4. Perilaku dan perlindungan konsumen

(1)

ACCESS

not EXCESS

3P

(2)

AGENDA

1. AB & PERILAKU

2. AMR & RESPONS dunia

3. PERLINDUNGAN bagi masyarakat

Yayasan Orang Tua Peduli; Purnamawati Sujud

(3)

1. PERILAKU KITA

MAGIC BULLET?

(4)

Bagaimana Perilaku kita?

•

Perilaku tidak “appropriate” &

“misconceptions” yang berakar kuat.

• Pasien: swa medikasi, menuntut diresepkan ketika tidak terindikasi

• Nakes: meresepkan &

merekomendasikan tanpa indikasi

•

Di ranah non medis mis, growth

promoter di pakan ternak.

•

Masalah: al pemahaman kurang, kampanye pemasaran yang intensif, factor ekonomi.

Ab - ternak

Sebagian mati

terkontaminasi

Makanan terkontaminasi _Lingkungan terkontaminasi

(5)

Treatment

Choices

Prior Knowledge Habits Scientific Information Relationships With Peers Influence of Drug Industry Workload & Staffing Infra- structure Authority & Supervision Societal Information Intrinsic Workplace Workgroup Social & Cultural Factors Economic & Legal Factors

(6)

”…whenever I get these symptoms and go to a doctor, he gives me the same medicine and charges me 10 rupees. So why not just buy the medicine?”

(7)

PERESEPAN ANTIBIOTIK

• YOP 2010: Demam (86.4%), diare

(74.1%), ISPA (54.6%), batuk (46.3%).

• WHO 2005: 50% resep AB di

Puskesmas dan rumah sakit Indonesia.

• Survei nasional 2009: antibiotik

diresepkan untuk penyakit2 virus seperti diare akut dan selesma (flu).

• Riskesdas 2013: 86,1% rumah tangga menyimpan antibiotik di rumah tanpa resep dokter.

• Survei WHO & YOP 2015 pada dokter: 57% dokter (umum, spesialis, gigi) dari 153 responden mengaku meresepkan antibiotik untuk kondisi tidak butuh antibiotik.

• 68% dari 139 dokter umum/spesialis memberikan antibiotik kepada pasien dengan diagnosis batuk pilek.

• 68% juga menggunakan antibiotik untuk pasien bedah minor.

(8)

2. AMR & RESPONS DUNIA

ONE HEALTH APPROACH

Menangkar AMR secara holistik:

Kesehatan manusia, hewan, lingkungan, keamanan pangan

(9)

Dunia menyikapi

_…

WHO - GAP

1. improve awareness & understanding of AMR through effective communication, education and training;

2. strengthen the knowledge and evidence base through surveillance, research;

3. reduce incidence of infection through effective sanitation, hygiene, prevention measures;

4. optimize the use of antimicrobial medicines in human and animal health; and

5. develop the economic case for sustainable investment (in new medicines, diagnostic tools, vaccines and other interventions).

ReAct International CSO – KOALISI

(10)

CSO; MASYARAKAT

•

Antibiotic Resistance Coalition (ARC);

Deklarasi -- advokasi perubahan kebijakan & action untuk cegah

terwujudnya the post-antibiotic era. Aksi tematiknya:

• Access not excess

• Curbing use of antibiotics in food and agriculture

• Catalyzing antibiotic innovation

•

Malaysia, Thailand, Amerika Selatan, Indonesia, Eropa (Belanda)

• Penang: meat free of AB

• Belanda: No AGP

(11)

CSO Indonesia?

_…

YOP

•

Seminar & FGD, “kursus” (2-6 bulan)

•

Mailing List: [email protected]

•

Radio Talk shows, Articles, Books, Child health corner (magazine)

•

Website: www.milissehat.web.id ; bijak ab

•

Model Clinic, Drug info, penelitiaan pola peresepan sector swasta

•

Social media : Twitter, face book

•

Roadshow AMR

(12)

AMR & pasien (harapan?)

Di BERDAYA kan

•

Akses - informasi & shared decision

making

• Evidence based guidelines

• Kebijakan nasional dengan law enforcement nya

• Formularium

•

Pelatihan

•

Compassionate and dedicated champions

•

Community education and campaigns

(13)

3. STRATEGI

Raising awareness

1.

Whole-of-society engagement including a one health approach

2.

Prevention first

(14)

Economic:

ü Offer incentives

– Institutions

– Providers and patients

Managerial:

ü Guide clinical practice

– Information systems/STGs

– Drug supply / lab capacity

Regulatory:

ü Restrict choices

– Market or practice controls – Enforcement

Educational:

ü  Inform or persuade

– Health providers

– CONSUMERS

Use of

Medicines

(15)

12 national strategies to promote RUD

WHO/EDM policy perspective paper published in 2002

1. Mandated national body to coordinate medicines use policies 2. Evidence-based standard treatment guidelines

3. Essential Drug Lists based on treatments of choice 4. Drug & Therapeutic Committees in hospitals

5. Problem-based training in pharmacotherapy in UG training 6. Continuing medical education as a licensure requirement 7. Independent drug information e.g bulletins, formularies 8. Supervision, audit and feedback

9. Public education about drugs

10. Avoidance of perverse financial incentives 11. Appropriate and enforced drug regulation

(16)

Tidak sadar – Perlu berubah Sadar – Tetapi belum siap Siap – Melakukan persiapan untuk berubah Aktif – terjadi perubahan perilaku Memper-tahankan perubahan

•

Tujuan:

• mengubah perilaku & norma sosial.

• Aktif berperan

• Menjadi konsumen yang Bertanggung jawab

•

Target: masyarakat umum, nakes, guru, CSO, pemangku

(17)

Bagaimana?

•

Masyarakat = stakeholder yang tidak boleh

terlupakan termasuk oleh Perguruan Tinggi.

•

Pembekalan ilmu utuh sesuai konsep one health

•

Merangkul kader alias “champions” (juru kampanye AMR)

•

Community engagement ini bertujuan agar bertahap, masyarakat

bisa berperan di 4 ranah (kebijakan, organisasi, layanan pribadi, dan ranah komunitas).

(18)

RESPONSIBLE USE

AKSES

SAFETY

Morbiditas Mortalitas

Sumber Daya

Ekonomi Security

Do No

Harm

(19)

Perlindungan bagi masyarakat

_…

.

•

Pengendalian infeksi

•

Cuci tangan; Imunisasi; hygiene sanitasi

•

Guideline penggunaan ab di faskes primer dan rujukan; SWASTA

•

Formularium

•

Sistem

•

Implementasi

•

Pemantauan

(20)

USE OF ANTIBIOTICS - 2006

Before & After

0 10 20 30 40 50 60 70 80 90 100

(21)

THE USE OF ANTIBIOTICS – 2010

197 maling list members

6.60

29.44

32.49

87.82 96.45

0.00 0.51 0.51

0.00 20.00 40.00 60.00 80.00 100.00 120.00

bacterial infection for common cold for high fever use antibiotic to prevent bacterial

infection in viral disease.

(22)

Masyarakat sadar

pentingnya

mempergunakan antibiotic secara

bertanggung jawab. Masyarakat sadar

perannya mengawal

penggunaan antibiotic bertanggung jawab.

•

better health outcomes,

•

better care,

•

better patient experience and

(23)

Kalau bukan KITA, siapa lagi?

Kalau tidak SEKARANG, kapan lagi?

(1)