IMPLEMENTATION OF HEALTH PROGRAMS IN THE

DECENTRALIZATION ERA AT BANGKA BELITUNG ISLANDS

PROVINCE

BY : drg. MULYONO SUSANTO, MHSMHead of Health Department Bangka Belitung Islands Province

1. INTRODUCTIONS

2. NATIONAL AND REGIONAL HEALTH DEVELOPMENT ACHIEVEMENT

3. RESOURCES ENDORSEMENT OF HEALTH DEVELOPMENT

4. CHALLENGES & STRATEGIC STEPS TO ACCELERATE HEALTH DEVELOMENT

5. BEST PRACTICES

6. NATIONAL HEALTH INSURANCE

3

1. INTRODUCTIONS

Geographic andpopulation- Total Population: 1.339.773- Ecological

zones : Tropicalclimate, andarchipelagicgeography

The issue of decentralization in the post-reform Indonesia emerged around 1999 - 2000. It was signed with the enactment of Law No. 32 of 2004

Emergence of Law 32 0f 2004 on Regional Govermenthas brought a new wind the Indonesian goverment from centralizedto the decentralized

With a decentralized model of Health, local government is given full authority to regulate the sector of regional health systems.

In the process, the local government is highly dependent on several factors; the financial support, cooperation, coordination across sectors, etc. in the success of the health system in the region.

Bangka Belitung has officially ratified on 09 February 2001 when Indonesia has entered the era of decentralization.

PP 38 of 2007 on the division of power between central and regional government as well as covering the field of Health.

MINISTRY OF HEALTH

DEPARTMENT OF HEALTH PROVINCE

DEPARTMENT OF HEALTH DISTRICT

COMMUNITY HEALTH CENTER / PKM

HEALTH VILLAGE POST (POSKESDES)/ SECOND COMMUNITY

HEALTH CENTER (PUSTU)

Cadre

HOSPITAL CENTER

REGIONAL

HOSPITAL

PROVINCE

DISTRIC

2. NATIONAL AND PROVINCEHEALTH DEVELOMENT

ACHIEVEMENT

9Ket : 1) SDKI, 2007; 2) Riskesdas, 2010; 3) SDKI, 2012; 4) Sensus Penduduk,2010; 5) Profil Kesehatan; 6) Program Terkait

Numb INDICATORS

STATUS

ACHIEVEMENTSTARGET

2014STATUS

Beginning

2009 2010 2011 2012 20132014

TRW I

1 Life expectancy (years) 70,7 70,9 71,1 71,1 n.A n.A 72,0  

2The maternal mortality rate per 100,000 born alive

228 154,2 5) 149.8 5) 137,6 5) 119.7 5) 90.96 6) 118  

3The percentage of births attended by skilled health personnel.

84,3 91.09 5) 94.46 5) 94.42 5) 91.62 5) 21.62 6) 90  

4The infant mortality rate per 1000 live births.

34 9.25 5) 8.4 5) 9.7 5) 7.69 5) 8.79 6) 24  

5 Total Fertility Rate (TFR) 2,6 2,4 4) n.A 2,63) n.A n.A 2,1  

6Percentage of population with access to drinking water quality.

47,7 36.69 5) 83.36 5) 90.56 5) 80.87 5) n.A 68  

7Percentage of population 15 years and over who have knowledge of HIV and AIDS.

66,2 1) 57,5 2) n.A 79,5 3) n.A n.A 90  

8 Annual Parasite Index (API) 1,85 4.82 5) 4.10 5) 2.36 5) 1.39 5) 0.17 6)

 1  

9Percentage of population with health insurance.

n.a 78.39 5) 79.53 5) 100 5) 93.74 5) n.A 80,10  

10

MDG’s 2015 : ≤ 23/1000 KH

11Source : Ditjen P2PL, 2013

12Source : Report of the Director General Nutrition, Ministry of Health,

Update 11 Januari 2013

Renstra’s Target : 75%

Source :Diit.PPBB –Ditjen PP dan PL, Ministry of Healt 201113

MDG’s Target : 1/1000 of Population

3. SUPPORT RESOURCES FOR HEALTH DEVELOPMENT

14

DOCTOR RATIO PER 100,000 POPULATION IN 2012

Source : Pusdatin 15

17,48

25,9823,34

25,57 26,26

31,8135,83

43,7745,53

47,54

36,03

0

5

10

15

20

25

30

35

40

45

50

LAMPUNG KEP. BABEL JAMBI SUMSEL BENGKULU KEP. RIAU RIAU ACEH SUMBAR SUMUT INDONESIA

40/100.000 target of population

MIDWIFE RATIO PER 100,000 POPULATION IN 2013

Souce : Pusdatin

Rasio Bidan : 100 / 100.000 penduduk

16

Sumber : Data dan Informasi Prop. Kep. Babel

CENTRAL GOVERMENT PROVIDES DOCTORS, DENTIST AND MIDWIVESTO BE WORK IN REGENCY / MUNICIPALITY IN RURAL AREA

Numb

Dist/City

DOCTOR DENTIST MIDWIVES

B T ST JML B T ST JML B T ST JML

1 KAB. BANGKA

- 4 - 4 - - - - 8 5 - 13

2 KAB. BELITUNG

- 1 - 1 - - - - 4 - 1 5

3 KAB. BANGKA BARAT

- - - - - 1 - 1 9 15 - 24

4 KAB. BANGKA TENGAH

- - - - - - - - 9 - - 9

5 KAB. BANGKA SELATAN

- - - - - - 2 2 7 14 1 22

6 KAB. BELITUNG TIMUR

- - - - - - - - 1 - 1 2

7 KOTA PANGKAL PINANG

- - - - - - - - 14 - - 14

JUMLAH - 5 - 5 - 1 2 3 52 34 3 89

17

18

NO SOURCE COST TOTAL

1 DECONCENTRATION 18,934,837,000

2 Co-TASK / TP 9,006,000,000

3BASIC SERVICES PUBLIC HEALTH INSURANCE

984,525,000

4PUBLIC HEALTH INSURANCE REFERRAL SERVICE

508,888,000

5 LABOR INSURANCE (JAMPERSAL) 6,711,698,250

6 SALARY & INCENTIVES OF PTT 3,402,350,000

7 VACCINE AND DRUG PROGRAM 8,420,702,850

8 SPECIAL ALLOCATION FUND (PURE) / DAK 38,299,060,200

9 TPG KIT and Dacin 335,125,000

10 LOANS / GRANTS FOREIGN (PHLN) 11,324,748,072

TOTAL BUDGET HEALTH 97,927,934,372 97,927,934,372 / 163,916,444,689 out of total = 59.74259298 %

19

Revenue and Expenditure Budget

of Local Government (APBD) TOTAL

PROVINCE 51,878,637,393

DISTRICT / CITY 112,037,807,296

TOTAL 163,916,444,689

21

K4 National’s Target 2015: 95% PN National’s Target 2015: 90%

Still below targetK4

Upper targetPN

22Source : Data and Information of Babel Province2013

23

MAP OF MALARIA IN BANGKA BELITUNG PROVINCE

Malaria still an endemic disease in Bangka Belitung Province

25

Number of Cases of Malnutrition Bangka Belitung: 95 Cases

PROBLEMS STRATEGIC STEPS

Disparities in access to maternal and child health services (facilities, personnel, health services limited warranty).

1. Strengthening health services in regions A, B, C2. Improving access and quality of health services : • Community health centers PONED• Hospital PONEK• Assurance processes of birth (Jampersal), • BOK • Linakes Skilled

Preventive and promotive efforts really not optimal

Increased promotive-preventive:•Program Planning & Childbirth Complications Prevention: ANC - KB & exclusive breastfeeding•Mothers movement - exclusive breastfeeding PP 33/2012•Integrated health posts (posyandu) and sub-village active standby•Fully immunized

management of health services is too weak

Improved management of health services:•The integrated system of vital registration,•Accreditation & referral network optimization.•System of maternal and child health services (KIA) which meet the criteria continum of care.

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Problems Strategic Steps

1. New infections continue to rise, more extensive transmission area.

• Prevention Efforts (condoms, IHS, PDB, PPIA), early diagnosis (PITC) and early treatment (CD4 350) should be increased.

2. Promotive-preventive GTT HIV and AIDS at the age of 15-24 years.

• Increased knowledge pd age 15 years upwards on HIV and AIDS.

• Campaign, “I Know I'm Proud”.

3. The percentage of people living with HIV who received antiretroviral treatment is still low (44.2 percent).

The increase in the percentage of people living with HIV who get antiretroviral treatment to 50 percent.

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EDUCATIONEDUCATION

PREVENTION•Prevention of Sexual Transmission Through (PMTS)•Bad effects of drug prevention (PDBN)•Prevention of transmission through the Maternal and Child ( PPIA)

PREVENTION•Prevention of Sexual Transmission Through (PMTS)•Bad effects of drug prevention (PDBN)•Prevention of transmission through the Maternal and Child ( PPIA)

TREATMENT•Expansion Testing

• STI patients• injecting drug

users• HIV + Pregnant

Women • serodiscordant

couples• TB Coinfection• Patients with

Hepatities B & C•Early initiation of antiretroviral drugs on key populations, pregnant women, TB, Hepatitis B & C co-infection

TREATMENT•Expansion Testing

• STI patients• injecting drug

users• HIV + Pregnant

Women • serodiscordant

couples• TB Coinfection• Patients with

Hepatities B & C•Early initiation of antiretroviral drugs on key populations, pregnant women, TB, Hepatitis B & C co-infection

KONDOM

KONDOM TES

HIVTES HIV

LASS

LASS

L K B L K B P

“PERKUAT JEJARING INTERNAL”“PERKUAT JEJARING EKSTERNAL”

P

“PERKUAT JEJARING INTERNAL”“PERKUAT JEJARING EKSTERNAL”

KPAKPA

Health-care facilities

Health-care facilities communitescommunites

• MORAL

• RELIGION

• REPRODUCTIVE HEALTH

• DANGER OF NAPZA

• MORAL

• RELIGION

• REPRODUCTIVE HEALTH

• DANGER OF NAPZA

IPWLIPWL

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5. BEST PRACTICE

29

ADULT ELDERLY

TEEN

TEEN

SMS GATEWAY

•Service Post (posyandu )

CHILD CLASS MOM -Elderly

Gymnastics PREGNANT •PTM

BABY P4K

Integrated Service

Post : KB

Neonatus visits

early childhood education (PAUD)

School Health Unit (UKS)

HOME VISITE BY MIDWIFES TO PREGNANT WOMEN TWICE IN A MONTH

immunization Basics BKB PKPR

PARTNERSHIP MIDWIFE and shaman

Integrated Management of

Childhood Health (MTBS) SDIDTK

Clean and Healthy

Behavior (PHBS)

PONED/PONEK

VILLAGE ALERT

JKN

Alert Village

BEST PRACTICES

1. MTBS Stand for Integrated Management of Childhood Illness or Integrated Management of Childhood Illness (IMCI in English) is an integrated approach / integrated in the management of sick children with a focus on the health of children aged 0-5 years (toddlers) thoroughly.

2. UKS abbreviated school health is an effort made to help school pupils and the school community who are sick in the school environment. UKS is usually done in a school nurse's office.

3. Adolescent Health Care Services (PKPR) is a Youth Care Health Services, serving all of the youth in the form of counseling and various things related to adolescent health. Here teenagers do not need to hesitate and worry for vent / counseling, getting the right information and the right to a variety of things to know teenagers.

4. ANTE Natal Care (ANC) health examination given to pregnant women on a regular basis that is four times during pregnancy.

5. CLASS OF PREGNANT WOMEN (Kelas Ibu Hamil) Pregnancy Class is a study group of pregnant mothers with gestational age between 20 weeks s / d 32 weeks with a maximum number of 10 participants. In this class of expectant mothers will learn together, discuss and exchange experiences on Maternal and Child Health thorough and systematic and can be done on a scheduled basis and continuously.

.

6. Integrated Service Post is a neighborhood health center providing primary health services, integrated with early childhood activities, BKB and SDIDTK.7. Early childhood education (PAUD/ECD) is the level of education before primary education which is an effort aimed at the development of children from birth to the age of six, which is done through the provision of educational stimulation to assist the growth and development of the child's physical and spiritual so has the readiness to enter further education, which was held in formal, non-formal, and informal.8. Detection of Early Intervention Stimulation of Growth (SDIDTK) is to make an effort monitoring the growth and development of children.9. PHBS is a set of behaviors that is practiced on the basis of consciousness as a result of learning that makes a person or family can help themselves in the field of health and play an active role in creating public health.

.

6.NATIONAL HEALTH INSURANCE

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The National Health Insurance (JKN) is part of the National Social Security System (Navigation) held by the Social Security Agency (BPJS) using the mechanism of social health insurance which is compulsory (mandatory) based on Law Number 40 Year 2004 on National Social Security System with the aim of to meet the basic needs of a decent public health given to every person who has paid dues or dues paid by the Government. 

BASIC OPERATION LAW OF JKN

1945 Article 28 H paragraph (1), (2), (3) 1945 Article 34 paragraph (1), (2) Law No. 40 of 2004 on National Social Security

System (Navigation). Act No. 24 of 2011 of the Social Security Agency

(BPJS) Regulation No 101/2012 on the Recipient

Contribution (PBI) Presidential Decree No. 12/2013 on Health

Insurance Regulations and other provisions there are 14

product regulation

JAMINANKESEHATANNASIONAL

37

Contribution

MEMBERSHIP

AMOUNT OF CONTRIBUTIO

N FACILITIESCARE CLASS LEVEL 3

CARE CLASS LEVEL 2

CARE CLASS LEVEL 1

Thank you