HEALTH IN SUSTAINABLE

DEVELOPMENT GOALS,
WORLD IN 2030

Dr. Untung Suseno Sutarjo, MKes

The Secretary General of The Ministry of Health
 SDGs: UNFINISHED BUSINESS + NEW EMPHASIS
UNFINISHED BUSSINESS:
SDGs NEW EMPHASIS:
1. Decreasing malnourished prevalence on
children under 5 y.o
2. Decreasing neonatal and under 5 y.o
mortality rate
3. Decreasing mother mortality rate
4. Decreasing HIV and AIDS prevalence
5. Improving comprehensive education to
15 - 24 y.o population about HIV and
AIDS
6. Improving access to healthy drinking
water and sanitation
1. Sustainable solutions to overcome
nutritional problems: integrated with the
improvement of access to food and
agricultural production
2. Universal Health Coverage
3. Mortality cause by non communicable
diseases and tobacco control
4. Narcotics and alcohol abuse
5. Death and injuries from traffic accidents
6. Water, air and soil contamination and
pollution
7. Crisis and emergency management
8. Gender equality as a cross-cutting issue
9. Adolescents as an important actors of
health sexual and reproduction
 CONTINUATION of MDG’s
2000 2015 2030

MDGs Goals Target Indicator SDGs Goals Target Indicator

TOTAL 8 18 63 TOTAL 17 169 230
HEALTH 5 9 32 HEALTH 4 19 31
MDG’s POSITIVE IMPACT FOR HEALTH SECTOR: Presidential Decree Goals Target Indicator Goals Number
a. Improve awareness of health issues No 59 year 2017
b. Improve allocation for health budgeting HEALTH 1 8 24 3
c. Unite in health development direction
RELATED WITH HEALTH 7 13 35 1, 2, 5, 6, 8, 16, 17
d. Integrated in monitoring and evaluation of priorities issues

FOCUS SDGs:
5P : PEOPLE, PLANET, PEACE, PROSPERITY AND PARTNERSHIP
 Health sector special interest
Integrating all health issues in one goal (#3
Goal). Every achievement effort have to
consider the linkage and cause-effect among all
health issues
#3 Goal: Ensuring healthy
life and encourage
welfare for all people of
all ages
Unfinished business:
1. Decreasing MMR, NMR, Under 5 years MR
2. Reduce HIV/AIDS, TB, Malaria prevalence
3. Access to health reproduction (Including Family Planning, ASFR)
New interest:
1. Death cause by Non Communicable Diseases and tobacco
control
2. Narcotics and alcohol abuse
3. Death and injuries cause by traffic accident
4. Universal Health Coverage
5. Water, air and soil contaminations and pollutions
6. Crisis and emergency management
 INDONESIA’s HEALTH SDG ‘s PROFILE 2016

Sources: WHO 2016

INDONESIA’s HEALTH SDG PROFILE 2016
 PRESIDENT’S VISION & MISSION

Three Focus (TRISAKTI):

3 DEVELOPMENT DEMENTIONS: HUMAN DEVELOPMENT,

WORKING CABINET NORM of DEVELOPMENT

PRIORITIES SECTOR, EQUITY AND TERRITORIALITY

Independent in economic; sovereign in politics;

personalities in culture

9 PRIORITIES AGENDA (NAWA CITA)

5th Agenda: Promote Indonesian people qualities of life

INDONESIA SMART PROGRAM HEALTHY INDONESIA INDONESIA WORK PROGRAM

PROGRAM INDOENSIA WELFARE PROGRAM

STRENGTHEN HEALTH NATIONAL HEALTH

HEALTH PARADIGM
SERVICES INSURANCE

HEALTHY FAMILY REMOTE AREA

 HEALTHY INDONESIA PROGRAM
Pillar 1.
Health Paradigm
Program
• Promotive – preventive as a
basic of health development
• Community empowerment
• Involvement of other sectors
FAMILY APPROACH
Pillar 2.
Strengthening Health Services
Program
• Improve access especially to first
level health facilities
• Referral System optimization
• Quality Improvement
Continuum of care approach
implementation
Basic health risk intervention
Distribution of Health Workers to underdeveloped
HEALHTY FAMILY
Pillar 3.
National Health Insurance
Program
• Benefit
• Finance system: insurance –
mutual cooperation principals
• Quality control & quality
financing
• Target: Universal Coverage
Membership identification: Healthy
Indonesia Card (known as Kartu
Indonesia Sehat/KIS)
Special program:
areas, borders and islands
 CONTINUUM OF CARE

ELDERLY
ADULT • Elderly Posyandu
• Improving independency
TEENAGER of the quality of life
• Family planning for
couples of • Deceleration degenerative
CHILDREN process
• Reproduction health childbearing age
UNDER 5 y.o • Nutrition, HIV/AIDS • PKRT
• School health and drug • Detection of
program consultation communicable and
PREGNANT, INFANT • SDIDTK • Immunization for non communicable
• Tablet Fe
• Immunization students • Reproduction health diseases
MATERNITY & • Health sport and
• Exclusive • Nutrition • Health screening for consultation
CHILDBIRTH breastfeeding • Collaboration PAUD, students • PKRT occupational
• P4K BKB, and Posyandu • Supplementary • Brain Healty Life Style
• ANC book
• Complete basic
• Cognitive detection feeding
Imimmunization
• Integrated ANC
and simulation
• Pregnant women class • Supplementary
• RTK feeding
• Midwives partnership
Birth attendant • Weighing
• Family Planning
• PONED/ PONEK • Vit A
• MTBS
 Population
DEMOGRAPHIC
BONUS 2030 Majority
PRODUCTIVE
AGE
Demographic bonus and windows opportunity
90

80
Demographic bonus Window
70 opportunity
Youth
60 Determine
50
Indonesia’s
Percentage

40

30
chance to
20 become develop
10 Eldery country
0
1950
1955

1965
1970
1975

1985
1990

2005
2010

2020
2025
2030

2040
2045
2050
1960

1980

1995
2000

2015

2035

Years 10
 FUTURE GENERATION

Intervention 2017 2030

ELDERLY ELDERLY

ADULT ADULT

YOUTH YOUTH

CHILDREN CHILDREN

UNDER 5 y.o UNDER 5 y.o

INFANT INFANT

FETUS FETUS

Investation
EXCELLENT QUALITY GENERATION PREPARATION
 NATIONAL HEALTH SYSTEM
Presidential Decree Number 72 Year 2012

HEALTH
MANAGEMENT

HUMAN RESOURCE OF
HEALTH  HEALTH STATUS
HEALTH CARE
PHARMACEUTICALS, FOOD
 FINANCIAL
AND MEDICAL DEVICES PROTECTION
COMMUNITY  HEALTH SERVICES
HEALTH RESEARCH AND EMPOWERMENT
DEVELOPMENT RESPONSIVENESS

HEALTH FINANCE
(Include National
Health Insurance)
PROMOTIVE – PREVENTIVE – CURATIVE - REHABILITATIVE
 SUB-SYSTEM 1: HEALTH CARE

Referral
National Province
NATIONAL, PROVINCE, AND REGIONAL REFERRAL HOSPITAL Hospital
Class A 12 2
RSU Dr. Zainoel Abidin
RSUD Tarakan Class B 2 15
Class C -- 3
RSU H Adam Malik
RSU Prof.Dr. R.D Kandou Total
TOTAL REGIONAL 14
REFERRAL 20
RSUD Kep. Riau HOSPITAL: 110
RSU Sorong
RSU Dr Sudarso PTK RSU Dr. Hasan Busor
RSU Dr. M.Jamil RSUD H A WahabSjahranie RSU Prof. Dr. Aloei
RSUD Arifin Achmad
RSUD Dr. Doris Sylvanus
RSUD Raden Mattaher RSUD Mamuju RSU Kendari RSU Jayapura CLASS A 2 hospitlas
RSUD Ulin
RSU Dr. Ir. Soekarno RSU Dr W Sudirohusodo RSU Dr. M Haulussy CLASS B 58 hospitlas
RSUD Dr. M. Yunus
RSU Dr. Mohammad Hoesin
CLASS C 46 hospitlas
RSU Dr. H. Abdul Moelok RSU Tangerang
CLASS D 4 hospitlas
RSU Dr. Cipto Mangunkusumo RSU Dr. Kariadi

RSU Dr Hasan Sadikin RSU Dr. Soetomo

**Ministry of Health decree
RSUD Prov NTB
HK.02.02/MENKES/390/2014
RSUP Dr. Sarjito RSU Prof. Dr. WZ Johanes
HK.02.02/MENKES/391/2014
RSUP Sanglah Denpasar
NATIONAL REFERRAL HOSPITAL
PROVINCE REFERRAL HOSPITAL
 ENHANCING ACCESS OF HEALTH SERVICES

HOSPITAL COMMUNITY HEALTH CENTER

1. The amount of Community Health

1. The amount of hospitals in Indonesia is Center in Indonesia is 9754.
2598. Currently, developing 104 2. Establishing 24 Community Health
Regional Referral Hospital. Center in border areas.
2. Establishing 23 Pratama Hospital. 3. Establishing 362 Community Health
3. Strengthening 4 Province Hospital as Center in remote areas.
National Referral Hospital.
4. 2017 : Planning to establish 3 new
vertical hospital in di Eastern Indonesia
(Provincial of Maluku, Papua, and Nusa
Tenggara Timur ).
 ENHANCING QUALITY OF HEALTH
SERVICES THROUGH COMMUNITY
HEALTH CENTER AND HOSPITAL
13, 1% ACCREDITATION

131, 10%
63, 31%

82, 41%
589, 45%

COMMUNITY HEALTH HOSPITAL

CENTER
8, 4%
576, 44%

14, 7%

34, 17%

DATA PER DECEMBER 31st 2016

PERDANA DASAR MADYA UTAMA PARIPURNA PERDANA DASAR MADYA UTAMA PARIPURNA

A number of sub-district owns minimum 1 A number of district/city owns

accredited Community Health Center is 1308 sub- minimum 1 accredited Hospital is 201
districts districts/cities
 SPECIALIST DOCTORS COMPULSORY DUTY
(WAJIB KERJA DOKTER SPESIALIS/WKDS)

Location of placement:
Presidential Decree Number 4 Year Central government and local government
2017 concerning Specialist Doctors hospitals, prioritized :
Compulsory Duty (WKDS) 1. Hospitals in remote area
2. Regional referral hospitals
3. Provincial referral hospitals
The fulfilment of needs and
increased community access
to obtain quality health
services throughout
Indonesia

The participants are a fresh graduate specialist Stakeholder involved:

doctors from domestic public university and abroad.
WKDS duration:
One year for independent participants, while for
scholarship recipient the duration will be in
accordance with the provisions of legislation
Ministry of Health, Ministry of Research Technology
and Higher Education, Ministry of Home Affair,
Ministry of Finance, Local and Provincial
Government, Educational institutions, Indonesia
Medical Council, Professional Organization dan
Collegium
SPECIALISED DOCTORS COMPULSORY SERVICES (WKDS)
Presidential Decree Number 4 Year 2017

1 kab, 1 RS, 1 Peserta 1 kab, 1 RS, 3 Peserta

2 kab, 2 RS, 2 peserta 2 kab, 2 RS, 2 Peserta

2 kab, 2 RS,
2 peserta

2 kota, 2 RS, 2 peserta 4 kab, 4 RS, 4 Peserta

2 kab, 2 RS, 2 peserta 3 kab, 3 RS, 3 Peserta

4 kab, 5 RS, 3 kab, 3 RS, 3 peserta

6 peserta
2 kab, 2 RS, 3 Peserta

1 kab, 1 RS, 3 kab, 3 RS, 3 peserta

2 peserta

7 kab, 8 RS, 8 Peserta

3 kab, 3 RS, 4 Peserta
1 kab, 1 RS,
1 peserta

1 kab, 1 RS, 1 Peserta

4 kab, 4 RS,
1 kota, 1 RS, 4 peserta
1 peserta 3 kab, 3 RS,
3 peserta

2 kab, 2 RS, 2 peserta

4 kab, 4 RS, 1 kab, 1 RS,
5 peserta 1 peserta
SUB-SYSTEM 2: HEALTH RESEARCH AND DEVELOPMENT

Strengthening the sub-system of health research and development

carried
out by conducting a national scale of research such as:
 Basic Health Research;
 Human Resources of Health Research
 Health Facilities Research
 Cause of Death Research
 Vector Research
 Indonesian Herbal Research
 SUB-SYSTEM 3: HEALTH FINANCE

ROADMAP MEMBERSHIP RECRUITMENT

Target 1st 2019 UNIVERSAL

COVERAGE
January
133.423.653
members
2016
Target 1st 2015 TARGET MEMBERS
Micro business

January TARGET MEMBERS

114.339.825 1. Government-owned enterprises
members 2. Macro business
3. Medium business

2014 TARGET MEMBERS

4. Micro business

1. Beneficiaries Presidential Decree No 111 Year 2013:

2. Army & Police
3. Former Askes participants The national health insurance membership is
Askes Co mandatory to cover the entire population of
4. Former labor social security
16,4 billion IDR 5. others Indonesia
out of pocket expenditure, as % of the
health expenditure (2014)

47, 47%
 EPIDEMIOLOGY TRANSITION
• Increase of mortality caused by Non Communicable diseases
• This trend is likely to continue along with changes in life style behaviors such as diet with unbalanced nutrition, lack of physical activities, smoking and others

Main Cause of Disease Burden

1990-2015
1990 2000 2010 2015

Non Communicable Non Communicable Non Communicable

communicable diseases Non Communicable communicable diseases
communicable diseases
diseases communicable diseases diseases
diseases
diseases
36% 30%
33%
56% 50% 43% 58% 57%
Road accident
Road accident
Road accident Road accident 9% 13%
8%
7%

Note: Measurement of diseases burden using Disability-adjusted Life Years (DALYs)

Loss of life in years due to illness and premature death

Source: Double Burden of Diseases & WHO NCD Country Profiles (2014)
 Economic Burden Cause By Non Communicable Diseases
Projected number of outpatient and inpatient cases year 2014 - 2019
Rawat Inap
inpatient Rawat Jalan
outpatient

2,690,660 3,112,908 3,543,801

1,901,805 2,277,367 3,783,861
2,703,915
1,627,387 1,922,723 2,224,458 2,532,370
1,359,013
2014 2015 2016 2017 2018 2019
BPJS, January – June 2014
Out patient cost In patient cost VISITE CONTACT CLAIMED COST
Diseases NO DISEASES CASES
(times) RATE
IDR IDR TOTAL (billion) MEAN (billion)
All diseases 3,45 trillion 12,66 trillion 1 Heart 905,223 2,756,216 3.0 6,934,361 2,515,899
Catastrophic diseases 1,03 trillion 4,24 trillion 2 Stroke 270,290 508,306 1.9 1,548,826 3,047,034
Catastrophic burden 30% 33,50% 3 Diabetes 202,526 306,632 1.5 1,256,664 4,098,281
4 Cancer 133,966 446,048 3.3 1,887,308 4,231,176
Catastrophic 5 Renal 77,276 952,995 12.3 1,545,772 1,622,018
29.67% 6 Hepatitis 39,864 88,403 2.2 277,775 3,142,145
7 Thalassemia 13,632 125,494 9.2 602,852 4,803,827
8 Leukemia 8,374 28,738 3.4 154,145 5,363,809
9 Hemophilia 4,382 28,156 6.4 120,554 4,281,645
10 Other 21,013,270 72,612,388 3.5 60,063,446 827,179
TOTAL/MEAN 22,668,803 77,853,376 3.4 74,391,706 955,536
5 diseases with the highest cost burden are Non Communicable Diseases.
1,69 Trillion or 29,67% the burden of national insurance costs Without investment in the form of preventive-promotive efforts, the
are absorbed for the cost of catastrophic diseases burden of health expenditure in Indonesia is projected to increase
 Sexual Behavior Bullying And Suicidal Inclination

Risk Behavior National Risk Behavior National

PICTURE OF
SCHOOL AGE Force to do sexual intercourse 4.3 Had been bullied 20.6
POPULATION

Had been sexual intercourse 11.6 Intention suicide 5.2

Proportion (%) of 10 Highest Risk Factors Proportion (%) of 10 Highest Risk Factors
in Junior & Senior High Student (female) - GSHS 2015 in Junior & Senior High Student (male) - GSHS 2015

Less fruit and vegetable consumption 78.9 Less fruit and vegetable consumption 77.8

Soda consumption once/more a day 58.2 Soda consumption once/more a day 66.5

Smoking parents 56.4 Junk food consumption once/more a day 51.6

Junk food consumption once/more a day 54.2 Smoking parents 51.0

Less phisical activities 51.6 Passive smoker 46.6

Not always had breakfast 50.9 Less phisical activities 45.3

Passive smoker 38.7 Phisical attack once/more a year 41.6

Not always wash hands with soap 35.4 Not always wash hands with soap 40.1

Feel lonely and anxiety 33.7 Had been smoking 40.1

Feel parents less understanding 25.3 Not always had breakfast 39.9

0 10 20 30 40 50 60 70 80 90 0 10 20 30 40 50 60 70 80 90
 % Elderly Population Estimate % Elderly Population Prevalence of Three Highest Diseases in Elderly
9 18
8.5 67.0
8 16 15.77 70.0 63.8
7.6 57.6
7 7.2 14 13.82 60.0 54.8
51.9
6.3 45.9 45.0 46.1
6 12 11.83 50.0

5 10 9.99 40.0 33.0

4.5 4.6
8 30.0
4
20.0
3 6
10.0
2 4
0.0
1 2
Hipertensi Artritis Stroke
0 0
1960 1970 1980 1990 2000 2010 2020 2015 2020 2025 2030 2035 2040 55-64 65-74 75+

Proportion of Dependency in Elderly

16 15.0

14 13.1

PICTURE OF
12
THE ELDERLY 9.8
10
8.2

8 7.0

5.4 5.4
6 4.7
3.6
4 3.0
2.6
1.9 2.1 2.0
1.7 1.7
1.4 1.3
2 0.6 0.8 1.0 0.9
0.5 0.5

0
60-64 65-69 70-74 75-79 80-84 85-89 90+ 60+
male female total
 HEALTH SERVICE COVERAGE

coverage (%) coverage (%)

IMPROVED WATER SOURCE AND ADEQUAT CARE SEEKING BEHAVIOUR SUSPECTED
SANITATION 74 PENUMONIA 75
INSECTICIDE-TREATED BEDNETS/INDOOR CHILD IMMUNIZATION COVERAGE (DPT3)
RESIDUAL SPRAY COVERAGE FOR MALARIA… 55 81

HIV ANTI RETROVIRAL THERAPY COVERAGE PREGNANCY CARE

6 85

TB TREATMENT SUCCESS RATE FAMILY PLANNING COVERAGE

88 79

coverage (%) coverage (%)

TOBACCO NON-USE HEALTH SECURITY: IHR COMPLIANCE

64 96

CERVICAL CANCER SCREENING ACCESS TO ESSENTIAL MEDICINES

PREVALENCE OF NORMAL GLUCOSE LEVEL HEALTH WORKER DENSITY, EXPRESSED AS %

IN POPULATION 91 OF NEW GLOBAL BENCHMARK 66
PREVALENCE OF NORMAL BLOOD PRESSURE POSTNATAL CARE FOR MOTHERS AND
LEVEL IN POPULATION 77 BABIES WITHIN TWO DASYS OF BIRTH 58
 THE CONCEPT OF
GOVERNMENT
NATIONAL HEALTH INSURANCE

SOCIAL HEALTH
INSURANCE BOARD
PROFESSIONAL
ORGANIZATION Strengthening Check & Balance
OTHER Mechanism
STAKEHOLDER HEALTH
FACILITIES The role of all parties in
ORGANIZATION supervising, monitoring and
evaluating the health care services
SYSTEM

Ensuring the quality of health care

and payment accuracy

INCENTIVES

HEALTH FACILITIES HUMAN RESOURCE of

MANAGEMENT HEALTH
 NATIONAL HEALTH INSURANCE
ANALYSIS OF THE ECONOMIC AND SOCIAL HEALTH INVESTMENT IMPACT

Health
Industry

Life Neo natus

NATIONAL HEALTH INSURANCE Expectancy Mortality
Rate
Pharmaceutical
Industry Hospital
Psychologic
Health construction

Health work Labor

field productivity

HEALTH SERVICES
DIRECT
INDIRECT
Level of poverty

NOTE: psychology health caused direct and indirect impact to

INFESTATION IMPACT
economic and social infestation
Source: Pusat Data Bisnis Indonesia cit. BPJS
SUB-SYSTEM 4: HUMAN RESOURCE OF HEALTH

+
WKDS
SUB-SYSTEM 5: PHARMACEUTICALS, FOOD SAFETY AND MEDICAL DEVICES

Strengthening the sub-system of Pharmaceuticals,

food safety and medical devices through:
 National drug formulary;
 Drug procurement through e-catalogue
 Monitoring and Evaluation to the planning of drug
needs
 And others
 SUB-SYSTEM 6: HEALTH MANAGEMENT

Strengthening the sub-system of Health Management

through: :
 Strengthening Health Information System
 Bureaucracy reform by running E – Government E –
Health Office
 And others
 SUB-SYSTEM 7: COMMUNITY EMPOWERMENT

GERMAS (Community Movement for Healthy

Living) is a systematic plan of action undertaken by the
collaboration of all national components through
awareness, willingness, and ability to behave healthily with
the intention to improve the quality of life
PRESIDENT INSTRUCTION NUMBER 1 YEAR 2017

Improving Physical Improving Healthy Increasing Prevention Increasing Increasing

Provision of Healthy Foods and Early Detection
Activities Lifestyle Behaviour Environment Healthy Life
and the Acceleration of Disease Quality Education
of Nutrition Improvement

Circular Letter of Ministry of

Ministry of Home Affair Decree • Circular Letter of Governor of
Home Affair Number East Java, Central Java, Jambi,
Number 32 Year 2017 440/2797/SJ concerning DIY, West Nusa Tenggara and Bali
concerning Establishing Local year 2017
Supporting the
Government Work Plan year • Governor Instruction of
Implementation of Presiden
2018 Kepulauan Riau Number 1/2017
Instruction year 1/2017
 10 Things That Need To Be Strengthened
In The Era Of SDGs (Lesson Learn From MDGs)
*) National Development & Planning Agency 2015
1. Minimize gaps inter provincial, inter district, inter city as well as inter social economic level in achieving
health sector targets
2. Health sector resources mobilization that comes from business world, community including from
collaboration with partners
3. Health indicators data availability which integrate with short-term and mid-term planning and budgeting
system
4. Health indicator database availability in district and city level
5. Strengthening strategy in health communication and advocacy to all stakeholders
6. Understanding every operational definition indicators from central to local level
7. Facilitation from central level to local specially to district and city
8. Collaboration cross-sector and cross-program among health sector
9. Monitoring and evaluation in health sector accomplishment
10. Program and activities support for achieving health sector targets
 CONCLUSIONS

1. Strengthening the National Health System and involving cross-

sectoral in the implementation of various programs to achieve the
SDGs goals, is a must
2. In achieving the objectives of the SDG’s, it is necessary to give
special attention to the epidemiology of diseases and also the
demographic.
3. Various parties need to support the Universal Health Coverage as it
is one of the keys success in achieving SDGs goals in the year 2030
THANK YOU