Asyhadu anlaa ilaaha illalloh

wa asyhadu anna Muhammadan rasuululloh

Rodliitu billahi robbaa

wa bil-islaami diinaa
wa bi Muhammadin nabiyyaw wa rosuulaa

Robbii zidni ‘ilmaa

warzuqnii fahmaa
Aamiin....
 Introduction Of Family Medicine
Present Status Of
Health Care Services In Indonesia

Denny Anggoro Prakoso MD MSc

Public Health and Family Medicine Department
FKIK UMY 2013
Sistem Kesehatan Nasional
 The General Objective Of The National Health
Development Program In Indonesia as Stipulated
In The National Health System (SKN)

To Provide A Healthy Life For

All Indonesians
 The specific objectives of the National
Health Development Program in
Indonesia
• To enable people to maintain their own health
and live a healthy and productive life
• To promote an environment conducive to the
health of the people
• To promote good nutrition among the people
• To decrease morbidity and mortality
• To promote a healthy and prosperous family life
 Healthcare Efforts To Achieve
These Objectives

• The strengthening of the healthcare

delivery system as part of an overall health
development program.
• This is being carried out both by
government and the private sector.
 NATIONAL HEALTH STATUS
• The fact that Indonesia is still a developing country,
• The present condition of Indonesian healthcare remains
unsatisfactory although there have been major
improvements compared to two decades ago
• The primary cause of death in Indonesia since
1995 is cardiovascular diseases that now
overtake predominant infectious diseases,
reflecting the double burden faced today.
• The pattern of death in Indonesia is still strongly
related to general poverty, low income per
capita, high rates of illiteracy and various socio-
cultural factors.
O.M.G
 According To Household Health Surveys,
The 10 Leading Diseases In The Country
1. Acute respiratory tract infection
2. Diseases of skin
3. Diseases of teeth, mouth
4. Gastro-intestinal tract, other infectious diseases
5. Bronchitis-asthma and other disease of respiratory
tract
6. Malaria
7. Nerve disorders
8. Cardiovascular disorders
9. Diarrhoea
10. Tuberculosis.
Kerjasama Pemerintah dan Swasta
 PUBLIC HEALTH SERVICES
• The responsiblility for dealing with public health problem
in Indonesia lies with the Government
• The main health body entrusted with carrying out public
health services in Indonesia is the Community Health
Center (Puskesmas), situated at sub-district level serving
a population of about 30,000-40,000. There are over
7,000 such centers in the country by the year 2000.
 The Puskesmas Render
6 Basic Services (BASIC SIX)

1. Health promotion
2. MCH/FP (Maternal Child Health/Family
planning)
3. CDC (Communicable disease control)
4. Nutrition
5. Environmental sanitation
6. Curative care and various developmental
services according to local areas’ need
 PUSTU
• In most instances, a doctor, with a staffing
between 8-32,consisting of nurses, midwives
and other auxiliary personnel, heads each
Puskesmas.
• In densely populated areas, there are Sub-
Community Health Centers (Puskesmas
Pembantu) at the village level, generally headed
by a senior nurse or midwife, and operated
under the supervision of, and linked to, the
Community Health Center.
• At present, the total number of Puskesmas
Pembantu in Indonesia is 19,977
 PUSLING
• To serve people who live in very remote areas,
there are Mobile Community Health Center
(Puskesmas Keliling), operated by and based at
the local Puskesmas.
• The staff of Puskesmas Keliling consist of one
doctor, assisted by two or three personnel,
including nurses/midwives and a driver.
• At present, there are about 6,024 Puskesmas
Keliling serving villages within the sub-district.
 POSYANDU
• To support the activities of the
Puskesmas, the community health effort is
organized in the form of the Integrated
Services Post (Posyandu), located at the
hamlet level.
• The responsible community institution to
Posyandu is the village community
resilience committee.
• The activities of each Posyandu, assisted and
supervised by local Puskesmas staff, consist of
five basic types of health services.
• These are:
(i) MCH Services
(ii) Nutrition Services
(iii) Family Planning Services
(iv) Diarrhoeal Disease Control and
(v) Immunization Services.
• At present, there are about 251,459 Posyandu
registered in Indonesia
 MEDICAL CARE SERVICES
The healthcare delivery system that is
responsible for medical problems in
Indonesia, in general can be divided into
three categories:
(i) Primary medical care facilities
(ii) Secondary medical care
(iii) Tertiary medical care facilities
 Primary Medical Care
• The primary level personal/medical care facility managed
by the government is the Puskesmas assisted by the
Puskesmas Pembantu and Puskesmas Keliling.
• Besides the provision of medical personal care, the
Puskesmas also makes provision for public health care
services in the community medical care facilities.
• The primary medical care facilities managed by the
private sector vary. There are private midwives
practitioners and private medical practitioners found in
almost every part of the country.
• The number of private midwives practitioners in
Indonesia is estimated to be approximately 34,000.
Around 20% of the private medical practitioners are
specialists, while the rest are general practitioners.
• Since most of the midwives and doctors are government
employees, their private practice is usually conducted in
the afternoon after the closing of government offices.
• In some places, although it is illegal, paramedics also
have their own private practices.
• Most private medical practitioners in Indonesia operate
their practices as a solo practice, although in the big
cities there is now an increasing trend for group
practices that become more popular.
• Other types of primary medical care facilities managed
by the private sector in Indonesia are the MCH clinic and
the polyclinic. These types of medical facilities are
usually managed by midwives or nurses, although the
responsible person for these facilities is still the doctor.
(Klinik Pratama, Klinik Utama)
• Unfortunately, the actual number of private MCH clinics
and private polyclinics in Indonesia is not available.
“KITA INGIN SEHAT”
Secondary & Tertiary Medical Care
• The secondary and tertiary medical care
facilities in Indonesia are located at hospitals.
• There are around 1,200 hospitals registered in
the country, of which 404 hospitals are
government or local government hospitals.
• The total number of beds available in all hospital
is 111,460, which means that for every 100,000
people there are around 59.8 hospital beds
available
Primary Care is The Basis of
Health Service
Primary Health Care system
Roles in a very important position

BETTER HEALTH
OUTCOMES

LOWER COST

GREATER EQUITY
IN HEALTH
Global Health Data Showed

PRIMARY HEALTH COMMUNITY

CARE HEALTH STATUS
NATIONAL HEALTH SYSTEM DOCUMENT 2004

“Primary health Care system in the

future will be conduct by
implementing the family medicine
concept”
Why family medicine ??
1. Personal care
2. Holistic care
3. Comprehensive care
4. Emphasize on preventive medicine
5. Continuing care
6. Coordinated and collllaborative care
7. Patient centered, family focused, community
oriented care
8. Quality and cost effective care
9. Patient advocacy
FINANCING OF HEALTHCARE SERVICES

• Health Services in Indonesia are operated

under a “fee for service” system.
• The number of people covered by health
insurance schemes is still limited mainly to
civil servants and some private employees
• Annual health expenditure in Indonesia is still very low. It
is estimated to be around 2.5% of GNP or about US$18
per capita, a level far under the WHO recommended
expenditure level of at least 5% GNP. A big portion of
total health expenditure in Indonesia comes from the
people, whereas the contribution of government is only
around 30%.
• The small contribution of government are utilized for all-
line subsidy that creates unfair health financing for the
poor. Most of private spending on health care is out-of-
pocket, because only around 20% are protected by
various types of prepaid care.
 CONCLUSION

• Indonesia still faces various health problems. To

overcome these challenges, Indonesia has implemented,
since 1969, a series of Five Year National Development
Programs, including the National Health Development
program. Significant progress has been achieved in
health care sector, both in public health services as well
as in medical services.
• The management of the healthcare delivery system in
Indonesia is carried out both by government and the
private sector, including some forms of public-private
mix.
• The low level of health spending, the misdirection of
government subsidies, and the big portion of population
with out-of-pocket spending indicating low proportion of
people protected by prepaid care, are challenges in that
needs to be reformed gradually towards more fairness in
health financing.

FAMILY MEDICINE CAN BE

A SOLUTION