human rights and social welfare Studi Kasus : HAK ATAS JAMINAN SOSIAL DAN HAK ATAS KESEHATAN

1. human rights and social welfareStudi Kasus :HAK ATAS JAMINAN SOSIAL DAN HAK ATAS KESEHATAN Heru Susetyo, SH. LL.M. M.Si.

2. Sejak Januari hingga Maret 2008 sebanyak 5 orang di Rote Ndao, NTT meninggal dunia karena busung lapar. Sumber-sumber kehidupan masyarakat setempat tidak lagi berproduksi, dan daya beli masyarakat tidak ada sama sekali. Kelimanya meninggal di Rumah Sakit Umum Daerah Rote Ndao. Belum termasuk yang meninggal di Puskesmas atau keluarga.Pasien gizi buruk yang sedang dirawat di rumah sakit setempat sebanyak delapan orang. Sementara itu selama 2007 sebanyak 17 anak Balita meninggal dunia case

3. SITUASI KESEHATAN INDONESIA • Jumlah Puskesmas (2005) 7669 unit • Rasio : 3.46 – 3.56 per 100.000 penduduk • (setiap 100.000 penduduk dilayani oleh 4 unit Puskesmas) • Jumlah Rumah Sakit (Umum dan Khusus) pada tahun 2005 : 1268 unit • Pada tahun 2000 – 2005 rasi tempat tidur RS per 100.000 penduduk relatif berkisar antara 61 – 62 per 100.000 penduduk

4. SITUASI KESEHATAN INDONESIA (2) • Jumlah penduduk Indonesia tahun 2010 diperkirakan 236 juta jiwa • Untuk mencapai Indonesia Sehat 2010 diperkirakan kebutuhan tenaga kesehatan sebanyak 1.000.338 jiwa

5. SDM Kesehatan • Provinsi dengan Jumlah SDM Kesehatan terendah tahun 2005 : • Gorontalo (258 orang) • Maluku Utara (351 orang) • Bangka Belitung (521 orang) • Berdasarkan profesinya jumlah tenaga kesehatan yang bekerja di RS per 2005 adalah 159.999 dengan komposisi perawat 105.563 jiwa dan dokter 25.941 jiwa

6. Pembiayaan Kesehatan oleh Pemerintah Alokasi Anggaran tahun 2005 (rutin, pembangunan) Depkes Rp 10.67 trilyun dan realisasinya sebesr Rp 6.52 trilyun

7. Pembiayaan Kesehatan oleh Masyarakat • Persentase Kepersertaan Jaminan Pemeliharaan Kesehatan tahun 2005 • Kartu Sehat 27.7 % • Askes 6.7 % • Jamsostek 2.08% • Dana sehat 1.92% • JPKM 0.95% • Lain-lain 2.51%

8. Penyebab kematian di middle income countries • Stroke and other cerebrovascular disease • Coronary heart disease • Chronic obstructive pulmonary disease • Lower respiratory infectrion • HIV/ AIDS • Perinatal conditions • Stomach cancer • Trachea, bronchus, lung, cancers • Road traffic accidents • Hypertensive heart disease

9. Low income countries • Coronary heart disease • Lower respiratory infections • HIV/ AIDS • Perinatal conditions • Stroke and other cerebrovascular diseases • Diarrhoeal diseases • Malaria • TBC • Chronic obstructive pulmonary disease • Road traffic accidents

10. Article 22 UDHR • Article 22 Everyone, as a member of society, has the right to social security and is entitled to realization, through national effort and international co-operation and in accordance with the organization and resources of each State, of the economic, social and cultural rights indispensable for his dignity and the free development of his personality.

11. Perbandingan Pembiayaan Kesehatan di ASEAN (2003)

12. Article 25 UDHR Article 25 • Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control. 2. Motherhood and childhood are entitled to special care and assistance. All children, whether born in or out of wedlock, shall enjoy the same social protection.

13. Article 9 ICESCR (ratified by UU No. 11/ 2005) Article 9 • The States Parties to the present Covenant recognize the right of everyone to social security, including social insurance.

14. AArticle 9 ICESCR (ratified by UU No. 11/ 2005) Article 12 • The States Parties to the present Covenant recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. 2. The steps to be taken by the States Parties to the present Covenant to achieve the full realization of this right shall include those necessary for: (a) The provision for the reduction of the stillbirth-rate and of infant mortality and for the healthy development of the child; (b) The improvement of all aspects of environmental and industrial hygiene; (c) The prevention, treatment and control of epidemic, endemic, occupational and other diseases; (d) The creation of conditions which would assure to all medical service and medical attention in the event of sickness.

15. UU No. 39 tahun 1999 • Pasal 41(1)     Setiap warga negara berhak atas jaminan social yang dibutuhkan untuk hidup layak serta untuk perkembangan pribadinya secara utuh.(2)     Setiap penyandang cacat, orang yang berusia lanjut, wanita hamil, dan anak-anak, berhak memperoleh kemudahan dan perlakuan khusus.Pasal 42Setiap warga negara yang berusia lanjut, cacat fisik dan atau cacat mental berhak memperoleh perawatan, pendidikan, pelatihan, dan bantuan khusus atas biaya negara, untuk menjamin kehidupan yang layak sesuai dengan martabat kemanusiaannya, meningkatkan rasa percaya diri, dan kemampuan berpartisipasi dalam kehidupan bermasyarakat, berbangsa, dan bernegara.

16. TIGA GENERASI HAK ASASI MANUSIA

17. TIGA GENERASI HAK ASASI MANUSIA (2)

18. Kewajiban Negara terhadap HAM • Amnesty International (2007) mentioned that the State’s obligations are derived from four key principles : • Equality and non-discrimination, which require the State to take measures to prevent discrimination including taking affirmative measures; • Indivisibility and interdependence of rights; • Accountability; • Participation, which requires that policies must be devised, implemented and monitored in a manner that allows for popular participation.

19. Kewajiban Negara terhadap HAM (2) • Obligation to Respect; In the context of delivering essential services, the duty to respect means that the State is responsible for ensuring the enjoyment of human rights relevant to the concerned service. • Obligation to Protect; The State has an obligation to protect citizens from human rights violations. The duty to protect requires that vulnerable groups be given special protection. • Obligations to Fulfill and to Promote; The State’s duty to fulfill includes the duty to promote, essential to ensuring effective public participation and access to information. The obligation to fulfill requires the adoption of positive measures that enable and assist individuals and communities to enjoy their rights. Additionally, there is an obligation to provide the right when individuals or groupsare unable to realize the right by their own means.

20. Paradigma Kesejahteraan Sosial • Titmuss suggested three models of social policy for the provision of social welfare : • The residual welfare model asserts that social welfare institutions come into play only temporarily when the institutions of family and the private market fail. • The industrial achievement-performance model says that social needs should be met on the basis of merit, work, and productivity. • The institutional redistributive model calls for universal services to be provided outside the market and on the basis of need. (Iatridis, 1994).

21. Paradigma Kesejahteraan Sosial (2) • Residual paradigm views that the state responsible only in the last resort of social welfare system or so called `minimalist` system. This system applies only when other systems (market, family system, etc) have failed in meeting individual needs. • Institutional paradigm or Institutional welfare model is developed by consensual values between state and the people. Conformity is met by social integration process not only rely on individual choices. • Developmental paradigm, on the other hand, is a social welfare system based largely on social justice or democratic socialist perspective which strongly emphasizes social justice and equality. The role of the state, in this paradigm, is very strong and proactive, and therefore lies as antitheses of residual paradigm which tends to be reactive (Adi, 2006).

22. Social Security/ Jaminan Sosial • Danny Pieters (2006) defines social security as : the compilation of benefits in cash and in kind, including services, granted to some persons. The arrangement as granting protection against the insecurity resulting from the risks related to the ascent of the industrial society and its development or, in short, against social risk. • Sinfield (2006) defines social security as a situation of complete protection against the loss of resources while Berghman (2006) perceives it as a situation of complete protection against human damage.

23. Hak Atas Jaminan Sosial • The right to social security is recognized, since the end of the Second World War, as a basic human right. Nobody doubts its fundamental importance. Social security is one of the greatest achievements of modern society, even if it is certainly not fully available to every human being on this planet. For those who have access to it, social security means freedom. • (Langendonck & Put).

24. Hak Jaminan Sosial seperti apa? • What should social security offer? Most people will agree on the following: • it has to provide an income to those who are deprived of it; it has to guarantee a replacement income to those who are temporarily out of employment; • it has to provide suitable employment or a replacement income for those who have permanently lost their employment; • it has to offer possibilities of social integration to those who are handicapped; and • it should provide the necessary care for those who cannot lead an independent life. These must be the benefits to be provided by social security in present-day society. (Langendonck & Put).

25. Social security has to : • offer every person sufficient resources for a living according to human dignity, including health care; • offer workers (employed and self-employed) replacement incomes at the end of their working life, or when their earnings are interrupted because of sickness, accident, maternity, invalidity or unemployment; • contribute to social integration of all residents and to integration of all potential workers into the labor market (Langendonck & Put).

26. Social security systems in many developed countries consist of a combination of two major programs: social insurance and social assistance. Characteristics of social insurance programs arethey are financed by contributions, they generate "earned" benefits for work­ers and their families, and they provide for various contingencies that interrupt or stop earnings (such as illness, old age, maternity and unem­ployment). On the other hand, characteristics of social assistance pro­grams arethey are non-contributory and met from general revenues; they are designed to supplement the incomes of particularly vulnerable groups (elderly and dis­abled).  In some countries they provide a "safety net" for those who are not able to access social insurance bene­fits. The benefits and eligibility conditions vary from country to country.  The benefits may be either in cash or in-kind in the form of food aid.  The schemes include "income replace­ment schemes" or "cost compensation schemes" that provide complete or partial com­pensation for family care, health care, funeral costs, etc (University of Minnesota Training Module, 2008).