Global Health and

Physician
Responsibility
VIERA WARDHANI
Why?
We all live in the
same word

We are all member of a single

humanity inside our heart we all
speak the same, we all love our
children and our parents, we all live in
the same world…….(Mac Forne
Malne)
We all live in the same
world

If civilization is to survive we must

cultivate the science of human
relationship the ability of all people
all kind to live together in the same
world at peace (Franklin D Rosevelt)
Global Health Challenges
Tujuan Pembelajaran

 Menjelaskan isi MDG dan Post MDG yang terkait dengan bidang
kesehatan
 Menyebutkan indikator dan target pencapaian MDG dan Post MDG
yang terkait dengan bidang kesehatan
 Menjelaskan pencapaian indikator dan target pencapaian MDG
bidang kesehatan di Indonesia dibandingkan dengan negara ASEAN
 Menjelaskan permasalahan dalam pencapaian indikator dan target
pencapaian MDG bidang kesehatan
 Mengidentifikasi peran dokter dalam sistem pelayanan kesehatan
untuk menjamin pencapaian MDG dan agenda post MDG
 Menjelaskan tantangan AFTA 2015 dan UHC dalam bidang kesehatan
dan peran aktif dokter.
What is MDG and current state
achievement
Topic 1-2

 Why MDG
 What is MDG
4. Reducing Child Mortality

Indicator 1997 Target 2007 Comments

Under five 81 32 40
mortality
rate/1000
Infant mortality 57 19 32
rate/1000
Child Mortality Health
Neonatal death causes
Infant mortality causes
U-5 Mortality causes
5. Improving maternal health

Indicator 1990 Target 2007 Comment

s
Maternal 390 110 300
mortality rate
per 100.000
Birth helped by 40.7% 100% 72.4
trained nurse
Married women 50.5% 100% 57.9
age 15-49 using
contraception
MMR Trend
Cause MMR
Three delay model
Making Pregnancy Safer
Messages
1 All pregnancy is
intended (wanted)
2
All delivery is helped
by trained health
care attendance
3 All pregnancy
complication
managed with an
adequate health
6. Combating HIV/AIDS and other
Diseases (TB, Malaria)
Indicator 1997 Target 2007
Prevalence of Control the 5.6
HIV/AIDS spread
Case of 8.5
Malaria/1000
Tuberculosis 786 262
prevalence
/100.000
Why HIV Epidemic?
230,000
Wanita
230.000 Pekerja seks
penasun

3,1 Juta Pria

1,6 Juta
membeli Sex menikah
(2-20% dari Pria Dewasa)
dg pria risiko
tinggi
800,000
GWL

Anak-anak

Laki-laki Perempuan
Jumlah Penduduk Indonesia: 240 juta
ASEAN Human development index
Rank
Country ASEAN HDI Income GDP
rank category
Group Rank Index

Singapore High High 25 0.992 High 29.663

Brunei High High 30 0.894 High 28.161

Malaysia Upper med High 63 0.811 Upper med 10.882

Thailand Upper med Medium 78 0.781 Lower med 8.672

Philippine Medium Medium 90 0.711 Lower med 5.137

Vietnam Medium Medium 105 0.733 Low 3.071

Indonesia Medium Medium 107 0.738 Lower med 3.843

Laos Lower med Medium 130 0.601 Low 2.039

Cambodia Lower med Medium 131 0.598 Low 2.727

Myanmar Lower med Medium 132 0.583 Low 1.027

ASEAN Human development index
Rank
Thai Mal Phil Indo Vietn. Cam Lao Myan.
Poverty A A A ?
Hunger A A A
Primary A A
education
Gender A A A
disparity
Under 5 M A A
MMR A A
HIV/AIDS A A
Infectious A A
disease
Environment ? ?
Safe water, A A A
sanitation
What are the remaining global
problems?
SUSTAINABILITY AND GOOD GOVERNANCE
From MDGs to Sustainable
Development Goals

8 GOALS MDGs

12 GOALS SDGs
 Comparing MDGs and SDGs
MDGs 2000 - 2015 POST 2015
1. Menanggung Kemiskinan dan 1. Mengakhiri Kemiskinan
Kelaparan
2. Memberdayakan Anak Perempuan, Kaum Perempuan &
Pencapaian Kesetaraan Gender
2. Mencapai Pendidikan dasar untuk
semua 3. Meningkatkan Mutu Pendidikan & Penerapan Belajar
Seumur Hidup

3. Mendorong Kesetaraan Gender dan 4. Menjamin Hidup Sehat

Pemberdayaan Perempuan
5. Menjamin Ketahanan Pangan & Gizi Baik

4. Menurunkan Kematian Anak 6. Menjamin Tersediannya Akses Air Bersih & Sanitasi

7. Membangun Ketahanan Energi Berkelanjutan

5. Meningkatkan Kesehatan Ibu

8. Menciptakan Lapangan Kerja, Penghidupan

Berkelanjutan, & Pertumbuhan Berkeadilan
6. Mengendalikan HIV dan AIDS, Malaria
& Penyakit Menular Lainnya (TB) 9. Mengelola Aset Sumber Daya Alam secara Berkelanjutan

10. Meningkatkan Penyelenggaraan Pemerintahan yang baik

7. Menjamin Kelestarian Lingkungan dan efektif
Hidup
11. Menjamin Kehidupan Bermasyarakat yang Aman dan
Damai
8. Mengembangkan Kemitraan
Pembangunan Tingkat Global 12. Menciptakan Lingkungan Global yang Kondusif sebagai
Katalisator Pembiayaan Jangka Panjang
Two Important Keys

 Good governance
 Sustainability
AFTA Challenges and Universal
Health Coverage
AFTA challenges

Global
Standard
Free
Trading

Global
Competition
Universal Health Coverage &
Sustainable Development
Health enables sustainable
development
The right of everyone to Increase access
Health is enjoy the highest to health
a Right attainable standard of services
physical and mental Improve level &
health is globally
distribution of
recognized
health
Health is
75% of health outcome is Outcomes
socially
highly depend on working
determine and living condition
d Better health
for citizen

Health Healthy population mean Improve country

contributes higher labor productivity competitiveness
to growth & Higher return to household
development from labor market
Inclusive &
participation
sustainable growth
The contribution of health sector
Post 2015 Development Agenda : Wellbeing for All

Sustainable wellbeing for all: poverty

eradication, education, nutrition,
environment, security, etc

Healthy lives at all stages: child survival,

maternal survival, MDG6, adolescent
health NCD burden reduction

Universal Health Coverage; health

promotion, prevention, treatment,
financial risk protection
Health Other
Sector Sector
UHC Means

 All people can access the health service they need

without incurring financial hardship
 Access
 Financial protection
 72% Road map of Indonesian
(2013) universal health coverage 34
86,4 juta
PBI (UHC)
257,5 juta
111,6 juta peserta
KEGIATAN: (semua
peserta dikelola
BPJS Keesehatan Pengalihan, Integrasi, Perluasan penduduk)
Penduduk yang
dijamin di berbagai 60,07 Juta pst dikelola BPJS
skema 148,2 jt jiwa dikelola oleh `Perusahaan 2014 2015 2016 2017 2018 2019 Keesehatan
Badan Lain USAHA BESAR 20% 50% 75% 100%    
Tingkat
90,4juta belum jadi 73,8 juta belum USAHA SEDANG 20% 50% 75% 100%    
Kepuasan
peserta jadi peserta USAHA KECIL 10% 30% 50% 70% 100%  
USAHA MIKRO 10% 25% 40% 60% 80% 100%
Peserta 85%

201 201 201 201 201 201 201 201

2Pengalihan3Peserta JPK 4 5 6 7 8 9
Jamsostek, Jamkesmas, Askes Integrasi Kepesertaan Jamkesda dan askes
PNS, TNI Polri ke BPJS komersial ke BPJS Kesehatan
Kesehatan
Perpres Pengalihan
Dukungan
Kepesertaan
Operasional
Kesehatan bagi TNI/POLRI ke
TNI Polri BPJS Kesehatan
Penyusunan
Sisdur Pemetaan Perluasan Peserta di Usaha Besar, Sedang, Kecil & Mikro
Kepesertaa Perusahaa 20% 50% 75% 100%
n dan n dan
Pengumpul 20% 50% 75% 100%
sosialisasi
an Iuran 10% 30% 50% 70% 100% 100%

Sinkronisasi Data
Pengukuran kepuasan peserta berkala, tiap 6 bulan
Kepesertaan: JPK
Jamsostek, Jamkesmas dan
Askes PNS/Sosial -- NIK Kajian perbaikan manfaat dan pelayanan peserta tiap
tahun
 National Health Security
System

Kendali Biaya & kualitas Yankes

Government
BPJS
National policy for
regulation and implement

Regulation for , health

personal, medical equipment,
Regulato medicine formularies etc.
r
Regulasi Pricing of health
services/provider (TARIF)
Pembayar tunggal, regulasi, kesetaraan

Health Services
Participan Health
Primary
Secondary
ts Access to Health service facilities Referral
Tertiary Referral
Sistem system
Rujukan
2014 2015 2019 2020
Keep in mind