Firman Lubis MD, MPH Professor in Community Medicine FKUI

 “Public Health” has a long history in Indonesia  Started as “People’s Health” or “Volksgezondheids” in mid 19th century during Dutch colonial era  Improving the health status of the people  Control of epidemics and communicable diseases  For productivity and economic reason

 Managed by Volksgezondheids Dienst (Dinas Kesehatan Rakyat)  Establishment of Indigenous Medical School or Sekolah Dokterdjawa  Gradually upgraded into STOVIA and GHS  Distribution of doctors throughout the country  Mainly control of Communicable Diseases

 Control of small pox (vaccination), plagues (pest control), typhoid, dysentery, malaria, TB, hookworms etc  Health education (propaganda)  Sanitation and hygiene  Nutrition  Maternal and child health  Etc.

 Disruption after Japanese occupation and independence war in the 1940s  Epidemics of communicable diseases  Lack of Medical Doctors and professors due to Dutch repatriation  Seeking for foreign aids and support  Revitalized public health programs and medical education

 Sending doctors for PH training abroad  Close collaboration between MOH and Medical Schools  Sufficient PH content in curriculum  Field work and practice for medical students  Training for Kabupaten doctor in 1950s and 1960s  Training for Puskesmas doctor after 1970s

 School of Public Health (FKM) in 1965  Graduate school mainly for non medical health workers, USA  Divergency and widening gap between PH and Medicine  Development of medical industry and technology  Effort to integrate PH and Medicine  Community Medicine

 Health is human right  Stated in our constitution and laws  It’s the duty of the state  For the welfare and satisfaction of the people  Social order and justice  Productivity, economic development

 Health is part of human right (Universal Declaration of Human Rights, UN, 1948)  Basic capital for National Development (WHO, 2002)  “Health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infinity” (WHO)

 Good or no good?  Health indicators - Mortality Rates: MMR, IMR - Morbidity statistics: socioeconomic impact - Life expectancy - Health budget - Health facilities - Etc.

HHuman Development Index (HDI) Indonesia ranks number 124 among 186 nations According to important health indicators, our health condition is worse compared to our neighboring countries such as Malaysia, Thailand and Vietnam Big challenge to improve it!! HOW???

 To maintain and improve health condition of the people  Every nation should develop it’s health care system accordingly  Should be effective, efficient and good quality  Accessible, affordable, acceptable and sustainable  Health service facilities and health finance  Doctors are the most important providers in health care service

70 to 80 % of health problems could be handled in primary care Very important to strengthen the primary care TERTIARY SECONDARY PRIMARY VERY EXPENSIVE EXPENSIVE CHEAP

 First line service  Close to the community, easy access  Simple facilities, relative inexpensive and affordable  Mainly promotion, prevention, general care, ambulatory  Majority of health care services

 Health Centers, clinics, private doctors etc.  Majority of people go to private GPs  Number of doctors in Indonesia now around , GPs and specialists  72 Medical Schools, every year about graduates  Limited and low quality services by GPs  Inadequate support by health insurance

 Still not a solid good system  Lack of leadership and regulator  More as “free fight liberalism” system  Relative expensive, majority are still not covered by health insurance  Free to go to any health facilities  Weak referral system  Many complaints on the quality  Ethical and moral violation

 Strengthen primary care facilities  Upgrade GPs into family physician  Additional training after graduate as primary care doctor  Strengthen effectiveness, efficiency and quality of health care system as a whole  Universal health insurance, health maintenance scheme

THANK YOU