INDONESIA S COUNTRY REPORT

Transcription

1 The 4 th ASEAN & Japan High Level Officials Meeting on Caring Societies: Support to Vulnerable People in Welfare and Medical Services Collaboration of Social Welfare and Health Services, and Development of Human Resources Tokyo, Japan, August 2006 INDONESIA S COUNTRY REPORT Dr. Rachmi Untoro, MPH Director of Child Health Directorate General of Community Health Ministry of Health of the Republic of Indonesia Indonesia CR-RU-MOH

2 INDONESIA'S COUNTRY REPORT Medical policy on The 4 th ASEAN & Japan High Level Officials Meeting on Caring Societies: Support to Vulnerable People in Welfare and Medical Services Collaboration of Social Welfare and Health Services, and Development of Human Resources Tokyo-Japan, August 28-31, 2006 A. INTRODUCTION Indonesia is the largest archipelago in the world consists of small and large islands. There are five large islands, i.e. Sumatera, Jawa, Kalimantan, Sulawesi and Irian. It stretches around 5111 km from the most western part in Sabang, Nangroe Aceh Darussalam province to the most eastern part in Merauke, Papua province. Around two third of the Indonesian area is water, and the total land area is around 1.89 million km 2. Since 2001 Indonesia has implemented the decentralization policy, and since 2005 has been administratively divided into 33 provinces, and 440 districts/cities. It covered subdistricts, villages, and hamlets. From 440 districts/cities, 199 districts or (45%) are isolated area. According to the National Social Economic Survey 2004 conducted by the Central Board of Statistic (CBS) the total population of Indonesia is 217million. It ranked the fourth most populous countries after China, India and United States of America. According to UNDP report on 2004, the income per capita of Indonesia people in 2002 is around USD 817. In 2004, the population living with income less than USD 1/day is 36 million (16.6 %) and the population living with income under USD 2 is around 60 million. Based on the Indonesia Demography and Health Survey in the estimation of children (0-19 year) around 87 million or 41%, age 0-5 year is 22 million or 10%, age 5-9 year is 23 million or 11%, age year is 22 million or 11%, and age year is 20 million or 9%. In 2003 the rate of population growth was 1.59 %, and the life expectancy at birth of Indonesian people is 66.6 years (UNDP report in 2004). According to the Household Survey in 2002, maternal mortality rate was 307 per live births and neonates mortality rate was 20 per 1000 live births. Based on the National Social Economic Survey Indonesia CR-RU-MOH

3 in 2004 infant mortality rate was 32 per 1000 live births and under five year mortality rate was 38 per 1000 live births. Indonesia has 300 ethnic groups and in 2000, 57.7 % of the population living in rural areas. The population in some area has belief and behaviour which contradiction with mother and child health likes gives liquid rice for newborn baby, living in near forest after delivery and etc. In 2000, the literacy rate of Indonesia people is 89.5%, 93.5% for man and 85.7 % for woman. To improve health of Indonesia's people, the vision of Indonesian health development is Self Motivated Community to Live Healthy Lives. To achieve this vision, our mission is Make People Healthy, and the grand strategies are: 1. Social Mobilization and Community Empowerment for Healthy Living 2. To improve access and quality of health services 3. To improve health surveillance, monitoring and information system 4. To increase health financing B. MEDICAL SERVICES FOR CHILDREN AND PERINATAL CARE FOR WOMAN 1. Current situation The institutions which give services in sub districts for primary level are PUSKESMAS (Community Health Centers). In district/cities for secondary level there are hospitals. In same provinces for tertiary level there are same specialized hospitals and province/national referral hospitals. The Community Health Centers and their networking such as sub health centers, integrated services posts, maternity huts, village health post and mobile health service provide promotive preventive as well as simple curative services. The basic services in Community Health Center are as follows (1) Health Promotion, (2) Environmental Health, (3) Mother, Child and Family Health, (4) Improvement Community Nutrition, (5) Prevent and Control Communicable Disease, and (6) Curative Services. The hospitals mostly provide curative and rehabilitative services and also promotive, preventive services such as health education, counseling and immunization. In 2005, the number of hospitals is consists of 995 general hospitals and 273 specialized hospitals. The number of Community Health Centers is and out of it provided with bed. In 2003, the number of general practitioners are , specialist doctors are , nurses are and midwives are In 2004, Indonesia CR-RU-MOH

4 the number of the obstetricians are 1104 and the pediatricians are 1800 and the ratio of pediatrician per children is 2.4. Women and children health services program in the community were started on 1950 through Mother-Child Health Institution (Balai Kesehatan Ibu dan Anak), since 1974 the PUSKESMAS (Community Health Centers) has been developed to provide integrated services on promotive, preventive, and curative including MCH. Currently the number of Community Health Centers are To support MCH program, the system starts from the individual or family level with communication information and education, services and empowerment. In the community or village level through integrated services posts (Posyandu), maternity huts (Polindes), village health post (Pos Kesehatan Desa) for promotive- preventive and simple health services including delivery. In 2005, the number of integrated services posts are , maternity huts are and village health posts are Community Health Centers carry out services such as antenatal care, delivery by skilled midwife, preparation for breastfeeding, new born care, postnatal care through 2 times neonatal visits, immunization, Integrated Management of Childhood Illness, Early Stimulation, Detection and Early Intervention for Growth and Development, Youth Reproductive Health, Health care for street children disabled children and child Labour, School Health Programme, and Adolescent Friendly Health Services and Family Planning. Community Health Centre which provide Adolescent Friendly Health Services have networking with Junior High School and Senior High School and adolescent organization to solve adolescent problem through counselling and treatment. Hospitals provide services such as antenatal care for pregnant women with complication or have chronic disease, delivery with complication (hemorrhage, infection and eclampsia), and or with obstacles and operational contraceptive services, immunization, and treatment for Mother & Child illness. To protect reproductive and fulfil human rights by reducing the burden of unnecessary illness, disability and death associated with pregnancy, childbirth and neonatal period, in October 12, 2000 the Indonesia government launched Making Pregnancy Safer as the part of Safe Motherhood program, to increase both the supply of and demand for emergency obstetric services. The strategies of Making Pregnancy Safer are every delivery by skilled health personnel; every obstetric and neonatal complication get adequate services and every woman at reproductive aged Indonesia CR-RU-MOH

5 have access to prevent unwanted pregnancy and services for complication abortion. To fulfil the rights of the child, the government in collaboration with family, community, private sector, non government organization and agencies have attempted to fulfil the right to live, growth and development of the child by providing skilled health personnel. The strategies of maternal and child health are to increase access and quality of health services with cost effective financing, in collaboration with other program/other sectors, community, private and other stakeholders, community and family empowerment as well as woman empowerment. 2. Institutional framework Mother and Child Health Program are implemented in collaboration with related units such as: Directorates in Ministry of Health such as Directorate of Child Health, Directorate of Mother Health, Directorate of Community Nutrition, Directorate of Community of Health, Directorate of Basic Medical Care, Directorate of Specialist Medical Care, Directorate of Nursing Care, Directorate of Surveillance, Epidemiological, Immunization and Matra Health, Directorate of Direct Communicable Disease Control. In order to improve the commitment there are related ministry deal with mother and child program such as Coordinating Ministry of People s Welfare, Ministry of National Education, Ministry of Woman Empowerment, Ministry of Home Affairs, Ministry of Social, Ministry Religious Affair, Ministry of Labor, Ministry of Law and Human Rights, National Development Planning Board, National Family Planing Coordination Board, National Body of Narcotic, Indonesian Commission of Child Protection, and non-governmental organization such as Indonesia Medical Association, Indonesia Midwife Association, Indonesia Nurse Association, Indonesia Pediatric Association, Indonesia Obstetric Gynecology Association, Perinasia and Aliansi Pita Putih, donor agencies and private sectors. コメント [t1]: コメント [t2]: Indonesia CR-RU-MOH

6 3. Recent activities and problems for the following items: a. Health professionals Professional organizations namely Indonesia Medical Association, Indonesia Obstetric Gynecology Association, Indonesia Pediatric Association, Indonesia Midwife Association and Indonesia Nurse Association, work closely with government in improving the knowledge and skills of health personnel through training on mother and child health, normal delivery care, basic emergency obstetric and neonatal care, Management of Asphyxia, Management of Newborn Care including Management of Low Birth Weight, Management of Breastfeeding, Integrated Management of Childhood Illness and Stimulation Early Detection and Intervention Growth Development for under Five, MCH handbooks, Management of Child Abuse and Neglected, Adolescent Friendly Health Centre and Family Planning Counselling. コメント [t3]: b. Collaboration of social welfare and health and medical services (e.g homes for abandoned infants) The collaboration between social welfare and medical services such as early detection and screening, immunization, medical treatment at homes for abandoned infants, and use of MCH handbook. The health facilities are as referral for health services for mother and children including for child abuse or woman abuse. c. Role sharing between public and private sectors (including international NGOs) The public sector develop regulation, technical policy, standardization, provide services technical assistance and monitoring. The private sector contributes on health program, such as building private clinics/hospitals provide health and medical services. e. Roles of community and family Family plays an important role on identifying and reporting woman abuse and child abuse cases, if they are aware of the impact. While the role of community could be improved through training for volunteer on sensitization the mother and child problem. 4. Challenges and actions for future Challenges: - Commitment from local government in improving public private partnership in health services and health financing. Indonesia CR-RU-MOH

7 - Commitment from local government for income generating activities in order to reduce poverty. - To improve the awareness of people and family regarding mother child health including the rights of child and the management of child abuse and child disabilities consists of: a. Supply's sides are the number & distribution of health personnel, health facilities and health personnel for MCH which is still limited, the sustainability of MCH services including referral system need to be improved, and increase the budget for MCH services. b. Demand's sides are woman education still low and woman s status is not beneficial, Socio economic status still low, belief and culture is not supporting, and lack of transportation in some isolated area. Actions in the future are: a. To improve the access and quality of health services. b. To improve the knowledge and skills of health personnel through training. c. To socialize and enforce CRC cq. Indonesia Law Number 23 of 2002 on Child Protection. d. To develop management guidelines for child abuse and child with disabilities for health personnel. e. To strengthen networking in management of child abuse and neglected and child with disabilities. f. To improve shelter and family take care of child abuse or orphaned. g. To improve trauma centers for woman abuse and child abused and neglected at least in one hospital in every provinces. f. To improve partnership and community participation in terms of the health of disabled child. 5. Children who need special health care Children who need special health care are; child abuse, child labor, trafficking, street children, Juvenile delinquencies and Children with disabilities/handicapped. Indonesia CR-RU-MOH

8 C. SUPPORT MEDICAL EXPENSES, ESPECIALLY FOR LOW INCOME FAMILY. Before economic crisis hit Indonesia in 1997, the health service providers such as primary health centers and hospitals has given free-of-charge health services for poor families in order to conduct their social functions. But during the economic crisis, these functions were not done due to the increasing health cost and number of poor people. To solve this problem, in the Indonesian Government has provided free health services to poor people, gave supplements nutrition to under nutrition and nourishes nutrition through Social Safety Net Program. In 2002 these program through Program on fuel compensation (Program Kompensasi Pengurangan Subsidi Bahan Bakar Minyak or PKPS BBM). This policy continues until 2005, free health services in primary health centers and hospitalize in the third class of public and private hospitals which have contract through state enterprise PT. ASKES through Askeskin (Health Insurance for the poor), and for supplementation through deconcentration budget and support from local government. Target population of Askeskin is low income and people without health insurance around 60 million. Indonesia CR-RU-MOH