PAPARAN KETUA AIPTKMI PADA WEBINAR

ICU “ PSBB DAN ‘NEW NORMAL’

KEMANAKAH KITA MELANGKAH?
ZOOM WEBINAR
KAMIS, 4 JUNI 2020
 Mempersiapkan
Masyarakat Memasuki
Kehidupan Normal
Baru
Agustin Kusumayati
Fakultas Kesehatan Masyarakat
Universitas Indonesia
● University Secretary – Universitas
Indonesia
● Chairperson – Indonesian Public Health
Schools Association
● President Elect – Asia-Pacific Academic
Consortium for Public Health
● Advisory Board Member – Indonesian
Public Health Association
● Dean – Faculty of Public Health
Universitas Indonesia (2013-2017, 2017-
2019)
● Advisory Board Member – AUN Health
Promotion Network
● Advisory Board Member – Indonesia One
Health University Network
● International Committee Member –
Global Partnership on MCH Handbook
Bagaimanakah kehidupan
normal yang baru itu … ?
Definisi Sehat Menurut WHO

Health is a state of complete

physical, mental, and social well-
being and not merely the absence of
diseases or infirmity
 Evolution of Public Health
Public Health 1.0
Public Health 2.0
Comprehensive PH
protection, from primary Public Health 3.0
prevention to treatment Tremendously uneven PH
capacity at the local levels
Development of Social determinants of
astonishing array of PH Department strained to health are the conditions
health-protecting tools address new infectious in which people are born,
and capacity with diseases challenges as live, work and age
increasingly well as the growing
- Economic opportunity
sophisticated techniques challenge of chronic non-
communicable disease - Housing
to ensure sanitation and - Environment
food safety prevention/preparedness
- Education
Governmental PH came of - Food
age - Safe neighborhoods
- Transportation
Piramida Kebahagiaan
 Satu Tujuan
Bersama

Rakyat yang
Sehat, Produktif,
dan Sejahtera
 Berdamai dengan Penyakit
ala John Gordon

HOST AGENT

ENVIRONMENT
Beberapa contoh perdamaian
antara manusia dan penyakit

 Penyakit-penyakit yang dapat dicegah dengan

imunisasi  tuberkulosis, difteri, pertusis, tetanus, polio,
campak, hepatitis B
 Malaria
 Demam Dengue, Demam Berdarah Dengue
 Deman Chikungunya
 Penyakit saluran cerna  diare, kolera, tifus, disentri
  Human dan virus Covid-19 live
together  we can control the disease
 New standards in various aspects of
life and daily activities are applied 
The New aiming to prevent Covid-19
 Application of technology [ICT, AI, IoT,
Normal etc.] as part of the new standards
 Behavior change of the people is a
must  need interventions to modify
predisposing, enabling, and
reinforcing factors
 BUKAN & TIDAK SAMA DENGAN
≠ Pelonggaran PSBB
≠ Kembali ke perilaku dan gaya hidup
sebelum terjadinya wabah
The New ≠ Abnormal
≠ Perilaku tak sehat atau berisiko
Normal
TIDAK DAPAT TERJADI
≠ Secara tiba-tiba tanpa persiapan
≠ Secara bersamaan pada tingkat individu
dan tingkat komunitas/tatanan
Kehidupan Normal Baru adalah

Sebuah tatanan kehidupan baru yang dipicu

oleh keberadaan Covid-19, yang memungkinkan
manusia untuk hidup sehat, menjalankan fungsi
dan perannya sebagai mahluk sosial, dan
menjadi produktif, sehingga terciptalah
kehidupan yang mulia dan sejahtera
Apakah kita sudah siap untuk memulai
kehidupan normal yang baru?
 The health system
capacities are in place to
The transmission is
detect, test, isolate, and
controlled
treat every case and
trace every contact
The outbreak risks are
minimized in special
settings like health
facilities and nursing
homes

The preventive measures

The communities are
are in place in
The importation risks can fully educated, engaged,
workplaces, schools, and
be managed and empowered to
other places where it’s
adjust to the new norms
essential for people to go

6 Criteria for Countries to Consider Lifting Restrictions

Langkah-langkah
Menuju
Hidup Baru
“ Kendalikan
Penularan Covid-19
”
*https://www.tibco.com/covid19
“ Perkuat
Sistem Kesehatan
”
How reliable is our
Health System capacity to

Detect Test Isolate Treat Trace

How big is our Covid-19 Iceberg … ?
Jakarta (03/06/20)
Estimation of the Iceberg
7.623
– Confirmed positive cases = 7.623
– Real positive (sensitivity of PCR 66%-73%)
= 9.900 – 11.550
– RDT result 3.8% reactive*  approximately
3,8% x 10.300.000 = 391.400 have been
infected.
– Since (the best) RDT sensitivity is about 563.333
60%**, the real infected people in Jakarta
is 391.400/60% = 563.333.
*https://corona.jakarta.go.id/data
**PDS PatKlin, 2020
How is Indonesia? (03/06/2020)
– Confirmed positive cases = 28.233
– Real positive = 28.233/66% = 42.777
28.233
– The Covid-19 iceberg is estimated

?
much bigger due to:
 Delay due to specimen transport
 Specimen queuing in the lab
 Availability of the test kits
 Jawa vs non-Jawa variation
 No national serological survey
strategy
*www.covid19.go.id
Per 3 Juni 2020
Indonesia: 18.129 (64,2%) dirawat
Wilayah Kasus Meninggal Sembuh
Terkonfirmasi
Indonesia 28.233 1.698 8.406
6.01% 29,8%
DKI Jakarta 7.623 523 2586
6,86% 33,9%
Jawa Timur 5.318 429 799
8,07% 15.0%
 Detect
Test
Strengthen
Public Health Isolate
System
Treat
Trace
+
Penguatan Sistem
Kesehatan Masyarakat
 Capacity, coverage, reliability and validity of lab tests
 Implementation of national or sentinel serological
survey to monitor the prevalence of Covid-19
– Use standardized RDT kit
– Adequate sample size and sampling design
– Repeated surveys
 Control people mobility
 Monitor social distancing and physical distancing
+
Penguatan Sistem
Pelayanan Kesehatan

 Tingkatkan kapasitas, cakupan, dan

kehandalan laboratorium  uji
diagnostik
 Tingkatkan kapasitas dan kehandalan
rumah sakit
How do we minimize
outbreak risks in
special settings … ?
Protokol Pencegahan KLB Covid-19
pada Berbagai Tatanan Khusus
● Fasilitas pelayanan kesehatan
● Laboratorium
● Asrama
● Pesantren
● Panti Asuhan
● Panti Werda
 Do we have preventive
measures in places where it’s
essential for people to go … ?
Protokol Pencegahan Transmisi Covid-19
di Tempat-tempat Umum
● Alat transportasi umum  kereta, bus, angkot, taksi, ojeg
● Kampus. sekolah, day care
● Tempat kerja  kantor, pabrik, pertambangan, perkebunan
● Pasar, mall
● Hotel, penginapan, resort
● Restoran, warung makan
● Tempat hiburan  bioskop, pub, bar
● Tempat olah raga dan rekreasi
● Objek wisata
 Do we have standard
management of imported
risk or case … ?
Pencegahan & penatalaksanaan
risiko dan kasus impor

Protokol pemantauan dan pengendalian

risiko di pintu-pintu masuk Republik Indonesia
 Perbatasan darat
 Pelabuhan laut
 Pelabuhan udara
 How do we
educate,
empower,
and involve
people … ?
Bagaimana cara
menciptakan
tatanan
kehidupan
baru tersebut ??
Public Health is a combination of science and
art, knowledge and skill, ethics and morality,
that mean to improve health status and prolong
the life of all people through organized
collective efforts to prevent diseases and fulfill
all health needs by empowering communities to
live healthy life.
+

Focus on Health Promotion

and Disease Prevention
Five Level of
Prevention Rehabilitation Tertiary
Prevention
Happy Disability Limitation
people Secondary
Early Diagnosis Prevention
Excellent
Young Prompt Treatment
Generation Specific Protection
High quality Disease Prevention
Primary
of life Prevention
Health Promotion
Reduce morbidity
and mortality
Socio-Ecological Model of Health Promotion
+

Build and Rely on

National Self Resilience
Community Empowerment

 Promote community development by providing motivation,

education and proper cognitive, democratic and social skills
 Increase communities’ capacities and resources to bring
people together around common goals and interests
 Increase participation of the communities in decision-
making and problem-solving processes
 Enhance exchange and partnership with local, regional
and international communities and groups
 Build up social capital
Important Principles

 People centered, from the people to the people

 Rights based and action oriented
 Increases focus on cooperation and networking with
local and international organizations
 Promotes social justice, participation and ownership
 Promotes peer education and community involvement
 Empowers marginalized groups to take positive control of
their own lives
Community Empowerment1

 Promote community development by providing motivation,

education and proper cognitive, democratic and social skills
 Increase communities’ capacities and resources to bring
people together around common goals and interests
 Increase participation of the communities in decision-making
and problem-solving processes
 Enhance exchange and partnership with local, regional and
international communities and groups
 Build up social capital
Community Empowerment2

 People centered, from the people to the people

 Rights based and action oriented
 Increases focus on cooperation and networking with local
and international organizations
 Promotes social justice, participation and ownership
 Promotes peer education and community involvement
 Empowers marginalized groups to take positive control of
their own lives
+

Focus on
Behavior Change
Behavior Change

 Behavior change is the secret to success for the new normal life
 Strategy to change behavior
 Increase awareness
 Educate
 Motivate
 Provide skills and tools
 Change in the environment and support
 Phases in behavioral change  (1) precontemplation,
(2) contemplation, (3) preparation, (4) action, (5) maintenance
+
PRECEDE stands for Predisposing, Reinforcing, and
Enabling Constructs in Educational Diagnosis & Evaluation

It involves assessing the following community factors

● Social assessment: Determine the social problems and needs of a given population
and identify desired results.
● Epidemiological assessment: Identify the health determinants of the identified
problems and set priorities and goals.
● Ecological assessment: Analyze behavioral and environmental determinants that
predispose, reinforce, and enable the behaviors and lifestyles are identified.
● Identify administrative and policy factors that influence implementation
and match appropriate interventions that encourage desired and expected changes.
● Implementation of interventions.
+
PROCEED stands for Policy, Regulatory & Organizational
Constructs in Educational and Environmental Development

It involves the identification of desired outcomes and program implementation

● Implementation: Design intervention, assess availability of resources, and
implement program.
● Process Evaluation: Determine if program is reaching the targeted population and
achieving desired goals.
● Impact Evaluation: Evaluate the change in behavior.
● Outcome Evaluation: Identify if there is a decrease in the incidence or prevalence
of the identified negative behavior or an increase in identified positive behavior.
+

Apply Technology
 WHO Definition of e-Health

e-Health is the cost-effective and secure use of

information and communications technologies in
support of health and health-related fields, including
 health-care services

 health surveillance

 health literature

 health education, knowledge and research

[World Health Organization, 9th Plenary Meeting, 25 May 2005 - Committee A, 7th Report]
 Application of e-Health
 Electronic Health Record (EHR), or Electronic Medical
Record (EMR): systematized collection of patient and population
health data in a digital format that is electronically-stored
 Clinical Decision Support System (CDSS): ICT solution
designed to provide health professionals with clinical decision
support (CDS) such as assistance with clinical decision-making
tasks
 Telemedicine: physical and psychological diagnosis and
treatments at a distance, including tele-monitoring of patient
functions
 Application of e-Health
Data Collection
• Use of hand-held devices
• Automated information messaging
• Use of different data management applications to collect, aggregate, and
report routine data.
Data Management and Storage
• To address requirements of interoperability and integrated sets of data
• More sophisticated data storage to address complexity and variability of
health data across the health enterprise
• Relational databases are increasingly the norm, as opposed to the older,
flat database formats that limited functionality and scalability
Application of e-Health
Data analysis, presentation, and use
• Extraction and triangulation of health data
• Data analysis and synthesis tools to produce routine or ad hoc
reports, identify trends and issues of concerns, and track
progress
• Data dashboards and other data visualization tools can be
customized to include maps (GIS)
Data quality
• Tools for improving data quality include data standardization,
geocoding, data matching, data monitoring, and profiling
 m-Health Applications
● Rapid collection/sharing of current data via mobile phones
● Public health and lifestyle messages over mobile phones
● Medication alerts using mobile phones
● E-prescribing for repeat prescriptions via mobile phones
● Telemonitoring to transmit patient results to clinicians
● Transmission of test results to patients via SMS messages
● Online electronic health records via computer or phone
● Clinical emergency care for accidents, natural disasters
● Patient appointment booking and alerts via wireless e-mail (continuity of care)
● Efficient workflow via wireless communication
+

Multidisciplinary,
Multisector Teamwork
Definition of Inter- Collaborative practice
Professional Collaboration occurs when multiple
health workers from
different professional
backgrounds provide
comprehensive services
by working with patients,
their families, caregivers,
and communities to
deliver the highest quality
of care across settings
RECOMMENDATION
 Prioritas Menuju
Tatanan Kehidupan Baru

SEKTOR
KESEHATAN
Fokus Sektor Kesehatan1
Strengthen measures to control C19 transmission
– Focus on intervention at the upstream level that rely on the
community  community empowerment: Perang Akar Rumput
dengan pendampingan melekat
– Prevent higher national health expenditure due to higher number
of Covid-19 cases
– Prevent further and higher negative impact to other health
programs  e.g. Tuberculosis, HIV-AIDS, Malaria, Immunization,
Maternal Health, Child Health
– Prevent human capital loss due to sickness and death
*Dono Widiatmoko,
dkk, 2020
Fokus Sektor Kesehatan2
• Strengthen healthcare capacity
– Laboratory services
– Hospital services
• Strengthen Surveillance System
– Apply the principle of test – treat – isolate
– Apply standardized national or sentinel serologic
surveys
• Follow WHO criteria and strategy to lifting restrictions
Fokus Sektor Kesehatan3
• Strengthen Primary Health Care to ensure various
public health measures
– Community empowerment and engagement
– Inspection to informal sectors (mis. pasar, warung makan,
industri rumah tangga)
– Contact tracing
– Surveillance
• Prepare phases to lift the restriction with a clear criteria
and protocol  evidence-based decision making
Terima Kasih