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
 s
PRESIDENT’S VISION & MISSION
SDG
G s
SD Three Focus (TRISAKTI):
DEVELOPMENT,
HUMAN DEVELOPMENT,

WORKING
WORKING CABINET
TERRITORIALITY
AND TERRITORIALITY

Independent in economic; sovereign in politics;

personalities in culture

CABINET NORM
9 PRIORITIES AGENDA (NAWA CITA)
DEMENTIONS: HUMAN

5th
th Agenda: Promote Indonesian people qualities of life
EQUITY AND
DEVELOPMENT DEMENTIONS:
SECTOR, EQUITY

NORM of
INDONESIA SMART PROGRAM HEALTHY INDONESIA INDONESIA WORK PROGRAM
INDOENSIA WELFARE PROGRAM
PROGRAM
PRIORITIES SECTOR,

of DEVELOPMENT
DEVELOPMENT
STRENGTHEN HEALTH NATIONAL HEALTH
33 DEVELOPMENT

HEALTH PARADIGM
SERVICES
PRIORITIES

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

of life ADULT
days
• Elderly Posyandu

10 0 0 TEENAGER • Improving independency

first • Family planning for of the quality of life
The CHILDREN couples of • Deceleration degenerative
• Reproduction health childbearing age process

UNDER 5 y.o • Nutrition, HIV/AIDS • PKRT

• School health and drug • Detection of
program consultation communicable and
PREGNANT, INFANT • SDIDTK • Immunization for • Tablet Fe non communicable
• Immunization students • Reproduction health diseases
MATERNITY & • Nutrition • Health screening for consultation • Health sport and
• Exclusive
CHILDBIRTH breastfeeding • Collaboration PAUD, students • PKRT occupational
• P4K BKB, and Posyandu • Supplementary • Brain Healty Life Style
• ANC book • Complete basic feeding
• Cognitive detection
• Integrated ANC Imimmunization

e
and simulation
• Pregnant women class
• Supplementary
c yc l
Life
• RTK
• feeding
Midwives partnership
Birth attendant • Weighing
• Family Planning
• PONED/ PONEK • Vit A

• MTBS
 Population
DEMOGRAPHIC
BONUS 2030 Majority
PRODUCTIVE
AGE

Determine
Indonesia’s
chance to
become develop
country

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  FINANCIAL
PHARMACEUTICALS, FOOD
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 Class B 2 15

RSUD Tarakan
Class C -- 3
RSU H Adam Malik Total
RSU Prof.Dr. R.D Kandou 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. M Haulussy
CLASS B 58 hospitlas
RSUD Dr. M. Yunus RSU Dr W Sudirohusodo
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
13; 0.99% AND HOSPITAL ACCREDITATION
131; 10.01%

63; 31.34%

82; 40.80%
PERDANA; 589; 45.00%

COMMUNITY HEALTH HOSPITAL

CENTER

576; 44.00% 8; 3.98%

14; 6.97%

34; 16.92%

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

UNIVERSAL
Target 1st
January
2019 COVERAGE
133.423.653
members 2016
2015
TARGET MEMBERS
Micro business
Target 1stst
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; 47.00%
2; 53; 53.00%
 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

33.00% 30.00%
Non Communicable Non Communicable
36.00% Non Communicable
Non Communicable communicable diseases
communicable diseases communicable diseases
diseases 43.00% communicable diseases diseases
diseases
diseases
50.00%

56.00% 57.00%
58.00%
Road accident
Road accident
13.00%
Road accident Road accident 9.00%
8.00%

7.00%

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
inpatient
Rawat Inap Rawat Jalan
outpatient
3,112,9 3,543,8
2,277,3 2,690,6 01
60 08 3,783,861
1,901,805
67
2,703,915
1,359,013
1,922,7 2,224,4 2,532,3
2014 1,627,3
2015 2016 2017 2018
70 2019
87 23 58
BPJS, January – June 2014
Out patient cost In patient cost CLAIMED COST
Diseases IDR IDR NO DISEASES CASES VISITE CONTACT
(times) RATE 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
67
8.5 63.8
16 70.0
8 15.77 57.6
7.6 54.8
7.2 60.0 51.9
7 14 13.82
45.9 45.0 46.1
6.3 50.0
6 12 11.83
40.0 33.0
5 10 9.99
4.5 4.6 30.0
4 8
20.0
3 6
10.0
2 4
0.0
2
Hipertensi Artritis Stroke
1

0 0
1960 1970 1980 1990 2000 2010 2020 2018 2020 2022 2024 2026 2028 2030 2032 2034 2036 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 0.8 1.0 0.9
0.5 0.6 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 sanitation Care s eeki ng behavi our sus pected penumoni a
74 75

Insecticide-treated bednets/indoor residual spray coverage for malaria prevention Chi l d i mmuni zation coverage (DPT3)
55 81

HIV anti retroviral therapy coverage Pregna ncy care

6 85

TB treatment success rate Fami l y pl anni ng coverage

88 79

0102030405060708090 70 72 74 76 78 80 82 84 86

coverage (%) coverage (%)

Tobacco non-us e Hea l th security: IHR compl i ance

Cervi ca l cancer s creeni ng Acces s to es s ential medi ci nes

64 96
Preval ence of norma l gl ucos e l evel i n popul ation Heal th worker dens i ty, expres s ed as % of new gl obal benchma rk
91 66
Preval ence of norma l bl ood press ure l evel i n popul ation Postnatal ca re for mothers a nd babi es wi thi n two dasys of bi rth
77 58

0 20 40 60 80 0
10 0 20 40 60 80 100
 THE CONCEPT OF
GOVERNMENT NATIONAL HEALTH INSURANCE
SOCIAL HEALTH
INSURANCE BOARD
PROFESSIONAL
ORGANIZATION Strengthening Check &
OTHER Balance Mechanism
STAKEHOLDER HEALTH
FACILITIES The role of all parties in
ORGANIZATION supervising, monitoring and
evaluating the health care services
SYSTEM

Pr
of
l
ea

es
sio
p t
Ap di

na
au

lS
n/

ta
i o
vis

dan
er

rd
su
p 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:
NOTE: psychology
psychology health
health caused
caused direct
direct and
and indirect
indirect impact
impact to
to
INFESTATION IMPACT
economic
economic and
and social
social infestation
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 • Circular Letter of Governor of

Ministry of Home Affair Decree 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