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2 broad de-concentration authority or task. What is meant by the limited decentralization authority or task is the implementation of health effort that can not be
handled by the society that is cross district municipal or still unable to be handled by district municipal government or that is more effective and efficient if handled by the
provincial government. 5.
Central Level Health Organization
In order to improve the organization at the central level is always based on development in health effort and function that should be done. Development in the form of expansion
or retrenchment can occur in the main operating element such as at the level of Directorate General, since the work volume and load of developmental task in health
sector is increasing or conversely decreasing due to merger. Development can also occur at the element of assistant chief according to the addition of functions and efforts that
have to be done especially in the managerial fields. The act number 22 1992 about health stipulates that health development is done by
government and society. The society should be turned into the prime actor of health development, while government only acts as the companion. This means that only health
efforts that are still unhandleable by the society requires settlement by the government. For efforts already manageable by society the government only acts as the cultivator,
supervisor and facilitator. The cultivating task is done through determination of national policy standardization and regulation. Supervising task is done through licensing,
accreditation and safeguarding. While facilitative task is done through guidance and control.
According to the decentralization strategy, the task of implementation of health efforts that can not be tackled by the society will be done by regional government, i.e. either by
the district municipal regional government or the provincial government. While for effectiveness and efficiency except regarding the management of several types of
pharmaceutical inventories such as medicines, and the task of facilitating will be done by the provincial regional government.
Abiding to the principle, then it can be decided that at the central level the main task of the Ministry of Health is to cultivate supervision and facilitation of health development
through determination of national policy in health sector, standardization, and regulation as well as coordination of licensing, accreditation, cultivation and control.
Actuation of Implementation
1. Government
The realization of healthy society is one of the tasks and responsibilities of the government, though it has not been realized yet by all the governmental apparatus. Many
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of the various government’s institutions are less attentive to health efforts. Some of them even give negative contribution to health, e.g. damage to the environment and ecosystem
due to agricultural and mining activities. In order to achieve optimal result in health developmental effort to actuate all
governmental institutions with health concerns has become a must. Success of health development can not be relied on the Ministry of Health alone, but should be relied on all
departments and or other governmental institutions. Success of health development is very much determined by the involvement of many sides in the implementation of various
health efforts through cross-sectoral cooperation that is well-matched, harmonious, effective and efficient.
In order to actuate stronger implementation of therefore mentioned things, it needs strong leadership in all administrative levels followed by an adequate reward system which is
related to personnel’s performance, and enough infrastructures and facilities. In implementation of the imminent decentralization, it is hoped that innovation related to the
above mentioned things can be improved further according to specific conditions of each region.
2.
The Public Potential
a. Young Generation
Young generation is a development succeed generation whose cultivation is directed at among other things to handle the aspects of skill, leadership, physical fitness and creative
power. In the health sector, young generation beside being the target of health efforts, it has the potential to participate in developmental efforts. What is meant by young
generation is any one whose age is between 0 and 30 years. Cultivation of young
generation’s potential should be done integrally among various sectors, both in planning and implementation. By observing the comprehensive and integral approach toward that
group, developmental effort in various sectors that are intervention in nature in certain time is hoped to be so directed that in the end it has mutually supporting power.
b. NGO non-governmental organization
NGO is a strong potential and has a big role in the effort to make the society healthy. In this respect, a directed cultivation is needed, among others, to manage the aspects of
participation and implementation of programs that touch the society. Now there are many NGOs in the health sector, part of them have reliable workforce and strong network to the
regions. 3.
Female Group
When viewed from social, economic and political aspects and by perceiving as well the projected changes expected in the future, special cultivation to this group can not be
neglected. This matter has been not only a national concern but also an international concern as well.
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In terms of planned changes, the potential of the female group is at the beginning only being concentrated on family cultivation toward a healthy, wealthy life based on the norm
of family that is small, happy and wealthy. But as her position, role and responsibility have been growing broader, this group is not only tied to the family life but has also been
expanded in terms of the working fields and social tasks in the society. Hence, the management of female group needs the increasing intra health sectoral coordination and
between the health sector and other sectors. 4.
The Health Profession
The health profession occupies a strategic position in the society in thinking and implementing health sector’s developmental programs. For that reason, the function of
health profession must be directed and cultivated by the government so they would appreciate the significance of the vision and mission of health rows and then participate
actively in health development. Beside that they are expected to implement and co- supervise their members so that they would do their tasks according to the professional
standards and do cultivation mainly in the aspect of professional ethics. 5.
The Business Community
It is understandable that health effort in one side can be seen as a business that yields profit, hence it draws the business community to enter it. The role of business community
tends to grow greater in the future, while on the other side the government’s capacity becomes more limited, hence the government will become more selective in funding
health efforts, i.e. only limited to the ‘public goods’. While health efforts of ‘private goods’ nature that are supposed to yield profit will be given to the private business
community. The demand for health sector that becomes increasingly specialistic, sophisticated and practicing high quality is an opportunity for the business community to
participate in health development according to economic principles without forgetting the social and ethical aspects.
6.
The Informal Public Figures
The informal public figures teachers, educators, scotts, religious figures, faith cultivators, etc.
are a social group that can channel the public’s aspiration and they preferably can motivate the society in health development. Beside that, the informal public figures are
also hoped to prepare young generation through educational institutions that grow in the society so that they will become progressive leaders.
7.
The Rural Community
As the developmental potential are found much in the rural area, so the implementation of rural community health development PKMD program needs improvement as an integral
part of the rural development. In this context, clarity and firmness are required in the integrated cultivation implementation that covers among other things: types of cadet to be
formed, the role of helper puskesmas at rural area, and the role of health and family planning section in Rural Community Tenacity Insitution LKMD in the implementation
of activities that nowadays are easily found in the rural areas such as the under 5 years old cultivation post, posyandu and polindes.
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Intra and Inter-Sectoral Cooperation
In order to increase the intra and inter-sectoral cooperation, there are several things need attention regarding organization and motivation and public participation. To realize the
cooperation, the importance of coordination, integration and synchronization of activities should be understood in terms of systemic approach and dynamic cooperation. Activity
integration will be operable and developed if the coordination is clear. In order to realize a good coordination, communication between units based on transparent attitude is an
absolute requirement. Intra and inter-sectoral communication system need to be improved so that it can open
wider opportunity for mutual knowledge of each other’s programs and reach concensus on each role in the effort to formulate problem and its settlement effort. Arrangement of
various activities should be mutually supportive and the impacts can be felt by the society as a whole.
In this respect matrices on the table can give an illustration of how important is the support from various related sectors for the successful implementation of developmental
programs with health concerns for the ten most favored programs see table next to this page.
Table
Table on Identification of Sectors Related to the Most Favored Health Programs Toward Healthy Indonesia 2010
Program’s Name Related Sectors
Related Units
1. Program of Health
Policy, Health Funding and Health
Laws Bappenas
Dept. of Internal affairs Bappeda
Financial Dept. Justice Dept.
Coord. Min. of Developmental Secretary general
Planning bureau Public legal bureau
Economic bureau Organizational bureau
All directorate generals
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Supervision State Apparatus Organizing
Private health insurance Universities
Health RD Body JPKM develop. body
Health data center 2.
Nutritional improvement
program Bappenas
Public welfare Coord. Min. Dept. of internal affairs
Financial Dept. Social Dept.
Dept. of educ. culture Dept. of agriculture
Dept. of food and holticulture Dept. of female roles
‘Binkesmas’ Dit. of Public Nutrition
Dit. ‘Kesga’ family health Planning bureau
Nutrition research center
3. P2M Contagious
disease eradication Program including
immunization Bappenas
Dept. of internal affairs, PKK Dept. of finance
Dept. of edu culture Dept. of information
P2M Dit. Immunization
‘Binkesmas’ public health cultivation
BUKP Planning bureau
Contag. Disease research center Medical service Yanmed
Dit. Public Participation 4.
Healthy Living Behaviour and
Mental Health Improvement
Program Bappenas - KSKG
Dept. of internal affairs Dept. of finance
Dept. of information Dept. of social
Dept. of religion Dept. of edu culture
Public health instruction center ‘Binkesmas’
BUKP Planning bureau
Dit. Mental health
Program’s Name Related Sectors
Related Units
5. Program of
Residential areal Environment,
Healthy Water and Air
Bappenas Dept. of internal affairs
Dept. of finance Dept. of public works
Dept. of settlement Dept. of transmigration
Dept. of industry trade Dept. of social
Dept. of information Dept. of environ. forest cutter
Dept. of agriculture Universities
Environmental NGOs P2M – PLP
Dit. Healthy clean water Dit. Healthy settlement
Health ecology research center Public health instruction center
Dit. Public participation Health laboratory center
Environmental health technic clinic BTKL
Planning bureau
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6. Family health,
Reproductive health and Family planning
Program Bappenas
Dept. of internal affairs Dept. of population affairs
Dept. of finance Dept. of social
Dept. of religion Dept. of female roles
Dept. of edu culture Dept. of youth sports
Universities Professional organizations:
POGI, IBI, IDI, PKBI. Population affairs’ NGOs
Binkesmas Kesga
Yanmed Medical services Public health instruction center
Planning bureau
7. Health and
Occupational Health Program
Bappenas Dept. of labours
Dept. of industry trade Health insurance
Binkesmas PSM
Public health instruction center Planning bureau
8. Anti Tobacco,
Alcohol and Hashish Program
Bappenas Dept. of internal affairs
Dept. of finance Dept. of education culture
Dept. of social Dept. of information
Dept. of religion Dept. of industry trade
Universities Professional organizations
NGOs Dept. of justice
Attorney general Police dept.
Public health instruction center Binkesmas
Yanmed Medical services POM drug food supervision
Dit. mental health Planning bureau
Program’s Name Related Sectors
Related Units
9. Supervision of
Drugs, Dangerous Substances, Foods
Beverages Program Bappenas
Dept. of internal affairs Dept. of finance -- Customs
office Dept. of industry trade
Dept. of justice Dept. of information
Attorney general Police dept.
Professional organization NGOs
POM ‘Binkesmas’
Yanmed medical services P2M - PLP
POM clinic Puslabkes health labor. center
Planning bureau
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10. Accident and Injury
Prevention, including Traffic
Safety Program Bappenas
Dept. of internal affairs Dept. of finance
Dept. of transportation Dept. of educ. culture
Dept. of justice Dept. of female roles
Attorney general Police dept.
Universities NGOs Public health instruction
Yanmed Dit. mental health
Binkesmas Health RD body
Planning bureau
Cultivation
Based on the importance of integrity principle in implementation, so in order to get optimal result the cultivation effort needs to be increased for the common interest at all
levels of administration. The cultivation effort is mainly toward the health manpower, so that they can work with high dedication, ethics, professionalism and nationalism.
In order to implement this cultivation effort, in depth investigation and consideration are needed, as related to the fact that health manpower is a man that needs fulfillment of
primary needs and self actualization. As to what is meant by cultivation in this respect is the activity of giving direction about how to implement effort according to the rules and is
intended to get a unison of action in order to reach maximum effectiveness and efficiency.
Supervision, Control and Evaluation
Supervision
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The system and implementation of developmental supervision in Indonesia includes internal supervision which includes functional supervision and adhering supervision as a
part of the internal control, as well as external supervision which includes the supervision by constitutional institutions and the public supervision.
Basically supervision implementation is directed to the strategic sectors, and operationally focused on activities that can provide more significant input for the Departmental Chief in
the compilation of accountability regarding success failure in the implementation of
organization’s mission to achieve the target and objective of Healthy Indonesia 2010. The accountability exercised by an organization individual needs a supervision audit
evaluation assessment on aspects of the accountability itself from the other sides, before being reported to the one giving authority to manage the state owned resources.
Supervisory Pattern and Mechanism
1. The policy that needs to be acted in the area of supervision can be differentiated