mdg menuju sdg-peran profesi kesmas_iakmi
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Peran ProfesiTRANSCRIPT
DARIMDG MENUJU SDG
Peran Profesi KesmasAdang Bachtiar
Ketua Umum IAKMI Pusat
2014
Download site: Facebook IAKMI.PUSAT
Born in Cirebon, West JawaDokter from UNIVERSITAS INDONESIAMaster of Public Health (MPH): HARVARD-USADoctor of Science (DSc): JOHNS HOPKINS-USAPost Doctoral in Statistics: UNIV of MICHIGAN-USACurrent Activities:
Indonesian Public Health Association, PresidentGlobal Fund TB at FPH-UI, DirectorHealth Professions Coalition for Anti Smoking (KPK-AR), ChairmanNational Expert Panel on TB, Health Policy SpesialistMoH-Community trial for Mothers’ Compliance Improvement on ARV Treatment, Head of TeamKomnas Penelitian & Pengkajian Penyakit Infeksi (PINERE) Litbangkes -Kemenkes, Expert PanelIndonesian MCH-Nutrition Eval Team-Ministry of Health, Head of TeamDept of Health Policy & Administration, UI, Past Chairman; Advice & examine more than 150 PhD dissertations, in
medicine, dentistry, nursing, public health, regional planningNational Health Research Committee, Expert PanelThe development of RPJMN Kesehatan 2015-2019, Expert PanelThe development of Oral Health Strategic Plan of MoH, Expert Panel
Adang Bachtiar
BERBAGAI KENDALA MENCAPAI MDG• Indonesia memulai lebih lambat daripada banyak negara lain
• Peta jalan efektif belum dijalankan sepenuhnya
• Kendala struktural termasuk dukungan politis di daerah, pertumbuhan
ekonomi dan kapasitas fiskal yang terbatas, serta kapabilitas pelaksana yg
terbatas
• Guncangan ketidakstabilan termasuk keamanan, bencana, ekonomi dan
epidemi penyakit (misal HIV)
KepemimpinanDi Puskesmas
PerencanaanPuskesmas
Pemenuhan Target disesuaikan
kebutuhan (Need) Masy
Kapasitasi SDMPuskesmas
ImplementasiPelayanan di Puskesmas
Pencapaian
Indikator
Puskesmas
Kemampuan SIK utk Added Value
FAKTOR KONTEKSTUAL: SUPRASTRUKTUR-KAWASAN
PEMBANGUNAN-KEMANDIRIAN MASY
.
Time to access 1st ANC
Limited accesibility
56% akses
1st ANC compliance
Mothers w/ =<12 mo. babies
w/ 12-60mos. Babies Total
n % n % n %
Yes 482 37,1 662 38,4 1144 37,9
No 816 62,9 1060 61,6 1876 62,1
DECREASING QUALITY OF MIDWIVES
4th ANC compliance
Mothers w/ =<12 mo. babies
w/ 12-60mos. Babies Total
n % n % n %
Yes 75 5.8 133 7.7 208 6.9
No 1223 94.2 1589 92.3 2812 93.1
PHC SUSTAINABILITY
LOCAL GOVT BUDGETING FOR HEALTH Means (7 provs)
PR.1 Public Health Programs 6.58%PR 1.1 MCH 0.70%
PR 1.2 Nutrition 0.97%PR 1.3 Immunization 0.12%
PR 1.4 TBC 0.06%PR 1.5 Malaria 0.30%
PR 1.6 HIV/AIDS 0.03%PR 1.7 Diarea 0.00%
PR 1.8 Pneumonia 0.01%PR 1.9 Dengue 0.06%
PR 1.10 Other infectious diseases 0.15%PR 1.11 Non-infectious diseases 0.03%
PR 1.12 Family Planning 0.57%PR 1.13 School Health Programs 0.07%
PR 1.14 Reproductive Health 0.01%PR 1.15 Environmental Health 1.20%
PR 1.16 Health Promotion 0.41%PR 1.17 Disaster Program 0.02%
PR 1.18 Surveillance 0.05%PR 1.19 Other Public Health Programs 1.83%
Gani, 2011
MDG ACCELERATION FRAMEWORK (MAF)
• Diagnostic, scaling-up proven interventions
• PHC approach
• Local-level initiative
• Academic-Business-Govt for empowerment
• Protecting public expenditures
• “Mencegah lbh murah drpd mengobati”
FOKUS PENYELESAIAN MDG
• Rencana Aksi Berbiaya di Propinsi dan Kab/Kota
• Fokus pada under-target, termasuk
• Ibu-anak, dengan pendekatan Continuum of Care
• HIV/AIDS
• Monev indikator pencapaian dan akuntabilitas
RENCANA AKSI BERBIAYA
• Mendorong kapasitasi Propinsi dan Kab/Kota untuk capai target prioritas MDG
dg susun Rencana Aksi 2014-2015
• Sinergi Akademisi-Masy tmsk swasta-Pemerintah
• Melalui Musrenbang
• Membangun Task-force
• Indentifikasi sumberdaya masyarakat untuk kesadaran kepentingan
kesehatannya
• Continum of Care
• HIV/AIDS
FOKUS PADA UNDER-TARGET
• Kes Ibu dan Anak
• Menekan jumlah ibu meninggal
• HIV/AIDS
• Berfokus juga pada mereka yang sehat
• Memberdayakan setiap unsur masyarakat untuk mencegah – mengobati dan
rehabilitasi
1991 1995 1999 2003 2007 2012 2014 20150
10
20
30
40
50
60
70
80
68
57
46
35 3432
2423
Target RPJMN
Capaian Target MDGs
SASARAN INDIKATOR STATUS
PENINGKATAN KUALITAS PELAYANAN KESEHATAN IBU DAN BAYI
1. Penurunan tingkat kematian Ibu (AKI)
2. Penurunan tingkat kematian bayi (AKB)
3
3
Target dan Capaian
ANGKA KEMATIAN IBU DAN ANGKA KEMATIAN BAYI
ANGKA KEMATIAN BAYI
Masih tingginya Angka Kematian Ibu dan Bayi (AKI dan AKB) terutama karena : •Cakupan persalinan oleh tenaga kesehatan terlatih sudah mencapai 88,64 persen namun kualitas pelayanan dan kompetensi tenaga kesehatan belum sepenuhnya sesuai standar pelayanan.
•SDKI 2012 melaporkan cakupan imunisasi dasar lengkap meliputi HBV, BCG, DPT, Polio, dan Campak baru mencapai 66 persen, meskipun khusus imunisasi campak sudah mencapai 80,1 persen.
1991 1997 2003 2007 2012 2014 20150
50
100
150
200
250
300
350
400
450
390
334307
228
359
118102
ANGKA KEMATIAN IBU
Target dan Capaian
Target RPJMN
Target MDGs
ImpactOutcome
• Persalinan aman
• KAP ttg persalinan normal dan beresiko
Output
• UKBM yg efektif utk “desa siaga bumil-
bulin-buteki”
• Nakes terlatih siap tugas
• Akses yang membaik
• Prosedur dipatuhi
Process Input
I. Faktor PemungkinANC & Persalinan•Persalinan o nakesPenanganan kompilkasi•UKBM•Sistem transport•Pembiayaan•Donor darah
Ibu dan anak
selamatII. Kebjakan dan advokasi•Kebijakan untuk akses-ketersediaan-mutu-sustain
III. Emergensi Obstertri•PONED dan PONEK•Pelatihan nakes
•Anggaran
•Sarana
•Prasarana
•Transportasi
•SDM
•SPO
•Dukungan politis
Menyelamatkan Ibu dan Anak
FOKUS PDEKOLOGI
SDA dan KapasitasEkologis
FOKUS PD EKONOMI
Sistem2 Ekonomi
FOKUS PDSOSIAL
Modal Sosial &Tujuan Kesejahteraan
Pembangunan Yang Sustainabel
AGENDA PEMBANGUNAN POST 2015
SUMBER DAYA ALAM (DATA DUNIA)
• Sumber air bersih:• 1M penduduk tidak akses air bersih• 2,5M (1/3 total penduduk dunia) tdk miliki sanitasi dasar
• Udara bersih• Hampir semua kota besar tidak miliki udara bersih
• Tanah• Lahan terkontaminasi• Hutan gundul• Desertifikasi (lahan menjadi gersang)
• 50% SDA (fossil fuels, minerals) habis dikonsumsi
DAMPAK KERUSAKAN LINGKUNGAN• Pemanasan global
• Deplesi lapisan ozon
• Kerusakan biodiversitas
• Hujan asam
• Etrofikasi
• Human and eco-toxicity
MASALAH SOSEK (DATA DUNIA)• Jumlah penduduk tidak terkendali:
• Menuju 10M di abad ini
• Ketimpangan ekonomi dan kemiskinan• Proporsi 20% penduduk terkaya miliki 83% pendapatan ekonomi• Sedangkan 20% termiskin miliki 1.4% pendapatan dpl. < $1/hari• Hampir 50% jumlah penduduk (3M) hidup dengan $2/hari• Lebih lanjut: 790juta pendudukan dalam kelaparan dan tidak miliki
pangan yang cukup
AGENDA PEMBANGUNAN POST 2015
Objective Enablers/Pre-requisites
A sustainable Post 2015
Development Agenda
• Peace and Security• Good Governance and transparency• Strengthened institutional capacity• Strengthened access to justice and
information• Human rights for all• A credible participatory process with
cultural sensitivity• Enhanced statistical capacity to measure
progress and ensure accountability
Objective Enablers/Pre-requisitesA sustainable Post 2015
Development Agenda
• Growth oriented macro-economic policy • A developmental state• Means of implementation and monitoring• Domestic resource mobilization; • Social inclusiveness and equality• Infrastructure development• Reliable access to energy • Global cooperation and partnerships.
AGENDA PEMBANGUNAN POST 2015
Goal IndicatorsEconomic transformation and inclusive growth
Employment creation Rural development Value addition of primary commodities
and resources Food security Fair trade, markets and regional
integration and investment Prioritize sustainability and support
inclusive green economy initiatives
Goal IndicatorsInnovation and technology transfer
Quality education at all levels with emphasis on science and technology
Vocational training and adult education Market relevant curricula and placements Technology for sustainable development technology transfer Investment in research and development
Goal IndicatorsHuman development
Gender parity: women and youth empowerment Access to social protection for vulnerable groups Health for all, with special focus on women and
child health Empowerment of elderly and disabled Strengthened capacity to implement disaster risk
reduction and climate adaptation initiatives Adequate shelter and access to water, sanitation
and hygiene
AGENDA POST-2015 YANG TERKAIT BIDANG KESEHATAN
3. Provide quality education and lifelong journey
3a. Increase by x% the proportion of children able to access and complete pre-primary education
4. Ensure Healthy Lives
4a. End preventable infant and under-5 deaths
4b. Increase by x% the proportion of children, adolescents, at-risk adults and older people that are fully vaccinated
4c. Decrease the maternal mortality ratio to no more than x per 100,000
4d. Ensure universal sexual and reproductive health and rights
4e. Reduce the burden of disease from HIV/AIDS, tuberculosis, malaria, neglected tropical diseases and priority non-communicable diseases
Strategi Diperlukan?BACK TO BASIC
•Sehat merupakan nilai kemanusiaan yg mendasar keberadaannya,
melekat pd setiap insan, melingkupi, mengakar dan merupakan
interaksi dinamis dari berbagai kekuatan sosial yang dihargai
sepanjang sejarah kemanusiaan (Health is seen as embedded in social
relations of power and historically inscribed contexts)
SEHAT HARUS DILIHAT DARI NILAI KATA “SEHAT” SECARA SOSIAL
Labonte, 2005
Stra-1
•Dengan demikian setiap upaya menjaga dan memperbaiki status
“sehat” harus untuk kepentingan masyarakat yang sedang alami
persoalan kesehatan (...should be shaped by the interests of those
communities who carry the greatest burden of disease).
Labonte, 2005
•Cara-cara dalam upaya menjaga dan memperbaiki status “sehat”
tersebut harus melibatkan, mengikutsertakan, memberdayakan
masyarakat dan kelembagaannya sebagai unsur aktif dalam setiap
proses upaya perbaikan (... methods should engage community
constituencies as active agents in the process of research)
Labonte, 2005
• Efektifitas kolektif dalam upaya untuk tetap sehat
• Keberhasilan (perseptif) baik individu, keluarga, organisasi dan masyarakat
luas terkait pengendalian untuk tetap sehat
• Tekanan dan pengaruh sosial yang efektif untuk tetap sehat
• Perubahan dan peningkatan kehidupan keseharian, norma, sumber dan
kondisi sosial untuk tetap sehat
UKURAN KEBERHASILAN PEMBERDAYAANModifikasi dari: Becker, 1992
o Sense of self-worth (berharga-dihargai-menghargai)
o Right to have and to determine choices (pilihan hidup efektif)
o Right to have access to opportunities and resources (meraih cita2)
o Right to have the power to control their own lives (kendali & hak hidup)
o Ability to influence the direction of social change (including family
health) to create a more just social and economic order, nationally and
internationally (kemampuan saling pengaruhi utk lebih baik)
5 KOMPONEN KEBERDAYAAN
Domain Pertama:PERLU KETRAMPILAN
.
.
. 1a.M
onito
r Sta
tus
Kes K
eluar
ga
1b.Diagnosis & Investigasi
2a.Informasi, Kapasitasi,
Pemberdayaan
2b.Mobilisasi A
liansi
3a.K
apas
itas K
ebija
kan
3b.Penegakan Regulasi
4.Penyediaan layanan
5.SDM berkompeten
6.Monev
7.Mgmt System
8.Riset
Libatkan end-user
Kembangkan & diseminasi strategi program
Libatkan stakeholders dlm tiap proses
Tetapkan Goal & tujuan
Rumuskan ProsesKerja
ImplemKeg & Aliansi
Hasil Langsung
(direct)
Outcome (Hasil tdk
lgs)
Domain dampak dari produksi Aliansi:Kapasitasi sisyan kesehatan
Kebijakan kesehatan berbasis dataPerbaikan mgmt program
Peningkatan skills staf
Domain Kedua:Keterkaitan dg Users
Domain Ketiga:ALIANSI MENGELOLA
PENGETAHUAN
4-KapasitasiMengelola
Pengetahuan
1-KapasitasiKebijakan &
Pemograman
3-KapasitasiPartisipasiKel & Masy
2-Kapasitasi Aliansi
Kapasitas Dekonsentrasi
Kapasitasi NSPK
Global Opportunity
Governance
Stewardship
Financial
Capacity building
benchmarking
Standarization
StewardshipGovernance
Financial
Capacity building
Benchmarking
Standards
Kinerja
staf
Kapasitas Otonomi Daerah
Policy Capacity
Hlth Mgtm capacity
HRD capacity
Financial capacity
IS & Knowl mgmtMedia & nerworks
Knowl management & network
International funding
Health Devt Policy & communicationCapacities devt
Modif: Bachtiar 2009
1-Mengelola pengetahuan s/d skala global
Community Empowerment
Global-regional , K
earifan lokal
4-Mengelola Pengetahuan Oleh Kaum Berpengetahuan
PT & ORGANISASI PROFESI
IPTEK
Learning-Knowledge–Innovation
Peran Profesi (bersama PT)
adalah mencipta pengetahuan dan
ketrampilan (KNOWLDEGE
CREATION & PRESERVATION)
sehingga bermanfaat bagi
SEMUA
Suplai YANKES
Modal Sosial Masy
ORGANISASI PELAKSANA (PEM & MASY)
PELKESMAS
Tacit&embedded knowlPeluang & Ancaman
OUTCOME KESEHATAN
DAPAT DIBERIKAN OLEH
“Kaum Berpengetahuan”
Adaptasi dari Hughes-Tuohy 2003 & Hicks & Mishra 1993
KelembagaanALIANSI yg kuat
Sumberdaya ”aksi/power”
MobilisasiSumberdayaKetrampilan
Sumberdaya Pengetahuan
• SOLIDITAS ALIANSI• Advokasi Healthy Public Policy
• Kekuatan politik (pol pressure)•Kekuatan advokasi
•Kapasitasi sistem•Fasilitasi kebijakan•Fasilitasi Perenc&mgmt•Fasilitasi evaluasi
•Kemampuan regulasi&kebijakan•Kemampuan Perenc&mgmt•Kemampuan evaluasi
“MIRACLE” BRANDM MANAGING PUBLIC HEALTH POLICY&
PROGRAM EFFORTS
I INNOVATING APPROACHES – METHODS AND PARADIGM
R RESEARCHING COMPREHENSIVE EVIDENCES
A APPRENTICING (OBSESSION) FOR PERFECTION
C COMMUNITARIAN (LIVE WITH-FROM-TO-BY)
L LEADING FOR A PUBLIC HEALTH VISION
E EDUCATING ALL FOR SELF RELIANCE IN HEALTHY LIFE
Stra-2
PROFESSIONAL VISION
FOR PUBLIC HEALTH GRADUATES
PUBLIC HEALTH GRADUATES MUST HAVE_1
• Knowledge-driven practices
• Adequate knowledge and skills to understand
health problems, at all levels, ie, individual and
community
• Problem-solving attitudes
• Adequate professional skills to solve public health
problems
• Interactive ability
• Adequate softskills for implementing public health
solutions within social economic development
frameworks and perspectives
• Enlightenment capacity
• A comprehensive involvement in social cultural, poltical
and economic development for the sake of people’s health
PUBLIC HEALTH GRADUATES MUST HAVE_2
.
.
SOFTSKILLS
MIRACLE
P.HSKILLS
BASIC PUBLIC HEALTH SKILLS1. Analysis and Assessment
2. Policy development and program planning
3. Communication skills
4. Cultural competency/local wisdom
5. Community dimensions of practice
6. Basic public health sciences
7. Financial planning and management
8. Leadership and systems thinking/total system
Source: IPHA academic draft for PH Competencies, 2011
"TELL ME, I'LL FORGET. SHOW ME,
I MAY REMEMBER. BUT INVOLVE ME AND
I'LL UNDERSTAND."
Confucius, Ancient Chinese Philosopher
Stra-3
A FOUR PHASE EDUCATIONAL MODEL
•PHASE 1 – P.H COMPETENCIES DEVELOPMENT
Depts Participating All PH Departments in the School of PH
Who Participates PH Practitioners, Professors & StudentsWhat 8 PH CompetenciesWhere School and PH fieldsFunding University Funding; Student Tuition
PHASE 1
A FOUR PHASE EDUCATIONAL MODEL
•PHASE 2 – INDIVIDUAL OR GROUP PROBLEM BASED LEARNING
Dept. Related to course topicsWho Practitioners, Profs. & Students
What PH mini case report on PH situation in surrounding
Where In-class and PH “fields”Funds University, Tuition
PHASE 2 PHASE 1
A FOUR PHASE PROCESS MODEL
•PHASE 3 – DESCRIPTIVE & QUALITATIVE INDIVIDUAL RESEARCH
Dept. Related to research topic Other depts within school
Who Practitioners, profs, candidate Practitioners, profs, students
What Translational descrip research
Multi dept contribution to res.
Where Faculty Project location(s) Faculty Project location(s)
Funds Dept funds, Private, Grants University, Tuition, Grants
PHASE 2 PHASE 1PHASE 3
A FOUR PHASE PROCESS MODEL
•PHASE 4 – SUSTAINABLE TRANSLATION & DISTRIBUTION
Dept. Related to research topicWho Practitioners, profs, candidateWhat Thesis exam and publication in journalWhere PH seminarsFunds Dept funds, Private, Grants
PHASE 2 PHASE 1PHASE 3PHASE 4
.
STRUCTURING THE
COLLABORATION
UNIVERSITY ROADMAP
(Continuing) PH
education progr
Impact toHlth System
• Evidence based policy
• Improved Hlth capacity
• Hlth Devt Leadership
• Health systems effectiveness
Internal univ networks
External networks with PH Professions
Globally
External network with donors
External networks with reserachers
MONEV & CONTINUOUS IMPROVEMENT
• Knowledge CreationTranslational research, policy devt
Knowledge brokering and codification
Knowledge warehousingPublications, seminars, workshops
• Knowledge Preservation Knowledge exchange & portal
Policy analysis• Knowledge internalization and
useTeaching/training
Practice guidelines/tools Evaluation studies
EFFECTIVE ALLIANCES:FRAMEWORK USED
Stra-4
Social media & PH education
technology
Strategy & Process for PH
education quality
Social Capital including market
and users
VIRTUALISATIONGLOBAL
HARMONIZATION
PH COMPETENCIES
THE IPHA ACTIONS
• Further actions are planned as follows:
• Strengthening local PH professional
organizations
• Continuing PH Education
• Aliances
• Empowering stakeholders
• Shift the IPHA as holding organization for all
professional health organizations with similar
goal to achive healthy people
CLOSING REMARKS
Membangun Ketahanan Sosial Pasien & Keluarga
O - Output terukur
U - Utamakan budaya sehat-pemulihan & ancamannya
T - Training menuju kemandirian pasien dg fasilitasi UKM-UKP yg terpadu
R - Rancang mobilisasi sumberdaya tmsk jenjang keluarga
E - Eratkan partisipasi semua anggota keluarga, lingk, tempat kerja dll
A - Adopsi dan adaptasi rencana kerja sesuai kebutuhan
C - Cerahkan stakeholders (pasien/kel/dll) mel komunikasi-komunikasi-komunikasi
H – Himpun-pelajari sukses & tahapan2nya untuk adopsi-adaptasi
Being attentive along the journey is as important as the destination