HEALTH SYSTEM

1. HEALTH SYSTEM Team Teaching HSM Departemen Ilmu Kesehatan Masyarakat Fakultas kedokteran Universitas Padjadjaran

2. Introduction • Most of the burden diseases can be prevented or cured with known, affordable technologies. The problem is getting drugs, vaccines, information and other forms of prevention, care or treatment – on time, reliably, in sufficient quantity and at reasonable cost – to those who need them. • Health systems of some sort have existed as long as people have tried to protect their health and treat disease, but organized health systems are barely 100 years old, even in industrialized countries.

3. Introduction The health system differs from other social systems such as education, & from the markets for most consumer goods and services, in two ways which make the goals of fair financing and responsiveness particularly significant. • One is that health care can be catastrophically costly. Much of the need for care is unpredictable, so it is vital for people to be protected from having to choose between financial ruin and loss of health. Mechanisms for sharing risk and providing financial protection are more important even than in other cases where people buy insurance, as for physical assets like houses or vehicles, or against the financial risk to the family’s breadwinner who dying young. • The other peculiarity of health is that illness itself, and medical care as well, can threaten people’s dignity and their ability to control what happens to them more than most other events to which they are exposed.

4. Definition System A set which consist of components that relate to each other and have a clear and same objective(s). Health A condition of physical, mental, and social wellbeing that enable every person to live productive, socially and economically.

5. Definition Health System • The sum total of all the organizations, institutions and resources whose primary purpose is to promote, restore or maintain health. (WHO, 2000) • Combination between health institution, supporting human resources, financial system, information system, organization and management –including administration, in an attempt to provide healthcare services for the patients.(Lassey, 1997)

6. Health as a system • Input • Resources required to the implementation of health system (human, money, drugs, medical devices, etc) • Process • Health delivering service, health empowerment, health management, health research and development. • Output • The implementation of health development • Outcome • Achieve maximal health status

7. Main elements of Health System • Healthcare Organization A good health system have clear type, form, quantity, distribution, stage and relation between one healthcare delivery to another. • Financial Organization A good health system have clear quantity, distribution, utilization, and valid financial mechanism.

8. Main Elements of Health System • Quality of healthcare & finance • Good health system is able to guarantee the quality of healthcare and finance which in tune with the community needs and demand as well as the situation of social and economy.

9. Main form of Health System • The roles of health system’s components (Government, community, Healthcare provider) • Monopoly of the Government→Socialist Country; private healthcare provider is not known • Government domination → Developing Countries; Indonesia • Private domination →Liberalist Country; Government roles → public goods

10. Main form of Health System • The utilization of resources, procedures & capability • Health system which optimally utilize the advancement of science and technology  Developed country • Health system which just started to utilize the newest science and technology  Developing country • Health system which not yet used the advancement of science and technology  Underdeveloped country

11. Main form of Health System • Dimension of Economic, Politic, and Government intervention • Entrepreneurial & permissive The influence of market is so dominant thus making government interventions minimum • Well-fare oriented Government intervention and other entity of the elements toward the private sector, especially for personal healthcare finance

12. Main form of Health System • Universal & comprehensive More intense interventions toward the market in order to provide the healthcare services for all people, with no limits. • Socialist & centrally planned The government intervention toward private sector is very tight in order to minimalize the growth of private sector and make centrally health system.

13. Health System Performa

14. HEALTH SYSTEM FUNCTIONS The Stewardship • Stewardship (oversight) sets the context & policy framework for the overall health system, reflects the fact that people entrust both their lives and their resources to the health system • This function is usually (but not always) a governmental responsibility to play the role of a steward, because it spends revenues that people pay through taxes and social insurance, and because government makes many of the regulations that govern the operation of health services in other private and voluntary transactions • It involves three key aspects: setting, implementing and monitoring the rules of the game for the health system; assuring a level playing field among all actors in the system (particularly purchasers, providers and patients); and defining strategic directions for the health system as a whole.

15. HEALTH SYSTEM FUNCTION Health Financing • The process by which revenues are collected from primary and secondary sources, accumulated in fund pools and allocated to specific activities of particular providers. For the purposes of analysis, it is useful to subdivide health financing into three sub-functions: revenue collection, fund pooling and purchasing. • Understanding health financing can help answer questions such as the following : • Are resource mobilization mechanisms equitable? Do the wealthier subsidize the poor and those most in need? • Is the distribution of resources equitable? Efficient? Or are wealthier populations benefiting more from public financing than are poorer populations? • Do provider payments reward efficiency? Quality?

16. HEALTH SYSTEM FUNCTION • By understanding how the government health system and services are financed, programs and resources can be better directed to strategically complement the health financing already in place, advocate for financing of needed health priorities, and aid populations to access available resources.

17. HEALTH SYSTEM FUNCTION Creating Resources • The assembling of essential resources for delivering health services, include recruitment, training, deployment, and retention of qualified human resources (produced mostly by the education system with some input from the health system), procurement, allocation, and distribution of essential medicines and supplies; and investment in physical health infrastructure • WHO notes that progress toward health-related Millennium Development Goals (MDGs) is seriously impeded by a lack of human resources in health. • Availability of medicines is commonly cited as the most important element of quality by health care consumers, and the absence of medicines is a key factor in the underused of government health services. Where medicines are available, price may be a barrier for the poor.

18. HEALTH SYSTEM FUNCTION Delivering Services (Provision) • Thus an essential part of what the system does, but it is not what the system is. Defining the health system more broadly means that the people and organizations which deliver medical care are not the whole system; rather, they exercise one of the principal functions of the system. They also share, sometimes appropriately and sometimes less so, in the other functions of financing, investment and stewardship. • The most visible product of the health care system, includes a broad array of health sector components, including the role of the private sector, government contracting of services, decentralization, quality assurance, and sustainability.

19. Health System Goals • The World health report 2000 defined overall health system outcomes or goals as: • Health is the defining objective for the health system. This means making the health status of the entire population as good as possible over people’s whole life cycle, taking account of both premature mortality and disability • Responsiveness is not a measure of how the system responds to health needs, which shows up in health outcomes, but of how the system performs relative to non-health aspects, meeting or not meeting a population’s expectations of how it should be treated by providers of prevention, care or non-personal services.

20. Health System Goals • Fair financing means that the risks each household faces due to the costs of the health system are distributed according to ability to pay rather than to the risk of illness: a fairly financed system ensures financial protection for everyone.

21. Health System Framework

22. Health System Framework • To achieve all health systems’ goals, the World health report 2000 have developed health system framework in been broken down into a set of six essential ‘building blocks’ to help strengthen health systems. These building blocks are : • Good health services are those which deliver effective, safe, quality personal and non-personal health interventions to those who need them, when and where needed, with minimum waste of resources. • A well-performing health workforce is one which works in ways that are responsive, fair and efficient to achieve the best health outcomes possible, given available resources & circumstances. I.e. There are sufficient numbers and mix of staff, fairly distributed; they are competent, responsive and productive.

23. Health System Framework • A well-functioning health information system is one that ensures the production, analysis, dissemination & use of reliable & timely information on health determinants, health systems performance and health status. • A well-functioning health system ensures equitable access to essential medical products, vaccines & technologies of assured quality, safety, efficacy & cost-effectiveness, & their scientifically sound and cost-effective use. • A good health financing system raises adequate funds for health, in ways that ensure people can use needed services, & are protected from financial catastrophe/impoverishment associated with having to pay for them. • Leadership & governance involves ensuring strategic policy frameworks exist & are combined with effective oversight, coalition building, the provision of appropriate regulations and incentives, attention to system-design, and accountability

24. Sistem Kesehatan Nasional2009Kepmenkes No.374/Menkes/SK/V/2009 Definition “Bentuk dan cara penyelenggaraan pembangunan kesehatan yang memadukan berbagai upaya bangsa Indonesia dalam satu derap langkah guna menjamin tercapainya tujuan pembangunan kesehatan dalam kerangka mewujudkan kesejahteraan rakyat sebagaimana dimaksud dalam Undang-undang Dasar 1945.”

25. Sistem Kesehatan Nasional2009Kepmenkes No.374/Menkes/SK/V/2009 Goals The implementation of health development by all the country’s elements; community, private sector, and government, synergistic, effectively and efficiently, to achieve health status as high as possible

26. Sistem Kesehatan Nasional2009Kepmenkes No.374/Menkes/SK/V/2009 Functions As a guidance about the form and method in health development implementation, by community, private sector, or Government (local or central) and other related sectors.

27. Sistem Kesehatan Nasional2009Kepmenkes No.374/Menkes/SK/V/2009 • Subsystems • Health delivery services • Health Financing • Health workforce • Medicines, Medical devices and Food Availability • Health Information and Management • Community Empowerment

28. Sistem Kesehatan Daerah Definition “Tatanan yang menghimpun berbagai upaya pemerintah, masyarakat, dan sektor swasta di daerah secara terpadu & saling mendukung guna menjamin tercapainya derajat kesehatan setinggi-tingginya”

29. Sistem Kesehatan Daerah • Local Health System was established to adjust with the health system in a region with adaptation and external and internal challenges as an integral part of national health development. • Sistem Kesehatan Daerah is specifically translate the Sistem Kesehatan Nasional subsystems based on condition and potency in a region.

30. Health Delivering Service Definition Bentuk & cara penyelenggaraan upaya kesehatan yg paripurna, terpadu, & berkualitas, meliputi upaya peningkatan, pencegahan, pengobatan, & pemulihan, mencakup kesehatan fisik, mental, termasuk intelegensia & sosial; baik pelayanan kesehatan konvensional maupun pengobatan tradisional dan komplementer melalui pendidikan & pelatihan dgn selalu mengutamakan keamanan & efektifitas yg tinggi guna menjamin tercapainya derajat kesehatan masyarakat yg setinggi-tingginya.

31. Upaya Kesehatan Pelayanan kesehatan sbg satu sistem • Input : perangkat administrasi (modal, tata cara, kesanggupan) • Proses : fungsi manajemen (perencanaan, pengorganisasian, penggerakkan & evalu-asi) • Output : pelayanan kesehatan yg dimanfa-atkan oleh masyarakat • Outcome : derajat kesehatan masyarakat

32. Upaya Kesehatan Prinsip • Berkesinambungan & Paripurna, meliputi upaya peningkatan, pencegahan, pengobatan hingga pemulihan, serta rujukan antar tingkatan upaya. • Bermutu, Aman, dan Sesuai Kebutuhan bagi penerima, pemberi upaya, dan masyarakat, serta mampu menghadapi tantangan global dan regional. • Adil & Merata, utk memenuhi kebutuhan masyarakat di bidang kesehatan di seluruh wilayah Republik Indonesia & di luar negeri dalam kondisi tertentu.

33. Upaya Kesehatan Prinsip • Non diskriminatif, sesuai kebutuhan medis, bukan status sosial ekonomi & tdk membeda-bedakan suku/ras, budaya & agama, dengan tetap memperhatikan pengarus-utamaan gender. • Terjangkau, harus terjangkau oleh seluruh masyarakat. • Teknologi Tepat Guna, berasas pada kesesuaian kebutuhan & tdk bertentangan dengan etika, moral, dan nilai agama. • Bekerja dlm Tim scr Cepat & Tepat, melibatkan semua pihak yg kompeten, dilakukan secara cepat dengan ketepatan/presisi yang tinggi.

34. Upaya Kesehatan Tujuan penyelenggaraan upaya kesehatan adalah terselenggaranya upaya kesehatan yg adil, merata, terjangkau, & bermutu utk menjamin terselengga-ranya pembangunan kesehatan guna meningkat-kan derajat kesehatan masyarakat yg setinggi-tingginya. Upaya kesehatan diutamakan pd berbagai upaya dgn daya ungkit tinggi dlm pencapaian sasaran pembangunan kesehatan utamanya penduduk rentan, antara lain : ibu, bayi, anak, manusia usia lanjut, & masyarakat miskin.

35. Sistem Pelayanan Kesehatan • Upaya kesehatan primer adalah upaya kesehatan dimana terjadi kontak pertama scr perorangan/ masyarakat dgn pelayanan kesehatan melalui meka-nisme rujukan timbal-balik, termasuk penanggulangan bencana dan pelayanan gawat darurat. • Upaya kesehatan sekunder adalah upaya kesehatan rujukan lanjutan, yang terdiri dari pelayanan kesehatan perorangan sekunder & pelayanan kesehatan masya-rakat sekunder. • Upaya kesehatan tersier adalah upaya kesehatan rujukan unggulan yg terdiri dari pelayanan kesehatan perorangan tersier & pelayanan kesehatan masyarakat tersier.

36. Upaya Kesehatan Bentuk Pokok • Pelayanan Kesehatan Masyarakat • Primer, pelayanan peningkatan dan pencegahan tanpa mengabaikan keluarga, kelompok, dan masyarakat. Merupakan tanggung-jawab Dinkes Kabupaten/Kota yg pelaksanaan operasionalnya dpt didele-gasikan kpd Puskesmas.

37. Upaya Kesehatan • Masyarakat termasuk swasta dpt menyeleng-garakan pelayanan kesehatan sesuai peraturan yg berlaku dan berkerjasama dgn pemerintah. Pembiayaan pelayanan kesehatan masyarakat primer ditanggung oleh pemerintah bersama masyarakat, termasuk swasta. • Sekunder,menerima rujukan kesehatan dari pe-layanan kesehatan masyarakat primer & mem-berikan fasilitasi dlm bentuk sarana, teknologi, & sumber daya manusia kesehatan serta didukung oleh pelayanan kesehatan masyarakat tersier.

38. Upaya Kesehatan • Merupakan tanggung-jawab Dinkes Kabupaten/ Kota dan atau Provinsi sbg fungsi teknisnya, yakni melaksanakan pelayanan kesehatan masyarakat yg tidak sanggup/tidak memadai dilakukan pada pelayanan kesehatan masyarakat primer. • Fasilitas pelayanan kesehatan milik swasta hrs mempunyai izin sesuai peraturan yang berlaku serta bekerjasama dgn unit kerja Pemda, seperti laboratorium kesehatan, Balai Teknik Kesehatan Lingkungan, Balai Pengamanan Fasilitas Kesehatan, dll.

39. Upaya Kesehatan • Tersier,menerima rujukan kesehatan dari pelayanan kesehatan masyarakat sekunder dan memberikan fasilitasi dalam bentuk sarana, teknologi, sumber daya manusia kesehatan, dan rujukan operasional. • Merupakan tanggung-jawab Dinkes Provinsi dan Kemkes yg didukung dgn kerja sama lintas sektor. Institut pelayanan kesehatan masyarakat tertentu scr nasional dapat dikembangkan untuk menampung kebutuhan. • Pelaksananya adalah Dinkes Provinsi, Unit kerja terkait di tingkat Provinsi, Kemkes, & Unit kerja terkait di tingkat nasional.

40. Upaya Kesehatan • Pelayanan Kesehatan Perorangan • Primer, kontak pertama scr perorangan sbg proses awal pelayanan kesehatan dgn penekanan pd pengobatan & pemulihan tanpa mengabaikan upaya peningkatan & pencegahan, termasuk gaya hidup sehat. • Pembiayaan utk penduduk miskin dibiayai oleh pemerintah, sedangkan golongan lainnya diatur oleh pemerintah dalam sistem pembiayaan yang berlaku.

41. Upaya Kesehatan Pelayanan kesehatan diberikan oleh dokter dan dokter gigi di puskesmas, puskesmas perawatan, tempat praktik perorangan, klinik pratama, klinik umum di balai/lembaga pelayanan kesehatan, dan rumah sakit pratama, termasuk Pos Kesehatan Desa (Poskesdes) dan pengobatan tradisional serta pengobatan alternatif yang secara ilmiah telah terbukti terjamin keamanan dan khasiatnya. Dalam keadaan tertentu, bidan atau perawat dapat memberikan pelayanan kesehatan tingkat pertama sesuai ketentuan peraturan perundang-undangan.

42. Upaya Kesehatan • Sekunder, pelayanan kesehatan spesialistik yg menerima rujukan dari pelayanan kesehatan perorangan primer, dapat juga dijadikan sebagai wahana pendidikan dan pelatihan tenaga kesehatan sesuai dengan kebutuhan pendidikan dan pelatihan. Pelayanan kesehatan perorangan sekunder dilaksanakan di tempat kerja maupun fasilitas kesehatan baik Rumah Sakit setara kelas C serta fasilitas kesehatan lainnya milik pemerintah, masyarakat, maupun swasta oleh dokter spesialis atau dokter gigi spesialis yang menggunakan pengetahuandan teknologi kesehatan spesialistik

43. Upaya Kesehatan Pelayanan kesehatan perorangan sekunder yang bersifat tradisional dan komplementer dilaksanakan dengan berafiliasi dengan atau di rumah sakit pendidikan. • Tersier, menerima rujukan sub-spesialistik dari pelayanan kesehatan di bawahnya Pelaksana pelayanan kesehatan perorangan tersier adalah dokter sub-spesialis atau dokter spesialis yang telah mendapatkan pendidikan khusus atau pelatihan dan mempunyai izin praktik dan didukung oleh tenaga kesehatan lainnya yang diperlukan.

44. Upaya Kesehatan Pelaksananya adalah dokter sub-spesialis atau dokter spesialis yg telah mendapatkan pendidikan khusus/ pelatihan & mempunyai izin praktik dan didukung oleh tenaga kesehatan lainnya yang diperlukan. Pelayanan kesehatan perorangan tersier dilak-sanakan di Rumah Sakit Umum, Rumah Sakit Khusus setara kelas A dan B, baik milik pemerintah maupun swasta yg mampu memberikan pelayanan kesehatan sub-spesialistik dan juga termasuk klinik khusus.

45. Upaya Kesehatan Pelayanan kesehatan tingkat ketiga merupakan pelayanan kesehatan sub spesialistik yang dilakukan oleh dokter sub spesialis atau dokter gigi sub spesialis yang menggunakan pengetahuan dan teknologi kesehatan sub spesialistik. Pelayanan kesehatan perorangan tersier wajib melaksanakan penelitian dan pengembangan dasar maupun terapan dan dapat dijadikan sebagai pusat pendidikan dan pelatihan tenaga kesehatan sesuai dengan kebutuhan.

46. Puskesmas Pengertian UPTD kesehatan kab/kota yg bertanggung jawab menye-lenggarakan pembangunan kesehatan di wilayah kerjanya Unit Pelaksana Teknis Dinas Unit pelaksana tk. pertama, ujung tombak pembangunan kesehatan Indonesia, penyelenggara sebagian tugas teknis-operasional dinkes kab/kota Pembangunan Kesehatan Penyelenggaraan upaya kesehatan utk meningkatkan ke-sadaran, kemauan & kemampuan hidup sehat bagi tiap orang agar terwujud derajat kesehatan optimal

47. Puskesmas Pertanggunjawaban Penyelenggaraan Bertanggung jawab utk sebagian upaya pembangunan ke-sehatan yg dibebankan oleh dinkes kab/kota sesuai ke-mampuannya Wilayah Kerja Batasan wilayah tempat pelaksanaan tugas & fungsinya, ditetapkan oleh dinkes kab/kota. Biasanya 1 kecamatan; bila 1 kecamatan ada 2 Puskesmas/lebih tanggung jawab dibagi antar Puskesmas dgn memperhatikan keutuhan konsep wilayah (Desa/kelurahan atau RW).

48. Puskesmas Fungsi • Pusat penggerak pembangunan berwawasan kesehatan • Pusat pemberdayaan masyarakat • Pusat pelayanan kesehatan strata pertama, meliputi : • Pelayanan kesehatan perorangan (private goods) • Pelayanan kesehatan masyarakat (public goods)

49. Puskesmas TATA KERJA Bupati Dinkes Kab/Kota RSUD Camat Puskesmas BPP Jaringan Pelayanan Puskesmas Pelayanan Kesehatan Strata Pertama UKBM

50. Puskesmas Upaya Kesehatan Puskesmas • Upaya Kesehatan Wajib (Basic Six Depkes) • - Promosi Kesehatan • - Kesehatan Lingkungan • - KIA – KB • - Perbaikan Gizi Masyarakat • - P2M • - Pengobatan • Upaya Kesehatan Pengembangan • - UKS - Kesehatan Kerja • - Olah Raga - Gigi Mulut • - Perkesmas - Jiwa • - Usila - Battra • Berdasarkan permasalahan & • kemampuan yg ada Komitmen nasional – global Memiliki daya ungkit tinggi