1. Issues in Health Service
Indah Amelia – Public Health Department

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

3. 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

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

5. New roles for managers
LEADER
DESIGNER
STRATEGIST

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

7. Health issues in the World

8. MDGs

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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)

16. Health issues in Indonesia

17. 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

18. 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)

19. 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

20. ANY QUESTION??