Primary health care in indonesia challenges and opportunities
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Primary Health Care in Indonesia: Challenges and Opportunities. Prof. Dr. dr. Akmal Taher Directorate General of Health Services Ministry of Health Indonesia. Indonesia is an archipelagic nation containing over 18,000 islands. Number of Population: 259.940.857

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Primary Health Care in Indonesia: Challenges and Opportunities

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Primary health care in indonesia challenges and opportunities

Primary Health Care in Indonesia:Challenges and Opportunities

Prof. Dr. dr. Akmal Taher

Directorate General of Health Services

Ministry of Health

Indonesia


Primary health care in indonesia challenges and opportunities

Indonesia is an archipelagic nation containing over 18,000 islands.

Number of Population: 259.940.857

Land Sizes: 1,904,569 km2

Number of Provinces: 34 Provinces

Number of Districts: 497 Districts

Number of Community Health Centers: 9655 Puskesmas


Public health center as the back bone of primary health care

Public Health Center as the Back Bone of Primary Health Care

  • Program started early 1970s, mandated by Presidential Decree

  • Working unit at subdistric level and responsible for that area

  • One PHC for 30.000 to 100.000 people

  • More than 9500 PHC in all over Indonesia

  • Large variations in geographic accessability

    • Remote interior

    • Isolated island


Public health services program

Public Health Services Program

  • Stimulate and supervise community based health services

  • Managing preventive health services

  • Managing basic medical care affordable for all

  • Coordination and collaboration with other sector in distric and subdistric level

    • Ministry of Education

    • Minsitry of Social Affair


Primary health care in indonesia challenges and opportunities

Program in Public Health Center

Generic Health Program

Local-specific Program

Essential Health Services

Health services to overcome specific problem ie, yodium deficiency, diabetic, geriatry

Mpther & child

Nutrition

Sanitation

Communicable disease control (+ NCD)

Health promotion

Basic medical & emergency care


Primary health care in indonesia challenges and opportunities

KONDISI KETENAGAAN DI FASYANKES PRIMER

Percentage of Public Health Center (CHC) with

Number of Doctor below Standard

32,86% of 9.510 PHC with number of doctor < standard

14,7% of PHC without doctor


Proportion of good washing hand behavior by province 2007 2013

Proportion of Good Washing Hand Behavior*) ,by Province 2007-2013

*) bila cuci tangan pakai sabun sebelum menyiapkan makanan, setiapkali tangan kotor (memegang uang, binatang dan berkebun),setelah buang air besar, setelah menceboki bayi/anak, dan setelah menggunakan pestisida/insektisida, sebelum menyusui bayi.sebelum makan, dan setelah memegang unggas/binatang


Proportion o f married women of 15 49 years old in family planning program 2010 2013

Proportion of Married Women of 15-49 years old in Family Planning Program, 2010-2013


Ante natal care 2010 2013

Ante Natal Care, 2010-2013*

* Periode3 tahunterakhir


Proportion of anemia during pregnancy in urban rural area 2013

Proportion of Anemia during Pregnancy in Urban & Rural Area, 2013

*) NilairujukanmenurutWHO/MNH/NHD/MNN/11.1,2011 danKemenkes,1999

**) Cut off points anemia IbuHamil, Hb < 11,0 g/dl


Proportion of deliveries attended by skilled health personal 1 2010 2 2013 3

Proportion of Deliveries Attended by Skilled Health Personal 1, 20102-20133

  • Drkandungan, drumumdanbidan

  • Periode 3 tahunterakhir, penolongterakhir

  • Periode 3 tahunterakhir, jika > 1 penolongdipilihkualifikasitertinggi


Proportion of births in health facilities by province 2013

Proportion of Births in Health Facilities by Province, 2013*

*) Kelahiran Periode 1 Januari 2010 - wawancara


Proportion of household using traditional medicine 2013

Proportion of Household Using Traditional Medicine, 2013


Proportion of household know the community based health program by province 2013

Proportion of Household Know the Communitybased Health Program* by Province, 2013

* The activity mainly preventive and promotive, ie,

education, under five year children


The prevalence of diabetes mellitus by province 2007 2013

The Prevalence of Diabetes Mellitus by Province, 2007-2013

*) Diabetes Melitus (DM) responden 15+ berdasarkanwawancaramenurut diagnosis dokterdangejala


Key challenges of primary health care governance in indonesia

Key Challenges of Primary Health Care Governance in Indonesia

  • Decentralization, which implemented since 2001, affect

    • Health financing and integrated planning

    • Health information systtem difficulty to develop strategies and monitor health program in provinces and distric level

    • Human resources for health and service provision

  • Low level of health financing (2-2,3% of total gov budget)

    • Compare to other nation

    • Compare to allocation for hospital (curative more than preventive)

  • Maldistribution of medical doctors

    • no obligatory government services program

    • Not enougfh insentives to work in remote area


Primary health care in indonesia challenges and opportunities

  • Quality and competency of medical doctor working in primary health care

    • No formal education after graduation

    • Temporary job

    • Working in primary care is not a “carrier”

  • Many Public Health Centers more focus on curative program instead of promotive and preventive.

    • Fee for services

    • More income


Strategic action

Strategic Action

  • Amendment of The Act of Local Government

    • Clear authority and responsibility between Central Government, Province, and Distric in providing Health services and resources

  • Increase the quality of medical doctor working in primary care

    • Primary Care Physician

    • 2-3 years training post graduate

    • More competency, more salary, and more attractive

  • Universal Health Coverage

    • National Social Health Insurance


National social health insurance jkn

National Social Health Insurance (JKN)

Insurance body (single payer)

Government

Standardization of health care delivery

Standardization of medicine, equipment, etc

Regulator

Contribution

Contract

Payment

Claims

Complain management

Regulation on tariff

Delivery of service

Members

Healthcare providers

utilization of service

19


Primary health care in indonesia challenges and opportunities

Roadmap To UHC

86,4 mio PBI

Activities:

Transformation, Integration, Expansion

111,6mio covered by BPJS Keesehatan

257,5 mio (all Indonesian people) covered by national insurance scheme

Coverage of various existing schemes148,2mio

60,07 mio covered by other schemes

Uninsured people 90,4mio

Level of satisfaction 85%

73,8 mio uninsured people

Transformation from 4 existing schemes to national insurance scheme

(employee, poor people, civil servants ,army/police scheme)

Integration of local government insurance scheme into national social insurance and regulation of commercial insurance industry

Presidential decree on operational support for Army/Police

membership transfer of army/police scheme toBPJS Kesehatan

Procedure setting on membership and contribution

Company mapping and socialization

Membership expansion to big, middle, small and micro enterprises

B

M

S

Synchronization membership data: JPK Jamsostek, Jamkesmas dan Askes PNS/Sosial – single identity number

Consumer satisfaction measurement every 6 month

20

Benefit package and sevices review annually


Referral system national f ormulary

Referral System & National Formulary

tertiary

National formulary

923 items

secondary

Primary care

Gate keeper

155 disease/symptoms

should be resolved in

primary care

community


Primary health care in indonesia challenges and opportunities

PUBLIC GOODS AND PRIVATE GOODS IN PRIMARY HEALTH CARE

Medical Care

Public Health

Program at national level

National Social Health Insurance

  • Family planning and prevention of complications of delivery/labor

  • Community based health services

  • Integrated health service Center

  • HIVScreening

  • Malariaprevention

  • TB Dots

  • Vaccine for basic immunization

  • Basic contraception methods

Medical care in primary health care facilities

(capitation fee)

Public Insurance Body

FUNDED BY GOVERNMENT


Primary health care in indonesia challenges and opportunities

Provider Payment Mechanism

KEMENKES

Primary care

Capitation (per member per month)

0.3 – 0.6 USD (Urban and semi urban)

0.8 – 1.0USD (Remote)

Other mechanism (non capitation)

Payment Mechanism

Secondary and Tertiary Care

BPJS KES

INA-CBG’s (casemix)


Primary health care in indonesia challenges and opportunities

PUBLIC &PRIVATE GOODS IN PRIMARY HEALTH CARE

Medical Care

Public Health

Program at national level

National Social Health Insurance

  • Family planning and prevention of complications of delivery/labor

  • Community based health services

  • Integrated health service Center

  • HIVScreening

  • Malariaprevention

  • TB Dots

  • Vaccine for basic immunization

  • Basic contraception methods

Medical care in primary health care facilities

(capitation fee)

Public Insurance Body

FUNDED BY GOVERNMENT


Visits and referral in primary care january february 2014

Visits and Referral in Primary CareJanuary-February 2014

Utilization rate : 12%

Sumber Data BPJS Kes, 2014


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