THE FUTURE OF HEALTH CARE IN INDONESIA

1
THE FUTURE OF HEALTH CARE IN INDONESIA

• Azrul Azwar
• Director-General for Community Health,
• Ministry of Health, Republic of Indonesia

2
GEOGRAPHY

• Indonesia is the largest archipelago country in
  the world
• Extending between two continents, Asia to the
  North and Australia to the South, and between two
  oceans, the Indian to the West and the Pacific to
  the East
• The distance from the westernmost point to the
  easternmost point is 3,200 miles, and from the
  north to the south is 1,100 miles

3
ADMINISTRATIVE DIVISIONS

• Number of Provinces
  30
• Number of Districts
  268
• Number of Municipalities
  73
• Number of Sub Districts 4,085
• Number of Villages
  66,946

4

SOCIAL ECONOMIC CONDITIONS

• Total population 2001 (millions)
  214
• Rate of population increase 1991-2001 ()
  1.5
• People living in rural areas 2000 ()
  57.7
• Ethnic groups
  300
• Religious Moslem ()
  90.0
• Literacy rate 2000 ()
  89.8
• Primary school enrolment rate 2001 ()
  92.9
• GNP per capita (US)
• - before economic crisis
  (1997) 1,124
• - after economic crisis
  (2000) 647.7

5
HEALTH SITUATION KEY INDICATORS

• IMR per 1000 live births
  34.4
• Under-five mortality rate per 1000 children
  49.0
• MMR per 100,000 live births
  373.0
• CDR per 1000 population
  7.2
• Life expectancy (years)
• -male
  64.4
• -female
  67.4
• Low birth weight per 100 live births
  14.0
  
• Protein calorie deficiency per 100 under-five
  30.0
• Clean water supply per 100 population
  75.0
• Latrines per 100 population
  61.0
• EPI coverage ()
  93.6
• 
  (National Health
  Survey 2001)

6
TEN LEADING DISEASES

• Diseases of the teeth, mouth and GIT
  61/100 pop
• Refraction eye diseases
  31/100 pop
• Acute Resp Tract infection
  24/100 pop
• Anemia
  20/100 pop
• Diseases of the GI tract
  15/100 pop
• Other eye diseases
  13/100 pop
• Diseases of the skin
  13/100 pop
• Hypertension
  11/100 pop
• Diseases of the joints
  11/100 pop
• Chronic Resp Tract infection
  10/100 pop
• 
  (National Health Survey 2001)
  

7
CAUSES OF DEATH

• INFANT
• Perinatal disorder
  34.7
• Respiratory disorder
  27.6
• Diarrhea
  9.4
• GI tract disorder
  4.3
• Tetanus
  3.4
• Nervous disorder
  3.2
• Unknown
  4.1
• 
  (National Health Survey, 2001)

8
CAUSES OF DEATH

• ALL
• Circulatory disorder
  26.4
• Respiratory disorder
  12.7
• TB
  9.4
• GI Tract disorder
  7.0
• Neoplasm
  6.0
• Accident
  5.6
• Perinatal disorder
  4.9
• Typhoid
  4.3
• Diarrhea
  3.8
• Endocrine and metabolic
  2.7
• 
  (National Health Survey, 2001)

9
VISION

• Healthy Indonesia 2010
• In 2010, the people of Indonesia will be
  living a healthy lifestyle and in a healthy
  environment will have the ability to access
  quality and equitable health care services and
  will enjoy an optimal health status

10
Healthy Lifestyle
Healthy Environ- ment
Access to to quality and equitable health
services
Enjoy optimal health status
11
VARIABLES INDICATORS

• Healthy life style
• Exercises
• No smoking
• No alcohol
• Etc

• Healthy environment
• Clean water
• Healthy housing
• Good waste disposal system
• Etc

• Access to health services
• Immunization
• Ante natal care
• Family planning service
• Etc

• Health status
• IMR
• U-5 MR
• MMR
• Etc

12
MISSION

• Provide leadership for health-oriented national
  development
• Promote community self-reliance in achieving good
  health
• Maintain and enhance the quality, equitability,
  and affordability of health services
• Maintain and enhance the health of the
  individual, family and community, as well as the
  environment

13
STRATEGY

• Promote healthy public policies
• Increase the professionalism of health man-power
• Develop and implement pre-paid Healthcare
  Financing Program
• Decentralization of health system and management
• People empowerment

14
PROGRAM AREAS

• Health promotion and Healthy lifestyle
• Environmental Health
• Health Care Services
• Control of food safety, toxic substances and
  drug
• Health resources
• Health Policies, Leadership Management
• Health Sciences and Technology and Health
  Researches

40 Health Programs
10 Priority Programs
15
PRIORITY

• Health policies, laws, and financing
• Family nutrition
• CDC, including immunization
• Healthy life-style and mental health
• Safe healthy housing conditions, clean water
  reduced air pollution
• Family and reproductive health, and family
  planning
• Occupational safety and health
• Control of use of tobacco, alcohol, and narcotics
• Control of food safety, toxic substances, and
  drugs
• Prevention of injuries, including traffic-related
  injuries

16
HEALTHY PARADIGM

• The implementation of health development program
  in Indonesia is put under a new paradigm
• This new paradigm is called the Healthy Paradigm,
  a sifting from the 15 old health determinants to
  15 new health determinants

17
THE PARADIGM SHIFT

• OLD
• Consumption
• Margin of development
• Need demand
• Centralized
• Top-down
• Fragmented
• Short term
• Curative
• Disease
• Medical care
• Participation
• Fee for-service
• Subsidy
• Public
• Bureaucratic

• NEW
• Investment
• Center of development
• Human right
• Decentralized
• Bottom-up
• Integrated
• Long term
• Preventive
• Market segment
• Health care
• Partnership
• Prepayment
• Subsidy User charge
• Public Private Mix
• Entrepreneurship

18
HEALTH CARE SYSTEM

• Health care system in Indonesia is divided into
  two main sub-systems
• Public health care sub-system
• Responsible to provide comprehensive public
  health services that emphasize promotive and
  preventive services
• Medical care sub-system
• Responsible to provide comprehensive medical
  services that focus more on curative and
  rehabilitative services

19
THE PUBLIC HEALTH CARE SUB-SYSTEM

• Public health care sub-system in Indonesia is
  dominated by the government and divided into
  three levels of services
• Primary level responsible institutions are the
  Community Health Center, supported by Sub CHC and
  Mobile CHC. All of these primary health
  facilities are located at all sub district
• Secondary level responsible institutions are
  the District/Township Health Offices which are
  located at all district/ municipality
• Tertiary level responsible institutions are the
  Provincial Health Offices which are located at
  all province

20
THE PUBLIC HEALTH CARE SUB-SYSTEM

• The implementation of public health program in
  Indonesia encourages active and effective
  community participation. Types of community based
  health institution available include
• Integrated Service Post (Posyandu)
• Maternity Huts ( Polindes)
• Drug Post (Pos Obat)

21
NUMBER OF PUBLIC HEALTH FACILITIES

• Primary level
• CHC 6,954
• Sub-CHC 19,977
• Mobile CHC 6,024
• Secondary level
• District/Township Health Office
  341
• Tertiary level
• Provincial Health Office 30
• (Ministry of Health, 2003)

22
NUMBER OF COMMUNITY BASED HEALTH FACILITIES

• Integrated service posts 244,032
• Maternity posts
  12,377
• Drug Posts
  11,474

23
THE MECICAL CARE SUB-SYSTEM

• The medical care sub-system in Indonesia is
  implemented both by government and private
  sectors, divided into three levels of services
• Primary level
• Responsible institutions for the government are
  the Community Health Center, supported by Sub CHC
  and Mobile CHC. All of these primary health
  facilities are located at all sub district
• Responsible institutions for the private sector
  vary but included private midwifes, private
  medical doctors, Polyclinics, MCH Clinics, etc

24
THE MECICAL CARE SUB-SYSTEM

• Secondary level
• Responsible institutions for the government are
  district/municipality hospitals that are owned by
  government and located at all districts/
  municipalities
• Responsible institutions for the private sector
  are specialist clinics and private hospitals
  managed both by profit and not-for-profit
  organizations
• Tertiary level
• Responsible institutions for the government are
  provincial hospitals that are owned by the
  government and located at all province
• Responsible institutions for the private sector
  are private hospitals managed both by profit and
  not-for-profit organizations

25
NUMBER OF MEDICAL CARE FACILITIES - GOVERNMENT

• Primary level (2002)
• Community Health Centers (CHC) 6,954
• Sub-CHCs 19,977
• Mobile CHCs 6,024
• Secondary/Tertiary level (2001)
• Hospital (2001)
  598
• General hospitals
  524
• Specific/Mental hospitals 74

26
NUMBER OF MEDICAL CARE FACILITIES - PRIVATE

• Primary level
• Private midwifes
  50.000 (est)
• Private medical doctors
  30.000 (est)
• Polyclinics
  6,820 (est)
• MCH clinics
  3,410 (est)
• Secondary/Tertiary level
• Specialist Medical Practitioners/Clinics
  8,000 (est)
• Hospitals (2001) 580
• General hospitals
  411
• Specific/Mental hospitals
  169

27
NUMBER OF HOSPITALS

• Ownership of hospitals
• Government (beds) 598
  (81,095)
• Central/regional 417 (63,282)
• Military/Police 111 (10,977)
• State Owned Enterprises 70 (
  6,839)
• Private
  580 (47,189)
• 
  
• Total 1,178 (128,284)

28
NUMBER OF HOSPITALS

• Type of hospitals
• General hospitals (beds) 935 (109,984)
• Mental hospitals 50 (7,824)
• Leprosy hospitals 23 (2,359)
• TB hospitals 9 (711)
• Eye hospitals 10 (446)
• Maternity hospitals 53 (2,361)
• Others 108 (5,081)
• 
  Total 1,178 (128,284)

29
HEALTH FINANCING

• Total health expenditure is still very low. It is
  estimated to be only 1,4 of the GNP
• government 30
• community 70
• 80 out of pocket
• 20 health insurance
• A national health insurance program is still not
  yet available. Compulsory health insurance is
  available only for civil servant and private
  employees working at bigger private enterprises

30
THE FUTURE OF HEALTH CARE

• Factors influencing
• Fast development of health science and technology
• More educated and better socio-economic status of
  the people
• Strong role of NGOs and civil society
• Improving role of the private sectors
• Decentralized government
• Free market system (Globalization Era)

31
THE FUTURE OF HEALTH CARE

• Trends in the future
• The role of government will be more focused on
  public health services
• Medical care services will be provided mainly by
  the private sector
• Foreign investment in health will rapidly
  increased, both in the pharmaceutical and the
  medical industries
• A National Health Insurance Program will be
  implemented nation-wide. Premiums for the poor
  will be paid by the government

32
Thank You