The Sketch of The Sketch of Indonesia Indonesia MedicineMedicine

Sugma AP,MD,MARSSugma AP,MD,MARSsigmahealthconsult@gmail.comsigmahealthconsult@gmail.com

Indonesia Characteristic

Located on the meet point of earth’s crust

Contain of thousand islands that separated by the sea

Supermarket of disasters

There are so many volcanoesMany Forests

Climate change extremely

AccessAdequate Transportation

Earthquake Landslide

Tsunami

Indonesia CharacteristicThe 4th rank of the most populated

country in the world

The inhabitant doesn’t spread evenly

Various of socio-economical status

vsContain of many ethnics, religions, cultures

Indonesia Health Condition The Shift of the pattern of disease from infectious to

degenerative disease:– Acute respiratory syndrome.– Tuberculoses of lungs (the 3rd rank in the world).– Skin disease.– Diarrhea.– Diabetes mellitus. – Hypertension.

The major cause of death:– Vascular disturbance (heart disease or stroke)– Tuberculoses– Respiratory infectious disease (pneumonia),

etc.

Indonesia Health Condition

Indonesia Health Condition The Maternal mortality rate is 307 per

100,000Lb (↓) The Infant mortality rate is 45 per 1,000Lb (↓) The Under five mortality rate is 64 per 1,000Lb

The Crude death rate 7.4 per 1,000p (↓) The increase of life age expectancy 66.2ys (↑) The malnutrition prevalence of under five

children is 25.8% (↑)

Indonesia Health Condition

Indonesia Health Condition The Incidence rate of Malaria is still high

especially at the provinces outside of Java and Bali (the east of Indonesia)22.3 per 1,000p

The cure rate of lung TB with BTA+ 70.23% with new case finding 76,230p.

The HIV prevalence estimates >500,000p, AIDS was reported as 5,321 cases in 2005 (↑)

The Incidence rate of DHF is about 62 per 100,000p (↑) (2007)

Indonesia Health Condition

National Health SystemMinistry of Health

Health official at province level

Health official at district level

Functional unit

Secondary & Tertiary HealthcarePrimary Healthcare

Subdistrict levelDistrict level

The strategies are:The strategies are: Empowering the citizens to live in a Empowering the citizens to live in a

healthy way and to give contribution healthy way and to give contribution for their health improvement.for their health improvement.

Increasing the people access to the Increasing the people access to the high quality health provider.high quality health provider.

Upgrading the surveillance, monitoring Upgrading the surveillance, monitoring and health information system.and health information system.

Increasing the health expense. Increasing the health expense.

National Health SystemNational Health System

•Inhabitant•Health behavior•Environment•Resources•policy

•Strategy •Missions •Health programs•Health provider with quality improvement and good management

Healthy Indonesia

2015

National Health SystemNational Health System

Health Resources

• Health worker– General Physician 8 : 100,000p– Dentist 2 : 100,000p– Specialist 3 : 100,000p

– Nurse 49 : 100,000p– Pharmacist 3 : 100,000p– Midwife 26 : 100,000p– Public health 1 : 100,000p– Sanitarian 1 : 100,000p– Nutritionist 3 : 100,000p

Health Educational Institution Health Educational Institution We have the Faculty of Medicine in state and private We have the Faculty of Medicine in state and private

university.university. The state Faculties of Medicine are mostly located at the The state Faculties of Medicine are mostly located at the

capitals of province. capitals of province. The private are usually located nearby the state ones. The private are usually located nearby the state ones. There are 45 state faculties of medicine There are 45 state faculties of medicine that produced that produced

about 5,000 doctors per year and specialist 1,700 per year.about 5,000 doctors per year and specialist 1,700 per year.

We have 32 Health polytechnics and We have 32 Health polytechnics and 598 health academy (state and 598 health academy (state and private) that produced about 23,000 private) that produced about 23,000 nurses per year.nurses per year.

They’re mostly located at big cities.They’re mostly located at big cities.

Research on MedicineResearch on Medicine In 2004, Asia pacific had In 2004, Asia pacific had

contributed to 25% of total contributed to 25% of total scientific papers from all over scientific papers from all over the world. (↑)the world. (↑)

In ASEAN, Indonesia is at the In ASEAN, Indonesia is at the 44thth position and has contributed position and has contributed 5781 papers. It is under 5781 papers. It is under Singapore position. Singapore position.

Japan is on the top position.Japan is on the top position.

In 2004, 522 scientific papers of Indonesian In 2004, 522 scientific papers of Indonesian Researcher had been published. Researcher had been published.

Especially in Medicine, it contributed 50 papers to Especially in Medicine, it contributed 50 papers to National Journal and less than 5 to International National Journal and less than 5 to International Journal. Journal.

Research on medical science expense is just 0.5% Research on medical science expense is just 0.5% from total Research and Development (Government) from total Research and Development (Government) expense.expense.

Research on MedicineResearch on Medicine

Health ServicesHealth Services Based on the kinds of service:Based on the kinds of service:

– Primary healthcare.Primary healthcare.– Secondary healthcare.Secondary healthcare.– Tertiary healthcare.Tertiary healthcare.

Based on the owner Based on the owner status:status:– State provider.State provider.– Private provider.Private provider.

Health ServicesHealth ServicesPrimary HealthcarePrimary Healthcare

Basic Seven Program•Health Promotion•Mother & Child Healthcare•Contraception

•Communicable disease controlling•Environmental health•Nutrition •Treatment center (curative)

Community Health Center

Health ServicesHealth ServicesPrimary HealthcarePrimary Healthcare

Extended Program•Methadone •Harm reduction•Geriatric Healthcare •VCT •Etc.

Community Health Center

PHC ProgramPHC Program We have 7,309 Community Health Centers We have 7,309 Community Health Centers

(Puskesmas) with ratio 3.46 per 100,000p (1 CHC (Puskesmas) with ratio 3.46 per 100,000p (1 CHC for 29,000p). for 29,000p).

Basic seven program is a health program that is Basic seven program is a health program that is provided by PHC.provided by PHC.

The program is arranged based on community The program is arranged based on community health needs and it’s convinced to be able to health needs and it’s convinced to be able to elevate the health status of Indonesian people. elevate the health status of Indonesian people.

PHC Program PHC Program Extended program is a program that Extended program is a program that

is arranged based on local health is arranged based on local health needs. For example: In Jakarta, the needs. For example: In Jakarta, the CHC has developed VCT clinic for CHC has developed VCT clinic for HIV/AIDS patients and methadone or HIV/AIDS patients and methadone or harm reduction program for the drug harm reduction program for the drug users.users.

Health PromotionHealth Promotion

Dissemination of information for students

Leaflets and brochuresCommunity elucidation

Community elucidation

Specific ProtectionSpecific Protection

Under five children immunization

•BCG •Polio •DPT•Hepatitis B•Measles

Preventive and Curative Preventive and Curative

Tetanus Toxin for Pregnancy woman

Treatment

Laboratory

Communicable Disease Communicable Disease Controlling Controlling

3M+ Action, epidemiological investigation 3M+ Action, epidemiological investigation and fogging focus for DHF vector and fogging focus for DHF vector eradication.eradication.

Empowering local inhabitants for participating health activities of PHC

Mother & Child Healthcare

Posyandu (Integrated service Posyandu (Integrated service center)center)

immunization

Weight monitoring

Under five children:

Nutrition improvementImplant contraception

Mobile CHCMobile CHC

Car

Boat

Mobile CHCMobile CHC

Health workers come to local residence to provide the health services

Health ServicesSecondary & Tertiary Healthcare

It focuses on curative and rehabilitative health services.The preventive service is provided by the form of medical check up.Hospital is the form of secondary and tertiary healthcare.In secondary level, the hospital has at least 4 major of specializations (internist, surgery, pediatric, obstetric).

Hospital

In tertiary level, besides the condition at secondary level, the hospital should be supported by sub-specialization experts. There are three classes of the hospital in Indonesia at general (A, B, C).We have 1,215 hospitals (state and private) which is used by people as 78.99% for inpatient and 7.41% for outpatient.

Secondary & Tertiary Healthcare

International Hospital

Facilities Facilities

• 4-Dimension USG• 64-slices CT-scan• MRI• PET-scan

Services Services

Support Support

Specialized Hospital

• Heart Center Hospital• Surgery Hospital• Woman and Children Hospital

Cryosurgery Cephal-cephalopagus separation surgeryFacelift surgery

• Eye Center Hospital• Mental Health Hospital• Dental Care Hospital

Specialized Hospital

Lasic technology

• Nuclear medicine is used for diagnostic, therapeutic, and research purpose.

• This field develops fast and uses for many purposes in community.

• Nowadays, almost all of big cities in Java island have at least one hospital equipped by nuclear medicine unit.

Nuclear Medicine