimally. Bureaucracy in licensing and
regulating which should be followed is in fact like a barrier for private sector
participation in health development.
7. Health Manpower
The weakness of health development from the point of view of health manpower is
regarding the uneven distribution, yet inadequate educational quality, unbalanced health
manpower composition due to over dominance of medical manpower and the low
performance and productivity.
Cross-sectoral coordination especially with the Education and Cultural Dept. in terms of
increasing the number of graduates of 4 basic medical specialists badly required by
district hospitals in order to improve their service quality is still lacking. Beside that,
review and re-structuring of other health manpower educational systems are also needed,
either those run by the government or the private.
One of the issues in health manpower development is the manpower utilization, where
their uneven distribution becomes a principle problem. Beside that, the career
development of the manpower becomes a matter that strongly needs to be developed, it
covers manpower of both the public sector and the private sector. All the aforementioned
efforts need the support of comprehensive, integrated and effective manpower
information system.
8. Health Inventory
The majority of medicinal raw materials for the pharmaceutical industries and the health
instruments using high technology are still dependent on import hence their prices rise
due to depreciation of Rupiah against foreign currencies.
Acceptability towards all levels of the society who need them is striven for through the
supply of medicines in 2 channels i.e. the services channels of the public sector and the
private sector. In the public sector the efficient management of medicines, including the
purchasing and integrated planning at districts and direct medicine distribution at GFK, is
an absolute matter. In this case, the ability to analyze essential drug requirement using
bottom-up planning according to disease pattern is a main matter. Beside that there is a
matter of coordination complexity.
C. OPPORTUNITIES
1. Demography
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The number of Indonesian people is still increasing with a decreasing rate. In 1980 the
Indonesian population totals 147,49 millions, it increases to 179,38 millions in 1990, and
projected to 210,439 millions in year 2000. Indonesian population in 2010 is projected to
be ca 235 millions. The growth of population is also signaled by the change in age
structure of the population where there is a shift from young population age structure to
old population age structure.
The large number of Indonesian population and the productive age structure are potential
market and resources for the development of nation-wide health efforts. Beside that,
various changes occurring on the demographic characteristics as a result of development
success such as education and social economic sectors will open the opportunities for the
implementation of health services that are more effective, efficient and qualified.
Reform in the legal and political sectors as required by the society opens big
opportunities for improvement of system and values in various sectors, including health
sector. This big opportunities can be utilized optimally to produce clean governance with
health concerns for the interest and prosperity of the people.
The governance system of the Unitary State of the Rep. of Indonesia based on the 1945
Constitution gives freedom to the regions to execute governance autonomically. In
facing the domestic as well as international development vis-a-vis the global competition
which is in principle a free competition, then the implementation of regional autonomy
with wide, real and responsible authorities proportionally is an opportunity which can be
used by the regions to prepare themselves as well as possible. With the implementation
of the Act No. 22 year 1999 about Regional Governance and Act No. 25 year 1999 about
Economic Balance between Central and Regional Governments, it is also an opportunity
for the regions to implement development including development in health sector, to
accelerate even distribution and justice according to local problems, potentials and
variousity by involving the public’s participation.
3. Globalization
Globalization in economic sector with its main core being free global trading gives
opportunity for Indonesia to take part in international trading. In the health sector, the
opportunity is mainly the chance for health workers to work abroad.
For that efforts to increase quality of the health workers to equal those from the other
countries should be done among other ways through improvement in education system.
The entry of foreign capital to Indonesia will expand even more the employment
opportunities for health workers, beside it will help accelerate the transfer of technologies
that are needed for the improvement of quality and professionalism of health services in
Indonesia.
4. Economic Crisis
The economic and credibility crises hitting Indonesia until now is a good opportunity to
do various changes in health sector, including to eliminate various bureaucratic obstacles
in the effort to increase efficiency and partnership in development implementation.
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Difficulty in getting health services due to low purchasing power opens bigger chance for
development and consolidation of JPKM.
5. Natural Resources
Indonesian soils and oceans are very rich in various sources for medicinal materials or
simplicia. Indonesia has the largest biologic varieties in the world with ca 30.000 types
of plants, and part of those plants are sources of natural medicinal materials. This is a
very big opportunity to produce medicinal materials as well as completed products
domestically by ourselves.
In the global era there are many changes that have occurred in national, regional, as well
as international levels which bring multidimensional impacts and which possess high
intensity of interrelationship between sectors. Hence, cooperation and interconnection
are the main pre-requisite to achieve a new era which is better off based on the new
paradigm based on the win-win principle.
The phenomenon of partnership that is equal, open and mutually beneficial is a good
opportunity especially for the development of private businesses either of national,
regional, or international scales for the development of basic and referral health services,
prevention of diseases, and promotion of health.
D. THREATS
The macro economic situation which has not recovered from economic crisis is one of the
biggest and heaviest threats to national development, especially the health development
as the consequence of the even more limited existing resources. This situation becomes
more severe with the still high level of dependence upon imported goods for
implementation of health services. The macro economic situation recovery is very much
influenced by political situation which is not yet stable enough till now. Hence, though at
national level there is already a commitment to give larger allocation for health funding
up to 5% of GDP, but there is still a real threat from the macro economic situation that
the resource may still not yet preparable within 2-3 years time ahead.
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2. Demographic Structure
The great number of population, the relatively still high growth rate, the still low level of
education and income, as well as uneven distribution among regions can be a threat to
development, including the health development. Beside that the age structure that tends
to be young together with the increasing number of elderly groups become the double
burdens of development.
The blow of prolonged economic crisis has also shown increase in the number of poor
people together with the decline in various health indicators, especially the rise of overt
KEP incidence primarily among infants and children. This condition is a threat to the
achievement of health development’s target as one of the efforts in increasing the
nation’s productivity. The declining economic condition of the society also influences
access of the people toward health services, especially for the poor people. Efforts done
through the JPSBK (social safety net in health sector) have indeed increased the access,
but in the long run this program is hard to sustain by the available resources.
The various worriness in economic sector that is easy to be triggered into riots and also
conflicts occurring in various regions in Indonesia which have been unsettled so far
become threats toward health development and at the same time become obstacles to
achieve the healthy Indonesia.
4. Geography
The geographic condition of Indonesia that is an archipelagic country with more than
17.000 islands and the very great area of ocean is a threat in the implementation of health
development. An archipelagic state like this in fact needs transportation and
communication facilities as well as a high operational cost.
On the other side with the openness of various archipelagoes, Indonesia becomes
susceptible to the possible entry of prohibited goods/ drugs illegally. Beside that the
geographic condition that consists of active volcanoes chain that can erupt at no time, and
the frequent earth quakes can bring natural disasters threatening the social life. While
Indonesian location in the tropical region is an accurate reservoir for the reproduction of
various vectors and pathogens.
Indonesia being on the cross-road position between big countries in the world, is in the
transportation line, this potentially can bring negative impacts toward public health with
the possibility of entry of various negative habits toward health and various diseases from
outside world.
Healthy life style is very much influenced by education level of the people. The low
level of education is one of the causes of low understanding of the people regarding
health information and the formation of healthy behaviors.
Abuses of narcotics, psychotropic drugs and additives tend to rise, in fact it has touched
the poor people and primary school children with even wider and more complicated
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escalation of the problem. So are the production and utilization of alcoholic beverages
and other addictives including cigarettes inclined to rise steadily with broad negative
impacts to the public.
The use of prohibited chemical substances as food additives, sanitary problems as well as
hygienic processing especially among household industries are also threats to the
consumer community’s health.
7. Globalization
Globalization is a phenomenon occurring in the end of the 20th century that is signaled by
the occurrence of inter-penetration and inter-dependence among all sectors, either
economic, political, or social and cultural. This situation causes the occurrence of
transformation of the nation society toward global society so that state boundaries
become unconspicuous any more.
Trades liberalization as the main sign of globalization beside the ease in transportation,
communication and information contains great threat for developing countries including
Indonesia. The policies of GATS (General Agreement of Trade in Services) and TRIPS
(Agreement on Trade Related Aspects of Intellectual Property Rights) will influence very
much various aspects of public health services implementation in developing countries.
Entry of foreign capital and work force in the health service area can result in the even
more rising in quality of health services and management. But negative impacts that
should be anticipated are the closure of various already existing service facilities
especially those so far have given services to the less well to do people. This situation
can only be prevented by intensive attempts to improve professionalism and quality
management in the existing health facilities. Other implications are regarding the
intellectual property rights, including patent for various drugs and biomedical products.
This situation can impede the usage of various products that otherwise can be used but
being constraint by regulation on intellectual property rights. This matter also brings
implication for the rise in prices of medicines and various biomedical products and
instruments.
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In the future, the climate and environment will be less beneficial to health. Pollution to
the environments, including air, water, soil and food will increase. Air pollution in the
big cities in year 2000 is estimated to rise 2 folds from that of 1990 with its main source
coming from the emission of motor vehicles and industrial activities. Air pollution in the
rooms needs more attention as the still high prevalence of smoking habit in the society.
Management of domestic wastes in the urban, either solid or liquid wastes, which has not
taken into consideration its impacts on public health is a threat to people living in the
urban areas and their surroundings.
The limitation of clean water supply is a threat to the health of society. The limitation in
public affordability especially in the rural and urban slum areas is also a serious challenge
for the creation of healthy environment.
E. STRATEGIC ISSUES
After studying the various strengths, weaknesses, opportunities and threats as mentioned
above, then the strategic issues that should be dealt with are as follow.
1. Cross-Sectoral Cooperation
A part of the health problems are national problems that are inseparable from various
policies of other sectors so that the solution should strategically involve the related
sectors. The main issue is the improvement in cross-sectoral cooperation, as cross-
sectoral cooperation in health development so far has been frequently less success.
The change in society’s behavior toward a healthy life and the improvement in
environmental quality which strongly influences society’s health level improvement need
close cooperation between various sectors related to the health sector. So is the increase
in effort and management of health services inseparable from sectors governing finance,
regional governance and development, work force, education, trading, and social cultural
affairs.
The quality of health sector’s human resource is strongly determining the success of
health efforts and management qualified human resource in health sector must always
follow the progress in science and technology, and strive to master the state of the art
science and technology. Beside that, the quality of the human resource is also determined
by the moral values being adopted and applied in the task execution. It is realized that
the number of Indonesian human resource in health sector who follows the progress of
science and technology and apply professional moral and ethical values is still limited.
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The emergence of competition in the free market era as a result of globalization should be
anticipated by improving the quality and professionalism of the human resource in health
sector. This is necessary not only to increase the competitive capability of the health
sector, but also to help improve the competitive capability of other sectors as well, among
others safeguard the export commodities of foodstuffs and finished food products.
Viewed from physical aspect, the distribution of health services facilities either
puskesmas or hospitals and other health facilities including health efforts supporting
facilities can be regarded as evenly distributed all over the territory of Indonesia. None
the less it should be confessed that the physical distribution has not been fully followed
by increase in quality of services and accessibility by all layers of the society.
The quality of health services is very much influenced by the quality of physical
facilities, types of work force available, medicines, health instruments and other
supportive facilities, services conferring process, and compensation received and the
expectation of the consumer society. Hence the increase in physical quality and
aforementioned factors are preconditions to be fulfilled. Afterwards, the process of
services conferral is to be increased through increase in quality and professionalism of
health resources as stated above. While the expectation of the consumer society is being
adjusted through improvement in general education, health information, good
communication between health providers and the public.
So far health efforts are still lacking in prioritizing the approach of health maintenance
and promotion as well as disease prevention, and they are insufficiently supported by
adequate funding resource. It is recognized that financial constraint from the government
and the public is a big threat for the continuity of government’s programs and a threat to
the achievement of optimal health level.
Hence, more intense effort is required to increase funding resources from the public
sector being prioritized for health maintenance and promotion activities as well as for
diseases prevention. Funding resources for curative and rehabilitative activities need
more exploration from resources in the society and directed to become more rational, and
more effective and efficient in order to increase the services quality. Various researches
indicate that most of the direct spending of the public are used not as effective and
efficient as a result of unequal information between services providers and services
receivers (patients or their families). This situation urges the need for strategic steps in
creating funding system with prepayment property already known as JPKM.
The availability of limited resources, especially in the public sector requires efforts to
increase participation of the private sector especially in the attempt which are curative
and rehabilitative. The attempts are done through empowerment of the private sector to
become independent, improvement of equal partnership and mutual beneficiality between
the public and the private sectors so that available resources can be used optimally.
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Other matters that strongly require settlement are empowerment and independence of the
public in health efforts that have not been as expected. Equality, openness, and mutually
beneficial partnership in health efforts become a sine qua none for the civilization attempt
of a clean and healthy life style, application of healthy life norms and health promotion.
The great effort of Indonesia nation in rectifying the national development orientation
that has been done in the last 3 decades requires total reform in development policies in
all sectors. For health sector, the call for total reform emerges as there are still
discrepancies in health development results among the regions and communities, the
public health level is still left behind compared to neighboring countries, and due to the
lack of autonomy in health development. Beside that, health reform also is needed
considering there are 5 main phenomena that have great influences toward the success of
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health development. First, basic changes in demographic dynamics that urge the birth of
demographic and epidemiologic transition. Second, substantial discoveries in medical
science and technology that open new horizon in looking at living processes, health,
illness and death. Third, global challenges as a consequence of free trading policies, and
fast revolution in information, telecommunication and transportation sectors. Fourth,
changes in the environment that influence the health level and efforts. Fifth,
democratization in all sectors calling for empowerment and partnership in health
development.
In order to increase the resistance and struggling power of health development as the
main asset of national development, re-evaluation of health development policies has
become a must. Changes in the understanding of the concept of health and sick and the
increasing treasure of science and technology with information about determinants of
disease causation which is multi-factorial have aborted health development paradigm
which puts priority on curative and rehabilitative health services.
The application of the new health development paradigm i.e. HEALTHY PARADIGM is
an attempt to improve the nation’s health that is proactive. The healthy paradigm is a
health development model which in the long run can push the society to become
autonomous in maintaining their own health through heightened awareness on the
importance of health services that are promotive and preventive.
The ideal principle of the national development is the Pancasila, while the constitutional
principle is the 1945 Constitution. Health development is an integral part of the national
development. On the Act number 23 year 1992 about health it is stipulated that health is
the condition of well being of the body, mind and social life that enables every person to
live productively socially and economically. While on the constitution of WHO year
1948 it is agreed among other things that the achievement of the highest level of health
level is the fundamental right of every person regardless of his/ her race, religion,
political affiliation and social economic position. The principles of health development
are basically truth values and basic rules as the foundation for thinking and doing in
health development. The principles are the foundation for the compilation of vision,
mission and strategies as well as principal directors in the implementation of health
development nation-wide which include:
1. Humanity
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Every health attempt should be based on humanity which is being spirited, moved and
controlled by faith and devotion to The Only God. The health manpower needs to have
noble character and hold tight the professional ethics.
Every person and also the society together with the government have a role, vocation and
responsibility to maintain and improve the health level of each individual, family, society
and his/ her environment. Every health effort should be able to produce and push the
participation of the society. Health development is conducted based on trust and self-
capability and strength as well as making the personality of the nation as the pivot point.
In the health development, each person has the same right in getting the highest health
level, regardless of differences in ethnicity, grouping, religion, and social economic
status.
The implementation of qualified and following up to date science and technology’s health
efforts should put priority on health maintenance, promotion, and disease prevention
approaches. Beside that, health efforts should be done professionally, effectively and
efficiently by taking into consideration local needs and situation.
The health efforts are directed so that they would give maximal benefit for the
improvement of public health level, and they should be executed with full responsibility
according to the prevailing rules and regulations.
The picture of Indonesian society in the future that is hoped to be achieved through health
development is the society, nation and state characterized by its people living in a healthy
environment and with healthy living behaviors, having capability to reach qualified
health services justly and evenly, as well as possessing highest level of health in all the
territory of Indonesia. The picture of Indonesian society in the future or Vision expect to
be reached through the health development is formulated as:
In the Healthy Indonesia 2010, the expected environment is the conducive one for the
realization of healthy condition i.e. environment that is free from pollution, which is
equipped with clean water, adequate environmental sanitation, healthy housing and
settlement, zone planning with health concerns, and the realization of social life that is
helping each other by keeping cultural values of the nation.
The expected social behavior of Healthy Indonesia 2010 is the proactive one to maintain
and promote health, prevent risks for diseases, protect one from disease threats and active
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In order to materialize the vision HEALTHY INDONESIA 2010, four missions of health
development have been determined as follow:
The success in health development can not be merely decided by hard working of the
health sector alone, but it is strongly influenced by the results of hard working and
positive contribution from various other developmental sectors. In order to optimize the
results and positive contribution, the acceptance of health concerns as the principal
foundation of national developmental programs should be striven for. In other words, to
materialize HEALTHY INDONESIA 2010, the persons in charge of developmental
programs should put health considerations into all their developmental policies. The
developmental programs that do not contribute positively to health, not to mention those
being harmful to health, normally should not be implemented. In order to realize the
national development that contributes positively to health as stated before, then all
elements of the National Health System should take part as the main activators of the
national development with health concerns.
Health is the joint responsibility of all individuals, society, government and private. The
roles played by the government, without awareness of individuals and society to maintain
their health independently, will only bear little fruit. The healthy behavior and society’s
capability to select and acquire qualified health services strongly decide the success of
health development. Hence, one of the main health efforts or missions in health sector is
to urge the society’s autonomy for healthy living.
Maintaining and improving qualified, equal and accessible health services contain the
meaning that one of the responsibilities of the health sector is to assure the availability of
qualified, equal and accessible health services to the society. The implementation of
health services is not merely in the hands of the government, but it also involves
maximally the active participation of all members of the society and various private
potentials.
4. Maintaining and improving health of the individuals, families and society as well
as their surroundings
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Maintaining and improving health of the individuals, families and society as well as their
surroundings contain the meaning that the main task of the health sector is to maintain
and improve the health of all citizens, i.e. every individual, family and society of
Indonesia, without leaving behind the attempts to cure diseases and or to recover health.
For the implementation of this task, health efforts implementation should prioritize on
promotive and preventive efforts supported by curative and rehabilitative efforts. To
maintain and improve the health of individuals, families and society, it is also necessary
to create healthy environment, and hence the tasks in environmental sanitation should
also be better prioritized.
3. Health development is executed with the national development strategies with health
concerns, professionalism, decentralization and JPKM by paying attention to various
challenges existing now and in the future, among other things the economic crisis,
change in demographic dynamics, change in ecology and environment, progress in
science and technology, as well as globalization and democratization.
4. The public health maintenance and promotion efforts are done through healthy living
behavior improvement programs, healthy environment programs, public health
services that are effective and efficient, being supported by surveillance, information,
and management system that are reliable.
Improvement and revision of rules and regulations need to be done in order to support
health development and give legal protection to the public and health workers.
6. In order to support all the health development efforts, manpower with national
attitude, ethical and professional is required, it should also possess high dedication
spirit to the nation and country, being disciplined, creative, educated and skillful, with
noble character and able to hold tight professional ethics. Health manpower and
supportive manpower should be improved in quality, capability and distribution so
that they are evenly distributed and able to support the execution of health
development at every level especially in supporting the implementation of autonomy
at the districts/ municipalities.
The aims of health development toward Healthy Indonesia 2010 is to increase the
awareness, will and capability for healthy life of every individual in order to materialize
public health level that is optimal through the creation of an Indonesian society, nation
and country that is characterized by its residents living with healthy behavior and within
healthy environment, possessing capability to reach qualified health services justly and
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evenly, as well as having optimal health level throughout the territory of the Rep. of
Indonesia.
The targets of health development in order to materialize Healthy Indonesia 2010 are:
1. Cross-sectoral cooperation
The significant rise in cross-sectoral cooperation in health development, positive
contribution from other sectors toward health, efforts to overcome negative impacts
of development to health, and improvement in behavior and living environment that
are conducive to the achievement of healthy society.
4. Healthy environment
The significant rise in the number of healthy regions/ areas, healthy public places,
healthy tourism resorts, healthy working places, healthy houses and buildings,
sanitary facilities, drinking water facilities, waste disposal facilities, healthy social
environment including social inter-courses, and environmental safety, as well as
various standards and laws supporting the achievement of healthy environment.
5. Health efforts
The significant rise in number of qualified health facilities, coverage and reach of
health services, generic drugs usage in health sector, rational drugs usage, promotive
and preventive services utilization, efficiently managed health funds, and availability
of health services according to needs.
7. Health level
The significant rise in life expectancy, decrease in infant mortality rate and maternal
mortality rate, decrease in morbidity rates of several important diseases, decrease in
disability rate and dependency rate, increase in public nutritional state, and decrease
in fertility rate.
In order to achieve health development’s aims and targets toward realization of Healthy
Indonesia 2010, the general health development’s policies are:
waste disposal facilities and various other environment sanitary facilities. So that the
residents can live healthily and productively as well as be prevented from dangerous
diseases which are disseminated through or caused by unhealthy environment.
The quality of water, air and soil is to be improved to assure healthy and productive
life so that the country is prevented from conditions that can incur health hazards.
For that, improvement and revision of various rules and regulations, education on
healthy environment since early ages, and standardization of environmental quality
are necessary.
Control over agents, vectors and reservoirs of diseases is needed to create a healthy
environment for the whole society. Special attention is directed to environmental
troubles caused by technology utilization and dangerous substances, overt
exploitation of natural resources, and those caused by disasters, either natural or man
made ones.
The global impacts of climate change should be cautioned especially those related to
the occurrence of various health troubles, beside negative impacts of foodstuff
scarcity influencing the community’s nutrition.
After passing the economic critical period, health state of the society is managed to
improve through prevention and decrease in morbidity, mortality and disability
especially among the infants, under 5 years old children and pregnant, laboring and
puerperal women, through the healthy life promotive efforts, prevention and
eradication of contagious diseases and the cure and rehabilitation of diseases. The
main priority is given to eradication of contagious diseases and outbreaks which tend
to rise.
Basic health services that are implemented through puskesmas, helper puskesmas,
midwives at villages, and private health service efforts are improved in equality and
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quality. The same improvement is also applied on referral health services that are
implemented by hospitals owned by the government and the private.
In the effort to increase health inventories, the purchase and production of medical
raw materials which have economic yield will be stepped up. Supply, production and
distribution of finished drugs will be increased in efficiency and quality so that the
society will be able to get qualified drugs with affordable prices. Rational use of
drugs, especially with generic drugs is encouraged through promotion and
instructional efforts for the health workers and general public. Traditional medicines
that are useful to health will be utilized integrally in public health services. Beside
that, cultivation and utilization in the society will be improved further through
cultivation by the government or professional organizations.
Cultivation of the quality of foods and beverages that are marketed and consumed by
the society is improved to protect the society from substances and organisms harmful
to health.
Improved protection of society against danger of abuse and disuse of drugs, narcotics,
psychotropics, addictive substances and other dangerous substances needs to be
consolidated through control of their production, distribution and use tightly. The
risks of toxicity due to use of products containing dangerous substances need to be
prevented as early as possible through intensification of the information dispersion.
The even distribution and availability of drugs that are affordable and still being
prioritized nationally should be done consistently through the concept of essential
drugs. So is the utilization of generic drugs which should be further up graded.
Research and development in health sector will be further up graded gradually and
guided in order to support health efforts, primarily to support formulation of policies,
to help solve health problems and overcome troubles in the implementation of health
programs. Research and development in health will be continually up graded through
the partnership network and decentralized to become essential part of regional health
development. The upgrading of science and technology is encouraged to improve the
health services, nutrition, drugs utilization, and Indonesian indigenous medicine
development. Researches related to health economics are upgraded to optimize
utilization of health funds from government and private, as well as to improve
government’s contribution in health funding which is still limited. Researches in
social cultural field and healthy life style are done to develop healthy life style and
decrease existing community health problems.
While in micro, all health development policies that are and or will be arranged
should further push the increase in health level of all members of the society. While
it is known that the maintenance and promotion of health will be more effective and
efficient if done through promotion and preventive efforts, not curative and
rehabilitative ones then it is logical that the former two services can be given priority.
2. Professionalism
In the context of health service sub system structuring, the strategy of JPKM will be
prioritizing promotive and preventive services, which when successfully implemented
is assumed to be more effective and efficient in keeping and promoting health level
beside it will also bring positive influence as well in improving health service quality.
4. Decentralization
For the success of health development, arrangement of various health efforts should
start from the problems and specific potentials of each region.
In line with the situation, problems and trends being faced and by putting attention to the
direction, aims and targets as well as policies and strategies of health development
already decided, which in principle is putting more emphasis on health promotion and
maintenance efforts and attention is also put on the availability of health resources in the
future, then health development programs are grouped into program principles whose
implementation is done integrally with development of other related sectors as well as
with the support from the society.
This program principle is aimed at empowering individuals and society in health sector
through the increase in knowledge, positive attitude, behavior and active role by
individuals, families, and society according to local social cultures in order to maintain,
increase and protect their own health and environment towards healthy autonomous, and
productive society.
The target of this program principle is realization of individual and society empowerment
in health sector which is indicated by improvement in healthy living behavior and active
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role in maintaining, increasing and protecting self and environmental health according to
the local social cultures.
The focus of the program in terms of healthy living style change and society
empowerment is the maternal and child health, nutrition conscious family, anti tobacco,
alcohol and hashish, accident and injury prevalence, occupational safety and health,
mental health, environmental health, life style including exercise and physical fitness.
This program is aimed at increasing the number of mothers, families, students, schools,
workers, work places, users of public places, health institutions, consumer groups, health
institution’s personnel, society members, and community institutions that practice the
clean and healthy life styles.
The target to be reached is the increase in clean and healthy living behavior according to
the target groups and social cultures at the households, schools, work places, public
places (worship places, recreation and hobby parks, markets, stations, harbors, airports,
entertainment places, restaurants, etc.) at the health arrangements, at the public
arrangements.
This program is aimed at changing behavior and empowering the society in order to
decrease the morbidity and mortality due to diseases caused by smoking, alcohol and
hashish. While the specific aims are:
(a) to reduce abuses of alcohol, prohibited drugs/ narcotics;
(b) to increase awareness of the danger and effect of smoking, alcohol and narcotics,
mainly among school aged adolescents, pregnant women and groups using drugs/
narcotics;
(c) to increase consultative access for sufferers/ workers to get guidance in overcoming
problems of drugs/ narcotics abuse; and
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(d) to develop policies to overcome drugs/ narcotics abuse and to increase involvement of
basic service providers in helping overcome drugs/ narcotics problems.
This program is aimed at changing behavior and empowering the society to prevent
accidents and injuries at the houses, streets, schools, work places, and public areas; and
developing policies/ regulations in the prevention of accidents and injuries from
occurring.
Targets to be reached through this program are the decline of mortality and disability
rates due to accidents and injuries and to prevent the occurrence of accidents and injuries
at the houses, streets, schools, work places, and public areas; and developing policies/
regulations in the prevention of accidents and injuries from occurring.
This program is aimed at increasing public mental health by decreasing the prevalence
and impacts of mental disturbances, so that they no longer become public health
problems.
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This program is aimed at improving public health level through the improvement of
public sports health and physical fitness.
This program principle is aimed at achieving living environment quality that is healthier
to be able to protect the society from the dangerous threats from environment, so that
optimal health level of individuals, families and society can be reached.
Targets to be reached through this program is the increase in living environment’s quality
and the will and ability of individuals, families and society as well as the government in
planning and implementation of development with health concerns.
Programs included in the healthy environment program principle are among others:
This program is aimed at the formation of district/ municipal condition that is safe,
comfortable and healthy for the living of its residents through optimal improvement of
quality of the physical and social cultural environments in order to support productivity
and economy of the region.
Healthy zones/ areas program is a program which originates from the will and need of the
society and which is managed by the society, while government is only taking part as a
facilitator and motivator. This program is prioritizing process approach rather than target,
it has no time limit, and developing dynamically and gradually according to targets
expected by the society.
This program is aimed at improving healthy environment quality at the work places at the
office and industry so that the employees at both places and the surrounding society can
be avoided from diseases due to occupation, accidents and environmental pollution.
Meanwhile, the activities of this program include among other things the following:
(1) determination of standards and requirements of health;
(2) supervision of environmental health quality, data collection and classification;
(3) instruction and campaign of hygiene and sanitation;
(4) supply and development of instruments and media for instructions;
(5) monitoring and evaluation;
(6) development of occupational health services network;
(7) formation of work group motivators and healthy productive work group incentive
system;
(8) development of occupational health at health service facilities;
(9) compilation of rules and implementation of occupational health conditions, increase
of professionalism through education, training and positioning of occupational
health experts at the regions; and
(10) development of occupational health and safety information system.
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This program is aimed at environmental quality increase at the public places that meet the
healthy requirements so that the society is protected from contagious diseases, poisoning,
accidents, environmental pollution and other health troubles.
(8) achievement of clean and healthy living behavior implementation to 60% among
women having under 5 years children, school children, and teachers, public figures,
religious figures, and youth groups at urban area and 40% at rural areas.
This program is aimed at to increase safeguarding of water quality for various needs and
human life for all the people at rural or urban areas.
Water quality supervision activities are also aimed at doing surveillance of water quality
including pollution sources by various types of water (ground water, surface water, waste
water) and other substances influenced by water pollution.
The aim of health effort program principle is to improve the equality and quality of
health efforts which are successful and effective and accessible by all members of the
society.
Target of this program is the availability of basic and referral health services from either
the government or the private, which are supported by society participation and
prepayment system. The main attention is given to development of health efforts with
high leverage towards improvement of health level.
Programs included in the health efforts program principle are among others as the
following:
This program is aimed at decreasing morbidity, mortality and disability from contagious
diseases and preventing dissemination and decreasing social impacts of diseases so they
would not become health problems.
b. Immunization
This program is aimed at prevention against the occurrence of contagious diseases and
decreasing the morbidity and mortality from diseases preventable by immunization
(PD3I) so they would not become public health problems.
Targets to be reached through this program is the decrease in morbidity and mortality
rates from diseases preventable by immunization among all levels of society with priority
on infants, school aged children, reproductive aged women (including pregnant women)
and other high risk groups.
This program is aimed at increasing, consolidating, maintaining the coverage and even
distribution as well as increasing quality of puskesmas health service and increasing
utilization of puskesmas services by the society leading to the improvement of optimal
public health level.
This program is aimed at increased consolidation and maintenance of the reach and
equality as well as quality of referral health service toward the optimal public health level
improvement.
(1) formulating the revision of the basic concept of referral health efforts and policy
consolidation as well as management of referral health service program, to support
hospital autonomy and decentralization;
(2) development and consolidation of quality assurance program and rational treatment
in the hospitals;
(3) increased coverage of services to the poor people through development and
application of policy of subsidy that is accurately targeted;
(4) education and training of health manpower;
(5) research and screening of medical technology;
(6) motivating public participation in protection, maintenance, and improvement of
health; and
(7) monitoring and evaluation.
(11) technical training for laboratoric manpower in various areas and types of expertise
for various types and grades of laboratories;
(12) supply of simple laboratoric kit for midwife at village and to optimize midwife’s
role at village in health laboratoric service;
(13) supply of laboratory operational materials for examination, quality assurance and
safety of laboratories at puskesmas, hospitals, health laboratory office and other
health laboratories;
(14) implementation of inspection activity by gradation for public laboratory service,
clinical laboratory, and up grading of science and technology, doing technical
cultivation by laboratory in higher service grade to those below it, and from more
capable laboratory to those less capable; and
(15) increase in health laboratoric information system.
This program is aimed at increasing the utilization of traditional medicines and methods
which have been proved safe and effective either by itself or being combined in a
comprehensive health service, and protecting the society from negative effects of
traditional treatment.
This program is aimed at increasing the health level of mothers, children, adolescents, the
reproductive age, and elderly so as to create an optimal reproductive health.
This program is aimed at increasing the society’s and institution’s nutritional state in
order to increase autonomy, intellectuality and productivity of human resources.
Target to be reached through this program is the availability of information to all health
programs either promotive, preventive, curative or rehabilitative.
This program is aimed at to avoid human and environment from aftermath of disaster
caused by human behavior or natural cause, through surveillance effort, disaster
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prevention and settlement which are done integrally with active participation from the
society.
This program principle is aimed at to increase the number, quality and dissemination of
health manpower, to increase the number, effectivity and efficiency in using health fund,
and to increase supply and production of qualified and safe raw materials and finished
drugs.
Programs included in this program principle are among others the following:
This program is aimed at to create health manpower that is expert and skilled according
to progress of science and technology, faithful and devoted to The Only God, and tightly
keeping dedication to the nation and state as well as the professional ethics in adequate
number and quality so as to be able to implement the health development.
The main target of this program is availability of various health manpower from the
society including the private and government that can fully implement health efforts
based on health paradigm where health maintenance and promotion and disease
prevention are being prioritized.
(1) existence of policy and plan in health manpower development from the society and
government in all levels, that can offer direction regarding the implementation of
development in a specific, integrated and continuous way;
(2) utilization of existing health manpower and progression of career cultivation of all the
health manpower; and
(3) functioning of the education and training of health manpower that puts priority on
development of the educational participants in order to improve professionalism.
This program is aimed at assuring health maintenance of each people by being member of
a JPKM effort, either that run by the government or private.
This program is aimed at to safeguard the society from abuse and misuse of Medicines,
Narcotics, Psychotropics, other Addictives (NAPZA) that are permitted for marketing
and to prevent risks of poisoning from dangerous substances used by the society.
The target of this program is controlled production and distribution of medicines and
NAPZA, and stabilization of managerial system of dangerous substances.
This program is aimed at to assure the safety and quality of food products distributed in
the society and to protect the society from foods and food additives that do not meet
public health requirements.
Target of this program is to consolidate the system and to implement food safeguarding
so that food products in the society, including food products of home industries, are
assured in quality and safety.
The target are that all products in the market meet the requirements according to those
permitted in the context of registration, that the public is avoided from dis-information
and that the PPOM/ BPOM laboratory’s testing ability is recognized by the international
accreditation system.
The main activities to be done include among others are the following:
(1) compilation and development of evaluation and registration criteria standards;
(2) evaluation on the efficacy, safety, quality testing and registration that is centralized;
(3) periodic re-evaluation of products already being registered;
(4) evaluation on the pre-marketing labeling, advertising information and promotion
claim;
(5) development of harmonization of regional and international registration;
(6) realization of good manufacturing/ production method implementation;
(7) certification of PBF distribution facilities;
(8) development of drugs’ side effects monitoring system;
(9) examination of products and distribution facilities either of private or governmental
sector;
(10) taking samples and laboratoric testing of pharmaceutical products, foods and health
instruments marketed in 27 provinces;
(11) investigating counterfeit cases, black market and violation in production and
distribution;
(12) examination of advertisement/ promotion materials;
(13) training personnel in investigation, examination of production and distribution
facilities;
(14) training of testing personnel;
(15) accreditation of province wide testing laboratories for drugs and foods;
(16) referral service laboratories; and
(17) supply of instruments, standard raw materials and testing animals.
The aim of this program is to increase safety, benefit of drug use and optimize drug’s
efficacy to cost ratio.
The target of this program is the achievement of medical objective of drug use effectively
and safely; as well as efficacy in drug cost spending nation wide.
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The aim of this program is to assure the availability and accessibility of drugs nation
wide according to medical needs of the majority of population and individuals, and to
assure adequacy of generic essential drug needs for basic health service in governmental
sector.
Target of this program is the availability of drugs that are qualified, safe and effective
according to medical needs of the society and fulfillment of drugs for basic health
services and efficiency in drugs spending nationally.
The aim of this program is to develop and increase Indonesian indigenous drugs which
have high quality and safety as well as have real efficacy that is strictly tested, and which
have been used widely for self treatment by the society or used in the formal health
services.
The target of this program is Indonesian indigenous drugs (OAI) to be developed and
utilized widely primarily in the formal health services and for export.
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The aim of this program is to strengthen the structure and competitiveness of Indonesian
pharmaceutical industries so as to be able to fulfill domestic drug needs and for export at
reasonable price and with international standard of quality.
In order to organize health efforts according to the vision, mission and strategies that
have been determined requires effective and efficient policies and management of
resources, so that an equal and qualified service can be reached. The resources consist of
manpower, finance, facilities, knowledge, technology and information. The supporting
resources required to reach the vision, mission and strategies are from the government
and society, including the private.
Programs included in the health policy and management development are among others
as the following:
This program is aimed at to develop national health policies that can response to the
public needs in reaching Healthy Indonesia 2010. Health policies in the future should be
based on facts and real situation in the society, policies that support cross-sectoral
cooperation by taking into consideration the efficiency and effectivity of intervention
programs, so that an efficient, effective, qualified and everlasting health system can be
achieved.
(1) the creation of health policies that can assure the achievement of health system that is
efficient, effective, qualified and everlasting, and at the same time attend to the
basic values of society empowerment, individual rights to get health service;
(2) the creation of health policies that go in line with the change in the state organization
and governance system in general and that support reform in all sectors, especially
the health sector; and
(3) availability of human resource in health sector that is capable of doing various
investigations on the existing health policies as a base for a political development.
This program is aimed at to increase the utility of health apparatus in supporting health
efforts implementation.
The health laws development program is aimed at to increase the role of laws in health
sector so that the health development toward Healthy Indonesia 2010 can run smoothly.
This program is aimed at to develop health information system in order to create a health
information system that is comprehensive, effective, efficient in support of health
development toward Healthy Indonesia 2010.
The main target of this program is the availability of information that is accurate, timely,
complete and according to needs as a material for the process of decision making to
formulate health programs’ policies, planning, implementation, actuation, control,
supervision and evaluation at all levels of health administration.
This program is aimed at to offer input of science and technology in order to support
health development mainly in the support of policy formulation, help solve problems and
overcome troubles in the implementation of the behavioral improvement, public
empowerment and autonomy program.
(2) development of information package on balanced nutrition and healthy behavior for
the society;
(3) development of model of aids, guidance and protection for the society so they are
able to practice healthy behavior;
(4) development of modules on nutrition and health instruction toward healthy behavior;
(5) development of food package that is nutritious and safe for health;
(6) development of instruction modules on anti tobacco, alcohol and hashish;
(7) development of model on the prevention of (traffic) accidents and injuries;
(8) development of model on public participation; and
(9) development of model on health funding by the society.
This program is aimed at to offer science and technology input in order to support health
development mainly to support policies formulation, help problem solving and overcome
obstacles in the implementation of environment health improvement program.
Target to be reached through this program is the identification of factors affecting living
environment’s quality, beside the willingness and ability of government and society
including the private in planning and implementing development with health concerns.
This program is aimed at to offer input of science and technology for the support of
health development, especially to support policies formulation, help problem solving and
overcome obstacles in the implementation of quality improvement and health effort
equality program.
Target to be reached through this program is the identification of factors affecting quality
and equality of health efforts primarily in the basic health efforts at puskesmas and helper
puskesmas.
This program is aimed at to offer science and technology input to support health
development mainly to support policy formulation, help problem solving and overcome
obstacles in program implementation.
This program is aimed at to offer input of science and technology in order to support
health development, mainly to support policy formulation, help problem solving and
overcome obstacles in health policy and developmental management.
The target to be reached through this program is identification of factors affecting the
policy development and health developmental management to make them effective and
efficient.
7.6. Basic and Applied Science in Health Sector’s Research and Development
Program
This program is aimed at to find and master health science and technology in order to
reduce dependence on science and technology from abroad.
The target to be reached through this program is the production of new science and
technology in health and medical sector that is basic and applied in order to support
health development, mainly to support policy formulation, help problem solving and
overcome obstacles in the implementation of developmental programs.
Realizing the limitation of the available resources and adjusting it to the priority of health
problems found in the society and its trend in the future, so in order to further accelerate
improvement in public health level that is regarded important to support the success of
national developmental program, the following 10 prioritized programs are determined:
1. Health policy, health finance and health laws program.
2. Nutrition improvement program.
3. Contagious disease prevention program including immunization.
4. Healthy living behavior improvement and mental health program.
5. Settlement area, clean water and air program.
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For the implementation of health development toward Healthy Indonesia 2010, the
availability of adequate health resources is necessary. As for what is meant by resources
in this respect it covers manpower resource, fund resource and health facility resource.
A. MANPOWER RESOURCE
1. Manpower Requirement
Detailed picture of health manpower requirement from the society and the government,
as well as according to the types of manpower and respective program principles,
according to the types of manpower and place of duty can be seen on table 13 and table
14.
2. Supply of Manpower
Supply of health manpower is done through manpower administration and training that is
organized by the society and government. Government decides the policy of manpower
preparation for civil servants, which covers education and training as well as organization
of education and training for health manpower that is strategic.
Health manpower education and training, being an integral unity, should be developed as
a whole and related to the following matters:
1) Students
In the future the professional health manpower that will be developed is health
manpower with medium and scholar grade. This policy is determined because of the
ever increasing quality of manpower needed and the ever increasing number of
graduates equivalent to senior high school being produced.
2) Educators
With the increasing quality of health manpower needed, it needs educator manpower
that has high knowledge and skill beside having reliable ability to educate based on
the teaching technology.
3) Educational Institutions
Educational institutions in the future should be accredited and improved inquality so
as to be able to play the role as health technical source beside as health manpower
supply source.
Health manpower utilization will be the most important element in the development of
health manpower in the future. Hence ability to utilize manpower at all levels should be
increased.
The career development of health manpower either from private or government is vital to
be improved continually and matched gradually. In this respect, government applies the
policy of civil servant cultivation at central and regions that covers among other things
regulation of facilities, standards and procedures of workmanship and career
development. Professionalism of manpower will be increased continually and done
through the application of state of art science and technology and through the application
of moral values and ethics.
B. FACILITY RESOURCE
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For the future the need for health facility will be arranged by observing several basic
assumptions as the following:
(1) the shift in governmental role from being a dominant service organizer to become a
policy and regulation compiler by keeping attention on the services needed by the
poor people.
(2) the increasing potential of private sector in providing health services, especially that
of curative and rehabilitative ones; and
(3) the settlement of economic and political crises in not too long time.
With the above basic assumptions and limitation of available governmental resources at
present, and the willingness to increase service efficiency, then in general the number of
health facilities of governmental sector in the future will not differ much from now. New
health facility construction in governmental sector will be avoided as far as possible.
Developmental activity will be prioritized on quality improvement of the physical facility
and its service ability, e.g. up grading the state of helper puskesmas to become
puskesmas, while puskesmas to become puskesmas with in-patient caring beds. And then
puskesmas can also be up graded in its function into a general hospital according to the
public’s need. Also should be attended the needs of urban society which is different from
rural society, beside the fast wave of urbanization which should also be taken into
attention while calculating health facility need in the future.
Beside that, capability of the private sector’s health service is hoped to grow too, either in
number or in capacity.
Health facility management is very important, especially with the increasing complexity
of health service management in the future. Increased managerial, professional ability in
the government and private sectors, supported by improved technical ability of service
provider’s technical manpower is very necessary to be given attention in order to assure
the success and everlasting of health service efforts nationally. Specifically the capability
of regional leaders in doing advocation and building partnership with other sectors and
private sector should be improved.
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In line with the decentralization effort in health sector, special attention will be directed
to cost burdening, management, accountability of the resources following it. Flexibility in
doing managerial innovation will be further expanded. Specifically the balance of
funding between central and regional government is one of the strategic policy that needs
attention especially in regions with still low indigenous regional income. Conducive
climate for the organization of health facility in private sector will be further expanded in
order to push the growth of private sector. Various new regulations will be created in
order to regulate this matter.
C. FUNDING RESOURCE
1. Funding Need
The organization of health program needs the development of funding system that
originates from the government and society including the private that can produce ready
to use and adequate fund. Experience so far has shown the emergence of efficiency in
the utilization of governmental and private budget. Hence in the future will be striven for
the more efficient use of fund that can be reached through the compilation of funding
system that puts attention to equality, efficiency, and continuity and that can assure the
availability of qualified services.
The use of governmental fund hitherto is still directed more to health service efforts that
are curative and rehabilitative at the basic and referral health service levels. Therefore
mentioned funding system can hopefully be shifted to the promotive and preventive
services by observing the continuity of the existing available services especially those to
the poor people. With the imminent decentralization process, the funding sources of
central and regional governments will be developed optimally and proportionately, either
between health programs, regions or sectors.
Public direct spending to get health service is the biggest portion of national health
expenditure which will be directed to become pre payment system (JPKM), so as to make
it more efficient. So far JPKM has not run well and hence will be improved by preparing
professional field workers and creating conducive climate for its development. The
development of this system will take long enough time in order to cover most of the
people.
On the other side, the state economy at present is not yet bright and various other crises
are not sure yet when they will resolve, that makes calculation on fund requirement hard
to be done. The fact that health sector is one of the sectors that receives great attention
during crisis, beside education and social, is an opportunity that should be used optimally
to increase health sector’s budget portion in the future.
The macro picture of governmental budgetary need for health sector is hoped to rise from
only 2.5% to 5% in the future, it is followed by reallocation of budget to various
programs that are ‘cost-effective’. On the other side, in the short run we still have to take
into consideration funding need for arranging the social safety net in health sector which
is estimated to continue several years to come. This situation is very much dependent on
mobilization effort of public resources in the form of development of JPKM system and
its equipment.
2. Fund Raising
Resource for the implementation of health development originates from the government
and public/ private funds. Since the economic crisis, there is a great dependence on off
shore fund. It is estimated that the off shore fund will decline in the coming several years
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so exploration of the public’s funding source become an attempt that should be started
and implemented in the coming years.
It should be observed that in the future the role of regions become prominent in health
development funding as a logic consequence of decentralization process.
3. Funding Management
General
Implementation of national health developmental activities needs a broad and careful
management in various levels of administration of the government and the society itself.
Aside from that, the dynamics and rapid change in domestic situation and abroad should
also be watched. Beside that attention should also be given to the challenge from global
competition, the execution of regional autonomy, economic balance between central and
the regions, public participation, equity and justice, and potential and diversity of each
region.
Going in line with health developmental strategy in order to realize Healthy Indonesia
2010, it should be underlined that health development can not just rely on health sector’s
activity alone, but also on the developmental activities that are done synchronously and
efficiently from various related sectors. It has been realized since long that cross-sectoral
and cross program co-operations is one of the main keys of developmental success, that
has in fact so far received inadequate attention.
Activating the execution of various health programs is meant to make the health service
providers, consumers and other sides acting as supporters and supervisors can implement
the various health programs as perfect as possible.
The progress so far shows that the inter-dependence among human being is increasingly
felt. For the success of a program, communication and cooperation are needed between
various groups or working units. Beside that a high motivation and renewal in value
orientation which needs support from awareness on the importance of preparation and
utilization of data and information dissemination also needs to be grown.
Organizing
Pustu is an integral part of puskesmas and it does the function of puskesmas at the rural
level. At certain regions, in accordance to need, pustu and puskesmas encourage the
formation of health posts by the society which is coordinated by the rural governance.
a. Puskesmas
An UPT is formed when needed and its task is to arrange one of the health efforts
separately.
The organization of private health effort is a society organization including the private
that organizes health effort according to the rules and regulations as well as professional
standards and other regulations as determined by the government together with the
professional organization.
b. Hospitals
The regional general hospital is an organic unit of regional government that has the task
to implement health services, especially the curing of patients and rehabilitating
disabilities of body and mind. Service at the hospital is prioritized on referral service.
Hospital’s organizational structure is based on the type and class of service being offered
by the respective hospital.
This unit is formed according to need in order to implement one field of task in the
support of the principle task of its chief. The organizational structure of an UPT is
adjusted to organize pattern of UPT as determined by governmental regulation. One
example of UPT at the district level is the district/ municipal pharmaceutical warehouse
that is located in the circle of district/ municipal health office.
Health effort of the society/ private at district/ municipal level can be in the form of
hospital or other service unit. The organizational structure and work order of the private
health enterprise is arranged according to the prevailing regulation. Private hospital can
also be a network of foreign hospitals that has met the conditions for operation in
Indonesia.
According to the act number 22/ 1999 about Regional Government, the health
developmental implementation at the provincial level is the Provincial health Office that
holds two kinds of authority or task i.e.: (1) limited decentralization authority or task,
and (2) broad de-concentration authority or task. What is meant by the limited
decentralization authority or task is the implementation of health effort that can not be
handled by the society that is cross district/ municipal or still unable to be handled by
district/ municipal government or that is more effective and efficient if handled by the
provincial government.
In order to improve the organization at the central level is always based on development
in health effort and function that should be done. Development in the form of expansion
or retrenchment can occur in the main operating element such as at the level of
Directorate General, since the work volume and load of developmental task in health
sector is increasing or conversely decreasing due to merger. Development can also occur
at the element of assistant chief according to the addition of functions and efforts that
have to be done especially in the managerial fields.
The act number 22/ 1992 about health stipulates that health development is done by
government and society. The society should be turned into the prime actor of health
development, while government only acts as the companion. This means that only health
efforts that are still unhandleable by the society requires settlement by the government.
For efforts already manageable by society the government only acts as the cultivator,
supervisor and facilitator. The cultivating task is done through determination of national
policy standardization and regulation. Supervising task is done through licensing,
accreditation and safeguarding. While facilitative task is done through guidance and
control.
Abiding to the principle, then it can be decided that at the central level the main task of
the Ministry of Health is to cultivate supervision and facilitation of health development
through determination of national policy in health sector, standardization, and regulation
as well as coordination of licensing, accreditation, cultivation and control.
Actuation of Implementation
1. Government
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The realization of healthy society is one of the tasks and responsibilities of the
government, though it has not been realized yet by all the governmental apparatus. Many
of the various government’s institutions are less attentive to health efforts. Some of them
even give negative contribution to health, e.g. damage to the environment and ecosystem
due to agricultural and mining activities.
a. Young Generation
NGO is a strong potential and has a big role in the effort to make the society healthy. In
this respect, a directed cultivation is needed, among others, to manage the aspects of
participation and implementation of programs that touch the society. Now there are
many NGOs in the health sector, part of them have reliable workforce and strong network
to the regions.
3. Female Group
When viewed from social, economic and political aspects and by perceiving as well the
projected changes expected in the future, special cultivation to this group can not be
neglected. This matter has been not only a national concern but also an international
concern as well.
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In terms of planned changes, the potential of the female group is at the beginning only
being concentrated on family cultivation toward a healthy, wealthy life based on the
norm of family that is small, happy and wealthy. But as her position, role and
responsibility have been growing broader, this group is not only tied to the family life but
has also been expanded in terms of the working fields and social tasks in the society.
Hence, the management of female group needs the increasing intra health sectoral
coordination and between the health sector and other sectors.
The health profession occupies a strategic position in the society in thinking and
implementing health sector’s developmental programs. For that reason, the function of
health profession must be directed and cultivated by the government so they would
appreciate the significance of the vision and mission of health rows and then participate
actively in health development. Beside that they are expected to implement and co-
supervise their members so that they would do their tasks according to the professional
standards and do cultivation mainly in the aspect of professional ethics.
It is understandable that health effort in one side can be seen as a business that yields
profit, hence it draws the business community to enter it. The role of business
community tends to grow greater in the future, while on the other side the government’s
capacity becomes more limited, hence the government will become more selective in
funding health efforts, i.e. only limited to the ‘public goods’. While health efforts of
‘private goods’ nature that are supposed to yield profit will be given to the private/
business community. The demand for health sector that becomes increasingly
specialistic, sophisticated and practicing high quality is an opportunity for the business
community to participate in health development according to economic principles
without forgetting the social and ethical aspects.
The informal public figures (teachers, educators, scotts, religious figures, faith
cultivators, etc.) are a social group that can channel the public’s aspiration and they
preferably can motivate the society in health development. Beside that, the informal
public figures are also hoped to prepare young generation through educational institutions
that grow in the society so that they will become progressive leaders.
As the developmental potential are found much in the rural area, so the implementation
of rural community health development (PKMD) program needs improvement as an
integral part of the rural development. In this context, clarity and firmness are required
in the integrated cultivation implementation that covers among other things: types of
cadet to be formed, the role of helper puskesmas at rural area, and the role of health and
family planning section in Rural Community Tenacity Insitution (LKMD) in the
implementation of activities that nowadays are easily found in the rural areas such as the
under 5 years old cultivation post, posyandu and polindes.
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In order to increase the intra and inter-sectoral cooperation, there are several things need
attention regarding organization and motivation and public participation. To realize the
cooperation, the importance of coordination, integration and synchronization of activities
should be understood in terms of systemic approach and dynamic cooperation. Activity
integration will be operable and developed if the coordination is clear. In order to realize
a good coordination, communication between units based on transparent attitude is an
absolute requirement.
Intra and inter-sectoral communication system need to be improved so that it can open
wider opportunity for mutual knowledge of each other’s programs and reach concensus
on each role in the effort to formulate problem and its settlement effort. Arrangement of
various activities should be mutually supportive and the impacts can be felt by the society
as a whole.
In this respect matrices on the table can give an illustration of how important is the
support from various related sectors for the successful implementation of developmental
programs with health concerns for the ten most favored programs (see table next to this
page).
Table
Cultivation
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In order to implement this cultivation effort, in depth investigation and consideration are
needed, as related to the fact that health manpower is a man that needs fulfillment of
primary needs and self actualization. As to what is meant by cultivation in this respect is
the activity of giving direction about how to implement effort according to the rules and
is intended to get a unison of action in order to reach maximum effectiveness and
efficiency.
Supervision
1. The policy that needs to be acted in the area of supervision can be differentiated
into 5 groups as the following:
1) The policy of securing the supervisory system of state economy in order to
achieve efficiency in the state and developmental execution which is directed to
realize integrity and consistency in adhering supervision, functional supervision
and public supervision.
2) Supervision is needed in order to rectify governmental control and the
execution of development in general to prevent and to take action against
authority misuse, lavishness and leakage.
3) Supervision is expected to monitor the situation accurately so that an early
action can be taken, and hence opportunity can be grasped to overcome the newly
emerging problems.
4) Supervision is expected to be able to give information that is useful for
management or person in charge of a program, both for the current fiscal period
or for the next period.
5) Supervision is prioritized at improving efficiency of governance in general
and development.
In order to reach optimal supervisory result, then the supervisory target and scope
should be decided selectively based on accurate criteria, by focusing on programs
with large contribution to the realization of Healthy Indonesia 2010.
1) It should be able to give indications as a base for decision making that will
be done by Minister of Health.
2) It should present report with a constructive nuance and not a destructive
one.
3) It should be able to push public participation in development i.e. by
providing understanding through instruction about development that is executed
by the government and the role of supervision in the development.
2) Assessment to decide ability and main resources that can be used to develop
competitive strategy under the existing situation.
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3) To integrate the capability and resources that are special with specific chance within
the environment of the related institution.
5) To create several policies, plans, programs and principle tasks of the Department in
order to achieve the aims and targets that have been determined.
By considering the prevailing State Administrative System that is valid upon general
governmental and developmental administration, a performance measurement pattern that
is realized in the following consecutive steps can be used:
1) Definition of mission
An indicator is some thing that is made as a measure to know the success in the
implementation of a program. Hence indicators of a program are decided based on the
targets that want to be reached through the program. Based on the above matter, then
indicators of the health development that is intended to achieve Healthy Indonesia 2010
are measures of success that will be used for each of the following sectors:
1. Cross-sectoral cooperation
2. Autonomy of the public and private partnership
3. Healthy living behavior
4. Healthy environment
5. Health effort
6. Health developmental management
7. Health level
Closure
Closure
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Realizing that there are many factors affecting the execution of health development,
including the implementation of this Health Developmental Plan, then its execution can
be done through cross-sectoral and cross program approaches, as well as public the
empowerment toward Healthy Indonesia 2010. Beside that, it is realized that changes in
state administration, decentralization will strongly affect the implementation of health
development in the future. The availability of resources which experience contraction
due to the economic and political crises will also strongly affect the implementation of
programs that have been arranged. Even so, there is a common hope that this document
would be able to act as a base for the compilation of health developmental programs in
the provincial level and district/ municipal level in welcoming the decentralization era.
TABLE 1
INFANT MORTALITY RATE PER 1,000 LIVE BIRTHS
Source: Health Data Center, Health Profile year 1998.
TABLE 2
ESTIMATES OF LIFE EXPECTANCY DURING YEAR 1967-97
Source: Health Data Center, Health Profile year 1998.
TABLE 3
MATERNAL MORTALITY RATE PER 100,000 LIVE BIRTHS
Source: Health Data Center, Health Profile year 1998.
TABLE 4
THE UNDER-5 YEARS’ MORTALITY RATE PER 1,000 LIVE BIRTHS
Source: Health Data Center, Health Profile year 1998.
TABLE 5
CRUDE DEATH RATE PER 1,000 PEOPLE
Source: Health Data Center, Health Profile year 1998.
TABLE 6
THE PREVALENCE OF THE UNDER-5 YEARS SUFFERING FROM ENERGY
& PROTEIN MALNUTRITION
(Result of Nutritional Status Monitoring through Posyandu, 1994-1997)
Source: Health Data Center, Health Profile year 1998.
TABLE 7
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TABLE 8
RATIO OF TRAFFIC ACCIDENT VICTIM AND DEATH PER 100,000 PEOPLE,
1994-1997
blank: Victim
solid: Death
Source: Police Head quarter (1998)
TABLE 9
HEALTH FACILITIES
TABLE 10
HEALTH MANPOWER (1997)
Source: Planning bureau of the Health Dept. (Processed from data of CHS/ Dept. of
education & culture, Health manpower education center (Pusdiknakes), Personnel bureau
and Health Profile 1998)
TABLE 11
MEDICINES AND HEALTH INVENTORY (1997)
162 units
2 In 1996 there are recorded pharmaceutical industries that are
already able to produce finished products according to GMP
(‘CPOB’)
4 units
3 Generic drug production is done by: 60 units
- state owned corporates
- private pharmaceutical industries 678 units
TABLE 12
HEALTH FUNDING
TABLE 13.
MANPOWER REQUIREMENT –
ACCORDING TO THE KIND OF AND PRINCIPLE PROGRAM
TABLE 14
MANPOWER REQUIREMENT –
ACCORDING TO KIND AND PLACE OF DUTY
1. Specialist doctor
2. General practitioner
3. Nurse (S1/ scholar)
4. Nurse (D3/ 3 yrs diploma)
5. Assistant nurse (SPK)
6. Midwife (D3)
7. Midwife (D1)
8. Dentist
9. Dental nurse (D3)
10. Dental nurse
11. Dental technician (D3)
12. Public health scholar (S1/S2)
13. Sanitarian (D3)
14. Assistant sanitarian (D1)
15. Nutritionist (S1)
16. Nutritionist (D3)
17. Assistant nutritionist (D1)
18. Pharmacist
19. Assistant pharmacist
20. Analyst
21. Others
TOTAL
TABLE 15
PROJECTED REQUIREMENT FOR HEALTH MANPOWER
UPTO 2010 AND THE TREND OF HEALTH MANPOWER SUPPLY
PER ‘5 YEAR DEVELOPMENT’ (PELITA)
AND ITS PROJECTED SUPPLY UNTIL YEAR 2010
Appendices
Drug Supervision
6. Dr. Nardho Gunawan, MPH; Expert Staff of Minister
of Health in Environmental Health
7. Drg. Ibnu Effendi, DDPH; Expert staff of Minister of
Health in Organization and Institution
8. Dr. Brotowasisto, MPH; Consultant to Crisis Center
9. Dr. HR Hapsara, DPH; Consultant to Planning Bureau
10. Dr. Stephanus Indrajaya, PhD; Consultant to Planning
Bureau
11. Dr. Sofyan Mukti; Consultant to Planning Bureau
12. Representative of Bappenas
13. Representative of Department of Internal Affairs
14. Representative of Professional
15. Representative of Universities
16. Representative of Statistics Central Bureau
17. Representative of State Minister of Environmental
Health’s Office
18. Representative of Woman’s Role Office
Secretariat Team
Chief Dr. Gunawan Setiadi, MPH; Head of General Planning
Division
Secretary Drs. Teguh Budi Santoso; Head of Long- and
Intermediate-term Planning Compilation sub-Division
Technical 1. Dr. H. Setiawan Soeparan, MPH; Head of
Secretariat Developmental Program Planning and Compilation
Division
2. Dr. Bambang Sardjono, MPH; Head of
Developmental Program Planning and Compilation
Division
3. Drs. Johan Arief; Head of Health Resource Plan
Division
4. Mardiah Mawardi, MPH; Head of Evaluation &
Report Division
5. Drs. Abdurachman, MPH; Head of Program and
Report Compilation Division, Dir. Gen. of Community
Health
6. Dr. Ali Alkatiri, MSc; Head of Program and Report
Compilation Section, Dir. Gen. for Medical Care
7. Dr. H. Wan Alkadri, MSc; Head of Program and
Report Compilation Division, Dir. Gen. of Contagious
Disease Eradication and Settlement Environmental
Health
8. Farida Nurbaiti, SKM; Head of Program and Report
Compilation Division, Dir. Gen. of Food & Drug
Supervision
9. Drs. Tri Djoko Wahono; Program and Report
Compilation Division, Health Resource & Development
Body.
10. Dr. Tarufie Alhayas; Head of Program and Report
Compilation Division, Inspectorate General
11. Ir. Herwanti Bahar, MSc; Head of Health Technology
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