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SEMINAR NASIONAL

KESEHATAN MASYARAKAT
&
LOMBA PHOTOGRAFI
SABTU, 10 MARET 2018
AULA RSU USU LT. 4
Tema
“Disruption in Globalised World: Its
Implication in Healthcare Service?”
Topik: “Digital Disruption in Hospital”
“Heri Iswanto, SKM, MHA, PhD”

Topik: “Drug Resistance – A Time Bomb”


“Dono Widiatmoko, SKM,M.Sc.”

Topik: “Anticipating a global trend of aging population: What health system


and hospital should do?
“Sudirman Nasir, S.Ked., MWH, PhD”

Topik: “Global Movement on Health Services”


“Destanul Aulia, SKM, M. Ec., PhD”
Latar Belakang

Digital Disruption in Hospital •  Sepertiga penduduk dunia (67%) > 5 dari 7,5
Milyar > memiliki dan menggunakan ponsel
(GSMA Intelligence, 2017).
A. Heri Iswanto
•  Lebih dari separuh (54%) > 4,1 Milyar > memiliki
akses internet > berbagai media (Internet World
Stats, 2018a).
•  Penjualan buku elektronik di dunia > mencapai
31% dari penjualan buku cetak (Gilbert, 2015).
Disampaikan pada Seminar Nasional IAKMI Pengda Sumatera Utara
“Medan, 10 Maret 2018”
. 1 . 2

Indonesia Digitalisasi
•  Tahun 2017 > jumlah pengguna internet > •  Adanya digitalisasi berkelanjutan dalam
50,4% dari jumlah penduduk (Internet kehidupan manusia > membawa berbagai
Worlds Stats, 2018b) kemudahan.
•  Pengguna ponsel > jumlah orang yang
•  Komunikasi dan informasi > lebih cepat,
registrasi kartu prabayar per Januari 2018
tepat, dan akurat.
> mencapai 159 juta atau 60% dari total
penduduk Indonesia (Kominfo, 22 Januari •  Sisi lain > digitalisasi > memberikan
2018). berbagai efek yang tidak terduga.
. 3 . 4
Dampak Digital Disruption
•  Puluhan ribu orang yang bekerja di media cetak > •  Fenomena digitalisasi > memecahkan kendala-kendala
telah kehilangan pekerjaannya semenjak digital industri > menciptakan kesempatan-kesempatan baru >
disruption terjadi (Karimi dan Walter, 2015). menghancurkan model-model bisnis masa lalu > digital
disruption (Weill dan Woerner, 2015).
•  Robot > semakin menggantikan manusia >
•  Disrupsi > merupakan teknologi yang begitu inovatif >
berbagai pekerjaan; berpotensi mengubah sepenuhnya cara-cara menjalankan
–  iPads > pelayan toko, bisnis (Tsui, 2002).
–  Piranti lunak perpajakan > pekerjaan akuntan, •  Cepat atau lambat > digital disruption > semua jenis industri di
–  Kendaraan yang berkendara sendiri > para dunia > memberikan dampak perubahan dalam berbisnis
pengemudi (Slaughter, 2016). secara keseluruhan (Ivarsson dan Lindstrand, 2014).

. 5 . 6

Vassileva (2017) Digital Disruption


dalam Pelayanan Kesehatan
•  Digital disruption > terjadi akibat > empat trend global > disruptif.
1.  Perubahan > lokus ekonomi > pasar yang baru berkembang >
•  Dunia > mengimplementasikan rekam medis tanpa
urbanisasi
2.  Percepatan > dampak teknologi > ruang lingkup, ekonomi, dan skala kertas > integrasi > menembus batas-batas organisasi
3.  Penuaan > populasi dunia dan geografi (Garrety et al, 2014).
4.  Derajat keterhubungan > antar wilayah > aliran perdagangan,
manusia, modal, dan informasi (data dan komunikasi). •  BPJS Kesehatan > mengembangkan Mobile JKN >
•  Sejauh keempat trend global terjadi > digital disruption > terus
memberikan laporan rekam medis > bagi para
mempenetrasi sendi-sendi kehidupan manusia > lewat inovasi-
inovasi yang mengejutkan. pengguna.

. 7 . 8
Teknologi Baru Teknologi Baru
dalam Pelayanan Kesehatan dalam Pelayanan Kesehatan
•  Rekam medis elektronik > peresepan elektronik, •  Teknologi virtual > memasuki bidang pendidikan >
pembayaran otomatis > sistem perjanjian dokter pelayanan kesehatan (Taekman dan Shelley, 2010).
otomatis > dan sebagainya. •  Penelitian-penelitian klinis > bertopang > informatika
•  Asuransi > mengalami masalah > muncul kesehatan (Bellgard et al, 2017).
berbagai start-up > menggantikan perusahaan –  Pemetaan DNA > awalnya memerlukan dana 100 juta
asuransi tradisional (McFall, 2015). USD (2001) > saat ini hanya 100 USD
•  Kesehatan telemental > membantu pelayanan –  Waktu pemetaan > awalnya memakan waktu 10 tahun >
kesehatan mental (Vernig, 2016). memerlukan waktu 20 menit (Evans dan Forth, 2015).

. 9 . 10

Roman dan Conlee (2015) Garrety et al (2014)


•  Lima trend > dunia pelayanan kesehatan > akibat digital
disruption:
•  Rumah sakit & institusi pelayanan kesehatan >
1.  Miniaturisasi peralatan medis > akibat sensor yang lebih maju deretan perintah dan prosedur yang mekanistik >
> perkembangan teknologi mobile
2.  Perkembangan sistem kesehatan digital > lebih berbasis pada sebuah negosiasi sosial
luaran > deteksi dini > analisis data > lebih murah
3.  Basis data elektronik > bergeser > dari katalog data menjadi •  Pekerjaan pelayanan kesehatan > bukan
data-data > dapat ditindaklanjuti (actionable),
sederetan aturan dan prosedur > aksi & interaksi >
4.  Pemangku kepentingan > menerima > mencari cara-cara >
teknologi digital > mengubah pelayanan kesehatan, berdasarkan aturan dan ekspektasi formal dan
5.  Perusahaan pelayanan kesehatan “besar” > mulai
mengadopsi teknologi digital. informal > berbagai manusia di dalam sistem.
. 11 . 12
Antisipasi Digital Disruption
Garrety et al (2014)
oleh Rumah Sakit

•  Otomatisasi > teknologi digital > menghilangkan aspek •  Garrety et al (2014) > digitalisasi pelayanan kesehatan >
menjaga jangan sampai teknologi yang
manusiawi > sistem pelayanan kesehatan nir-manusia
diimplementasikan > mengalienasi pemangku-pemangku
(humanless).
kepentingan kunci.
•  Akibat > pengabaian kepentingan para pihak,
•  Hwang dan Christensen (2008) > agar pelayanan
ketidakjelasan hak dan tanggungjawab, hilangnya aspek kesehatan dapat bertahan > mengembangkan model-
manusiawi yang penting bagi kesehatan mental. model bisnis yang inovatif.

. 13 . 14

Manusiawi vs Efisiensi
•  Digital disruption > risiko > perubahan fokus >
hubungan > bersifat saling percaya dan individual >
1.  Rumah sakit > tetap fokus > pelayanan
efisiensi.
yang bertopang > kepercayaan > bersifat
•  Teknologi digital > menekankan efisiensi > standar,
individual
lengkap, kredibel, jelas, aksesibilitas > dari berbagai
tempat > saat yg sama (Garrety et al, 2014).
•  Aspek manusiawi > pelayanan kesehatan
bertentangan >< aspek efisiensi.
. 15 . 16
Aspek Manusiawi Kemanusiaan vs Efisiensi

•  Dokter > dapat membuat catatan rekam medis yang pendek > •  Pasien > manusia > memerlukan >
tidak mendetail > mencegah pasien merasa bosan > risih
kenyamanan dan hubungan sosial.
pertanyaan.
•  Dokter > dapat menjelaskan berbagai hal > sebaliknya > •  Rumah sakit > terjadi konflik > efisiensi vs
menyembunyikan informasi dari pasien > pertimbangan
psikologis > kenyamanan pasien > ketimbang berusaha aspek kemanusiaan > mengutamakan aspek
mengungkapkan data-data. kemanusiaan di atas efisiensi.
•  Dokter > dapat menghabiskan banyak waktu > menunjukkan
empati / simpati pada pasien atas penyakit yang dialaminya > •  Nilai tambah > rumah sakit digital > kering
walaupun tidak diperlukan > prosedur.
dan nir-manusia.
. 17 . 18

(Catlin et al, 2013)

•  Adaptasi > digital disruption > tidak sekedar mengubah


manual > digital.
•  Rumah sakit > memikirkan strategi > menghadapi digital.
2.  Pengembangan strategi digital > jelas
•  Tidak sekedar bertahan hidup > mampu maju >
persaingan > berlomba mengkonversi > manual ke
digital.
•  Strategi yang jelas > mampu menonjolkan diri > melebihi
para pesaing > tidak terprediksi.

. 19 . 20
Kane et al (2016) Kane et al (2016)
2.  Mengkomunikasikan > visi & risiko.
1.  Mengadopsi perencanaan > bersifat zoom out/ zoom
–  Strategi > memiliki visi kedepan > perusahaan mampu >
in.
perubahan.
–  Perencanaan zoom out > memprediksi dan menentukan
–  Jika hanya ada visi > terbutakan > janji ke depan &
> seperti apa pasar > bagaimana ekspektasi konsumen >
kurang mampu bereaksi > terjadi hal-hal yang tidak
rentang waktu 10 tahun ke depan atau lebih.
diprediksi.
–  Zoom in > melakukan hal yang sama > tetapi rentang
–  Visi > disertai > analisis risiko.
waktu 6 - 12 bulan ke depan > menentukan dua atau tiga
–  Analisis risiko > berfungsi menyiapkan rumah sakit >
inisiatif bisnis > berpotensi memberikan dampak terbesar
menghadapi situasi > mungkin terjadi akibat tindakannya
> telah digariskan > strategi zoom out.
> inovasi disruptif baru di lingkungan eksternal.

. 21 . 22

Kane et al (2016) Kane et al (2016)

3.  Mengintegrasikan strategi digital > strategi 4.  Belajar > berinovasi > mengulangnya terus menerus.
–  Menghubungkan > rumah sakit > lingkungan > mengalami
korporat.
digital disruption.
–  Menegaskan > komitmen strategis > mengatasi –  Belajar dari lingkungan > mengenai apa saja kemajuan yang
digital disruption. terjadi > bagaimana keberhasilan menerapkan strategi digital >
termasuk belajar dari kesalahan-kesalahan.
–  Memberikan reputasi > rumah sakit bagi >
–  Meningkatkan kemampuan berinovasi > berani berinvestasi
pemangku kepentingan > sadar akan adanya pada teknologi tepat guna > hasil dari pelajaran yang telah
digital disruption > telah siap menghadapi diperoleh.
situasi yang mungkin terjadi. –  Dilakukan terus menerus > tanpa henti..

. 23 . 24
Kapabilitas

•  Kapabilitas > kemampuan > pengelolaan


sumber daya.
3.  Berinvestasi > kapabilitas digital
•  Kapabilitas digital > mengelola sumber
daya digital > dimiliki oleh organisasi.
•  Memiliki investasi > kapabilitas digital >
merupakan elemen tak terpisahkan.
. 25 . 26

Henriette et al (2015) Henriette et al (2015)


2.  Internet
1.  Digitasi/ dematerialisasi –  Kemampuan > pelayanan rumah sakit > secara
online.
–  Kemampuan > menjadikan benda-benda
–  Kapabilitas internet > manajemen konten digital >
material > benda-benda elektronik. mengelola > dapat disebarkan > kepada siapa >
media digital.
–  Surat > e-mail, buku > e-book, rekam medis
–  Kapabilitas internet > optimisasi mesin pencari >
cetak > rekam medis elektronik, dan kemampuan > mendorong > dapat selalu muncul
dalam mesin pencari seperti Google > halaman
sebagainya. pertama > teratas.

. 27 . 28
Henriette et al (2015) Henriette et al (2015)

3.  Analitik 4.  Mobilitas


–  Kemampuan > menjadikan pelayanan rumah sakit >
–  Kemampuan > menganalisis masalah > diakses dimana saja.
diagnosis penyakit > menggunakan teknologi 5.  Jaringan sosial
digital. –  Kemampuan > memanfaatkan jaringan sosial > lewat
situs jejaring sosial.
–  Kapabilitas analitik > kemampuan mengelola
6.  Pengetahuan & kecakapan
data besar (data dalam jumlah besar) > –  Modal intelektual > menjalankan strategi digital > lima
dimiliki rumah sakit. kapabilitas digital lainnya.

. 29 . 30

4.  Pengembangan budaya adaptif yang kuat

•  Budaya (nilai, norma, perilaku) > dicirikan oleh


para petugas yang proaktif > berani mengambil 5.  Pensejajaran > struktur organisasi,
risiko > saling percaya satu sama lain > bekerja pengembangan bakat, mekanisme
sama > mengidentifikasi masalah & kesempatan
pembiayaan, dan indikator kinerja kunci
(Duke dan Edet, 2012).
dengan strategi digital yang dipilih
•  Berfungsi > meningkatkan respon organisasi >
yang penuh dengan tantangan > ancaman
persaingan > kesempatan-kesempatan baru
(Adewale dan Anthonia, 2013).

. 31 . 32
Strategi Digital Penutup

•  Strategi digital > tidak dapat dieksekusi > tidak ada pegawai yang •  Digital disruption > sebuah keniscayaan >
memiliki tugas dan tanggung jawab yang jelas > menjalankannya.
•  Tidak dapat dijalankan secara berkelanjutan > tidak ada
pelayanan kesehatan masa depan.
pengembangan > dari dalam rumah sakit sendiri.
•  Rumah sakit > semakin dihadapkan pada
•  Strategi digital > mekanisme pembiayaan yang jelas dan sesuai
dengan kebutuhan > memperlancar pencapaian tujuan. perubahan teknologi digital > mengganggu
•  Strategi digital > mensyaratkan sistem evaluasi > memungkinkan
strategi tersebut dinilai > efektivitasnya > indikator-indikator kinerja sistem-sistem pelayanan kesehatan >
yang relevan.
yang dimilikinya secara tradisional.
. 33 . 34

Penutup Referensi
1.  Adewale, A. O., & Anthonia, A. A. (2013). Impact of organizational culture 13.  Ivarsson, A., & Lindstrand, D. (2014). Developing a Tool for Digital

•  Agar mampu merespon digital disruption > tetap berfous > on human resource practices: a study of selected nigerian private
universities. Journal of Competitiveness, 5(4).
Transformations: How to Improve Service Quality in the Relocation Industry.
Master Thesis. KH Industrial Engineering and Management.
2.  Bellgard, M. I., Chartres, N., Watts, G. F., Wilton, S., Fletcher, S., Hunter, 14.  Kane, G. C., Palmer, D., Kiron, D., Phillips, A. N., & Buckley, N. (2016).

pelayanan > bertopang > kepercayaan & pelayanan individual;


A., & Snelling, T. (2017). Comprehending the health informatics spectrum: Aligning the organization for its digital future. MIT Sloan Management
Grappling with system entropy and advancing quality clinical Review, 58(1).
research. Frontiers in public health, 5, 224. 15.  Karimi, J., & Walter, Z. (2015). The role of dynamic capabilities in responding
3.  Catlin, T., Scanlan, J., & Willmott, P. (2015). Raising your digital to digital disruption: A factor-based study of the newspaper industry. Journal of
–  mengembangkan strategi digital yang jelas > bersifat zoom out/ zoom in, quotient. McKinsey Quarterly, 1-13. Management Information Systems, 32(1), 39-81.
4.  Duke II, J., & Edet, G. H. (2012). Organizational culture as a determinant 16.  Kominfo (22 Januari 2018). Kemkominfo: 159 Juta Orang Sudah Registrasi
of non-governmental organization performance: Primer evidence from Kartu Prabayar.
–  mengkomunikasikan > visi sekaligus risiko > terintegrasi dengan strategi Nigeria. International Business and Management, 4(1), 66-75. https://kominfo.go.id/content/detail/12450/kemkominfo-159-juta-orang-sudah-
registrasi-kartu-prabayar/0/sorotan_media
5.  Evans, P., & Forth, P. (2015). Navigating a world of digital disruption. IEEE
Engineering Management Review, 43(3), 89-97. 17.  McFall, L. (2015). Is digital disruption the end of health insurance? Some
korporat, 6.  Garrety, K., McLoughlin, I., Wilson, R., Zelle, G., & Martin, M. (2014). thoughts on the devising of risk. economic sociology_the european electronic
National electronic health records and the digital disruption of moral newsletter, 17(1), 32-44.
orders. Social Science & Medicine, 101, 70-77. 18.  Roman, D. H., & Conlee, K. D. (2015). The digital revolution comes to US
–  memiliki sistem > memungkinkan rumah sakit belajar > berinovasi secara 7.  Gilbert, R. J. (2015). E-books: A tale of digital disruption. Journal of healthcare. New York: Goldman Sachs.
Economic Perspectives, 29(3), 165-84. 19.  Slaughter, A. M. (2016). Global Complexity: Intersection of Chessboard and
berkelanjutan; 8.  GSMA Intelligence (13 Juni 2017) Number of Mobile Subscribers
Worldwide Hits 5 Billion. 20. 
Web Trends. Notes Internacionals CIDOB, 147.
Taekman, J. M., & Shelley, K. (2010). Virtual environments in healthcare:
https://www.gsma.com/newsroom/press-release/number-mobile- immersion, disruption, and flow. International anesthesiology clinics, 48(3),
–  berinvestasi > kapabilitas digital > digitasi/ dematerialisasi, internet, analitik, 9. 
subscribers-worldwide-hits-5-billion/
Henriette, E., Feki, M., & Boughzala, I. (2015). The shape of digital 21. 
101-121.
Tsui, E. (2002, July). Technologies for personal and peer-to-peer (p2p)
transformation: a systematic literature review. MCIS 2015 Proceedings, knowledge management. In CSC Leading Edge Forum Technology Grant
mobilitas, jaringan sosial, serta pengetahuan & kecakapan digital; 431-443. Report.
10.  Hwang, J., & Christensen, C. M. (2008). Disruptive innovation in health 22.  Vassileva, B. (2017). Marketing 4.0: How technologies transform marketing
care delivery: a framework for business-model innovation. Health organization. Obuda University e-Bulletin, 7(1), 47.
–  mengembangkan > budaya adaptif yang kuat > mensejajarkan struktur Affairs, 27(5), 1329-1335. 23.  Vernig, P. M. (2016). Telemental Health: Digital disruption and the opportunity
11.  Intenet World Stats (2018a) Internet Users in the World by Regions – to expand care. Journal of the American Psychiatric Nurses

organisasi > pengembangan bakat > mekanisme pembiayaan > indikator kinerja 12. 
December 31, 2017. https://www.internetworldstats.com/stats.htm
Internet World Stats (2018b) Asia Internet Use, Population Data and 24. 
Association, 22(1), 73-75.
Weill, P., & Woerner, S. L. (2015). Thriving in an increasingly digital
Facebook Statistics – June 2017. ecosystem. MIT Sloan Management Review, 56(4), 27.
kunci dengan strategi digital yang dipilih. https://www.internetworldstats.com/stats3.htm

. 35 . 36
DRUG RESISTANCE
A TIME BOMB
Dono Widiatmoko
What are the key health
challenges faced by the
Earth’s Population?
# World’s Population
Density – Distribution – Growth – Dynamics

http://www.worldometers.info
>7 Billion People

World’s Population
Ageing Scottish
Population Structure

 The Health and Well-Being of Older People in Scotland, 2000


Population Adjusted
World Map (2002)
Wealth (GDP) Adjusted
World Map (2002)
Something to eat
Source: North American Export Grain Association, 2007
Clean and safe drinking water
Food
► 1300 kg of grains
(wheat, oats, barley, corn, dry peas, soybean, etc)
► 7200 kg of roughages
(pasture, dry hay, silage, etc)

Water
► 24000 litres for drinking
► 7000 litres for servicing. [Hoekstra & Chapagain, 2008]
# Ensuring
survivability of the
world’s population
Aral Sea, 1985 Aral Sea, 2009
 Has our earth temperature
change?

 http://www.bbc.co.uk/news/world-south-asia-
15216875
Global Changes by 2090
Medium emission scenario
A Time Bomb
Resistance to Antimicrobials
 What is the difference between antimicrobials
and antibiotics?
 Antimicrobials include all agents that act against
microorganisms, namely fungi, bacteria,
protozoa and viruses.
 Antibacterials encompasses all compounds that
act only on bacteria, including antibiotics.
 Antibiotics are produced naturally by
microorganisms and kill or inhibit the growth of
other microorganisms, mainly bacteria.
What is drug resistance
 Antimicrobial resistance occurs when
microorganisms such as bacteria, viruses,
fungi and parasites change in ways that
render the medications used to cure the
infections they cause ineffective.
 This is a major concern because a resistant
infection may kill, can spread to others, and
imposes huge costs to individuals and
society.
Type of Antimicrobial
Resistance
 Antibacterial resistance (e.g. to antibiotics
and other antibacterials)
 Antiviral resistance (e.g. to anti HIV
medicines)
 Antiparasitic resistance (e.g. to anti-malarial
medicines
 Antifungal resistance (e.g. to medicines used
to treat Candidiasis)
Antibiotic Use
 Antibiotic consumption for human health increased
by 36% globally between 2000 and 2010, and the
demand for antibiotics keeps increasing.
 Antibiotics used in production of food animals was
estimated at >63,000 tons in 2010. Without major
policy changes, consumption in the livestock sector
is projected to rise by more than 60% by 2030.
 Studies show that up to 75% of patients with colds
are inappropriately given antibiotics. Antibiotics have
no effect at all on colds.
Types of drug resistance
 Intrinsic drug resistance
 Occurs naturally in all or most strain of that
species
 Chromosomally encoded

 Acquired drug resistance


 Results from a mutation in the existing DNA of
an organism or acquisition of new genes
How do we get too much
antibiotics?
 Inappropriate prescribing includes:
 unnecessary prescription of antibiotics
 unsuitable use of broad-spectrum antibiotics
 wrong selection of antibiotics
 inappropriate duration or dose of antibiotics
 Self medication
 not taking your antibiotics as prescribed
 skipping doses of antibiotics
 not taking antibiotics at regular intervals
 saving some for later
 sharing antibiotics with other
 Contaminated food source
Is it a problem in Indonesia?
 Antibiotic use in hospital 84%. 42% antibiotic
use without appropriate patient indication. 1
 Prevalence:
 MRSA (24%)
 E-Coli resistance to ampicillin (73%), trimethoprim-
sulfamethoxazole (56%), and ciprofloxacin (22%) 2
 S pneumoniae resistance to penicillin (24%), cotrimoxazole
(45%)3

1Hadi U, Kuntaman K, Qiptiyah M, Paraton H (2013)


2Severin JA, Mertaniasih NM, Kuntaman K (2010)
3Farida H, Severin JA, Gasem MH (2014)
Drug resistance in TB
 Estimated 6,800 new MDR TB cases every
year1. The national MDR-TB estimated 2.8%
among new TB Cases and 16% previously
treated TB cases.
 In 2016 (January to November), 2293 were
confirmed as MDR TB/ RR TB and 1420 (62%)
new cases were enrolled
 More than 55,000 TB patients being tested for
drugs resistance and 6,000 of DR-TB patients
(MDR, Pre XDR and XDR patients) have been
treated all over the country since 2009.
1WHO, Global Tuberculosis Report 2016
Option to tackle drug
resistance
 Develop new medicines
 kills drug resistant organism

 Manage the use of current available


medicines
 contain health issues with current
available medicines to limit the occurrence of
drug resistance
Why drug development
difficult?
Scientific difficulties:
 It is extremely difficult to develop an antibiotic drug. First, it needs to get to the right place
in the body at a high enough concentration without being toxic to the patient. Then, it also
has to enter and stay in the bacterial cell, which has proven very problematic.
Financial and regulatory hurdles:
 Medicine research is very expensive and takes a long time to complete. Each new
formulation needs to go through rigorous testing for activity and patient safety, and only a
minority will actually make it through the whole drug-development process.
 Resistance development can be fast and may hamper usability, which could result in low
profits for the developing company.
 When a new novel antibiotics actually developed, it would have to be used sparingly to
avoid resistance development as it will the last resource for fight against diseases.
Companies have pointed out regulatory requirements to be unclear, which have led to
uncertainty of the likelihood of approval of new drugs
Lack of know-how:
 Poor financial incentives in combination with the technical difficulty to develop new
antibiotics have made many pharmaceutical companies scale-down or abandon their
antibiotic development programs.
Drug development timelines
 The majority (more than 75%) of respondents across 12 countries included in the
WHO multi-country public awareness survey incorrectly believed that antibiotic
resistance occurs when their body becomes resistant to antibiotics, whereas in fact
bacteria, not humans, become antibiotic resistant 3.
 In the Eurobarometer survey, nearly half of the 26,680 participants across 27
European nations did not know that antibiotics are ineffective against viruses. 41%
did not know that they are ineffective against colds and flu. 4
 “Around 20% of 1050 healthcare profession students stated that antibiotics are
appropriate for viral infections” (cross sectional study at the School of Medicine at
University of Torino, Italy) 5.
 “Even if participants knew about the possible adverse effects of antibiotics, 57%
would recommend antibiotics to their friends and families” (cross-sectional survey in
Al-Ahsa community, Saudi Arabia) 6.
 “87% of the study participants listed viral diseases as an indication for antibiotics”
(cross-sectional questionnaire-based survey among Iraqis residing in Amman,
Jordan) 7.
 Resistant bacteria do not respect country borders,
especially we are now in the era of interconnected world
of trade and travel
 Resistance originating in one place can spread rapidly
worldwide.
 This means that misuse of antibiotics anywhere in the
world is enough to overturn achievements in containing
resistance elsewhere.
Core actions to fight Drug
Resistance
 Preventing infections, preventing the spread
of resistance
 Tracking drug-resistant infections
 Improve prescribing practices/stewardship
 Develop new drugs and diagnostics tests
Anticipating a Global Trend of Aging
Population: What Health System and
Hospital Should Do?

Sudirman Nasir, PhD

Faculty of Public Health, Hasanuddin University


The Indonesian Public Health Association (IAKMI)

Medan
10 Maret 2018
Demography of Asia
• Aging population as a global • Asians aged 65 and older will
trend grow from 250 millions
nowadays to approximately 1
• World and particularly Asia’s billion by 2050
population is growing both
larger and older

• Asia, the most important


continent in terms of
demographic perspective

• Asia’s population is about 4.2


billion and by 2050 is expected
to increase to approximately
5.9 billion
Demography of Asia
• Sharp decline in fertility

• Rising life expectancy

• Altering the age structure of


the Asian population

• In 2050, there will be


roughly as many people in
Asia under the age of 15
and over the age of 65
(e.g. Waite, 2012)
Demographic change
• Demographic change in
Asia, into a more mature
population, occurs more
rapidly

• It happened over more than


100 years in most countries Asian countries are
in Western Europe and currently aging more
rapidly at a lower
North America
incomes , weak non-
familial income and
• The changes are occuring in weak health security
China and Indonesia in less systems in place
than 25 years
(e.g Smith, 2012)
Success story and challenges
• Aging population as a • Challenges to provide
success story (socio- economic, social and
economic development, health security for their
modern medicine and elderly people at
public health) affordable budgets

• Implications to the
economy, health
services and for families
and kinship in Asia
Common challenges in Asian countries
Indonesia’s case
• A diverse country, an archipelago
(13 000 islands) of more than 700
ethnic groups

• The world’s fourth most populous


country, a Muslim majority nation
(259 million people)

• GDP per capita has steadily risen,


from $857 (in 2000) to $3,603 in
2016, the world’s 10th largest
economy

• Life expectancy has increased


significantly from 45 (in 1945) to
71 (2015)
Transition into aging population
• Estimated to experience an elderly population boom in the
first two decades of the 21st century, amounted to about
18.04 million elderly people

• The UN has predicted that the percentage of Indonesians over


60 will reach 25 percent in 2050 - or nearly 74 million
Transition into aging population
• Successes in development
programmes (nutrition, housing, poverty
reduction, health, family planning, cleaner
drinking water and sanitation, reducing
serious infections and prevent deaths)

• A declining birth rate and


increased life expectancy (individuals
aged 60 years and over are the fastest
growing segments of the population

• The number of children is


decreasing while the proportion
of the productive population
aged 15-59 years is increasing
Consequences
• The increasing degenerative diseases (hypertension,
heart and coronary diseases, cancer, diabetes mellitus type 2,
osteoporosis, alzheimer and dementia)

• Threatening the quality of life of the elderly people


and will increase the cost for their health care

• The issue of inadequate health and care services, lack


of welfare provision and legal frameworks that often
does not specifically address elderly people
Consequences

• Approximately 2.9 million elderly people who have


limited access to health and other social services

• Adjustment of our policies related to older people


issues such as health care, social welfare, social
security, employment, investment, consumption and
savings pattern
Implications for social and
health system
• The need to design a population responsive policy by taking into
consideration the unique needs of older population

• The need to enact population-influencing policy to promote active aging


aiming of enhancing the wellbeing, health and participation of older
people

• Population ageing needs to be addressed by the government, private


sectors and the general public

• The role of researchers, activists and mass media is crucial in advovating


the issues associated with Indonesia's ageing trend

• Elderly/senior friendly health system


Implications
• It is important to note that population ageing can contribute
positively to the nation development if we are prepared

• Countries who harness the rich potential of an ageing


population may obtain a longevity benefit as older people
usually have accumulated skills, experience and wisdom

• Ultimately, countries that promote active ageing will have a


competitive advantage over those that do not

• Both state and society should recognize the potential of older


people and ensure them a life of dignity and justice
On going programs
• The establishment of National Action Plan for Ageing,
National Commission for the Elderly and programmes
conducted by Ministry of Health and Ministry of Social
Affairs

• “Posyandu Lansia” (with its creative and fun activities


including health and nutrition counseling and gym for
seniors should be further developed and promoted)

• Those programmes should be improved and scaled up to


reach more elderly people and more intensively promote
active aging
On going programs
• Cities such in Indonesia are now establishing “Posyandu
Lansia” and received positive responses from the people in
that locales

• Indonesia should learn from the experience of Asian countries


who face the aging population earlier such as Japan (both
from their programs’ strengths and weaknesses)
Implications for hospital and PHC
• Elderly/Senior/Age-friendly
hospital

• Improving the availability and


quality of services/human
resources

• Promoting the available services

• Reducing barriers to utilization

• Improving the capacity and the


role of Puskesmas to facilitate
active/healthy aging
Collaboration among professionals
organizations
PERGERI
PERGEMI
IAKMI
IDI
PPNI
IPSPI
Etc

to promote and advocate the urgent need for elderly


friendly health system and senior friendly hospital in
Indonesia
But…
• While we are working to anticipate aging
population, we should also keep improving
our young people’s health
Thank you

• Terima kasih
• Horas
Global Movement
on Health Service

Destanul Aulia, SKM, M.BA, M.Ec, Ph.D


aulia_destanul@yahoo.com
1
KESEHATAN

Kebutuhan seluruh manusia

HAK DASAR (gratis)


Di Indonesia

Pasal 28 UUD 1945 :


Hak atas pelayanan kesehatan

Pasal 34 Ayat 3 :
Penyediaan fasilitas kesehatan
PELAYANAN KESEHATAN DI INDONESIA

Dilaksanakan
oleh Dibantu swasta
Pemerintah

Meningkatkan kualitas pelayanan kesehatan


Jumlah Fasilitas Kesehatan di
Sumatera Utara
Rumah Sakit Rumah Sakit PUSKES-
Tahun PUSTU Balai Pengobatan POSYANDU
Pemerintah Swasta MAS

2000 26 83 409 1,856 640 16,162


2001 30 141 408 1,789 599 17,243
2002 30 141 408 1,789 495 17,243
2003 28 93 430 1,698 765 16,852
2004 34 93 437 1,872 765 14,640
2005 29 102 449 1,917 886 13,011
2006 29 102 449 1,937 888 13,001
2007 57 112 459 1,797 1,214 14,533
2008 62 128 493 1,933 1,082 14,953
2009 59 141 501 1,941 1,082 14,961
2010 44 148 565 1,803 1,803 15,242
2011 44 148 545 1,917 1,148 14,644
2012 61 142 569 2,085 1,082 15,495

Sumber : Biro Pusat Statistik tahun 2000 - 2013


KUALITAS PELAYANAN
KESEHATAN???
Tahun 1990an :
Jika masalah kesehatan tidak dapat ditangani di dalam negeri, Masyarakat
Indonesia akan menuju negara maju untuk mendapatkan layanan
kesehatan yang lebih baik (Jepang, Jerman, Amerika Serikat)

Setelah Asian Financial Crisis 1998


Negara berkembang berhasil memajukan teknologi dan layanan kesehatan.
Masyarakat Indonesia tidak hanya menuju negara maju tetapi juga negara
berkembang
Singapura,
Malaysia
Thailand.

Di Malaysia, Masyarakat dari Indonesia mencari pelayanan kesehatan terutama


di Penang, Perak, Kuala Lumpur, Malaka dan Johor Bahru.
Menurut Arunanondchai dan Fink (2007) Malaysia
telah menjadikan industri pariwisata kesehatan
sebagai industri strategis nasional. Dengan
alokasi anggaran yang besar dari pemerintah,
Malaysia mampu menawarkan layanan
kesehatan berkualitas tinggi dengan dokter
berpengalaman dan fasilitas medis yang
memadai.
Peta Indonesia - Malaysia
Sumber :https://www.google.com/search/peta

Kedudukan Sumatera Utara yang bersempadan dengan negara Malaysia menyebabkan


Sumatera Utara menjadi wilayah Republik Indonesia yang paling berhampiran dengan
Semenanjung Malaysia.
Kedudukan Sumatera Utara dan
Semenanjung Malaysia

Sumber: https://www.google.com/maps/
Pelancong Medis Internasional ke Malaysia

Januari 1998 sampai • 400.000 pelancong medis internasional


mencari pengobatan di Malaysia
Juni 2000 (Mohamad Zaki Ahmad et al).

2000-2011 • Pasar pariwisata medis di Malaysia telah


berkembang lebih dari 15 kali (Mary Wong
(10 tahun) Lai Lin 2012).

Jumlah wisatawan medis terbesar yang datang ke Malaysia berasal dari


Indonesia
Pelancong Medis Indonesia ke Malaysia

• Jumlah wisatawan medis dari Indonesia


Tahun 2010 adalah 261.117. (70,11%) dari semua
pasien asing yang datang ke Malaysia.

• Jumlah wisatawan medis meningkat


menjadi 335.150 orang. (68,64%) dari
Tahun 2011 semua pasien asing yang datang ke
Malaysia.
Sumatera Utara-Semenanjung Malaysia

• Rata-rata jumlah wisatawan medis dari Sumatera Utara ke Malaysia


antara tahun 2000 dan 2011 adalah 53.423 orang per tahun

• Kedatangan masyarakat Sumatera Utara ke Malaysia adalah untuk


berbagai keperluan, baik untuk bekerja, mengunjungi kerabat atau untuk
pelayanan kesehatan.

• Aspek budaya, hubungan kekerabatan dan jumlah program


pembangunan yang dibuat antara Malaysia dan Sumatera Utara
menghasilkan pergerakan penduduk yang tinggi di antara kedua wilayah.
Wisata Kesehatan
Pergerakan masyarakat Indonesia dari Sumatera Utara ke
Malaysia untuk mencari pelayanan kesehatan menjadi
bisnis kesehatan di bawah kerangka General Agreement on
Trade in Services (GATS).

Pariwisata Kesehatan
Pariwisata Kesehatan
• Melintasi batas negara
• Melibatkan kegiatan wisata
• Adanya investasi langsung asing
misalnya, sebuah perusahaan Jerman mendirikan sebuah rumah sakit
dengan 200 tempat tidur di Delhi.
• Pergerakan penyedia layanan individual, di mana produsen atau penyedia
layanan pindah ke negara konsumen, misalnya China dan Kuba mengirim
pekerja kesehatan mereka ke Afrika dengan imbalan kontrak dibayar dan
di bawah pengawasan pemerintah (Chanda, 2001)
Mode Pariwisata Kesehatan
(Chanda 2001)

• Antar negara maju


• Antara negara maju dengan negara berkembang
Antar negara berkembang
Peningkatan Pariwisata Kesehatan
Peningkatan Pariwisata Kesehatan disebabkan oleh:

• Pertambahan penduduk,
• Penggunaan teknologi baru
• Berkembangnya keanekaragaman produk medis.
• Penguatan nilai tukar mata uang,
• Semakin kompetitifnya harga pengobatan,
• Kemungkinan terjadinya krisis ekonomi di negara maju dan
berdampak terhadap pertumbuhan pasar pariwisata medis di dunia