This document discusses the transition from the Millennium Development Goals (MDGs) to the Sustainable Development Goals (SDGs). It notes some of the challenges Indonesia faced in achieving the MDGs, including starting implementation later than other countries and limited structural support and fiscal capacity. It emphasizes focusing on under-targeted areas like maternal and child health and HIV/AIDS. It also outlines priorities for the post-2015 development agenda, including economic transformation, innovation/technology, and human development. Health goals discussed include reducing infant/child mortality, increasing vaccination rates, lowering maternal mortality, and addressing diseases like HIV/AIDS.
This document discusses the transition from the Millennium Development Goals (MDGs) to the Sustainable Development Goals (SDGs). It notes some of the challenges Indonesia faced in achieving the MDGs, including starting implementation later than other countries and limited structural support and fiscal capacity. It emphasizes focusing on under-targeted areas like maternal and child health and HIV/AIDS. It also outlines priorities for the post-2015 development agenda, including economic transformation, innovation/technology, and human development. Health goals discussed include reducing infant/child mortality, increasing vaccination rates, lowering maternal mortality, and addressing diseases like HIV/AIDS.
This document discusses the transition from the Millennium Development Goals (MDGs) to the Sustainable Development Goals (SDGs). It notes some of the challenges Indonesia faced in achieving the MDGs, including starting implementation later than other countries and limited structural support and fiscal capacity. It emphasizes focusing on under-targeted areas like maternal and child health and HIV/AIDS. It also outlines priorities for the post-2015 development agenda, including economic transformation, innovation/technology, and human development. Health goals discussed include reducing infant/child mortality, increasing vaccination rates, lowering maternal mortality, and addressing diseases like HIV/AIDS.
Adang Bachtiar Ketua Umum IAKMI Pusat 2014 Download site: Facebook IAKMI.PUSAT Born in Cirebon, West Jawa Dokter from UNIVERSITAS INDONESIA Master of Public Health (MPH): HARVARD-USA Doctor of Science (DSc): JOHNS HOPKINS-USA Post Doctoral in Statistics: UNIV of MICHIGAN-USA Current Activities: Indonesian Public Health Association, President Global Fund TB at FPH-UI, Director Health Professions Coalition for Anti Smoking (KPK-AR), Chairman National Expert Panel on TB, Health Policy Spesialist MoH-Community trial for Mothers Compliance Improvement on ARV Treatment, Head of Team Komnas Penelitian & Pengkajian Penyakit Infeksi (PINERE) Litbangkes -Kemenkes, Expert Panel Indonesian MCH-Nutrition Eval Team-Ministry of Health, Head of Team Dept of Health Policy & Administration, UI, Past Chairman; Advice & examine more than 150 PhD dissertations, in medicine, dentistry, nursing, public health, regional planning National Health Research Committee, Expert Panel The development of RPJMN Kesehatan 2015-2019, Expert Panel The development of Oral Health Strategic Plan of MoH, Expert Panel 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) Kepemimpinan Di Puskesmas Perencanaan Puskesmas Pemenuhan Target disesuaikan kebutuhan (Need) Masy Kapasitasi SDM Puskesmas Implementasi Pelayanan di Puskesmas Pencapa ian Indikator Puskes mas Kemampuan SIK utk Added Value FAKTOR KONTEKSTUAL: SUPRASTRUKTUR-KAWASAN PEMBANGUNAN-KEMANDIRIAN MASY . Time to access 1 st ANC 56% akses 1 st 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 4 th 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
68 57 46 35 34 32 24 23 0 20 40 60 80 1991 1995 1999 2003 2007 2012 2014 2015 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. 390 334 307 228 359 118 102 0 50 100 150 200 250 300 350 400 450 1991 1997 2003 2007 2012 2014 2015 ANGKA KEMATIAN IBU Target dan Capaian Target RPJMN Target MDGs Impact Outcome
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 Pemungkin ANC & Persalinan Persalinan o nakes Penanganan kompilkasi UKBM Sistem transport Pembiayaan Donor darah Ibu dan anak selamat II. 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 FOKUS PD EKOLOGI SDA dan Kapasitas Ekologis FOKUS PD EKONOMI Sistem2 Ekonomi FOKUS PD SOSIAL Modal Sosial & Tujuan Kesejahteraan 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-requisites A 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 Indicators Economic 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 Indicators Innovation 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 Indicators Human 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
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 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 PEMBERDAYAAN Modifikasi 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 . . . 1b.Diagnosis & Investigasi 7.Mgmt System 8.Riset Libatkan end-user Kembangkan & diseminasi strategi program Libatkan stakeholders dlm tiap proses Tetapkan Goal & tujuan Rumuskan Proses Kerja Implem Keg & Aliansi Hasil Langsung (direct) Outcome (Hasil tdk lgs) Domain dampak dari produksi Aliansi: Kapasitasi sisyan kesehatan Kebijakan kesehatan berbasis data Perbaikan mgmt program Peningkatan skills staf Domain Kedua: Keterkaitan dg Users Domain Ketiga: ALIANSI MENGELOLA PENGETAHUAN 4-Kapasitasi Mengelola Pengetahuan 1-Kapasitasi Kebijakan & Pemograman 3-Kapasitasi Partisipasi Kel & Masy 2-Kapasitasi Aliansi Kapasitas Dekonsentrasi Kapasitasi NSPK Global Opportunity Governance Stewardship Financial Capacity building benchmarking Standarization Stewardship Governance Financial Capacity building Benchmarking Standards Kinerja staf Predisposing Reinforcing Enabling Kapasitas Otonomi Daerah Policy Capacity Hlth Mgtm capacity HRD capacity Financial capacity IS & Knowl mgmt Media & nerworks Knowl management & network International funding Health Devt Policy & communication Capacities devt Modif: Bachtiar 2009 1-Mengelola pengetahuan s/d skala global Community Empowerment G l o b a l - r e g i o n a l
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K e a r i f a n
l o k a l
4-Mengelola Pengetahuan Oleh Kaum Berpengetahuan PT & ORGANISASI PROFESI IPTEK Learning-KnowledgeInnovation 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 knowl Peluang & Ancaman OUTCOME KESEHATAN DAPAT DIBERIKAN OLEH Kaum Berpengetahuan Adaptasi dari Hughes-Tuohy 2003 & Hicks & Mishra 1993 Kelembagaan ALIANSI yg kuat Sumberdaya aksi/power Mobilisasi Sumberdaya Ketrampilan 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 BRAND M 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 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 peoples health PUBLIC HEALTH GRADUATES MUST HAVE_2 . . SOFT SKILLS MIRACLE P.H SKILLS BASIC PUBLIC HEALTH SKILLS 1. 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 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 & Students What 8 PH Competencies Where School and PH fields Funding University Funding; Student Tuition PHASE 1 A FOUR PHASE EDUCATIONAL MODEL PHASE 2 INDIVIDUAL OR GROUP PROBLEM BASED LEARNING Dept. Related to course topics Who 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 1 PHASE 3 A FOUR PHASE PROCESS MODEL PHASE 4 SUSTAINABLE TRANSLATION & DISTRIBUTION Dept. Related to research topic Who Practitioners, profs, candidate What Thesis exam and publication in journal Where PH seminars Funds Dept funds, Private, Grants PHASE 2 PHASE 1 PHASE 3 PHASE 4 . STRUCTURING THE COLLABORATION UNIVERSITY ROADMAP (Continuing) PH education progr Impact to Hlth 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 Creation Translational research, policy devt Knowledge brokering and codification Knowledge warehousing Publications, seminars, workshops Knowledge Preservation Knowledge exchange & portal Policy analysis Knowledge internalization and use Teaching/training Practice guidelines/tools Evaluation studies EFFECTIVE ALLIANCES: FRAMEWORK USED Social media & PH education technology Strategy & Process for PH education quality Social Capital including market and users VIRTUALISATION GLOBAL 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