You are on page 1of 51

Children Health Care

System
In Indonesia

インドネシアの子供たちのヘルスケアシステム

Problem Based Approach
問題ベースの手法
Dian Kesumapramudya N.
Kobe University-Graduate School of Medicine
Department of Community Medicine & Social Health Care
Japan
Department of Pediatric, Gadjah Mada University,
Indonesia

INDONESIA IS An
ARCHIPELAGIC COUNTRY  ( 群島国)
Located : at South East Asia
NUSANTARA ( Nusa = continent 大陸 , antara = betwee n )
Between Asia continent and Australia Continent,
Hindian and Pasific ocean
6 hours from Osaka (KIX) to Bali (Ngurah Rai International
Airport)

INDONESIA

230 millions people as its citizens (2010). Growth

1,49%
Consists many tribes ( 部族 ) ~ + 268 tribes
With different local languages, cultures, behaviour,
Population pyramid of
Population pyramid of
etc
Indonesia
, year 1995
Indonesia , year 2010
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

14 12 10 8 6 4 2 0 2 4 6 8
10 12 14 In million

14 12 10 8 6 4 2 0 2 4 6 8
10 12 14 In million

Source : Indonesian Statistic Bureau, 2010 Data Base

INDONESIA NATIONAL CHILD
HEALTH PROBLEMS
High IMR/CMR
乳児死亡率
(34/1000)

Nutrition
Problems
栄養の問題
•Education
Participation level
•Knowledge
•Poverty & GDP
15% poor,
49% income below
2$/d)
•Population growth

coverage
of
Immuniz
ation
予防接種

Economic
, Social ,
and
Culture
Problems
Sanitation
Infectious
& Behaviour
Disease
衛生&行動
感染症

Source : Indonesian Statistic Bureau Research, 2010 &
MDG’s 2010 Achievement. Ministry of Health, Republic of

Children Health Problems in
Indonesia
Nutrition Problem

Short
NWB
Short
NBW
NBH
& Thin
short
NBH
NBH
Obesity
Source : Indonesian Basic Health
Riset (RISKESDAS)
Nutrition
Status
2010

short
Obesity

Republic of Indonesia .Children Health Problems in Indonesia Nutrition Problem Normal Body obesity Short stature slim body Source : Indonesian Basic Health Riset (RISKESDAS) 2010 Ministry of Health.

Rotaviral diarrhoea 2. Malaria 4. Typhoid fever 腸チフス . Pneumonia and tuberculosis ( 肺炎 & 結核 ) 3.Children Health Problems in Indonesia Infectious Disease 感染症 Each area of Indonesia may vary in the degree and in the characteristics The largest in National Scale 1. Dengue Fever and Dengue Haemmorhagic fever 5.

Children Health Problems in Indonesia Disease Distribution Profile among Children Malaria マラリア Diarrhoea. 赤痢 ) Source : Ministry of Health. Republic of Indonesia Data . typhoid fever and dysentriae ( 腸チフス .

Republic of Indonesia Data .Children Health Problems in Indonesia Disease Distribution Profile among Children TBC ( 結核 ) HIV & pneumonia 肺炎 Dengue Fever デング熱   and Dengue Hemmoraghic Fever   デング 出血熱 Source : Ministry of Health.

Children Health Problems in Indonesia Sanitation & Healthy Behaviour . City Trash management   市のゴミの管理 B. Culture and customs change   文化や習慣の変化 .Vary among area  Mostly influenced by traditional customs ( 伝統的な慣習 )  Government programe of PHBS (Clean and Healthy Live Program) had been launched since 2006 PROBLEM : The result is still unmeasurable yet  結果は測定ができない  The recent chalenge : A.

Pediatricians number are not enough and not well distributed ( at 2010 .Children Health Care System in Indonesia PROBLEMS : a. Various disease prevalence among regions e. (Discrepancy 不一致 and inequality 不平等 ) d. Various condition of health fascilities with limited resources . especially languages and customs c. the ratio = 1 : 8. Vast area along with various geographic and demographic features b. Various cultures. officers and infrastructures .900).

Outline of Children Health Care System in Indonesia .

Preventif. 3.Structure of Children Health Care System in Indonesia (multistep referral approach) a. Children as a children. Promotif& Supportif b. Spesialized base Primary Health Care a. Referral c. Family Environment Insurance And Private Based payment . 2. Curative b. Referral c. Spesialized base Tertiary Health Care Seconda ry Holistic Approach ( 全 Health 体的な方法 ) Paradigm Care ( 視点 ) 1. Curative b. Community Based a. 4.

000.Health Care Cost & Payment in Indonesia Insurance Based JAMKESMAS (National Insurance for Poor People) managed by Government via Askes corp.000.1 trillion ( ¥ 51.000) ASKES (National Health Insurance ) managed by Government via Askes Corp. self sustained (monthly payment)  the same with Japan Private Health Insurance Private Payment . In the year 2010 = Rp 5.

Primary Health Care Network System .

Primary Health Care Center (Puskesmas) .

promotive and supportive therapy 予防、促進し、支える Place : Public Health Center (Pusat Kesehatan Masyarakat ) 1st line of defense a. General practitioners d. Pediatrician private practice PROBLEM : Limited resource and standardization not all Health Care Center work . Government own b. Private c.Primary Health Care Focus : Preventive.

Coverage of Routine Health Screening of Elemetary School Student . Obstetric service coverage: 80 % c. Coverage of post partum (childbirth after) service : 90% e.Primary Health Care Service Standards and Targets 11 basic minimum standars of good practice health service a. Coverage of Under 5 YO Child (BALITA) Health care 90 % i. Coverage of Neonatal health care with complication 80% f. Coverage of Breastfeeding Food Supplementation : 100 % j. Coverage of labor service helping by health provider : 90% d. Pregnant woman visit coverage (K4) : 95% b. Coverage of Child imunization (Universal Child Immunization): 100 % h. Coverage of Malnutrition Baby Health Care : 100 % k. Coverage of Infant visit: 90 % g.

economic and culture problem Imunization Administration  Routine vaccination for baby 0-1 years in  Baby screening PROBLEM : Culture  Various differences Knowledge & Resistance ( 耐性 ) .Primary Health Care Working Program Nutrition Health Service  Routine baby screening  Investigation and intervention of nutrition problem in community  PROBLEM : low participation level  due to culture nutrition problem due to lack of knowledge .

Primary Health Care Working Program Nutrition Health Service Imunization Administration .

2009.Primary Health Care Working Program Imunization Administration Source : Indonesian Pediatric Association (IDAI) . .

malariae 2. Efforts of Integrated Health Check to Young infant and below 5 YO children Primary Treatment Care  Medical treatment  Nursing treatment  Simple rehabilitation treatment . Administration of MTBS Programme Disease focus : a.Primary Health Care Working Program Integrated Management of Childhood Illness (MTBS) Protocol 1. Pneumoniad. diarrhea and rehidration c. Neonatal visit by midwifes every week 3. Dysentriae b.

Integrated Management of Childhood Illness (MTBS) Protocol ( 幼年期の病気の統合管理 ) .

Integrated Management of Childhood Illness (MTBS) Protocol .

Integrated Management of Childhood Illness (MTBS) Protocol .

School Heatlh Unit and School Dentist Unit  Counselor and Guiding  Special Treatment and Rehabilitation (In certain Special Schools selected)  Training of “Junior Doctor / Kid Doctor” 3. In Pre-School  PAUD (Early Education of Children)  Growth and Development Response Check 2.Primary Health Care Working Program SCHOOL JOINT PROGRAMME 1. Teenager (Youth) Health Care Service  Counseling about Reproductive and Sexual Health in The School or Boarding School Health Post  Mentoring and Counseling about Youth Psychology Problem . Growth & Development Early Intervention  Examination of Children Growth & Dev.

private clinic and private practice .Regional Hospital (Class D.C) .In The Primary Health Care Center .Secondary Level of Children Health Care System Curative and Treatment Care .

Medic Rehabilitation Center .Tertiary / Third Level of Children Health Care System Curative (Treatment) & Rehabilitation Care .Referral or Central Hospital (Class B or A) .Center of Nutrition Rehabilitation .

Small Center Referral Hospital .Type D or Type C Regional Hospital .Research .Referral System in Medical Treatment Service Primar y Health Care -Public Health Care Center -Private Clinic -Private Practice Regional Hospital .Type B or Type A Hospital .

Yogyakarta) Educational Based Referral HOSPITAL (Type A) . UGM.Children Health Care in Hospital (Sardijto General Hospital.

内分泌学 2. Nutrition. 栄養 4.Emergency Unit of Pediatrics & Intensive Care Unit 救急室 集中治療部 In Alliance with several Network Hospital Around Yogyakarta . Gastro-hepatology 胃肝臓学 3.13 Sub Department Functional Medics Staffs of Pediatrics 1. Nephrology 腎臓学 9.Respirology 呼吸器 11. Neurology 神経学 10. Endocrinology.Social Pediatric (Growth & Development) 小児社会 12.Perinatology 出産期医学 13. Tropical Infection 熱帯の感染症 7. Cardiology 心臓病学 8. Hemato-oncology 造血腫瘍学 5. Immunology 免疫学 6.

UGM) • Center of Leukemia Study of South East Asia .Kinds of Health Care Service • • • • Outpatient Service Emergency & Intensive Care Unit In patient Service Medic Rehabilitation & Occupational Therapy Service • Additional Service • Education & Research Fascility (incorporated with Faculty of Medicine.

Additional Service  Oral Rehidration Room  Pediatric Integrated USG and EKG        Examination Room Spirometry (Lung function test) room Skin Prick test examination room (allergy test) Pharmacy service (pharmacy satellite) Integrated Laboratory Satellite Playing room Library Children Psychology Consultation .

Outpatient Service – General Outpatient Policlinic – Outpatient Policlinic with appointment (VIP) – Growth and Development Policlinic .

Pediatric Polyclinics .

Policlinic with Appointment .

Data .83 old / control 89.17 Source : Sardjito Pediatric Dept.Distribution Rate of The Outpatient Type visitors in 2010 visit rate new patient 10.

Departmen t Mean Visits Source : Sardjito Pediatric Dept.Patient Profile in the Outpatient Clinic 2010 Sub.Data .

GROWTH & DEVELOPMENT POLYCLINIC .

Neurology sub department b. Medic rehabilitation c. Center of Nutrition Rehabilitation (RPG) . Early Detection and Screening for Growth and Developmental Delay 2.GROWTH & DEVELOPMENT POLYCLINIC Services provided in the policlinic 1. Basic and Advanced Immunization 3. Early Stimulation and Intervention in Children with special needs Collaboration with a.

 Emotional Disorder .GROWTH & DEVELOPMENT POLYCLINIC Case Distribution  Autism  ADHD (Attention Deficit Hyperactivity Disorder)  ADD (Attention Deficit Disorder)  Pervasive Development Disorder (speaking disorder)  Learning Development Disorder.

Additional Service Simple USG room Oral Rehidration Satellite Laboratory .

IN PATIENT HEALTH CARE SERVICE .

Inpatient Ward capacity .

In Patient Ward VIP Room 1st class room .

In Patient Ward 2nd Class .

In Patient Ward 3rd Class .

In patient Ward playing room .

Nurse c. Limited advance medical equipment . Doctor b. Integrated and holistic patient management approach already established but needs to be improved a. Researcher from University or Research Fascility 4. Health Therapist d.Problems in Inward Patient Management 1. Job Distribution 3. Limited Bed Capacity 2. Limited Resource for Research Development 5. Psycholog and psychiatrist e.

Summary & Future Chalenge 1. Education c. Children health problem management complexly related and integrated with other sector policy a. Diversity in culture becomes threat in the Future Health management if it is not well managed 2. Need to revitalization of rural health care center (Puskesmas) and redistribute the health officer to equalization 4.Infrastructure 3. The Need to achieve the target of MDG’s 2010 . Economic growth b.

Thankyou For Your Attention .