Health development is an effort to meet one of the people's basic rights, namely the right to obtain health services in accordance with the Constitution of 1945 Article 28 subsection H (1) and Law No. 23 of 1992 on Health. Health development should be viewed as an investment to improve the quality of human resources, among others measured by Human Development Index (HDI). In the measurement of HDI, health is one of the major components in addition to education and income. Health is also an investment to support economic development and has an important role in poverty reduction efforts. In the implementation of health development required a shift in perspective (mindset) from paradigm to paradigm ill health, in line with the vision of Healthy Indonesia 2010.
Indonesia has made significant progress in improving the quality of population health. Data Indonesia Demographic and Health Survey (IDHS) shows infant mortality rate decreased from 46 (IDHS 1997) to 35 per 1,000 live births (IDHS 2002-2003) and the maternal mortality rate decreased from 334 (IDHS 1997) to 307 per 100,000 live births (IDHS 2002-2003). Life expectancy increased from 65.8 years (NSES 1999) to 66.2 years (NSES 2003). According to Iodized Salt Consumption Survey which also includes the nutrition status survey, the prevalence of malnutrition (underweight) in children under five, has declined from 34.4 percent (1999) to 25.8 percent (2002). However, in an effort to improve quality health care, some problems and new challenges arise as a result of socio-economic changes and changes in the global strategic environment and national. Global challenges include the achievement of the Millennium Development Goals (MDGs), while the national scope of the implementation of decentralization in health.
A. PROBLEM
Disparity in health status. Although nationally the quality of public health has improved, but disparities in health status between socioeconomic level, between regions, between urban-rural and is still quite high. Infant mortality and child mortality in the poorest nearly four times higher than the richest group. In addition, infant mortality and maternal mortality is higher in rural areas, in eastern Indonesia, as well as on the population with low education levels. Percentage of children under five with the status of malnutrition and poor in rural areas is higher than urban areas. Aid deliveries by trained health personnel and poor immunization coverage is lower than the rich.
Double burden of disease. The pattern of disease suffered by the public is mostly a disease transmitted infections such as tuberculosis, acute respiratory infections (ARI), malaria, diarrhea, and skin diseases. However, at the same time an increase in non-communicable diseases such as heart and blood vessel disease, and diabetes mellitus and cancer. In addition Indonesia also face emerging diseases such as dengue hemorrhagic fever
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(DHF), HIV / AIDS, chikunguya, Severe Acute Respiratory Syndrome (SARS). Thus there has been an epidemiological transition that Indonesia is facing a double burden at the same time (double burdens). The occurrence of a double burden coupled with increasing population, as well as changes in population age structure is characterized by an increased population of productive age and old age, will affect the amount and type of community health services needed in the future.
Performance of health services is low. The main factors causing high infant mortality rate in Indonesia can be prevented by interventions that can be affordable and simple. Therefore, the performance of health services is one important factor in improving the quality of population health. The low performance of health services can be seen from several indicators, such as the proportion of delivery assistance by health workers, the proportion of infants who received measles immunization, and the proportion of case finding (Case Detection Rate) pulmonary tuberculosis. In 2002, deliveries by skilled health coverage only reaches 66.7 percent, with variations between 34.0 percent in Southeast Sulawesi Province and 97.1 percent in DKI Jakarta. In 2002, measles immunization coverage for children aged 12-23 months reached 71.6 percent, with variations between 44.1 percent in Banten Province and 91.1 percent in the State of IN Yogyakarta. While the proportion of patients with pulmonary tuberculosis case finding in 2002 only reached 29 percent.
Behavior of people who are less supportive of clean and healthy lifestyle. Behavior of clean and healthy community is one important factor to support the improvement of population health status. Unhealthy behaviors that society can be seen from the habit of smoking, low breast-feeding (breast milk) exclusive, the high prevalence of malnutrition and over nutrition among children under five, as well as the increasing trend of HIV / AIDS, people with abuse of narcotics, psychotropic substances, addictive substances ( drug) and deaths due to accidents. The proportion of adult residents who smoke by 31.8 percent. Meanwhile, the proportion of smokers who started smoking at age below 20 years increased from 60 percent (1995) to 68 percent (2001). In 2002, the percentage of infants aged 4-5 months who are exclusively breastfed only reached 13.9 percent. The percentage of malnutrition among children under five 25.8 percent (2002) while the more nutrient-reaching 2.8 percent (2003). People with AIDS in 2004 there were 2363 people with HIV and as many as 3338 people, while the patient due to drug abuse increased from about 44.5 thousand people (2002) to 52.5 thousand people (2003). Accidents including the top ten common causes of death, that is the cause-8 in 1995 and rose to the cause to-6 year 2001.
Poor environmental health conditions. One other important factors that affect the health of society is reflected in environmental conditions, among others from the community access to clean water and basic sanitation. In 2002, the percentage of households that have access to potable water for consumption only reaches 50 percent, and household access to basic sanitation only reaches 63.5 percent. Environmental health is a cross-sector activity has not been managed in a regional health system.
Low quality, equity and affordability of health services. In 2002, the average per 100,000 population will be served by health centers 3.5. In addition to a less amount, quality, equity and affordability of health services in health centers is still a constraint. In 2003 there were 1179 Hospitals (RS), consisting of 598 government-owned hospitals and 581 private hospitals. Total number of beds (TT) in the TT RS as much as 127,217 or an average of 61 TT serving 100,000 residents. Although there are hospitals in almost all districts / cities, but most of the hospital service quality in general is still under
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the standard. Referral health care is not optimal and has not met the expectations of society. People feel less satisfied with the quality of hospital services and clinics, because of the slow service, administrative difficulties and the long waiting time. Protection of the public in the field of medicine and food are still low. In the era of free trade, public health conditions increasingly vulnerable due to the increased possibility of consumption of drugs and foods that do not meet quality requirements and safety.
Lack of health workers and uneven distribution. Indonesia is experiencing shortages in almost all types of health workers is needed. In 2001, estimated per 100,000 population will be served by a general practitioner 7.7, 2.7 dentists, 3.0 specialist physicians, and 8.0 midwives. For public health personnel, per 100,000 residents served by the new Public Health Degree 0.5, 1.7 pharmacists, nutritionists 6.6, 0.1 and 4.7 power epidemiology sanitation workers (sanitarian). Many centers do not have doctors and public health personnel. This limitation is exacerbated by the distribution of health personnel are not evenly distributed. For example, more than two thirds of physicians are specialists in Java and Bali. Disparity ratio of general practitioners per 100,000 population among regions is still high and ranged from 2.3 to 28.0 in Lampung in Yogyakarta.
The low health status of the poor. Infant mortality in the poorest group was 61 compared to 17 per 1,000 live births in the richest. Infectious diseases are a leading cause of death in infants and young children, such as ARI, diarrhea, neonatal tetanus and birth complications, are more common in poor people. Another disease that affects many of the poor is a disease of tuberculosis, malaria and HIV / AIDS. The low health status of the poor mainly due to limited access to health services due to geographical constraints and cost constraints (cost barrier). 2002-2003 IDHS data indicate that the majority (48.7 percent) to get the health care problem is due to cost constraints, distance and transportation. Hospital utilization is still dominated by the group is able, while the poor tend to utilize services in health centers. Similarly, deliveries by health personnel in the poor, only 39.1 percent compared to 82.3 percent in the rich population. The poor have not been reached by the system security / health insurance. Health insurance as a form of social security systems reach only 18.74 percent (2001) residents, most of whom are civil servants and residents can afford. Although the Act of the National Social Security System (Social Security System) has been established, managed care experience in various areas indicate that the affordability of the poor to health services have not been sufficiently assured.
B. TARGET
Health development goals by the end of 2009 is the increased level of public health through increased community access to health services, among others, reflected in the indicators of impact (impact) are:
1. Increased life expectancy from 66.2 years to 70.6 years;
2. The decline in infant mortality from 35 to 26 per 1,000 live births;
3. The decline in maternal mortality from 307 to 226 per 100,000 live births; and
4. The reduced prevalence of malnutrition among children under five from 25.8 percent to 20.0 percent.
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C. POLICY DIRECTION
To achieve these goals, health development policy mainly focused on: (1) Increasing the number, the network and the quality of health centers, (2) Improving the quality and quantity of health, (3) Development of the health insurance system, especially for the poor, (4) Increased socialization environmental health and a healthy lifestyle, (5) Improvement in public health education from an early age, and (6) Equitable and improved quality of basic health facilities.
Development to prioritize health promotive and preventive efforts are combined in a balanced way with curative and rehabilitative efforts. Special attention is given to health care for the poor, disadvantaged areas and disaster areas, with attention to gender equality.
D. PROGRAM DEVELOPMENT
The policy direction in order to improve community health status is described in development programs as follows.
1. HEALTH PROMOTION PROGRAMS AND COMMUNITY EMPOWERMENT
The program is intended to empower individuals, families, and communities to be able to grow a healthy behavior and develop community-based health efforts.
The main activities undertaken in this program include the following:
1. Development of health promotion media and communication technology, information and education (CIE);
2. Development of community based health, (such as integrated health post, village kiosks, and business school health) and the younger generation, and
3. Improved health education to the community.
2. ENVIRONMENTAL HEALTH PROGRAM
This program is intended to realize the quality of living a healthier environment through the development of regional health systems to drive the development of cross-sector health-minded.
The main activities undertaken in this program include the following:
1. Provision of clean water and basic sanitation;
2. Maintenance and monitoring of environmental quality;
3. Controlling the impact of the risk of environmental pollution; and
4. Healthy development of the region.
3. PUBLIC HEALTH PROGRAM EFFORTS
This program is intended to increase the number, distribution, and quality of health services through health centers and their networks include health centers, health centers and midwives in the villages around.
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The main activities undertaken in this program include the following:
1. Poor health services in health centers and networks;
2. The provision, improvement, and improvement of infrastructure facilities and public health centers and networks;
3. Procurement of equipment and medical supplies including essential generic drugs;
4. Improved basic health services that include at least health promotion, maternal and child health, family planning, nutrition, environmental health, the eradication of infectious diseases, and basic treatment, and
5. Provision of operational and maintenance costs.
4. PERSONAL HEALTH PROGRAM EFFORTS
This program is intended to improve access, affordability and quality of personal health services.
The main activities undertaken in this program include the following:
1. Health services for the poor in third class hospitals;
2. Construction of infrastructure facilities and hospitals in underdeveloped regions selectively;
3. Repair facilities and infrastructure hospital;
4. Procurement of medicines and hospital supplies;
5. Improved health services referral;
6. Development of family doctor services;
7. Provision of operational and maintenance costs, and
8. Increased private sector participation in individual health efforts.
5. DISEASE PREVENTION AND ERADICATION PROGRAM
The program is intended to reduce morbidity, mortality and disability due to infectious diseases and noninfectious diseases. Priority will be addressed infectious diseases are malaria, dengue fever, diarrhea, polio, filaria, leprosy, tuberculosis, HIV / AIDS, pneumonia, and diseases preventable by immunization. Priority non-communicable diseases are dealt with are heart disease and circulatory disorders, diabetes mellitus, and cancer.
The main activities undertaken in this program include the following:
1. Prevention and control of risk factors;
2. Increased immunization;
3. Discovery and management of the patient;
4. Improved epidemiological surveillance and outbreak response; and
5. Improved communication, information and education (CIE) prevention and eradication of disease.
6. COMMUNITY NUTRITION PROGRAM IMPROVEMENT
This program is intended to improve family nutrition awareness in an effort to improve the nutritional status of the community, especially in pregnant women, infants and toddlers.
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The main activities undertaken in this program include the following:
1. Improved nutrition education;
2. Reduction of protein energy (PEM), iron anemia, disturbances due to lack of iodine (IDD), lack of vitamin A and other micronutrient deficiencies;
3. More nutrition countermeasures;
4. Improved nutrition surveillance; and
5. Empowering communities to achieve nutrition conscious families.
7. HEALTH RESOURCES PROGRAM
This program is intended to increase the quantity, quality and distribution of health personnel, in accordance with the needs of health development.
The main activities undertaken in this program include the following:
1. Planning needs of health personnel;
2. Increasing the skills and professionalism of health workers through education and training of health personnel;
3. Meeting the needs of health personnel, particularly for health services in health centers and their networks, as well as hospital districts / cities;
4. Health personnel including coaching career development of health personnel; and
5. Competency standard setting and regulation of health professions.
8. PROGRAM medicines and health
The program is intended to ensure the availability, equity, quality, affordability of medicines and medical supplies including traditional medicines, household health supplies, and cosmetics.
The main activities undertaken in this program include the following:
1. Increased availability of drugs and medical supplies;
2. Increased distribution of drugs and medical supplies;
3. Improving the quality use of medicines and health supplies;
4. Increased affordability of medicines and medical supplies especially for the poor; and
5. Improved quality of service the community and hospital pharmacy.
9. FOOD AND DRUG CONTROL PROGRAM
The program is intended to ensure the fulfillment of the requirements of quality, safety and usefulness / efficacy of therapeutic products / medicines, medical supplies households, traditional medicines, cosmetics, food products and products of complement in order to protect consumer / community.
The main activities undertaken in this program include the following:
1. Increased oversight of food safety and hazardous materials;
2. Increased supervision of substance abuse, psychotropic drugs, the addictive substance (drug);
3. Improved quality control, efficacy and safety of therapeutic products / medicines, medical supplies households, traditional medicines, food supplements and cosmetics products, and
4. Strengthening the capacity of drug and food control laboratories.
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10. ORIGINAL DRUG DEVELOPMENT PROGRAM INDONESIA
This program is intended to improve the utilization of medicinal plants in Indonesia.
The main activities undertaken in this program include the following:
1. Research and development of medicinal plants;
2. Increased promotion of the utilization of natural medicine Indonesia; and
3. Development of standardization of medicinal plants of Indonesia's natural ingredients.
11. PROGRAM FOR HEALTH POLICY AND MANAGEMENT DEVELOPMENT
The program is aimed at developing health policy and development management for supporting the implementation of national health systems.
The main activities undertaken in the program include the following:
1. Assessment and policy formulation;
2. Development planning and budgeting, implementation and control, monitoring and improvement of financial administration, and health law;
3. Development of health information systems;
4. Development of regional health systems, and
5. Improved community health financing in capitation and pre efforts especially for the poor sustainability.
12. HEALTH RESEARCH AND DEVELOPMENT PROGRAM
This program is intended to enhance research and development of science and technology as inputs in the formulation of health policy and health development programs.
The main activities undertaken in this program include the following:
1. Research and development;
2. Development of researchers, research facilities and infrastructure; and
3. Dissemination and utilization of health research and development.
