Issues in Health Service Indah Amelia – Public Health Department

Content Issues in health service management Health issues in the world Health issues in Indonesia

Health Service Management Health services management will become even more challenging, because it is the point where increasing service demands, cost containment strategies, inter professional tensions, technological change pressures, guide lines implementation, and quality improvement mandates all converge. The managerial function in health service is unique because of the relative autonomy of providers and the complexity of assessing the quality of the service rendered

The new managerial challenges Cost Efficiency Quality Improvement Greater Accountability in delivering services Turbulence environment Inter-organizational Complexity

New roles for managers LEADER DESIGNER STRATEGIST

The organization and the environment Changing social norms and expectations Demographic composition and epidemiology Technology Development Organizational arrangements Financing Social experimentation

Health issues in the World

MDGs

MDGs’ Targets Goal 1: Eradicate Extreme Hunger and Poverty Target 1. Halve, between 1990 and 2015, the proportion of people whose income is less than $1 a day Target 2. Halve, between 1990 and 2015, the proportion of people who suffer from hunger Goal 2: Achieve Universal Primary Education Target 3. Ensure that, by 2015, children everywhere, boys and girls alike, will be able to complete a full course of primary schooling Goal 3: Promote Gender Equality and Empower Women Target 4. Eliminate gender disparity in primary and secondary education, preferably by 2005, and in all levels of education no later than 2015

MDGs’ Targets Goal 8: Develop a Global Partnership for Development Goal 7: Ensure Environmental Sustainability Target 9. Integrate the principles of sustainable development into country policies and programs and reverse the loss of environmental resources Target 10. Halve, by 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation Target 11. Have achieved by 2020 a significant improvement in the lives of at least 100 million slum dwellers Goal 8: Develop a Global Partnership for Development

MDGs’ Targets Goal 4: Reduce Child Mortality Target 5. Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate Goal 5: Improve Maternal Health Target 6. Reduce by three-quarters, between 1990 and 2015, the maternal mortality ratio Goal 6: Combat HIV/AIDS, Malaria and other diseases Target 7. Have halted by 2015 and begun to reverse the spread of HIV/AIDS  Target 8. Have halted by 2015 and begun to reverse the incidence of malaria and other major diseases

Emerging and re-emerging infections Emerging diseases  diseases that have newly appeared in a population or have existed but are rapidly increasing in incidence or geographic range. Example : AIDS, Ebola, Swine Flu, Legionaire disease, Shigellosis, Giardiasis, etc. Re-emerging disease  age-old diseases that have increased its prevalence again. Example : Diphteri, measles, Polio, Cholera, Malaria, Tuberculosis

Why these diseases emerge or re-emerge? Misused of drugs  drug resistance Increased in migration because of war or international travelling Ecological destructions  human exposed to previously unknown disease The change of human sexual behavior Immunization coverage is low

Non Communicable Disease Non communicable diseases - or NCDs - like heart attacks and strokes, cancers, diabetes and chronic respiratory disease account for over 63% of deaths in the world today. Every year, NCDs kill 9 million people under 60. The socio-economic impact is staggering. (WHO)

Health issues in Indonesia

Decentralization Decentralization  handing over some of the central government’s authority to the province government. Decentralization in health sector 1952  handing over about MCH and variolla immunization UU No. 32/2004 article 13 and 14  Health become an obligatory affairs that become the authority of Province and Kabupaten/Kota

Sistem Jaminan Sosial Nasional (SJSN) Legal basis : UUD 1945 article 5, 20, 28 and 34 Universal Declaration of Human Rights of UN TAP MPR RI no X/MPR/2001 UU No.40 tahun 2004 about SJSN Coverage : Jaminan Hari Tua (Retirement Insurance) Jaminan Kesehatan (Health Insurance) Jaminan Kematian (Death Insurance) Jaminan Kecelakaan Kerja (Occupational Accident Insurance)

Situation in Indonesia Budget for health sector from APBN/APBD is never more than 3% 70% of health expense are come from the community, only 30% are by the government Most of the community health expense are for curative expense Most of the health financing are come from out of pocket Only 20% from the community that already have health insurance

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