Fase persiapan

Fase analisa situasi dan kecenderungan SKD

Fase penyusunan SKD Fase penetapan SKD

Yosri Azwar

 All the activities whose primary purpose is to promote,

restore or maintain health. The complex of interrelated element that contribute to health in homes, educational institutions, workplaces, public places, and communities, as well as in the physical and psychosocial environment and the health and related sectors (WHO, Health for All, 1984).

 3 Fundamental objectives: improving the health of the population they serve; responding to peoples expectations; providing financial protection against the costs of ill-health.

Functions the system performs

Goals/ objectives of the system

Stewardship
(leadership, oversight)

Responsiveness
(to peoples nonmedical expectation)

Creating resources
(investment & training)

Delivering services
(provision)

HEALTH Fair(financial)

Financing
(collecting, pooling and purchasing)

contribution

Resource: WHO, World Health Report 2000

Private sector

Public sector

Community Family Self & Community Care

Health policy & planning in relation to: Needs Resources Strengthening and changing existing interventions Health resources: Taxes User fees Insurance Contribution from donor agencies Staff and equipment Community labor Other sectors

Health needs: Community perceived Professionally determined - morbidity - mortality - disability - ANC/FP

Interventions: - Adequacy (covering priority needs?) - Coverage (all?, risk groups?) - Acceptability (according to clients demands and culture?) - Cost-effectiveness (sound?, affordable for providers and clients?) - equitability

HEALTH

Keputusan Menkes RI Nomor: 99a/Men.Kes/SK/III/1982 tentang Berlakunya Sistem Kesehatan Nasional

Pemikiran Dasar SKN (bersifat lestari) RPJP Bidang Kesehatan

Bentuk Pokok SKN

 Pemikiran Dasar SKN (bersifat lestari)

BAB I: Pendahuluan
BAB II: Landasan SKN BAB III: Tujuan dan Dasar Pembangunan Kesehatan BAB IV: Pokok-Pokok Penyelenggaraan SKN A. Tujuan dan Sasaran B. Pokok-pokok Penyelenggaraan dan Kaitannya dengan berbagai Sub-Sistem serta komponen C. Hubungan antara Berbagai Sub-Sistem dan Komponen D. Supra Sistem dan Sistem Nasional Sektor Lain E. Dinamika dan Pengendalian BAB V: Penutup

 RPJP Bidang Kesehatan (1982 2000)

BAB I: Pendahuluan
BAB II: Keadaan & Masalah serta Kecenderungan BAB III: Kebijaksanaan dan Langkah-langkah BAB IV: Pokok-Pokok Upaya Kesehatan A. Peningkatan Upaya Kesehatan B. Perbaikan Gizi C. Peningkatan Kesehatan Lingkungan D. Pencegahan dan Pemberantasan Penyakit E. Peningkatan Kesehatan Kerja F. Pengendalian Pengadaan, Pengaturan dan Pengawasan Obat, Makanan dan Sebagainya

 RPJP Bidang Kesehatan (1982 2000)

BAB IV: Pokok-Pokok Upaya Kesehatan G. Peningkatan Manajemen dan Hukum H. Pengembangan Tenaga Kesehatan I. Penelitian dan Pengembangan Kesehatan BAB V: Penggerakan Pelaksanaan Upaya Kesehatan
BAB VI: Sumber Daya yang Dibutuhkan BAB VII: Pentahapan Pelaksanaan BAB VIII: Pengendalian dan Penilaian BAB IX: Penutup

 Bentuk Pokok Sistem Kesehatan Nasional

BAB I: Pendahuluan
BAB II: Keadaan dan Masalah Pengorganisasian Upaya

Kesehatan BAB III: Dasar-dasar Bentuk Pokok SKN

A. Pelaksanaan dan Pengembangan Upaya Kesehatan B. Manajemen Upaya Kesehatan
BAB IV: Bentuk Pokok Penyelenggaraan SKN BAB V: Pentahapan Pelaksanaan BAB VI: Penutup

 Keputusan Menkes RI Nomor: 131/MENKES/SK/II/2004 tentang SKN MEMUTUSKAN Menetapkan: Pertama : Keputusan Menkes tentang SKN Ketiga : Digunakan sebagai pedoman bagi semua pihak dalam penyelenggaraan pembangunan kesehatan di Indonesia Keempat : Keputusan Menkes Nomor 99a/Men.Kes/SK/III/1982 tidak berlaku lagi.

I.

PENDAHULUAN

A. LATAR BELAKANG B. MAKSUD DAN KEGUNAAN II. ANALISIS SITUASI DAN KECENDERUNGAN SKN III. POKOK-POKOK SKN
A. PENGERTIAN SKN B. LANDASAN SKN C. PRINSIP DASAR SKN D. TUJUAN SKN E. KEDUDUKAN SKN F. SUBSISTEM SKN

IV. SUBSISTEM UPAYA KESEHATAN

V. SUBSISTEM PEMBIAYAAN KESEHATAN VI. SUBSISTEM SUMBERDAYA MANUSIA KESEHATAN VII. SUBSISTEM OBAT DAN PERBEKALAN KESEHATAN VIII. SUBSISTEM PEMBERDAYAAN MASYARAKAT IX. SUBSISTEM MANAJEMEN KESEHATAN
A. B. C. D. E. PENGERTIAN TUJUAN UNSUR-UNSUR UTAMA PRINSIP BENTUK POKOK

X. PENYELENGGARAAN SKN XI. PENUTUP

 Maksud dan Kegunaan: Menyesuaikan SKN 1982 dengan berbagai perubahan dan tantangan eksternal dan internal. Mempertegas makna pembangunan kesehatan dalam rangka pemenuhan hak azasi manusia, memperjelas penyelenggaraan pembangunan kesehatan sesuai visi dan misinya, dst. Merupakan acuan dalam menerapkan pendekatan pelayanan kesehatan primer (Primary Health Care).

 Analisis Situasi dan Kecenderungan SKN:

World Health Report 2000 pencapaian SKN Indonesia masih terhitung rendah. Indikator Pencapaian SKN:
1. Status Kesehatan DALE 2. Tingkat Ketanggapan Responsiveness (urutan 106 dari 191 negara anggota WHO yang dinilai)

Indikator Kinerja SKN:

1. Distribusi Tingkat Kesehatan Angka Kematian Balita 2. Distribusi Ketanggapan Harapan Masyarakat 3. Distribusi Pembiayaan Kesehatan Penghasilan Keluarga (urutan 92 dari 191 negara anggota WHO yang dinilai)

 Indikator Pencapaian SKN:

1. Status Kesehatan DALE 2. Tingkat Ketanggapan Responsiveness Dipengaruhi oleh UPAYA KESEHATAN 1)

Indikator Kinerja SKN:

1. Distribusi Tingkat Kesehatan Angka Kematian Balita 2. Distribusi Ketanggapan Harapan Masyarakat Dipengaruhi oleh SUMBERDAYA KESEHATAN 2), PEMBERDAYAAN MASYARAKAT 3) dan MANAJEMEN KESEHATAN 4) 3. Distribusi Pembiayaan Kesehatan Penghasilan Keluarga Dipengaruhi oleh PEMBIAYAAN KESEHATAN 5)

 MILLENNIUM DEVELOPMENT GOAL (MDG) HEALTH & SUSTAINABLE DEVELOPMENT (AGENDA 21)

 MILLENIUM DEVELOPMENT GOAL (MDG) Millennium Declaration, signed by 189 countries, including 147 heads of State and Government, in September 2000. 8 Goal, 18 targets and 48 indicators. Goals, targets and indicators effective 8 September 2003. All goals should be achieved no later than 2015.

No. Goals & Targets

1. Eradicate extreme poverty and hunger (2) 2. Achieve universal primary education (1) 3. Promote gender equality and empower women (1) 4. Reduce child mortality (1) 5. Improve maternal health (1) 6. Combat HIV/AIDS, malaria and other diseases (2) 7. Ensure environmental sustainability (3) 8. Develop a global partnership for development (7)

Indicators
5 3 4 3 2 7 8 16

No.

Goals & Targets

4. Reduce child mortality (1)
Target 5: Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate

Indicators
13. Under-five mortality rate 14. Infant mortality rate 15. Proportion of 1 year-old children immunized against measles 16. Maternal mortality ratio 17. Proportion of births attended by skilled health personnel women aged 15-24 years 19. Condom use rate of the contraceptive prevalence rate
a. Condom use at last high-risk sex b. Percentage of population aged 15-24 years with comprehensive correct knowledge of HIV/AIDS c. Contraceptive prevalence rate

5. Improve maternal health (1)

Target 6: Reduce by three-quarters, between 1990 and 2015, the maternal mortality ratio Target 7: Have halted by 2015 and begun to reverse the spread of HIV/AIDS

6. Combat HIV/AIDS, malaria and other diseases (2) 18. HIV prevalence among pregnant

20. Ratio of school attendance of orphans to school attendance of non-orphans aged 10-14 years

No.

Goals & Targets

Target 8: Have halted by 2015 and begun to reverse the incidence of malaria and other major diseases

Indicators
associated with malaria 22. Proportion of population in malaria-risk areas using effective malaria prevention and treatment measures 23. Prevalence and death rates associated with tuberculosis 24. Proportion of tuberculosis cases detected and cured under directly observed treatment short course DOTS (Internationally recommended TB control strategy)

6. Combat HIV/AIDS, malaria and other diseases (2) 21. Prevalence and death rates

 HEALTH & SUSTAINABLE DEVELOPMENT (AGENDA 21)

In June 1992, government representatives from 178 countries met together in Rio de Janeiro for the Earth Summit, the United Nation Conference on Environment and Development. The major outcomes of this conference was Agenda 21 the United Nation action programme for sustainable development into 21st century. Sustainable development has been defined as: .development that meets the needs of the present without compromising the ability of future generations to meet their own needs. Sustainable development is a wide-ranging concept concerned not only with protecting the environment and living within the carrying capacity of the Earths support system but also with peoples quality of life, with equity within and between generations and with social justice.

 HEALTH & SUSTAINABLE DEVELOPMENT (AGENDA 21)

It thus brings together economic, environment, social, political, cultural, ethical and health considerations and requires new and integrated thinking and action.

Community Economic Development

Economic Development Conservatism

Sustainable Development

Community Development

Ecological Development

Deep ecology or Utopianism

Sumber: WHO, City Planning for Health and Sustainable Development, 1997

Community own services

Economic vitality

Local welfare benefit campaign

Recycling project Sustainable Society

Stress reduction project Social wellbeing Environmental integrity Local legislation and services provision

Eco-friendly housing project

Sumber: WHO, City Planning for Health and Sustainable Development, 1997

Age, sex & hereditary factors

Sumber: WHO, City Planning for Health and Sustainable Development, 1997

Sumber: WHO, City Planning for Health and Sustainable Development, 1997

 Health is not an activity. It is not jogging, or eating

well, or not smoking, or living in a good environment, or being employed. Rather it is the outcome of these and other activities as well. People are more, or less, healthy according to the resources which they have in their everyday lives. Health is the outcome of these factors combined in the lives of individuals and communities.

Source: Working together for Glasgows health: Glasgow city health plan

Well being
Prevention of illness
(healthy behaviour and lifestyles and preventive medicine)

Health and social care

(responsive and appropriate health and social services)

Health awareness
(knowledge and understanding of the factors affecting health)

Mental survival
(community and self-esteem)

Physical survival
(food, shelter, warmth and safety)

City Health Plan Community

Health & Social Sector

Economic Sector

Transport Sector

Business Sector

Environment

Local policies & Legislation National policies & Legislation Health For All/ Agenda 21 Strategy

Education

Industry

Yes

Public good?

No

Yes

Significant externalities?

No

Adequate demand?

Yes

Catastrophic cost?

No

No

Insurance appropriate?
No Yes

Yes

Beneficiaries poor?

No

Cost-effective?

Yes

No

Yes Leave to regulated private market

Do not provide Finance publicly

Public?

Private?

Providers

Risk Pooling Entity General Taxation1) Tax Collector Taxes Employers and Consumers Social Insurance2) Social Insurance Revenue Collector Private Insurance3) Out-of-Pocket Payments4)

1. Out-of-pocket payment:
Services

Consumers
Payment

Providers

Doctors/ Clinics/ Hospitals

2. Separation of payment and treatment:

Services Doctors/ Clinics/ Hospitals

Consumers

Providers

Third party

3. General taxation:

Services

Consumers
User Fees

Providers

Doctors/ Clinics/ Hospitals

State

4. Mandated Social Health Insurance:

Services

Consumers
User Fees

Providers

Doctors/ Clinics/ Hospitals

Taxes

Premium

Payments

State
Subsidies (non-income earners)

Financing Organization

Regulation

A. Revenue collection
1. Population coverage 2. Method of finance

B. Risk pooling
3. Level of fragmentation 4. Composition of risk pools

Resource generation (sufficient & sustainable)

Optimal resource use

Financial accessibility of health services for all

5. Benefit package

6. Provider payment mechanisms

7. Administrative efficiency

C. Purchasing

Responsiveness

Performance of social health insurance scheme in key design issues Resource generation (sufficient & sustainable) Optimal resource use

HEALTH

Financial accessibility Fair financial of health services for all contribution

Perinatal period

Pregnancy
Birth 7 days Early neonatal period 28 days

Neonatal period

Infancy

Death Aging

1 year

Adulthood

Pre-school years
5 years

Reproductive period

20 years 10 years

Childhood

Adolescence School-age

Pregnancy Birth Perinatal period

Antenatal care Essential obstetric care Essential family planning Nutritional interventions Community mobilization for safer homebirths

Neonatal period
Essential newborn care Breastfeeding counseling Immunization Management of illness

Birth 7 days 28 days

Infancy
Breastfeeding counseling Nutrition interventions Management of illness Care for development Immunization Other preventive measures

1 year

Reproductive period
Essential reproductive health services Contraceptive services STD care 20 years 10 years

1 year

5 years

Childhood Adolescence
Adolescent friendly health service Interventions to promote a safe and supportive environment Nutrition interventions Adolescent development Nutrition interventions Disease prevention and management Care for development Accident prevention

School-age
School health programmes

Policy makers

Health managers

HEALTH SYSTEM BASED ON PEOPLES NEEDS

Health professions

Communities

Academic institutions