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7. Cooperation and Partnership
In the global era there are many changes that have occurred in national, regional, as well as international levels which bring multidimensional impacts and which possess high
intensity of interrelationship between sectors. Hence, cooperation and interconnection are the main pre-requisite to achieve a new era which is better off based on the new paradigm
based on the win-win principle. The phenomenon of partnership that is equal, open and mutually beneficial is a good
opportunity especially for the development of private businesses either of national, regional, or international scales for the development of basic and referral health services,
prevention of diseases, and promotion of health. D.
THREATS
1.
Macro Economic Situation
The macro economic situation which has not recovered from economic crisis is one of the biggest and heaviest threats to national development, especially the health development as
the consequence of the even more limited existing resources. This situation becomes more severe with the still high level of dependence upon imported goods for
implementation of health services. The macro economic situation recovery is very much influenced by political situation which is not yet stable enough till now. Hence, though at
national level there is already a commitment to give larger allocation for health funding up to 5 of GDP, but there is still a real threat from the macro economic situation that the
resource may still not yet preparable within 2-3 years time ahead. 2.
Demographic Structure
The great number of population, the relatively still high growth rate, the still low level of education and income, as well as uneven distribution among regions can be a threat to
development, including the health development. Beside that the age structure that tends to be young together with the increasing number of elderly groups become the double
burdens of development. 3.
The Economic Condition of Society
The blow of prolonged economic crisis has also shown increase in the number of poor people together with the decline in various health indicators, especially the rise of overt
KEP incidence primarily among infants and children. This condition is a threat to the
achievement of health development’s target as one of the efforts in increasing the nation’s productivity. The declining economic condition of the society also influences access of
the people toward health services, especially for the poor people. Efforts done through
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the JPSBK social safety net in health sector have indeed increased the access, but in the long run this program is hard to sustain by the available resources.
The various worriness in economic sector that is easy to be triggered into riots and also conflicts occurring in various regions in Indonesia which have been unsettled so far
become threats toward health development and at the same time become obstacles to achieve the healthy Indonesia.
4.
Geography
The geographic condition of Indonesia that is an archipelagic country with more than 17.000 islands and the very great area of ocean is a threat in the implementation of health
development. An archipelagic state like this in fact needs transportation and communication facilities as well as a high operational cost.
On the other side with the openness of various archipelagoes, Indonesia becomes susceptible to the possible entry of prohibited goods drugs illegally. Beside that the
geographic condition that consists of active volcanoes chain that can erupt at no time, and the frequent earth quakes can bring natural disasters threatening the social life. While
Indonesian location in the tropical region is an accurate reservoir for the reproduction of various vectors and pathogens.
Indonesia being on the cross-road position between big countries in the world, is in the transportation line, this potentially can bring negative impacts toward public health with
the possibility of entry of various negative habits toward health and various diseases from outside world.
5.
The Low Health Behavior, Morale and Ethics
Healthy life style is very much influenced by education level of the people. The low level of education is one of the causes of low understanding of the people regarding health
information and the formation of healthy behaviors. Abuses of narcotics, psychotropic drugs and additives tend to rise, in fact it has touched
the poor people and primary school children with even wider and more complicated escalation of the problem. So are the production and utilization of alcoholic beverages
and other addictives including cigarettes inclined to rise steadily with broad negative impacts to the public.
Beside that, various deviations in sexual behavior, lack of discipline in traffic transportation, smoking habit and overt and unbalanced food consumption become threats
to the increment of public health level. The use of prohibited chemical substances as food additives, sanitary problems as well as
hygienic processing especially among household industries are also threats to the
consumer community’s health. 6.
Decentralization of Health Management
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Decentralization of health management is a political commitment that should be implemented by the coming national leadership. There are two acts UU related to
decentralization have been issued, i.e. act number 22 1999 and act number 251999. Experiences in many countries indicate clearly that when decentralization is done in a
hurry with inadequate preparation either in concept or in operation, great difficulty will arise in its implementation. In the era of decentralization, the control from central
government on various programs will decline drastically. If this is not supported by the increase in capability at the provinces and districts municipalities then success in health
development will be strongly in danger. 7.
Globalization
Globalization is a phenomenon occurring in the end of the 20
th
century that is signaled by the occurrence of inter-penetration and inter-dependence among all sectors, either
economic, political, or social and cultural. This situation causes the occurrence of transformation of the nation society toward global society so that state boundaries become
unconspicuous any more. Trades liberalization as the main sign of globalization beside the ease in transportation,
communication and information contains great threat for developing countries including Indonesia. The policies of GATS General Agreement of Trade in Services and TRIPS
Agreement on Trade Related Aspects of Intellectual Property Rights will influence very much various aspects of public health services implementation in developing countries.
Entry of foreign capital and work force in the health service area can result in the even more rising in quality of health services and management. But negative impacts that
should be anticipated are the closure of various already existing service facilities especially those so far have given services to the less well to do people. This situation
can only be prevented by intensive attempts to improve professionalism and quality management in the existing health facilities. Other implications are regarding the
intellectual property rights, including patent for various drugs and biomedical products. This situation can impede the usage of various products that otherwise can be used but
being constraint by regulation on intellectual property rights. This matter also brings implication for the rise in prices of medicines and various biomedical products and
instruments. Ease in transportation, communication, and various information dispersion will also
influence the dispersion of diseases, narcotics, psychotropic drugs and other addictives, free sexual behavior and other unhealthy life styles. This situation has very great
influence upon the health level of society, especially the younger generation of the nation. 8.
Environmental Pollution and Global Climate
In the future, the climate and environment will be less beneficial to health. Pollution to the environments, including air, water, soil and food will increase. Air pollution in the
big cities in year 2000 is estimated to rise 2 folds from that of 1990 with its main source coming from the emission of motor vehicles and industrial activities. Air pollution in the
rooms needs more attention as the still high prevalence of smoking habit in the society. Management of domestic wastes in the urban, either solid or liquid wastes, which has not
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taken into consideration its impacts on public health is a threat to people living in the urban areas and their surroundings.
The limitation of clean water supply is a threat to the health of society. The limitation in public affordability especially in the rural and urban slum areas is also a serious challenge
for the creation of healthy environment. E.
STRATEGIC ISSUES
After studying the various strengths, weaknesses, opportunities and threats as mentioned above, then the strategic issues that should be dealt with are as follow.
1.
Cross-Sectoral Cooperation
A part of the health problems are national problems that are inseparable from various policies of other sectors so that the solution should strategically involve the related
sectors. The main issue is the improvement in cross-sectoral cooperation, as cross- sectoral cooperation in health development so far has been frequently less success.
The change in society’s behavior toward a healthy life and the improvement in environmental quality which strongly influences society’s health level improvement need
close cooperation between various sectors related to the health sector. So is the increase in effort and management of health services inseparable from sectors governing finance,
regional governance and development, work force, education, trading, and social cultural affairs.
2.
Health Sector’s Human Resource
The quality of health sector’s human resource is strongly determining the success of health efforts and management qualified human resource in health sector must always
follow the progress in science and technology, and strive to master the state of the art science and technology. Beside that, the quality of the human resource is also determined
by the moral values being adopted and applied in the task execution. It is realized that the number of Indonesian human resource in health sector who follows the progress of
science and technology and apply professional moral and ethical values is still limited. The emergence of competition in the free market era as a result of globalization should be
anticipated by improving the quality and professionalism of the human resource in health sector. This is necessary not only to increase the competitive capability of the health
sector, but also to help improve the competitive capability of other sectors as well, among others safeguard the export commodities of foodstuffs and finished food products.
In relation to decentralization of the governance execution, an increase in capability and professionalism of the health managers in every level of administration is a very urging
need. 3.
Quality and Accessibility of Health Services
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Viewed from physical aspect, the distribution of health services facilities either puskesmas or hospitals and other health facilities including health efforts supporting
facilities can be regarded as evenly distributed all over the territory of Indonesia. None the less it should be confessed that the physical distribution has not been fully followed by
increase in quality of services and accessibility by all layers of the society. The quality of health services is very much influenced by the quality of physical facilities,
types of work force available, medicines, health instruments and other supportive facilities, services conferring process, and compensation received and the expectation of
the consumer society. Hence the increase in physical quality and aforementioned factors are preconditions to be fulfilled. Afterwards, the process of services conferral is to be
increased through increase in quality and professionalism of health resources as stated above. While the expectation of the consumer society is being adjusted through
improvement in general education, health information, good communication between health providers and the public.
4.
Prioritization, Funding Resource and Empowerment of the Society
So far health efforts are still lacking in prioritizing the approach of health maintenance and promotion as well as disease prevention, and they are insufficiently supported by
adequate funding resource. It is recognized that financial constraint from the government
and the public is a big threat for the continuity of government’s programs and a threat to the achievement of optimal health level.
Hence, more intense effort is required to increase funding resources from the public sector being prioritized for health maintenance and promotion activities as well as for diseases
prevention. Funding resources for curative and rehabilitative activities need more exploration from resources in the society and directed to become more rational, and more
effective and efficient in order to increase the services quality. Various researches indicate that most of the direct spending of the public are used not as effective and
efficient as a result of unequal information between services providers and services receivers patients or their families. This situation urges the need for strategic steps in
creating funding system with prepayment property already known as JPKM. The availability of limited resources, especially in the public sector requires efforts to
increase participation of the private sector especially in the attempt which are curative and rehabilitative. The attempts are done through empowerment of the private sector to
become independent, improvement of equal partnership and mutual beneficiality between the public and the private sectors so that available resources can be used optimally.
Other matters that strongly require settlement are empowerment and independence of the public in health efforts that have not been as expected. Equality, openness, and mutually
beneficial partnership in health efforts become a sine qua none for the civilization attempt of a clean and healthy life style, application of healthy life norms and health promotion.
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Principles, Vision and Mission of Health Development
Principles, Vision and Mission of Health Development
The great effort of Indonesia nation in rectifying the national development orientation that has been done in the last 3 decades requires total reform in development policies in all
sectors. For health sector, the call for total reform emerges as there are still discrepancies in health development results among the regions and communities, the public health level
is still left behind compared to neighboring countries, and due to the lack of autonomy in health development. Beside that, health reform also is needed considering there are 5
main phenomena that have great influences toward the success of health development. First, basic changes in demographic dynamics that urge the birth of demographic and
epidemiologic transition. Second, substantial discoveries in medical science and technology that open new horizon in looking at living processes, health, illness and death.
Third, global challenges as a consequence of free trading policies, and fast revolution in information, telecommunication and transportation sectors. Fourth, changes in the
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environment that influence the health level and efforts. Fifth, democratization in all sectors calling for empowerment and partnership in health development.
In order to increase the resistance and struggling power of health development as the main asset of national development, re-evaluation of health development policies has become a
must. Changes in the understanding of the concept of health and sick and the increasing treasure of science and technology with information about determinants of disease
causation which is multi-factorial have aborted health development paradigm which puts priority on curative and rehabilitative health services.
The application of the new health development paradigm i.e. HEALTHY PARADIGM is an attempt to improve the nation
’s health that is proactive. The healthy paradigm is a health development model which in the long run can push the society to become
autonomous in maintaining their own health through heightened awareness on the importance of health services that are promotive and preventive.
In order to materialize the HEALTHY PARADIGM as the new health development paradigm, a thorough review on principles, vision and mission of health development
needs to be done as soon as possible. The principles, vision and mission of health development should not only be able to settle all 5 challenges of therefore mentioned
conventional health development, but also should be able to anticipate various changes in the future. To materialize HEALTHY INDONESIA in the future, the new principles,
vision and mission of health development should be implemented consistently and continuously.
Principles of Health Development
The ideal principle of the national development is the Pancasila, while the constitutional principle is the 1945 Constitution. Health development is an integral part of the national
development. On the Act number 23 year 1992 about health it is stipulated that health is the condition of well being of the body, mind and social life that enables every person to
live productively socially and economically. While on the constitution of WHO year 1948 it is agreed among other things that the achievement of the highest level of health
level is the fundamental right of every person regardless of his her race, religion, political affiliation and social economic position. The principles of health development are
basically truth values and basic rules as the foundation for thinking and doing in health development. The principles are the foundation for the compilation of vision, mission
and strategies as well as principal directors in the implementation of health development nation-wide which include:
1.
Humanity
Every health attempt should be based on humanity which is being spirited, moved and controlled by faith and devotion to The Only God. The health manpower needs to have
noble character and hold tight the professional ethics.
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2. Empowerment and Autonomy
Kategori