Pediatric Health Care In Indonesia

Children Health Care System In IndonesiaProblem Based ApproachDian Kesumapramudya N.Kobe University-Graduate School of MedicineDepartment of Community Medicine & Social Health CareJapanDepartment of Pediatric, Gadjah Mada University, Indonesia = Monday base no suho1

INDONESIA IS An ARCHIPELAGIC COUNTRY Located : at South East AsiaNUSANTARA ( Nusa = continent, antara = betwee)

Between Asia continent and Australia Continent, Hindian and Pasific ocean

6 hours from Osaka (KIX) to Bali (Ngurah Rai International Airport) = gunto kuni2

230 millions people as its citizens (2010). Growth 1,49% Consists many tribes () ~ + 268 tribesWith different local languages, cultures, behaviour, etc

INDONESIA75+ 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 0-4Population pyramid of Indonesia , year 1995Population pyramid of Indonesia , year 201014 12 10 8 6 4 2 0 2 4 6 8 10 12 1414 12 10 8 6 4 2 0 2 4 6 8 10 12 14In millionIn millionSource : Indonesian Statistic Bureau, 2010 Data BaseSuku = buzoku3INDONESIA NATIONAL CHILD HEALTH PROBLEMSEducation Participation levelKnowledgePoverty & GDP 15% poor, 49% income below 2$/d)Population growth

Source : Indonesian Statistic Bureau Research, 2010 & MDGs 2010 Achievement. Ministry of Health, Republic of Indonesia = nyuji sibo rhitsu = yobosesshu ritsu = kansen-sho byo = eisei to kodo = keisai,sakai to bunka no mondaiSource = = minamoto4

Nutrition Problem Children Health Problems in IndonesiaSource : Indonesian Basic Health Riset (RISKESDAS) 2010Ministry of Health, Republic of Indonesia Short NWB Short NBW short NBH & Thin short NBH NBH Obesity ObesityNutrition Status5Nutrition Problem Normal Body Short stature slim body obesity

Children Health Problems in IndonesiaSource : Indonesian Basic Health Riset (RISKESDAS) 2010Ministry of Health, Republic of Indonesia6Children Health Problems in IndonesiaInfectious DiseaseEach area of Indonesia may vary in the degree and in the characteristicsThe largest in National Scale Rotaviral diarrhoeaPneumonia and tuberculosis ( &)MalariaDengue Fever and Dengue Haemmorhagic feverTyphoid fever

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Children Health Problems in IndonesiaDisease Distribution Profile among ChildrenMalariaDiarrhoea, typhoid fever and dysentriae (, )Source : Ministry of Health, Republic of Indonesia Data Base 2010 = cochi fusu = typhoid fever = sekiri = dysentrie8

Children Health Problems in IndonesiaDisease Distribution Profile among ChildrenTBC () HIV & pneumoniaDengue Fever and Dengue Hemmoraghic Fever Source : Ministry of Health, Republic of Indonesia Data Base 2010 = kekakku (TBC) = haien = pneumoniadengue suketsu netsu9Children Health Problems in IndonesiaSanitation & Healthy Behaviour- Vary among area Mostly influenced by traditional customs () Government programe of PHBS (Clean and Healthy Live Program) had been launched since 2006 PROBLEM : The result is still unmeasurable yetThe recent chalenge :A. City Trash management B. Culture and customs change

=10Children Health Care Systemin IndonesiaPROBLEMS :Vast area along with various geographic and demographic featuresVarious cultures, especially languages and customsPediatricians number are not enough and not well distributed ( at 2010 , the ratio = 1 : 8.900). (Discrepancy and inequality )Various disease prevalence among regionsVarious condition of health fascilities with limited resources , officers and infrastructures = discrepancy = fuitchi = inequality = fubiyodo11Outline of Children Health Care Systemin Indonesia

= shokai byoin = referral hospital12Structure of Children Health Care System in Indonesia (multistep referral approach)Preventif, Promotif& SupportifCommunity Based CurativeReferralSpesialized baseCurativeReferralSpesialized baseHolistic Approach () Paradigm ()Children as a children, FamilyEnvironmentInsurance And Private Based paymentHolistic approach paradigm : zentai tekina hoho shiten 13Health Care Cost & Payment in IndonesiaInsurance BasedJAMKESMAS (National Insurance for Poor People)managed by Government via Askes corp.In the year 2010 = Rp 5,1 trillion ( 51.000.000.000) ASKES (National Health Insurance )managed by Government via Askes Corp.self sustained (monthly payment) the same with JapanPrivate Health InsurancePrivate Payment Government = seifu 14

Primary Health Care Network System15

Primary Health Care Center(Puskesmas)

16Primary Health CareFocus : Preventive,promotive and supportive therapy Place :Public Health Center (Pusat Kesehatan Masyarakat ) 1st line of defensea. Government ownb. Privatec. General practitionersd. Pediatrician private practicePROBLEM : Limited resource and standardization not all Health Care Center work

= yobo,sokushin shi, sasaeru = seifu = government17Primary Health CareService Standards and Targets 11 basic minimum standars of good practice health service

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

18Primary Health CareWorking ProgramNutrition Health ServiceRoutine baby screening Investigation and intervention of nutrition problem in communityPROBLEM : low participation level due to culture nutrition problem due to lack of knowledge , economic and culture problemImunization AdministrationRoutine vaccination for baby 0-1 years in Baby screening PROBLEM : Culture Various differences Knowledge & Resistance ()

= eiyo mondai = nutrition problem = ubi19Primary Health CareWorking ProgramNutrition Health ServiceImunization Administration

Tanpaku amari sukunai20Primary Health CareWorking ProgramImunization Administration

Source : Indonesian Pediatric Association (IDAI) , 2009. www.idai.orgursi21Primary Health Care Working ProgramIntegrated Management of Childhood Illness (MTBS) Protocol 1.Administration of MTBS ProgrammeDisease focus : a. diarrhea and rehidrationc. Dysentriaeb. Pneumoniad. malariae2. Neonatal visit by midwifes every week3.Efforts of Integrated Health Check to Young infant and below 5 YO childrenPrimary Treatment CareMedical treatmentNursing treatment Simple rehabilitation treatment

22Integrated Management of Childhood Illness (MTBS) Protocol ()

= Yonen-ki no byouki no togo kanri23Integrated Management of Childhood Illness (MTBS) Protocol

Dehidration = dassui 24Integrated Management of Childhood Illness (MTBS) Protocol

25Primary Health Care Working ProgramSCHOOL JOINT PROGRAMME

1. Growth & Development Early Intervention Examination of Children Growth & Dev. In Pre-SchoolPAUD (Early Education of Children)Growth and Development Response Check

2. School Heatlh Unit and School Dentist UnitCounselor and GuidingSpecial Treatment and Rehabilitation (In certain Special Schools selected)Training of Junior Doctor / Kid Doctor

3. Teenager (Youth) Health Care ServiceCounseling about Reproductive and Sexual Health in The School or Boarding School Health PostMentoring and Counseling about Youth Psychology Problem

ursi26Secondary Level of Children Health Care SystemCurative and Treatment Care- In The Primary Health Care Center- private clinic and private practice- Regional Hospital (Class D,C)

27Tertiary / Third Level of Children Health Care SystemCurative (Treatment) & Rehabilitation Care- Referral or Central Hospital (Class B or A)- Medic Rehabilitation Center- Center of Nutrition Rehabilitation28Referral System in Medical Treatment ServicePublic Health Care CenterPrivate ClinicPrivate PracticeType D or Type C Regional HospitalSmall Research CenterType B or Type A HospitalResearch Center29Children Health Care in Hospital(Sardijto General Hospital, UGM, Yogyakarta)

Educational Based Referral HOSPITAL (Type A)3013 Sub Department Functional Medics Staffs of PediatricsEndocrinology, Gastro-hepatology Nutrition, Hemato-oncology Immunology Tropical Infection Cardiology Nephrology Neurology Respirology Social Pediatric (Growth & Development) Perinatology Emergency Unit of Pediatrics & Intensive Care Unit In Alliance with several Network Hospital Around Yogyakarta endocrinology = naibunpitsugaku = ikanzogaku = gastro = zoketsu,shuyogaku =hematooncolgoy = menenki gaku = immunology = nettai no kanshen-sho = shin so no byaku = jinzogaku = shinkei gaku = kyoku-ki = shoni sakai = bushanki igaku = kyu-kyu sitsu = shu-shu chiryu bu31Kinds of Health Care ServiceOutpatient ServiceEmergency & Intensive Care UnitIn patient ServiceMedic Rehabilitation & Occupational Therapy ServiceAdditional ServiceEducation & Research Fascility (incorporated with Faculty of Medicine, UGM)Center of Leukemia Study of South East Asia = haketsubyo = leukemia32Additional ServiceOral Rehidration Room Pediatric Integrated USG and EKG Examination RoomSpirometry (Lung function test) roomSkin Prick test examination room (allergy test)Pharmacy service (pharmacy satellite)Integrated Laboratory SatellitePlaying room Library Children Psychology Consultation

33Outpatient ServiceGeneral Outpatient PoliclinicOutpatient Policlinic with appointment (VIP)Growth and Development Policlinic

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Pediatric Polyclinics35

Policlinic with Appointment36Distribution Rate of The Outpatient Type visitors in 2010Source : Sardjito Pediatric Dept.Data Base 201037Patient Profile in the Outpatient Clinic2010Source : Sardjito Pediatric Dept.Data Base 2010

Sub.DepartmentMean Visits38

GROWTH & DEVELOPMENT POLYCLINIC39GROWTH & DEVELOPMENT POLYCLINICServices provided in the policlinicEarly Detection and Screening for Growth and Developmental DelayBasic and Advanced Immunization Early Stimulation and Intervention in Children with special needs

Collaboration with a. Neurology sub departmentb. Medic rehabilitationc. Center of Nutrition Rehabilitation (RPG)

40GROWTH & DEVELOPMENT POLYCLINICCase DistributionAutismADHD (Attention Deficit Hyperactivity Disorder)ADD (Attention Deficit Disorder)Pervasive Development Disorder (speaking disorder)Learning Development Disorder.Emotional Disorder41

Additional Service

Oral Rehidration RoomSatellite LaboratorySimple USG room

42IN PATIENT HEALTH CARE SERVICE

43Inpatient Wardcapacity

44In Patient Ward

VIP Room1st class room45

In Patient Ward2nd Class46

In Patient Ward3rd Class47In patient Ward playing room

48Problems in Inward Patient ManagementLimited Bed CapacityJob DistributionIntegrated and holistic patient management approach already established but needs to be improveda. Doctorb. Nursec. Health Therapist d. Psycholog and psychiatriste. Researcher from University or Research FascilityLimited Resource for Research DevelopmentLimited advance medical equipment

49Summary & Future Chalenge1.Diversity in culture becomes threat in the Future Health management if it is not well managed 2.Children health problem management complexly related and integrated with other sector policya. Economic growthb. Educationc.InfrastructureNeed to revitalization of rural health care center (Puskesmas) and redistribute the health officer to equalizationThe Need to achieve the target of MDGs 2010

50Thankyou For Your Attention

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