PRIMARY HEALTH PHYSICIAN /FAMILY DOCTOR AND PUBLIC HEALTH

PRIMARY HEALTH PHYSICIAN /FAMILY DOCTOR AND PUBLIC HEALTH Sharon Gondodiputro dr., MARS.,MH Dept. Of Public Health Faculty of Medicine Unpad

RUJUKAN YANKES PERORANGAN RUJUKAN YANKES MASYARAKAT RS UMUM/KHUSUS PUSAT/PROPINSI DINKES PROPINSI , DEPKES RI STRATA 3 , tersier STRATA 3 RS UMUM/KHUSUS KAB/KOTA, BP4, BKMM, BKOM, BKTK , KLINIK SPESIALIS, SPESIALIS DINKES KAB/KOTA ,DINAS LAIN ,BP4, BKMM, BKOM, BKTK STRATA 2, sekunder STRATA 2 PRAKTIK DOKTER,PUSKESMAS, BP, BKIA , PRAKTEK BIDAN PUSKESMAS , INSTANSI LAIN STRATA 1, primer STRATA 1 POSYANDU, POLINDES MASYARAKAT MASYARAKAT PERORANGAN/KELUARGA PERORANGAN/KELUARGA UPAYA KES KEL MANDIRI KADER ,PELATIH OR UPAYA KES KEL MANDIRI JEJARING RUJUKAN PELAYANAN KESEHATAN POSYANDU, POLINDES ,UKBM

DECLARATION of ALMA ATA International Conference on Primary Health Care, Alma-Ata, USSR, 6-12 September 1978 • Primary health care is essential health care based on practical scientifically sound and socially acceptable methods and technology made universally accessible to individuals and familiesin the community and country can afford to maintain at every stage of their development in the spirit of self reliance and self determination

Primary health care characteristics: • community full participation and at a cost that they can afford to maintain every stage of their development in the spirit of self-reliance and self-determination. • forms an integral part both of the country's health system, of which it is the central function and main focus, and of the overall social and economic development of the community.

Primary health care • It is the first level of contact of individuals, the family and community with the national health system • bringing health care as close as possible to where people live and work, and constitutes the first element of a continuing health care process.

PRIMARY HEALTH CARE • 3. Includes at least: • education concerning prevailing health problems • the methods of preventing and controlling them; • promotion of food supply and proper nutrition; • an adequate supply of safe water and basic sanitation; • maternal and child health care, including family planning; • immunization against the major infectious diseases; • prevention and control of locally endemic diseases; • appropriate treatment of common diseases and injuries; • provision of essential drugs;

Health care provider…… for the individual, family and community Community/ target group Individual/ Family Community physician Family Physician Professor Leela Karunaratne Faculty of Medical Science University of Sri Javawardenepura

the methods of preventing and controlling diseases • Communicable diseases: • Tuberculosis • DHF • HIV • Pneumonia • Scabies • ISPA • Noncommunicable diseases: • Hypertension • Diabetes mellitus • Thallasemia • Cancer

maternal and child health care • IMCI (integrated management of childhood illness) is • an integrated approach to child health • that focuses on the well-being of the whole child and aimed to reduce death, illness and disability, and • to promote improved growth and development among children 5 years of age. COST SAVING/COST EFFICIENT

Why is IMCI better than single condition approaches ? The most important realisation about child survival is that killer diseases operate in the same environtment of poor nutrition and lack immunisation to protect the child making a single diagnosis is impossible IMCI - Integrated strategy which takes into account the variety of factors that put children at serious risk - It Ensures The Combined Treatment Of The Major Childhood Illnesses, Emphasizing Prevention Of Disease Through Immunization And Improved Nutrition

INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS (IMCI) For Acute Respiratory InfectionSAVING COST ? SeptianiSusilowati1, Sharon Gondodiputro2, HenniDjuhaeni2 An observasional study Sample : 184 cases Data were analyzed usingchi square test and pooled t-test • Head of Puskesmas Kopo District Health Office Bandung Municipality, West Java, Indonesia • 2 Staf FS of Public Health Department, Faculty of Medicine , Universitas Padjadjaran Bandung , West Java, Indonesia

CAN BE PREVENTED

22.68 % IS CAUSED BY ARI 80-90 % IS CAUSED BY PNEUMONIA Per 1000 live births Children under 5 years of age Death Ratio 1992-2001 in Indonesia

PNEUMONIA PROPORTION FROM ALL ARI IS 10 % Infant < 1 year Children 1-4 year Acute Respiratory Infections (ARI) prevalence in Indonesia , 2001

< 38.5OC ≥ 38.5OC < 38.5OC ≥ 38.5OC ANTIPYRETICANTIBIOTIC NONE ANTIPYRETIC ANTIBIOTIC CRITERIA • COUGHING • WITHOUT OTHER SYMPTOMS NON PNEUMONIA PNEUMONIA • COUGHING AND OR • DIFFICULTY IN BREATHING • RESPIRATORY FREQUENCY : • 2 MONTHS - < 1 YEAR :  40X/MINUTE, • 1 YEAR - < 5 YEAR :  50X/MINUTE THERAPY

7 PUSKESMAS NON IMCI 7 PUSKESMAS IMCI 184 NEW CASES OF ARI 184 NEW CASES OF ARI NON PNEUMONIA PNEUMONIA NON PNEUMONIA PNEUMONIA < 38.5 C < 38.5 C < 38.5 C < 38.5 C > 38.5 C >38.5 C >38.5 C >38.5 C SORT OF DRUGS TOTAL COST OF DRUGS

PUSKESMAS TOTAL COST – DRUGS (Rp) t Nilai p IMCI NON IMCI NON PNEUMONIA,TEMP < 38.5C ~ N 67 138 ~ MEAN 1195.18 6539.83 13.976 P = 0.000 ~ SD 1764.00 3711.27 ~ MEDIAN 51.00 7259.00 NON PNEUMONIA,TEMP > 38.5C ~ N 43 9 ~MEAN 2345.73 4821.16 2.407 P = 0.041 ~ SD 1157.48 3039.20 ~ MEDIAN 2200.00 5484.00

Primary prevention increase a person’s ability to remain free of disease Secondary prevention is the early detection of disease/ precursors of disease , treatment can be started before irreversible damage Tertiary prevention is the management of established disease minimize disability

Health Enhancement Continuum Primary prevention increase a person’s ability to remain free of disease Secondary prevention is the early detection of disease/ precursors of disease , treatment can be started before irreversible damage Tertiary prevention is the management of established disease minimize disability Family Physician

THE METHODS OF PREVENTING DISEASES

PRIMARY HEALTH PHYSICIAN /FAMILY DOCTOR AND PUBLIC HEALTH