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Sutopo HKN 2011

Sutopo HKN 2011

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TANTANGAN PENGEMBANGAN TENAGA KESEHATAN DI INDONESIA

Sutopo Patria Jati FKM UNDIP

Siapa tenaga kesehatan ?
‡ Tenaga kesehatan adalah setiap orang yang mengabdikan diri dalam bidang kesehatan serta memiliki pengetahuan dan/atau keterampilan melalui pendidikan di bidang kesehatan yang untuk jenis tertentu memerlukan kewenangan untuk melakukan upaya kesehatan. (UU No 36 2009 ttg Kesehatan == > digunakan juga utk Draft RUU Tenaga Kesehatan 2011)

Evaluasi tentang Nakes
‡ Terbatasnya tenaga kesehatan dan distribusi tidak merata. Indonesia mengalami kekurangan pada hampir semua jenis tenaga kesehatan yang diperlukan. Pada tahun 2001, diperkirakan per 100.000 penduduk baru dapat dilayani oleh 7,7 dokter umum, 2,7 dokter gigi, 3,0 dokter spesialis, dan 8,0 bidan. Untuk tenaga kesehatan masyarakat, per 100.000 penduduk baru dilayani oleh 0,5 Sarjana Kesehatan Masyarakat, 1,7 apoteker, 6,6 ahli gizi, 0,1 tenaga epidemiologi dan 4,7 tenaga sanitasi (sanitarian). ‡ Banyak puskesmas belum memiliki dokter dan tenaga kesehatan masyarakat. Keterbatasan ini diperburuk oleh distribusi tenaga kesehatan yang tidak merata. Misalnya, lebih dari dua per tiga dokter spesialis berada di Jawa dan Bali. Disparitas rasio dokter umum per 100.000 penduduk antar wilayah juga masih tinggi dan berkisar dari 2,3 di Lampung hingga 28,0 di DI Yogyakarta. (Depkes, 2008)

‡ (i) there is a shortage and inequitable distribution of medical doctors and specialists; ‡ (ii) the education of health professionals is of poor quality and the accreditation and certification system is weak; ‡ (iii) health workforce policy development and planning are not based on evidence or demand, but rather on standard norms that do not reflect real need or take into account the contribution of the private health sector; nor have they adapted to a decentralized paradigm, and finally; ‡ (iv) the growing and changing demand for health care ‡ due to demographic and epidemiological changes will increase the burden on the already ineffective heal (WB, 2009)

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PROYEKSI KEBUTUHAN NAKES ? .

PROYEKSI KEBUTUHAN NAKES ? .

SERTA DEMAND UTK PELAYANAN YG LEBIH MODERN & LENGKAP KHUSUSNYA RANAP. ‡ POLA PERENCANAAN NAKES DI INDONESIA SUDAH SANGAT LAMA MENGGUNAKAN MODEL RASIO DIBANDINGKAN MODEL DEMAND DAN NEED . ‡ PENINGKATAN DEMAND TERJADI PADA KELOMPOK USILA YG SEMAKIN BANYAK. .FAKTOR PENYULIT DALAM PENGELOLAAN NAKES ‡ TRANSISI DEMOGRAFI DAN EPIDEMIOLOGI YG MENGUBAH DEMAND DARI YANKES.

000 15. 75+ 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4 -15.000 Population in Thousands 2000 Source: BPS 2005.000 0 5.000 -10.Indonesia s population is growing: by 2025 there will be 273 million people and the elderly population will almost double to 23 million. Population In Thousands 2025 10 .000 -10.000 75+ 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4 0 5.000 15.000 -5.000 -5.000 10.000 Males Females 10.000 -15.

(Mediascape) ´The Bottom Billionsµ (Pemiskinan/ Finanscape) Disaster (Environscape) Mobilisasi & Pandemi (Ethnoscape) .Utara-Selatan (Biosecurity/Ideoscape) Peny berbasis perilaku: Napza-HIV & Kes Jiwa (Socioscape) Industrialisasi & efek GRK (Technoscape) Communicated dis.

KOMPETENSI SPESIFIK. 2010 . JUGA KOMPREHENSIF: HDI Sumber: FA Moeloek.

BA. BS.Figure 1 Source: The Lancet 2011. 378:1139-1165 (D p Progress towards Millennium Development Goals 4 and 5 on maternal and child mortality: an updated systematic analysis Rafael Lozano. BS. MPH. Julie Knoll Rajaratnam. Kyle J Foreman. David Phillips. Jake R Marcus. Haidong Wang. Alan D Lopez. MPH. MD . PhD. Laura Dwyer-Lindgren. MD. PhD and Christopher JL Murray. Katherine T Lofgren. BA. PhD. MD. Charles Atkinson. Mohsen Naghavi.

1016/S0140-6736(11)61337-8) Terms and Conditions . 378:1139-1165 (DOI:10.Figure 4 Source: The Lancet 2011.

Figure 5 Source: The Lancet 2011.1016/S0140-6736(11)61337-8) Terms and Conditions . 378:1139-1165 (DOI:10.

1016/S0140-6736(11)61337-8) Terms and Conditions .Figure 6 Source: The Lancet 2011. 378:1139-1165 (DOI:10.

a good case can be made for reprioritizing in favor of health. 17 .Given current low levels of spending for health compared to other sectors. Presentation on Giving More Weight to Health: Assessing Fiscal Space for Health in Indonesia. With subsidies declining again (in 2009) there might be increased space for the health sector 7% 6% 5% Subsidies 4% % of GDP 3% Interest payments 2% Education Infrastructure National Defense Govt Apparatus Agriculture Health 1% 0% 1994 1996 1998 2000 2002 2004 2006 2008* World Bank. 2009.

2008.000.There are 2. Investing in Indonesia¶s Health: Health Expenditure Review 2008.200 200 400 600 800 0 West Papua North Sulawesi Maluku Papua Bali East Kalimantan West Sumatra D I Yogyakarta Health Center Ratio bed per 10.000 Indonesians. however.5 beds per 10.000 1. World Bank.5 Puskesmas per 100.000 and 5.000 DKI Jakarta Gorontalo North Maluku Nanggroe Aceh Darussalam South Sulawesi South Kalimantan Central Sulawesi Central Kalimantan East Nusa Tenggara Bengkulu West Kalimantan Bangka Belitung Island Jambi Central Java North Sumatra South East Sulawesi South Sumatra Riau East Java West Nusa Tenggara Lampung West Java Banten Indonesia 0 2 4 Ratio 6 8 10 .000. there are serious inequities among provinces.000 Health center ratio per 100.6 hospitals per 1. on average. 18 # Health center 1. 3.

TANTANGAN PENINGKATAN ASPEK KUANTITAS (PENYEBARAN NAKES) .

Source: KKI 2008.The ratio of physicians to population also masks significant inequities among urban and rural areas. 20 .

24 36.Distribution of Physicians in Indonesia.66 % change 17.4 -10.65 18.09 44.9 30. 1996-2006 Per 100K Residents 1996 2006 National 15. 16.96 Java & Bali Urban Rural Sumatera Urban Rural Other Provinces Urban Rural Source: PODES 1996 and 2006.39 5.6 2.59 18.18 Rural 5.1 -1.36 Urban 40.62 41.6 -9.72 41.18 38.97 4.16 7.98 5.4 15. 1996-2006 Table 3-1: Distribution of Physicians in Indonesia.44 40.49 18.63 17.6 14.1 10.76 7.9 .53 34.8 28.06 4.63 7.5 -12.2 0.85 15.37 14.

986 8.PTT Scheme Helps to Increase Recruitment to Rural Areas PTT Doctors Recruited and location classification Ordinary 1992-2002 Average per year 2003-2006 Average per year 2006-2007 Average per year 19..517 629 1.700 850 Total 29. D.885 471 1. 2007 .042 704 2.057 4.184 2.489 745 Very Remote 3.826 957 995 498 Remote 7.861 2.549 1.228 2.955 3.270 327 1.092 Source: Ruswendi.

23 . Government target is 100 midwives per 100.000 population by 2010. Source: Indonesia Health Profile 2008. Note: All types of midwives included.even though midwives are almost everywhere and are equally distributed.

69 Java & Bali Urban Rural Sumatera Urban Rural Other Provinces Urban Rural Source: PODES 1996 & 2006 27.Distribution of Midwives in Indonesia.02 26.12 -5.06 54.80 31. 1996-2006 Table 3-3: Distribution of Midwifes in Indonesia.45 42.19 5.63 9.07 43.12 25.21 -8.45 56. 1996 & 2006 Per 100K Residents 1996 2006 National 35.67 -2.64 3.26 31.67 3.55 23.36 Rural 37.84 29.36 45.47 53.22 36.86 Urban 30.25 38.06 39.07 51.19 0.08 27.23 55.45 1.29 40.05 57.09 48.55 .73 46.34 % change 4.

29 5.30 5.08 0.19 0.4 5.90 7. 1997-2007 Table 3-4: Facility Staffing of Puskesmas and Pustu.21 1.14 1.58 8.63 2.04 6. 1997-2007 National Urban 1997 2007 1997 2007 Puskesmas Number of MDs No MD (%) Number of Midwives Number of Nurses Pustu Number of Midwives Number of Nurses 0.50 0.99 0.02 Rural 1997 2007 1.08 7.86 1.69 6.14 1.78 6.99 4.05 1.85 5.06 1.51 3.0 3.44 4.81 1.65 3.Facility Staffing of Puskesmas and Pustu.34 1.18 3.51 6.98 1.88 2.42 .84 0.06 1.

54 7.98 10.27 26.98 3.69 1.50 2.15 28.40 % change 38.43 30.65 10.08 -6.79 57.31 26.65 40.95 7.Distribution of Physicians Providing Private Health Services Per 100 k of population 2006 13.33 34.26 37.90 26.80 41.21 9.01 15.78 .45 4.98 25.44 28.91 26.59 4.71 27.65 4.57 2.30 National Urban Rural Java & Bali Urban Rural Sumatera Urban Rural Other provinces Urban Rural 1996 9.53 2.03 11.98 25.06 4.90 3.

57 1.84 1169.86 8.15 26.81 18.64 200.50 46.57 National Urban Rural Java & Bali Urban Rural Sumatera Urban Rural Other provinces Urban Rural .58 21.24 1.29 93.64 21.56 11.66 11.28 77.74 27.71 120.57 1062.07 13.34 20. 1996-2006 1996 8.55 29.96 per 100 k of population 2006 20.07 20.45 6.87 64.33 0.97 1.76 12.Distribution of Midwives providing private health services.43 % change 140.67 1476.77 9.66 14.28 27.22 7.95 20.47 1510.

CJ=Central Java. DIY=Yogyakarta. . however. Ratio midwife (Indonesia health Profile. 2007) Ratio Traditional Birth Attendant (TBA) (PODES. 28 SBA VS Ratio midwife. W J=W est java. EJ=East Java World Bank. 2010.Midwife availability has increased significantly. 2007). 2008) Note Abbreviation: DKI=DKI Jakarta. 2007 % Delivery by health professional 60 80 100 DIY DKI % Delivery by health professional 60 80 100 DKI DIY CJ EJ WJ CJ EJ WJ 40 20 40 60 80100 Ratio midwife per 100000 pop 40 200 Ratio TBA per 100000 pop 400600 Source: Skilled Birth Attendant (SBA) (IDHS.´ Indonesia Maternal Health Assessment. TBA remains the preferred choice of provider for childbirth. Presentation on ³«and then she died. 2007 120 120 SBA VS Ratio TBA..

.

There is a serious shortage of Ob-Gyns in Indonesia and the few there are cluster in richer urban areas. 30 .

TANTANGAN PENINGKATAN ASPEK KUALITAS PELAYANAN OLEH NAKES ? .

2010. Indonesia Maternal Health Assessment..´. the quality of care varies widely. tetanus vaccination is very low and an important part of ANC. It is insufficient to rely only on ANC numbers World Bank. Although Riau scores high on ANC in general.Although more than 70 percent of pregnant women receive antenatal care by skilled providers. Presentation on ³«and then she died. 32 .

33 .Ob-Gyns provide the most comprehensive services but reach only a limited population.. 2010. Antenatal Care Services by Type of Assistance in West Java (DHS 2007) World Bank.´. ³«and then she died. Indonesia Maternal Health Assessment.

BAGAIMANA DENGAN TENAGA KESEHATAN MASYARAKAT ? .

Arsitawati 2010 .NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 PRODI Ilmu Kesehatan Masyarakat Epidemiologi Ilmu Kesehatan Masyarakat Epidemiologi Ilmu Kesehatan Masyarakat Kesehatan dan Keselamatan Kerja Analis Kesehatan Gizi Kesehatan Lingkungan Epidemiologi Promosi dan Perilaku Kesehatan Kesehatan Ibu dan Anak Analis Lingkungan Hiperkes dan Keselamatan Kerja Analis Kesehatan JENJANG S-3 S-3 S-2 S-2 S-1 D-IV D-IV D-III D-III D-III D-III D-III D-III D-III D-III JML 2 1 20 2 143 2 4 6 12 6 40 KODE 13-001 13-002 13-101 13-102 13-201 13-301 13-302 13-401 13-402 13-403 13-404 13-405 13-406 13-407 13-408 Sumber : Data EPSBED Tgl 03 Maret 2010 Modifikasi Penyajian DR.

Jumlah Progam Studi & Mhsw Kesmas jumlah institusi kesehatan 160 140 120 100 80 60 40 20 0 142 =250-350mhsw/PS 45000 40000 35000 30000 25000 20000 15000 10000 5000 0 jumlah Mahasiswa 38647 20 2457 S1 S2 jenjang pendidikan 2 42 S3 Jumlah Perguruan Tinggi Jumlah Mahasiswa Modifikasi dari:ARUM_BAPPENAS_MARET 2010 .

NTT Kalimantan Sulawesi. Maluku Papua JUMLAH 51 65 4 9 34 2 165 70% S1= Kategori C + Blm terakreditasi 80% S2= Kategori C + Blm terakreditasi Sumber : Data BAN PT tgl 03 Maret 2010 Modifikasi Penyajian DR.S1 Region A 3 3 B 10 20 2 2 5 1 40 C 10 9 1 2 12 34 Tdk Ada Data 24 23 5 13 1 66 A 2 2 B 1 1 2 S2 C 2 1 3 6 Tdk Ada Data 7 3 10 A 0 B 1 1 S3 C Tdk Ada Data 1 1 Total Sumatera Jawa Bali.Arsitawati/Staf khusus Wamendiknas 2010 .

PERKIRAAN KEBUTUHAN SKM Institusi/ Sarana Pusat Dinkes Provinsi Dinkes Kab/Kota RS Puskesmas Jumlah 69 33 495 1.372 8.860 34.548 Kebutuhan per institusi 20 20 20 5 4 Total Kebutuhan 1.900 6.992 Modifikasi dari: ARUM_BAPPENAS_MARET 2010 .380 660 9.192 52.

profesi & sertifikasi OP menetapkan standar profesi dan kode etik nya serta menerapkan dengan segala sangsi Akreditasi. kualifikasi & sertifikasi belum berkembang Masing-2 unit pelayanan menetapkan peraturan. compliance profesi kesmas berdasarkan kebutuhan setempat Masyarakat & industri kesehatan tidak perduli (ignore) dan tidak terlibat (involve with trust) thd profesi kesmas Misconduct & ³SKM´ yg dibiarkan dan ditangani bawah tangan shg tdk memuaskan masy Pengembangan profesi kesmas terutama tanggung jwb pemerintah & masy bukan profesi itu sendiri ? OP melaks advokasi & sosialisasi keprofesian dg customernya Kepercayaan masy thd ´SKMµ OP yang menerima mandat untuk pengemb anggota & profesinya .Konsep yang ditawarkan oleh IAKMI Pusat? Pusat? HARI INI Upaya yg perlu MASA DEPAN Orgn Profesi menentukan kriteria akreditasi. sop.

UNTUK BERUBAH MEMERLUKAN Implementasi & LessonsLearned Norma Baru Profesi Agenda Perubahan Keprofesian Sosialisasi Kebijakan & Program Survei & analisis situasi Aktivasi Kelompok Penekan Diskursus Politik Kesadaran Kolektif profesi Modifikasi dari Tarlov. 1999 .

TERIMA KASIH .

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