HEALTH DEVELOPMENT PLAN

TOWARDS
HEALTHY INDONESIA 2010

1999

Ministry of Health
Republic of Indonesia.
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BY THE BLESSING OF THE ONLY GOD

I PROCLAIM
THE DEVELOPMENT MOVEMENT WITH HEALTH CONCERNS
as the National Development Strategy in order to materialize
HEALTHY INDONESIA 2010.

JAKARTA, 1ST MARCH 1999

PRESIDENT OF THE REPUBLIC OF INDONESIA

BACHARUDDIN JUSUF HABIBIE

On the 1st of March 1999, President of the Republic of Indonesia,

Bacharuddin Jusuf Habibie, proclaims THE DEVELOPMENT MOVEMENT WITH
HEALTH CONCERNS as the National Development Strategy
in order to materialize HEALTHY INDONESIA 2010.

Healthy Indonesia 2010 is not belonged to Ministry of Health, Healthy Indonesia

2010 is belonged to all the people of Indonesia. Hence a harmonious, effective and
efficient cooperation is required in its realization implementation.

With the completion of this Health Development Plan towards Healthy Indonesia
2010, we confer appreciation and thanks to all sides for their attention and helps so far.

This plan is compiled after receiving input from various departments, universities,
experts, professional organizations, NGOs and international agencies. Even though all
related aspects and factors have been attended in this document, none the less there are
still shortcomings. Hence this document still requires revision.

Healthy Indonesia 2010 can only be achieved through the spirit, dedication and
hard work from all of us. Without that, Healthy Indonesia 2010 would be just an empty
slogan with no meaning. With high dedication, spirit and hard work from all of us, Insya
Allah (God willing) civil society that we all wish for, i.e. a social order that is healthy
physically, mentally as well as socially, the modern society that is civilized, faithful,
devout, can be achieved by us.

May the Only God always give His guide and confer strength to all of us in
implementing the health development. Amen.

Jakarta, October 1999

Minister of Health of the Rep. of Indonesia

Prof. Dr. F.A. Moeloek

TABLE OF CONTENTS
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Preface
Analysis of Situation and Trends
Development
Problems
Opportunities
Threats
Strategic Issues
Principles, Vision and Mission of Health Development
Principles of Health Development
Vision of Health Development
Mission of Health Development
Direction, Objectives, Targets, Regulations and Strategies of Health
Development
Direction of Health Development
Objectives of Health Development
Targets of Health Development
Regulations of Health Development
Strategies of Health Development
Programs of Health Development
Principle Programs of Health Development
Prioritized Health Programs
Requirements for Health Resources
Manpower resource
Facility resource
Financial resource
Organization and Motivation in Implementation
General affairs
Organization
Implementation motivation
Intra and Inter-sectoral Co-operation
Cultivation
Supervision, Controlling and Evaluation
Supervision
Model and Mechanism of Supervision
Controlling and Evaluation
Indicators of Health Development
Closure
Lists of Tables and Appendices

Preface
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The national aims of the nation Indonesia as stated in the Preamble of the 1945
Constitution is to protect all the nation of Indonesia and all the territory of Indonesia and
to promote public welfare, to develop the intellectual life of the nation, and to participate
in implementing the world order based on independence, eternal peace and social justice.

In order to achieve the national aims, a planned, comprehensive, integrated, directed and
continuous national development is conducted. The aim of the national development is to
achieve a just and prosperous society with evenly distributed materials and spirituality
based on Pancasila and the 1945 Constitution which is contained in the Unitary State of
the Rep. of Indonesia which is independent, sovereign, unitary, and having people’s
sovereignty within the nation’s living situation that is safe, peaceful, in order and
dynamic as well as within the world’s social environment that is independent, friendly, in
order and peaceful.

To achieve the national development’s aims requires among other things human resource
of integrity, autonomous and qualified. The data from UNDP of year 1997 states that the
human development index in Indonesia is still at the 106 rank out of 176 countries. The
level of education, income and health of Indonesian people is indeed still unsatisfactory.

Recognizing the achievement of the national development’s aims is the will of all the
people of Indonesia, and in order to face the even tighter free competition in the global
era, efforts to increase human resource quality must be implemented. In this case the
roles of health development’s success is very decisive. The healthy people will not only
support the success if the education program, but also push the increase in productivity
and income of the people.

To accelerate the success of health development requires health development policies that
are more dynamic and proactive by involving all the related sectors, the government, the
private, and the society. The success of health development is not only decided by the
performance of health sector alone, but also very much influenced by dynamic interaction
of various sectors. Attempts to make the national development with health concerns as
one of the new missions and strategies must be able to become the commitment of all
sides, beside shifting the old health development’s paradigm into the Health Paradigm.

The compilation of health development plan towards Healthy Indonesia 2010 is a

concrete manifestation of the will to execute the national development with health
concerns and the health paradigm.

Analysis of the Situation and Trends

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The existing health development programs so far being implemented has succeeded in
increasing health level of the people significantly, though there are still various problems
and obstacles that will influence health development implementation. To identify the
problems and obstacles requires analysis of the situation and trends in the future. Below
are described the development, problems, opportunities, threats and strategic issues of
health development Indonesia is facing these days.

A. DEVELOPMENT

1. Health Level

Up to now the infant mortality rate (IMR) has been lowered with a lowering rate of on
average 4.1% per annum. While in 1967 the IMR in Indonesia was still ranging 145 per
1000 live births, in 1991 IMR was already 51 per 1000 live births (Supas 1995) (see
tables 1 and 4). The under-five-years death rate (UFDR) (0-4 years) has also been
lowered significantly. In 1986 it was still 111 per 1000 live births, in 1993 it was
lowered to become 81 per 1000 live births. None the less, the differences of IMR and
UFDR between provinces still vary wide. Mean while the MMR has also lowered from
540 per 100.000 live births in 1986 to become 390 per 100.000 live births in 1994 (table
3). In line with this development, life expectancy at birth has also been increased from
average 45.7 years in 1967 to become 64.4 years in 1991 (Supas 1995) (see table 2).

The prevalence of moderate and severe Protein Energy Malnutrition (PEM) among the
under 5 years children has dropped from 18.9% in 1978 to 14.6% in 1995 (Susenas
1995). The total prevalence of (mild, moderate and severe) PEM has dropped from
48.2% in 1978 to 35.0% in 1995 (see table 6). So are the other nutritional problems,
such as blindness due to vitamin A deficiency, iron deficiency anemia, and iodine
deficiency, have shown decrements. The result of xerophthalmia survey done in 1992
concluded that blindness due to vitamin A deficiency was not a community health
problem any more. SKRT (Household Health Survey) discloses the prevalence of
pregnant women suffering from iron deficiency has dropped from 63.5% in 1992 to
50.5% in 1995. Among the pre-school age group, it dropped from 55.5% to 40.5%.
Prevalence of problems due to iodine deficiency (GAKY) has also shown a declining
figure. The total goiter rate (TGR) was 37.2% in 1982 and declined to 27.7% in 1990.

Indonesia has been declared as free from variola by WHO in 1974. Beside that, several
other contagious diseases have been decreased in their morbidities, e.g. framboesia,
leprosy, poliomyelitis, neonatal tetanus and schistosomiasis. While in 1995 there were
still 4 cases of poliomyelitis confirmed laboratorically, in 1997 there was no positive
cases confirmed laboratorically. Neonatal tetanus has been decreased from 3.77 per
10.000 live births in 1990 to become 1.56 per 10.000 live births in 1995. Schistosomiasis
in endemic areas has decreased from 3.48% to become 1.64%. Several contagious
diseases being observed were showing increasing trends of morbidity, such as malaria,
DHF and HIV/AIDS. Annual parasite incidence (API) of malaria decreased from 0.21
per 1000 residents in 1989 to become 0.09 per 1000 residents in 1996 in Java-Bali, then
increased again to 0.20 per 1000 in 1998. Parasite rate (PR) of malaria outside Java-Bali
which was formerly 3.97% in 1995 increased to 4.78% in 1997. Incidence rate of DHF
which was noted as 23.22 per 100.000 residents in 1996 increased to 35.19 per 100.000
residents in 1998. Lung TB is still an illness requiring attention as though its prevalence
has been decreased from 2.9 per 1000 residents in the period 1979-82 to become ca 2.4
per 1000 residents at the end of Pelita VI, though it has not been evenly distributed
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among all the provinces. In certain regions as West Java, Aceh, and Bali, the prevalences
of lung TB were still ranging between 6.5-9.6 per 1000 residents.

At the end of 1999 there were 23 provinces already reporting the existence of HIV, where
14 of them reporting of AIDS. National prevalence of AIDS in Indonesia is 0.11 per
100.000 residents with prominent disparities between provinces. In Jakarta the prevalence
of AIDS is 10 folds higher than the national, i.e. as high as 1,0 per 100.000 people. In
Irian Jaya the prevalence of AIDS is 40 folds higher than national figure, i.e. 4,4 per
100.000 people.

Degenerative diseases and non-contagious diseases also show rising trend. The results
Household Health Survey of 1995 show that 83 per 1.000 people suffering from
hypertension, and ischemic heart disease and stroke are suffered by 3 and 2 per 1.000
people respectively. Emotional mental disturbances among people aged 5-14 years old
and above 15 years old are respectively 104 and 140 per 1.000 people. Blindness is also
rising significantly from 1,2 percent in 1982 to become 1,47 percent in 1995. Traffic
accident in Indonesia in 1994 reaches 34.407 victims, it rises to 49,098 victims by 1997.
Mortality due to traffic accident rises from 3,2 per 100.000 people in 1994 to become 4,1
per 100.000 people in 1997 (see table 8).

2. Facilities

Health development that have been implemented during the last 30 years has succeeded
in preparing health service facilities and infrastructures evenly throughout Indonesia. At
the present time to fulfill basic health service there are 7.243 puskesmas available where
1.676 of them have been up graded to become caring-puskesmas that have in-patient
beds, 21.115 helper puskesmas and 6.849 mobile puskesmas. Hence there are at least one
puskesmas in each sub-district in Indonesia, and more than 40 percents villages have been
served by government’s health service facilities. The ratio of puskesmas to population is
recorded to be 1:27.600 and helper puskesmas to population is 1:9.400.

Beside that, there are also available special Treatment Clinics (Balai Pengobatan) owned
by the government, consisting of 21 units Treatment Clinics for Lung Diseases (BP4), 7
Public Eye Health Clinics (BKMM) and 1 Public Sports Health Clinic.

Beside that there are also various basic health service facilities owned by government’s
sectors outside the health sector, such as the correctional institution, state owned
enterprises (BUMN of the plantation, mining dept.) and so on.

In the private sector, basic health services are arranged in the form of general
practitioners, practicing midwives, private clinics and delivery clinics. The society and
private in the remote areas need much basic health services.

To expand the coverage and reach of puskesmas services various facilities of health
efforts with community’s resources have been developed. Now it has been recorded
243.783 units of posyandu with active cadets total 1.078.208 persons, 20.880 Polindes
(Village Delivery Hut), 15.828 POD (Village Medicine Post) and 1.853 Pos UKK
(Occupational Health Efforts Post).

The even distribution of basic health service facilities is also followed by the increase in
referral health service facilities. At the present there are 4 units of A Class General
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Hospital, 54 units of B Class General Hospital, 213 units of C Class General Hospital, 71
units of D Class General Hospital, 335 units Private General Hospital, 77 units of
Government’s Special Hospital, and 139 units of Private Special Hospital. Total beds are
reaching 120.000 units, so the ratio to residents is 1:1.700. The rate of utilization and the
capability of services of hospitals are increasing from year to year (see table 9).

In order to support the basic and referral health services have been developed 27 Health
Laboratory Offices (BLK), 27 Food and Drugs Supervision Offices (BPOM) and 10
Environmental Health Technique Offices (BTKL). Private laboratory services have also
improved very fast. At present there are registered 599 units private clinical laboratories
distributed among 27 provinces.

For the purpose of assuring the smoothness in medicines distribution in governmental

sectors especially for the puskesmas there have been built 314 units of district/ municipal
pharmaceutical warehouses (GFK). While in the private sector there have been
operational 5.724 units of dispensaries throughout Indonesia.

3. Health Manpowers

The number and distribution of health manpower have improved significantly enough so
that now there are registered about 32 thousands or so of medical manpower (physician,
specialist, and dentist) and 7 thousands or so of dentists, including specialists, and 6
thousands or so of pharmacists distributed throughout Indonesia. The number and
distribution of nurses and midwives are also improving very fast. There are registered
about 160 thousands or so of nurses with various levels of education. While the number
of midwives is registered 65 thousands persons or so including 52.042 persons in the
villages. Hence it means that nearly all villages in Indonesia have midwives already.

In order to support the development with health paradigm there have also been manpower
in the field of public health. At present there are registered about 11 thousands or so of
public health manpower with various expertise including among them in the nutritional
field about 1.500 persons, and in environmental health about 4 thousands so persons.

The total number of health manpower working in the Ministry of Health and regional
government throughout Indonesia in 1998 is registered about 400 thousands so persons,
where 302.947 persons out of them are central health personnel. While the rest about
90.000 persons more are staffs of regional government.

4. Health Inventories

At present there are 224 units pharmaceutical industries consisting of 4 BUMN (state
owned enterprises), 35 PMA (foreign investments), and 185 domestic private ones. Since
the enforcement of CPOB (good medicine manufacturing practices) in 1996, there are
162 pharmaceutical industries that have had the capability to manufacture medicines
according to CPOB.

Since early 1997 Indonesia has been able to produce generic drugs which are conducted
by 4 BUMN and 60 private owned pharmaceutical plants. The generic drugs have been
more and more accepted by the society.
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In the attempt to cure and improve health a portion of the society use Indonesian
indigenous medicines. Indonesia has the largest biologic varieties in the world with
about 30.000 types of plants. About 940 of them have been known to possess medicinal
effects and about 180 of them have been used in the native medicinal recipes by
Indonesian indigenous medicinal industries.

In 1992 the number of Indonesian indigenous medicinal industries was 449 units
consisting of 429 units of small scale traditional medicine industries (IKOT) and 20 units
of traditional medicine industries (IOT). In 1998 the number of Indonesian indigenous
medicinal industries has increased into 678 consisting of 602 units IKOT and 76 IOT.
Unincluded in the above records are manually mixed ‘jamu’ (Indonesian indigenous
herbs) businesses and ‘jamu’ vendors (see table 11).

The needs for vaccines in order to prevent diseases, among others the BCG, hepatitis,
polio, measles, DPT and tetanus toxoid have been fulfilled from domestic production.
Some of the health inventories such as health instruments have been manufactured
locally, while those using high technologies are still being imported.

5. Health Financing

In the last 30 years the government’s commitment for health financing has increased.
While the health budget in 1987/1988 was 2,32% of total government’s spending, then in
1997/1998 the health budget was 4,55% of total government’s spending.

The funding from private sector primarily the society’s spending is the largest portion of
the health funding. The contribution of private sector and society in funding health is
about 65 percents.

The majority of the society pay for their health still using the ‘fee for service’ model.
Only 14 percents of the society are covered in the health insurance programs. The Public
Health Maintenance Assurance Program (JPKM) which has been developed in all
districts/ municipalities is hoped to be able to rationalize funding from the public as a
base for achieving equality and improving health service quality. The details of JPKM
development result coverage up to the end of 1999 are as the following: (1) civil
servant’s health maintenance and pension revenue of 17,2 millions members, (2)
maintenance for employees and families of 1,6 millions members, (3) private health
maintenance of 600.000 members and (4) health funds of 22 millions members
distributed in about 15.000 villages. Besides, up to recently there are 19 executing bodies
(Bapel) of JPKM having license, and in the context of implementing the Social Safety
Net program in Health Sector there are 326 JPKM executors which are distributed in all
districts/ municipalities.

So far the health development has been built not only upon self strength, but it is also
supported by foreign helps either in the form of off shore loans or grants. To some extent
due to the economic crisis the foreign helps component in the health budget has shown
rising tendency.

6. Policies

The health development which had been done in nearly the last 40 years has undergone
enormous changes and improvements in policies. In Pelita I the policies were more
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emphasized on consolidation. The service functions were directed more towards

integration and comprehensively being focused more on the governmental sectors. In the
years 1980s the service model started to shift towards the private sector. In Pelita II the
policies were prioritized on equity such as through Inpres (presidential instruction) on
health facilities and manpower. During Pelita III and IV, beside equality, attention is
also given to health service quality improvement. The matter is reflected among others
on the change in puskesmas function to become caring puskesmas. Next, during Pelita V
a policy has been determined to put midwives in the villages.

In terms of hospital services, since Pelita V and specifically in Pelita VI, much attention
has been put to improve service quality through standardization of services, development
of accreditation instrument and compilation of indicators of hospital instruments’
performance. During this same period decentralization is also implemented, i.e.
delegation of a part of functions to the regions, without being followed by changes in
resources.

During Pelita V the policy on medicines is directed to the use of generic drugs, where all
government’s health facilities are obliged to use generic drugs.
With the issuance of act (UU) number 23 Year 1992 about Health, then a renewal has
happened in the written laws about health development. The act offers a legal base,
direction and various national policies for health development which formerly was based
on the National Health System (SKN). Policies that integrate funding system and health
maintenance system are clearly stated in the act number 23.

In order to protect the society from abuse and misuse of drugs, the act number 5 year
1997 about Psychotropics and the act number 22 year 1997 about Narcotics were issued.
For the sake of consumer protection, it is also enacted the act number 8 year 1999
concerning the protection against pharmaceutical preparations and foods. One of the
aims of the act is to increase the quality of goods and /or services that assure the
continual production of health goods and/ or services, comfortability, safety and survival
of consumers.

The development of state governance at the present time shows a very strong wave of
decentralization. The implementation of act number 22/ 1999 on Regional Government
and the act number 23/ 1999 on Financial Balance between Central and Region will
strongly influence the execution of development including the health development.

Decentralization of health efforts offer authority to the districts and municipalities to self
determine the health development’s priority of the respective regions according to local
capabilities, conditions and needs. As a consequence the success in health development
in the future will depend very much on the capability of the manpower resources in the
regions.

The trends which occur in the world nowadays are the increasing roles of the third party
in regulating health funding through the insurance system, either public or private one.
This condition will also become more flourished in Indonesia in the future when trades
between countries become more free. Hence the policies to be adopted in health
development effort through pre-service payment (pre-paid) system will very strongly
decide the direction of health service conferral to the public more evenly and with more
adequate quality.
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B. PROBLEMS

1. Health Level

Morbidities of some contagious diseases being observed which formerly were declining
or undetected, but recently have shown increasing trends, such as malaria, DHF and HIV/
AIDS. Besides with the increasing openness of Indonesia toward outside world and the
ease in transportation, there is a potential for the occurrence of new contagious diseases
which hitherto have not existed in Indonesia. On the other hand, the degenerative
diseases, non-contagious diseases, and traffic accidents have also shown increasing
trends. The problem of blindness is also rising significantly enough.

The trends in morbidity of contagious diseases, non-contagious diseases, degenerative

diseases, injuries due to traffic accidents, and other health problems as well as other
diseases are problems that will influence the health level of the public in the future, all
that require optimal management steps.

2. Cross-Sectoral Cooperation

Health problems are national problems that can not be disconnected from the various
policies of other sectors, hence their solution should involve other sectors as well. The
main issue is how to improve cross-sectoral cooperation more effectively?

The health development so far has not produced optimal results due to the lack of cross-
sectoral supports. There are sectoral programs which have not or not enough health
concerns so that they bring negative impacts to the health of the society. Part of the
health problems are caused by several factors, primarily the environment and behavior,
related closely to various policies and program implementation in sectors outside the
health. For the reason, a very nice cross-sectoral approach is required, so that the related
sectors can always calculate the impacts of their programs toward the public health.

For the same reasons, increase in attempt and management of health services can not be
separated from the roles of other sectors covering funding, regional governance and
development, work force, education, trade, and social and cultural affairs.

3. Health Development Policies

Even though the health development policies have been directed to and prioritized on
basic health services, emphasizing more on preventive and instructional health efforts,
but the public perception tends to remain oriented on disease curative and health
rehabilitation. The attempt to increase public awareness to create healthy life style
(Healthy Paradigm) is hard to achieve, as it is not supported by the factors of social
economic, educational level and public cultures.

The healthy life style that has not been well created as stated above is made even worse
by the highly expensive costs spent by patients or their families in order to get cure and
rehabilitation at the health service facilities such as the hospitals. Beside that, the loss in
productivity is another burden that should be born by the patient’s family. In other
words, such model of services is not only inefficient, but also wasting much costs. While
in the other side, the fund from government is declining.
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Beside that, the Indonesian territory which is geographically very wide with varying
tribes, cultures, religions and various communities, has not been given enough
consideration in deciding health policies. So far the decision making in health
development policies is viewed to be strongly centralized with the consequence that part
of the programs are not suitable to the regional or local needs and requirements. As a
result the health development being conducted so far is viewed to be not yet fully
effective and efficient.

4. Health Development Expenditure System

As a result of the strong roles of the central government in deciding policies, the mode of
spending given by the central government is based on budget allocation which has been
decided with its detailed activities. The mode of spending like that plus the inadequate
wage system of the civil servants have made it very difficult to produce an appropriate
incentive system for budget efficiency. The matter is worsen by the many regulations
made by the government and applied uniformly, which has abolished the spirit for
competition and obstructed the creation of efficient management model.

Subsidy given by the government for health sector in PJP I (1st phase of long term
development) is only about 2.5% from Gross Domestic Product (GDP) which is far from
the minimum standard recommended by WHO i.e. 5% from GDP. In practice the
relatively small budget subsidized by the government mostly is given in the form of
subsidy to the service provider as regular spending (including wages), development
spending, and operational costs as well as maintenance costs. In other words, the mode
of funding practiced so far is not oriented to the needs of the public and is not directly
directed to subsidy the poor people.

The subsidy given by the government is only 30% of the total health costs. While 70%
of the health costs are still the responsibility of the public, and it is dominated by
individual cash payment system. As a consequence of the above situation is the difficulty
in applying cost control policies and it is also burdening the consumers of health services.
In fact the health costs are inclined to increase even more and become unaffordable when
the mode of payment stated above is still going on.

5. Health Development Implementation

The mode of policy determination and mode of payment already being applied so far
have brought strong influence on the implementation of health development. The quality
of health service which is good and in line with prevailing standards is hard to find,
especially for the poor people and those living in remote areas.

Beside that, health development implementation is still not yet supported by the
utilization of progresses in applied science and technology. More over, the executors of
health development have not fully applied high level of ethics and morale. As a
consequence of that condition is health development implementation in Indonesia has not
fully implemented professionally.

6. Quality of Health Facilities

Even though the number and distribution of health facilities have been regarded adequate,
but from the aspect of service quality the services are still below standard. Other health
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facilities such as hospitals even have not met the minimum requirement yet. In such a
situation, the quality of health services being offered are still far from expectation.

The conducive climate for increased private participation from either domestics or abroad
in offering health services has not been created optimally. Bureaucracy in licensing and
regulating which should be followed is in fact like a barrier for private sector
participation in health development.

7. Health Manpower

The weakness of health development from the point of view of health manpower is
regarding the uneven distribution, yet inadequate educational quality, unbalanced health
manpower composition due to over dominance of medical manpower and the low
performance and productivity.

Cross-sectoral coordination especially with the Education and Cultural Dept. in terms of
increasing the number of graduates of 4 basic medical specialists badly required by
district hospitals in order to improve their service quality is still lacking. Beside that,
review and re-structuring of other health manpower educational systems are also needed,
either those run by the government or the private.

One of the issues in health manpower development is the manpower utilization, where
their uneven distribution becomes a principle problem. Beside that, the career
development of the manpower becomes a matter that strongly needs to be developed, it
covers manpower of both the public sector and the private sector. All the aforementioned
efforts need the support of comprehensive, integrated and effective manpower
information system.

8. Health Inventory

The majority of medicinal raw materials for the pharmaceutical industries and the health
instruments using high technology are still dependent on import hence their prices rise
due to depreciation of Rupiah against foreign currencies.

Acceptability towards all levels of the society who need them is striven for through the
supply of medicines in 2 channels i.e. the services channels of the public sector and the
private sector. In the public sector the efficient management of medicines, including the
purchasing and integrated planning at districts and direct medicine distribution at GFK, is
an absolute matter. In this case, the ability to analyze essential drug requirement using
bottom-up planning according to disease pattern is a main matter. Beside that there is a
matter of coordination complexity.

Another problem is concerning the maintenance of health inventories, beside

standardization and calibration of instruments being used.

C. OPPORTUNITIES

Various opportunities for success of health development in achieving Healthy Indonesia

2010 among other things are:

1. Demography
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The number of Indonesian people is still increasing with a decreasing rate. In 1980 the
Indonesian population totals 147,49 millions, it increases to 179,38 millions in 1990, and
projected to 210,439 millions in year 2000. Indonesian population in 2010 is projected to
be ca 235 millions. The growth of population is also signaled by the change in age
structure of the population where there is a shift from young population age structure to
old population age structure.

The large number of Indonesian population and the productive age structure are potential
market and resources for the development of nation-wide health efforts. Beside that,
various changes occurring on the demographic characteristics as a result of development
success such as education and social economic sectors will open the opportunities for the
implementation of health services that are more effective, efficient and qualified.

2. Laws and Politics

Reform in the legal and political sectors as required by the society opens big
opportunities for improvement of system and values in various sectors, including health
sector. This big opportunities can be utilized optimally to produce clean governance with
health concerns for the interest and prosperity of the people.

The governance system of the Unitary State of the Rep. of Indonesia based on the 1945
Constitution gives freedom to the regions to execute governance autonomically. In
facing the domestic as well as international development vis-a-vis the global competition
which is in principle a free competition, then the implementation of regional autonomy
with wide, real and responsible authorities proportionally is an opportunity which can be
used by the regions to prepare themselves as well as possible. With the implementation
of the Act No. 22 year 1999 about Regional Governance and Act No. 25 year 1999 about
Economic Balance between Central and Regional Governments, it is also an opportunity
for the regions to implement development including development in health sector, to
accelerate even distribution and justice according to local problems, potentials and
variousity by involving the public’s participation.

3. Globalization

Globalization in economic sector with its main core being free global trading gives
opportunity for Indonesia to take part in international trading. In the health sector, the
opportunity is mainly the chance for health workers to work abroad.

For that efforts to increase quality of the health workers to equal those from the other
countries should be done among other ways through improvement in education system.
The entry of foreign capital to Indonesia will expand even more the employment
opportunities for health workers, beside it will help accelerate the transfer of technologies
that are needed for the improvement of quality and professionalism of health services in
Indonesia.

4. Economic Crisis

The economic and credibility crises hitting Indonesia until now is a good opportunity to
do various changes in health sector, including to eliminate various bureaucratic obstacles
in the effort to increase efficiency and partnership in development implementation.
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Difficulty in getting health services due to low purchasing power opens bigger chance for
development and consolidation of JPKM.

5. Natural Resources

Indonesian soils and oceans are very rich in various sources for medicinal materials or
simplicia. Indonesia has the largest biologic varieties in the world with ca 30.000 types
of plants, and part of those plants are sources of natural medicinal materials. This is a
very big opportunity to produce medicinal materials as well as completed products
domestically by ourselves.

6. Progress in Science and Technology

The progress in science and technology in the telecommunication, information and

transportation sectors which are becoming better opens opportunity to accelerate the
achievement of equality in health services. While progress in science and technology in
health and medical sector gives opportunity for the improvement of the quality of health
service efforts which should yet be balanced and harmonized with faith, devotion and
ethics.

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.
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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 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
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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

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 25/1999.

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 20th 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.
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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
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.
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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

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.
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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.

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
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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 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
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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.

2. Empowerment and Autonomy

Every person and also the society together with the government have a role, vocation and
responsibility to maintain and improve the health level of each individual, family, society
and his/ her environment. Every health effort should be able to produce and push the
participation of the society. Health development is conducted based on trust and self-
capability and strength as well as making the personality of the nation as the pivot point.

3. Justice and Equality

In the health development, each person has the same right in getting the highest health
level, regardless of differences in ethnicity, grouping, religion, and social economic
status.

4. Prioritization and Utilization

The implementation of qualified and following up to date science and technology’s health
efforts should put priority on health maintenance, promotion, and disease prevention
approaches. Beside that, health efforts should be done professionally, effectively and
efficiently by taking into consideration local needs and situation.

The health efforts are directed so that they would give maximal benefit for the
improvement of public health level, and they should be executed with full responsibility
according to the prevailing rules and regulations.

Vision of Health Development

The picture of Indonesian society in the future that is hoped to be achieved through health
development is the society, nation and state characterized by its people living in a healthy
environment and with healthy living behaviors, having capability to reach qualified
health services justly and evenly, as well as possessing highest level of health in all the
territory of Indonesia. The picture of Indonesian society in the future or Vision expect to
be reached through the health development is formulated as:

HEALTHY INDONESIA 2010

In the Healthy Indonesia 2010, the expected environment is the conducive one for the
realization of healthy condition i.e. environment that is free from pollution, which is
equipped with clean water, adequate environmental sanitation, healthy housing and
settlement, zone planning with health concerns, and the realization of social life that is
helping each other by keeping cultural values of the nation.

The expected social behavior of Healthy Indonesia 2010 is the proactive one to maintain
and promote health, prevent risks for diseases, protect one from disease threats and active
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participate in healthy society movement. Furthermore, the expected capability of the

society in the future is able to access qualified health services without obstruction, either
economic or non-economic one. The qualified health services referred before are those
satisfying the users of the services and those being implemented according to standards
and ethics of professional services. Hopefully with the materialization of healthy
environment and living behavior beside the increase in the society’s capability as stated
above, the health level of individuals, families and society can be upgraded optimally.

Mission of Health Development

In order to materialize the vision HEALTHY INDONESIA 2010, four missions of health
development have been determined as follow:

1. Activating national development with health concerns

The success in health development can not be merely decided by hard working of the
health sector alone, but it is strongly influenced by the results of hard working and
positive contribution from various other developmental sectors. In order to optimize the
results and positive contribution, the acceptance of health concerns as the principal
foundation of national developmental programs should be striven for. In other words, to
materialize HEALTHY INDONESIA 2010, the persons in charge of developmental
programs should put health considerations into all their developmental policies. The
developmental programs that do not contribute positively to health, not to mention those
being harmful to health, normally should not be implemented. In order to realize the
national development that contributes positively to health as stated before, then all
elements of the National Health System should take part as the main activators of the
national development with health concerns.

2. Urging society’s autonomy for healthy living

Health is the joint responsibility of all individuals, society, government and private. The
roles played by the government, without awareness of individuals and society to maintain
their health independently, will only bear little fruit. The healthy behavior and society’s
capability to select and acquire qualified health services strongly decide the success of
health development. Hence, one of the main health efforts or missions in health sector is
to urge the society’s autonomy for healthy living.

3. Maintaining and improving qualified, equal and accessible health services

Maintaining and improving qualified, equal and accessible health services contain the
meaning that one of the responsibilities of the health sector is to assure the availability of
qualified, equal and accessible health services to the society. The implementation of
health services is not merely in the hands of the government, but it also involves
maximally the active participation of all members of the society and various private
potentials.

4. Maintaining and improving health of the individuals, families and society as well
as their surroundings
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Maintaining and improving health of the individuals, families and society as well as their
surroundings contain the meaning that the main task of the health sector is to maintain
and improve the health of all citizens, i.e. every individual, family and society of
Indonesia, without leaving behind the attempts to cure diseases and or to recover health.
For the implementation of this task, health efforts implementation should prioritize on
promotive and preventive efforts supported by curative and rehabilitative efforts. To
maintain and improve the health of individuals, families and society, it is also necessary
to create healthy environment, and hence the tasks in environmental sanitation should
also be better prioritized.

Direction, Aims, Targets, Policies

and Strategies of Health Development

Direction of Health Development

Direction of health development towards Healthy Indonesia 2010 according to the

national development so far consists of:

1. Health development is an integral part of the national development. The concept of

national development should have health concerns, i.e. taking into consideration
seriously various positive and negative impacts of each activity toward public health.
Health development is directed to improve quality of human resources who are
healthy, intelligent and productive, as well as capable of maintaining and improving
public health with high commitment toward humanity and ethics, and it is
implemented with the high spirit of empowerment and partnership. Health
development is executed with priority given to health promotion and disease
prevention efforts beside the curative and health recovery efforts.
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2. Health services run by either government or society should be implemented with

quality, justice and equality by giving special attention to the poor people, children,
and deserted elderlies, either living in urban or rural areas. Priority is also given to
remote villages, new settlements, frontier zones and recesses inhabited by poor
families.

3. Health development is executed with the national development strategies with health
concerns, professionalism, decentralization and JPKM by paying attention to various
challenges existing now and in the future, among other things the economic crisis,
change in demographic dynamics, change in ecology and environment, progress in
science and technology, as well as globalization and democratization.

4. The public health maintenance and promotion efforts are done through healthy living
behavior improvement programs, healthy environment programs, public health
services that are effective and efficient, being supported by surveillance, information,
and management system that are reliable.

Improvement and revision of rules and regulations need to be done in order to support
health development and give legal protection to the public and health workers.

5. The supply and improvement of health facilities and infrastructures are to be

continued. Health researches and improvement need to be upgraded to support the
improvement in quality of health efforts. Supply of medicines and health instruments
that are safe and accessible to the society are stepped up through the development of
pharmaceutical and health instrument industries that are more advanced and
supported by medicinal raw materials industries that are reliable and the development
of Indonesian indigenous drugs. Health funding is stepped up, either that coming
from the government or the public, it is managed effectively and efficiently as well as
responsibly.

6. In order to support all the health development efforts, manpower with national
attitude, ethical and professional is required, it should also possess high dedication
spirit to the nation and country, being disciplined, creative, educated and skillful, with
noble character and able to hold tight professional ethics. Health manpower and
supportive manpower should be improved in quality, capability and distribution so
that they are evenly distributed and able to support the execution of health
development at every level especially in supporting the implementation of autonomy
at the districts/ municipalities.

Aims of Health Development

The aims of health development toward Healthy Indonesia 2010 is to increase the
awareness, will and capability for healthy life of every individual in order to materialize
public health level that is optimal through the creation of an Indonesian society, nation
and country that is characterized by its residents living with healthy behavior and within
healthy environment, possessing capability to reach qualified health services justly and
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evenly, as well as having optimal health level throughout the territory of the Rep. of
Indonesia.

Targets of Health Development

The targets of health development in order to materialize Healthy Indonesia 2010 are:

1. Cross-sectoral cooperation
The significant rise in cross-sectoral cooperation in health development, positive
contribution from other sectors toward health, efforts to overcome negative impacts
of development to health, and improvement in behavior and living environment that
are conducive to the achievement of healthy society.

2. Community’s autonomy and private partnership

The significant rise in community’s capability to maintain and improve their health
condition, and to reach proper health services according to needs. The significant rise
in health efforts originating from private resources and the number of community
members utilizing private health efforts.

3. Healthy living behavior

The significant rise in the number of pregnant women examining themselves and
delivering attended by health manpower, the number of infants receiving complete
immunization, number of infants receiving exclusive breast feeding, number of the
under 5 years children having weighed each month, number of reproductive aged
couples using contraceptive, number of people taking balanced nutrition, number of
those using sanitary toilet, number of people receiving clean water, number of
settlements free from vectors and rodents, number of houses fulfilling healthy
condition, number of people exercising and resting regularly, number of families with
internal and external communication, number of families practicing well their
religious teaching, number of people not smoking and not drinking alcoholic
beverages/ addictive substances, number of people not having extra marital sex, and
number of people becoming members of JPKM.

4. Healthy environment
The significant rise in the number of healthy regions/ areas, healthy public places,
healthy tourism resorts, healthy working places, healthy houses and buildings,
sanitary facilities, drinking water facilities, waste disposal facilities, healthy social
environment including social inter-courses, and environmental safety, as well as
various standards and laws supporting the achievement of healthy environment.

5. Health efforts
The significant rise in number of qualified health facilities, coverage and reach of
health services, generic drugs usage in health sector, rational drugs usage, promotive
and preventive services utilization, efficiently managed health funds, and availability
of health services according to needs.

6. Health development management

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The significant rise in health development information system, region’s ability in

implementing health development decentralization, health leadership and
management as well as laws supporting the health development.

7. Health level
The significant rise in life expectancy, decrease in infant mortality rate and maternal
mortality rate, decrease in morbidity rates of several important diseases, decrease in
disability rate and dependency rate, increase in public nutritional state, and decrease
in fertility rate.

Health Development Policies

In order to achieve health development’s aims and targets toward realization of Healthy
Indonesia 2010, the general health development’s policies are:

1. Consolidation of Cross-Sectoral Cooperation

In order to optimize the results of development with health concerns, then
consolidation of cross-sectoral cooperation becomes the main concern, hence it needs
careful coordination and consolidation. Socialization of health concerns to other
sectors needs to be done intensively and periodically. Cross-sectoral cooperation
should cover planning, implementation and evaluation steps.

2. Improvement in Behavior, Society Empowerment and Private Partnership

Early started healthy life style in the society should be up-graded through various
health information and education activities, so that it can turn into a part of living
norms and cultures of the people in the context of increasing the awareness and
autonomy of the society for living healthily. The roles of the society in health
development, i.e. mainly through application of public health development concept, is
to be encouraged and even more improved to assure the fulfillment of health needs
and continuity in health efforts.

Private partnership is developed further by facilitating primarily the construction of

referral health service hospitals and other medical services, by attending the
efficiency of the overall health service system. Private partnership is also increased
in prevention of diseases and improvement of health level.

The roles of professional organizations as part of the society’s organizations are to be

stepped up mainly in aspects related to compilation and supervision of professional
standards and ethics in health services. Professional organizations are encouraged to
participate actively advancing science and technology in health, help government in
formulation of policies and management and supervision of health development
implementation and function also in providing input to development of health human
resources.

3. Improvement of Environmental Health

The environmental health of settlements, working places and public places and
tourism resorts is to be improved through the supply and supervision of qualified
water especially the plumbing, regulation of rubbish disposal places, preparation of
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waste disposal facilities and various other environment sanitary facilities. So that the
residents can live healthily and productively as well as be prevented from dangerous
diseases which are disseminated through or caused by unhealthy environment.

The quality of water, air and soil is to be improved to assure healthy and productive
life so that the country is prevented from conditions that can incur health hazards.
For that, improvement and revision of various rules and regulations, education on
healthy environment since early ages, and standardization of environmental quality
are necessary.

Control over agents, vectors and reservoirs of diseases is needed to create a healthy
environment for the whole society. Special attention is directed to environmental
troubles caused by technology utilization and dangerous substances, overt
exploitation of natural resources, and those caused by disasters, either natural or man
made ones.

The global impacts of climate change should be cautioned especially those related to
the occurrence of various health troubles, beside negative impacts of foodstuff
scarcity influencing the community’s nutrition.

4. Improvement of Health Efforts

In order to maintain public health status during the economic crisis, health efforts are
prioritized to overcome the aftermath of crisis beside to continue keeping health
development improvement. In overcoming the aftermath of crisis, special attention is
given to high-risk groups from poor families so that their health level do not worsen
and they remain productive. Government is in charge of health service fund for the
poor community.

After passing the economic critical period, health state of the society is managed to
improve through prevention and decrease in morbidity, mortality and disability
especially among the infants, under 5 years old children and pregnant, laboring and
puerperal women, through the healthy life promotive efforts, prevention and
eradication of contagious diseases and the cure and rehabilitation of diseases. The
main priority is given to eradication of contagious diseases and outbreaks which tend
to rise.

Greater attention is given to efforts to realize higher working productivity, through

various occupational health service efforts including nutritional improvement and
work force’s physical fitness and other health efforts related to health of work
environment and settlement areas, especially for people living in the slum areas.

Increase in health efforts is implemented through supporting private sector

partnership and society’s potentials. Improvement in health efforts of the
governmental sector is prioritized on health services having broad impacts to public
health. While individual health services of curative and rehabilitative nature are
mainly trusted to private.

Basic health services that are implemented through puskesmas, helper puskesmas,
midwives at villages, and private health service efforts are improved in equality and
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quality. The same improvement is also applied on referral health services that are
implemented by hospitals owned by the government and the private.

Improvement in quality is done through positioning midwives at villages,

development of existing puskesmas and construction of helper puskesmas equipped
with facilities. Improvement in service quality is done through implementation of
quality assurance by puskesmas and hospitals.

5. Improvement of Health Resources

Improvement in health manpower should support all health development efforts and
directed to create health manpower that is expert and skilled in line with the progress
in science and technology, devout and faithful to the Only God and holding tightly
dedication to the nation and country as well as professional ethics. Up grading of
health manpower is aimed at improving empowerment or utilization of manpower
and preparation of health manpower, either from the public or the government, that
can implement health development.

JPKM is developed further to assure implementation of health maintenance that is

more equal and qualified with controllable price. JPKM is run as a joint effort
between the society, private and government to fulfill the need for health service costs
which are rising continuously. Health service tariffs should be adjusted based on the
value of goods and service received by the society’s members getting the care. The
less well to do people will be helped through the JPKM system subsidized by the
government. At the same time, health insurance is also developed as a complement/
companion to JPKM. The development of health insurance is under the cultivation of
the government and insurance association. Beside that gradually the state owned
puskesmas and hospitals will be managed by self-financing system.

In the effort to increase health inventories, the purchase and production of medical
raw materials which have economic yield will be stepped up. Supply, production and
distribution of finished drugs will be increased in efficiency and quality so that the
society will be able to get qualified drugs with affordable prices. Rational use of
drugs, especially with generic drugs is encouraged through promotion and
instructional efforts for the health workers and general public. Traditional medicines
that are useful to health will be utilized integrally in public health services. Beside
that, cultivation and utilization in the society will be improved further through
cultivation by the government or professional organizations.

Cultivation of the quality of foods and beverages that are marketed and consumed by
the society is improved to protect the society from substances and organisms harmful
to health.

6. Improvement the Policies and Management of Health Development

Policies and management of health development need to be improved more intensely
especially through the strategic improvement in cooperation between health sector
and other related sectors, and between various health programs and between actors
within the health development itself.

Health effort management which consists of planning, implementation actuating,

controlling and evaluation is executed systematically to ensure integrated and overall
health efforts. The management is supported by information system which is reliable
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in order to produce right decisions and efficient working mechanism. The

information system is developed comprehensively at all levels of health
administration as a part of modern administrative development. Organization of
Ministry of Health needs to be readjusted with the functions of regulating, national
planning, cultivation and supervision. Decentralization based on real autonomy
principle, dynamic, harmonious and responsible is accelerated through delegation of
responsibilities of health effort management to the regions. The management ability
of health office (Dinas Kesehatan) is improved further so that it can do the planning
and funding of health effort arrangement more responsibly. The improvement in
managerial ability is done through a series of education and training in line with the
existing health development.

The aforementioned efforts need to be supported by the availability of adequate

health funding. For the reason, improvement in health funding should be striven for
either that coming from national budget or from the regional budget. The source of
revenue for health development can be explored from taxes on consumer goods that
are detrimental to health such as cigarettes and tobacco, and taxes on alcoholic drinks.
In line with that, all revenues are allocated fully back by the government to fund
health services and service quality improvement efforts.

7. Improved Protection of Public Health against the Use of Illegal Pharmaceuticals,

Foods and Health Instruments.
Improved protection of public health against the use of illegal pharmaceuticals, foods
and health instruments is done through prevention of distribution of products which
do not meet the conditions regarding quality, efficacy/ benefit and safety, beside
through expansion of the span of their supervision. Beside quality and safety
conditions, the claims of certain products through advertisement and promotion
should be assured of their validity according to the scientific data supporting them.
The community’s care regarding risks from using pharmaceuticals, foods and health
instruments is also not less important to be increased through various communication,
information and educational activities. So is the rational use of drugs by professional
personnel need to be encouraged through more concrete efforts.

Improved protection of society against danger of abuse and disuse of drugs, narcotics,
psychotropics, addictive substances and other dangerous substances needs to be
consolidated through control of their production, distribution and use tightly. The
risks of toxicity due to use of products containing dangerous substances need to be
prevented as early as possible through intensification of the information dispersion.

In order to utilize the potentials of Indonesian indigenous medicines, various efforts

should be developed and conducted from up stream to down stream integrally and
systematically, cooperating with other related sectors. Beside that the image of
Indonesian indigenous medicines should be upgraded mainly domestically through
wide spread use for self-healing by the society and in the formal health services.

The even distribution and availability of drugs that are affordable and still being
prioritized nationally should be done consistently through the concept of essential
drugs. So is the utilization of generic drugs which should be further up graded.

8. Improvement of Science and Technology in Health

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Research and development in health sector will be further up graded gradually and
guided in order to support health efforts, primarily to support formulation of policies,
to help solve health problems and overcome troubles in the implementation of health
programs. Research and development in health will be continually up graded through
the partnership network and decentralized to become essential part of regional health
development. The upgrading of science and technology is encouraged to improve the
health services, nutrition, drugs utilization, and Indonesian indigenous medicine
development. Researches related to health economics are upgraded to optimize
utilization of health funds from government and private, as well as to improve
government’s contribution in health funding which is still limited. Researches in
social cultural field and healthy life style are done to develop healthy life style and
decrease existing community health problems.

Strategies of Health Development

Health development strategies aimed at achieving Healthy Indonesia 2010 are:

1. National Development with Health Concerns

All national development policies that are still or will be arranged should have health
concerns. It means that national development programs should provide positive
contribution to health, at least in 2 aspects. First, toward the formation of healthy
environment. Second, toward the formation of healthy behavior. It is utmostly
hoped that each national development program being done in Indonesia can bring
positive contribution toward the achievement of the healthy environment and
behavior.

While in micro, all health development policies that are and or will be arranged
should further push the increase in health level of all members of the society. While
it is known that the maintenance and promotion of health will be more effective and
efficient if done through promotion and preventive efforts, not curative and
rehabilitative ones then it is logical that the former two services can be given priority.

In order to implement the development with health concerns, it needs socialization,

orientation, campaign and training activities so that all stakeholders understand and
can implement the national development with health concerns. Beside that, further
elaboration of activities is needed for the concept so that they become truly
operational and measurable regarding all the achievements and impacts resulted.

2. Professionalism

Professionalism is implemented through the application of progress in science and

technology, as well as through the application of moral and ethical values.
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The implementation of qualified services needs support from application of various

medical progresses in science and technology. To materialize health services like
that, it is clear that development of health human resources is deemed to be very
essential. Professional health services cannot be realized when they are not supported
by executing manpower, i.e. health human resources that follow the state of the art of
science and technology.

Moreover, for the implementation of qualified health services, it should also be

supported by the application of high professional moral and ethical values. For the
realization of health services like that, all health manpower are demanded to always
revere professional oaths and code of ethics. Conducts being demanded from health
manpower as stated above need periodic supervision through cooperation with
various professional organizations.

For the implementation of professionalism strategy, the following should be carried

out: determination of standards of competence of health manpower, training based on
competence, accreditation and legislation of health manpower, and other quality
improvement activities.

3. Public Health Maintenance Assurance (JPKM)

In order to consolidate public autonomy in healthy life style, public participation

needs to be supported as broad as possible, including participation in funding. JPKM
which is principally a structure of subsystem within health funding in the form of
public fund mobilization is a real shape of the public’s participation, when it is
successfully implemented will have a great role as well in accelerating equality and
accessibility of health services.

In the context of health service sub system structuring, the strategy of JPKM will be
prioritizing promotive and preventive services, which when successfully implemented
is assumed to be more effective and efficient in keeping and promoting health level
beside it will also bring positive influence as well in improving health service quality.

For implementation of the strategy, socialization, orientation, campaign and training

to all related sides will be done so that they understand the concept and program of
JPKM. Beside that, rules and regulations, training of JPKM executing agents, and
JPKM cultivation unit development will be constructed so that JPKM strategy can be
well implemented.

4. Decentralization

For the success of health development, arrangement of various health efforts should
start from the problems and specific potentials of each region.

Decentralization, whose core is delegation of greater authority to the regional

governments in regulating their own governance system and local affair is in fact
seemed to be more suitable for the management of various national development in
the future.
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It is a certainty that for the success of decentralization, various preparations is

necessary, including the utmost important are the organizational wares and the human
resources.

For the implementation of decentralization will be done analytical activities and

determination of roles of the central and regional governments in health sector,
determination of health efforts that should be run by the regions, analysis of regional
capabilities, upgrading of regional human resources, training, repositioning of
manpower and other activities so that decentralization strategy can be implemented
concretely.

Health Development Programs

Program Principals of Health Development

In line with the situation, problems and trends being faced and by putting attention to the
direction, aims and targets as well as policies and strategies of health development
already decided, which in principle is putting more emphasis on health promotion and
maintenance efforts and attention is also put on the availability of health resources in the
future, then health development programs are grouped into program principles whose
implementation is done integrally with development of other related sectors as well as
with the support from the society.

Therefore mentioned program principles of health development are:

1. Program Principle of Healthy Behavior and Society Empowerment

This program principle is aimed at empowering individuals and society in health sector
through the increase in knowledge, positive attitude, behavior and active role by
individuals, families, and society according to local social cultures in order to maintain,
increase and protect their own health and environment towards healthy autonomous, and
productive society.

The target of this program principle is realization of individual and society empowerment
in health sector which is indicated by improvement in healthy living behavior and active
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role in maintaining, increasing and protecting self and environmental health according to
the local social cultures.

The focus of the program in terms of healthy living style change and society
empowerment is the maternal and child health, nutrition conscious family, anti tobacco,
alcohol and hashish, accident and injury prevalence, occupational safety and health,
mental health, environmental health, life style including exercise and physical fitness.

Programs included in this program principle of behavior, health and society

empowerment are among others as follow:

1.1. Healthy Behavior Improvement Program

This program is aimed at increasing the number of mothers, families, students, schools,
workers, work places, users of public places, health institutions, consumer groups, health
institution’s personnel, society members, and community institutions that practice the
clean and healthy life styles.

The target to be reached is the increase in clean and healthy living behavior according to
the target groups and social cultures at the households, schools, work places, public
places (worship places, recreation and hobby parks, markets, stations, harbors, airports,
entertainment places, restaurants, etc.) at the health arrangements, at the public
arrangements.

Activities to be done are:

(1) Investigation on healthy behavior and social cultures at households, schools, work
places, public places, healthy institutions, and general public arrangements.
(2) Development of strategies and interventions at households, schools, work places,
public places, healthy institutions, and general public arrangements.
(3) Development of communication, information and educational media for various
arrangements (households, schools, work places, public places, healthy institutions,
and general public arrangements).
(4) Development of effective communication, information and educational techniques in
accordance to targets at various arrangements.
(5) Development of partnership network with programs, sectors, NGOs and related
organizations to get support for the implementation of clean and healthy living
behavior programs at various arrangements; and
(6) Development of method, instruments for maintenance and monitoring, as well as
indicators of success.

1.2. Anti Tobacco, Alcohol and Hashish Program

This program is aimed at changing behavior and empowering the society in order to
decrease the morbidity and mortality due to diseases caused by smoking, alcohol and
hashish. While the specific aims are:
(a) to reduce abuses of alcohol, prohibited drugs/ narcotics;
(b) to increase awareness of the danger and effect of smoking, alcohol and narcotics,
mainly among school aged adolescents, pregnant women and groups using drugs/
narcotics;
(c) to increase consultative access for sufferers/ workers to get guidance in overcoming
problems of drugs/ narcotics abuse; and
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(d) to develop policies to overcome drugs/ narcotics abuse and to increase involvement of
basic service providers in helping overcome drugs/ narcotics problems.

Targets of this program are:

1) decline in mortality rate due to diseases caused by smoking, alcohol and hashish;
2) decline in prevalence of smokers, abusers of drugs/ narcotics;
3) increase in awareness of the danger of smoking and side effects of prohibited drugs/
narcotics, especially among school aged adolescents, pregnant women and drugs/
narcotics user groups;
4) increase in smoke free zone at schools, work places and public areas;
5) increase in consultative access for sufferers/ workers to get guidance to overcome
problems of drugs/ narcotics abuse;
6) creation of policies to overcome drugs/ narcotics abuses and to increase involvement
of service providers in helping overcome drugs/ narcotics abuses.

Activities of this program are:

1) to do instruction on importance of awareness in danger of smoking and side effects of
prohibited drugs/ narcotics, smoking free zones at schools, work places and public
areas;
2) to offer consultative service for sufferer/ workers to get guidance to overcome
problems of drugs/ narcotics abuse problems, and stop smoking service; and
3) to formulate policies/ regulations to overcome drugs/ narcotics abuses and to increase
involvement of basic service providers in helping overcome drugs/ narcotics abuses
and to increase involvement of service providers in helping overcome drugs/
narcotics abuses.

1.3. Program of Accidents and Injuries Prevention

This program is aimed at changing behavior and empowering the society to prevent
accidents and injuries at the houses, streets, schools, work places, and public areas; and
developing policies/ regulations in the prevention of accidents and injuries from
occurring.

Targets to be reached through this program are the decline of mortality and disability
rates due to accidents and injuries and to prevent the occurrence of accidents and injuries
at the houses, streets, schools, work places, and public areas; and developing policies/
regulations in the prevention of accidents and injuries from occurring.

Activities of this program consist of:

(1) to develop policies and regulations for the prevention of accidents and injuries;
(2) to find and treat victims of accidents and injuries;
(3) to prevent risk factors and to manage accidents and injuries;
(4) to increase social awareness and ability in the prevention of accidents and injuries.

1.4. Public Mental Health Cultivation Program

This program is aimed at increasing public mental health by decreasing the prevalence
and impacts of mental disturbances, so that they no longer become public health
problems.
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Targets to be reached are:

(1) increase in public mental health, especially the adolescents and productive age
groups;
(2) cultivation of society empowerment through local community’s organizations in
guarding mental health and in overcoming impacts of mental disturbances in the
society.

Activities of this program are:

(1) formulation of policies to improve public mental health efforts which push and
consolidate decentralization;
(2) development of public and social organization participation in public mental health
efforts;
(3) development and consolidation of mental health services from and to the general
health facilities in the society, puskesmas and hospitals including psychiatric liaison
services;
(4) education and training of health workers in mental health services at general health
service facilities, puskesmas and hospitals;
(5) compilation and application of regulations, standards, guidelines of mental health
services at general health facilities, including management of victims of addictive
substance abuse in the governmental or private health service institutions;
(6) development of day care services in medical and psychosocial rehabilitation either
intra or extra mural one;
(7) co-operation with related sectors in job assisting and training, vocational
rehabilitation for psychotic patients who have undergone psychiatric medical
rehabilitation;
(8) improvement of compilation and dissemination of mental health information to the
public, it is integrated with health promotion especially mental health promotion;
and
(9) development of holistic family mental health program, starting from pre marital,
during pregnancy, post labor, preschool and school aged children.

1.5. Sports Health and Physical Fitness Program

This program is aimed at improving public health level through the improvement of
public sports health and physical fitness.

Targets to be reached through this program are:

(1) increase in public awareness to do sports properly and rightly, sports health service to
the public, and development of sports health;
(2) implementation of physical fitness level mapping in Indonesia gradually and
continuously;
(3) formation of Public Sports Health Office in the provinces potential to become center
for development, cultivation and instruction of sports health.

Activities of this program consist of:

(1) development of sports health science and technology;
(2) formation of Public Sports Health Office in the potential provinces;
(3) increase in work force ability through education and training;
(4) guidance and cultivation in sports health;
(5) development of sports health service to the public;
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(6) development of sports support facilities.

2. Healthy Environment Program Principle

This program principle is aimed at achieving living environment quality that is healthier
to be able to protect the society from the dangerous threats from environment, so that
optimal health level of individuals, families and society can be reached.

Targets to be reached through this program is the increase in living environment’s quality
and the will and ability of individuals, families and society as well as the government in
planning and implementation of development with health concerns.

Programs included in the healthy environment program principle are among others:

2.1. Healthy Zones/ Areas Program

This program is aimed at the formation of district/ municipal condition that is safe,
comfortable and healthy for the living of its residents through optimal improvement of
quality of the physical and social cultural environments in order to support productivity
and economy of the region.

Healthy zones/ areas program is a program which originates from the will and need of the
society and which is managed by the society, while government is only taking part as a
facilitator and motivator. This program is prioritizing process approach rather than target,
it has no time limit, and developing dynamically and gradually according to targets
expected by the society.

Targets to be reached through this program are:

(1) formation of forum that is able to form cooperation and aspiration between the
society, government and private sides;
(2) implementation of efforts to increase physical, social and cultural environments by
maximizing resource potentials autonomically;
(3) implementation of working pattern and mechanism between various related sides;
(4) achievement of society’s productivity and regional economy that is able to improve
public life and living better;
(5) achievement of government’s performance that is oriented to general public interests.

Implementation of healthy zones/ areas program in each region is based on local

problems, starting from problem priority as stated in the approach pattern selected by the
zones/ areas, followed by formation of a forum as an institution for the society. So each
region has different municipal/ district programs which can be grouped as the following:
(1) Healthy environment such as the blue sky, clean river, flood control program, etc.;
(2) Urban infrastructures which are safe and healthy;
(3) Healthy living behavior;
(4) Healthy social life;
(5) Healthy industrial estates;
(6) Healthy tourism areas;
(7) Development of education with health concerns; and
(8) Healthy villages (environment, infrastructures, social life, health services, food
supply and nutrition assurance).
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The activities of this program consist of:

(1) determination of related standards and requirements as well as regulations;
(2) compilation of general and technical guidelines;
(3) socialization of cross-sectoral/ program and promotion and dissemination of programs
to the regions;
(4) formation of healthy town/ district/ village working groups;
(5) empowerment of activity executors;
(6) compilation of plans according to local problems and implementation of programs;
and
(7) development of healthy areas/ zones information system.

2.2. Occupational Health Safety Program

This program is aimed at improving healthy environment quality at the work places at the
office and industry so that the employees at both places and the surrounding society can
be avoided from diseases due to occupation, accidents and environmental pollution.

Targets of this program include among others:

(1) all industries producing wastes have the ability to process the wastes safely and
healthily;
(2) 75% of work places (offices and industries) do not produce health troubling noises;
(3) all work places (offices and industries) do not produce radiation;
(4) decline in pesticide exposure at work places and industries, and achievement of
qualified pesticide processing places up to 100%;
(5) formation of institution cultivating occupational health and safety;
(6) increase in comprehensive occupational health and safety services;
(7) fulfillment of conditions for occupational health at various occupations;
(8) increase in autonomy for healthy life among workers and cultivation of healthy
norms in the works;
(9) increase professionalism of cultivators, implementers, motivators and supporters of
occupational health and safety programs; and
(10) erection of laws and implementation of occupational health and safety information
system.

Meanwhile, the activities of this program include among other things the following:
(1) determination of standards and requirements of health;
(2) supervision of environmental health quality, data collection and classification;
(3) instruction and campaign of hygiene and sanitation;
(4) supply and development of instruments and media for instructions;
(5) monitoring and evaluation;
(6) development of occupational health services network;
(7) formation of work group motivators and healthy productive work group incentive
system;
(8) development of occupational health at health service facilities;
(9) compilation of rules and implementation of occupational health conditions, increase
of professionalism through education, training and positioning of occupational
health experts at the regions; and
(10) development of occupational health and safety information system.
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2.3. Public places Hygiene and Sanitation Program

This program is aimed at environmental quality increase at the public places that meet the
healthy requirements so that the society is protected from contagious diseases, poisoning,
accidents, environmental pollution and other health troubles.

Targets of this program include among others the following:

(1) 75% of hotels and other boarding places meeting the healthy requirements;
(2) 75% of catering services, restaurants, and other food processing places meeting
healthy requirements;
(3) 50% of recreational parks and other entertainment places meeting healthy
requirements;
(4) all hospitals and other health service facilities meeting healthy requirements;
(5) 50% of praying facilities and educational facilities meeting healthy requirements;
(6) 50% of public transportation facilities and infra structures meeting healthy
requirements;
(7) 50% of other public facilities meeting healthy requirements.

Activities of this program include among others the following:

(1) determination of health standards and requirements;
(2) development of methods and tests;
(3) supervision, investigation and problem solution/ follow up;
(4) danger analysis of critical control points at food handling processes;
(5) analysis of environmental health impacts;
(6) accreditation/ grading of facilities and infra structures;
(7) improvement in human resource quality;
(8) instruction, stimulant and model offering;
(9) formation and development of groups, cadets, associations and the like;
(10) formation of PPNS and its application; and
(11) development of TTV information system.

2.4. Healthy Settlement Area and Building Program

This program is aimed at increasing environmental quality of settlement areas, housing

and building in order to meet healthy requirements.

Targets to be reached through this program are:

(1) achievement of 75% settlement areas meeting healthy requirements at urban and 60%
at rural areas;
(2) achievement of 75% housing areas meeting healthy requirements at urban and 60% at
rural areas;
(3) achievement of 75% house buildings meeting healthy requirements at urban and 60%
at rural areas;
(4) achievement of human/ closet wastes disposal facilities meeting healthy requirements
and their utilization to 100% either at urban or rural areas;
(5) achievement of utilization and supervision of final rubbish disposal location (TPA)
and temporary rubbish disposal location (TPS) meeting healthy requirements to
100%;
(6) achievement of fly control and environmental pollution at TPA and TPS to 100%;
(7) achievement of supervision of pesticide processing areas (TP2) to 100%; and
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(8) achievement of clean and healthy living behavior implementation to 60% among
women having under 5 years children, school children, and teachers, public figures,
religious figures, and youth groups at urban area and 40% at rural areas.

Activities of this program are:

(1) determination of health standards and requirements;
(2) instruction and campaign about hygiene and sanitation;
(3) offering model and stimulants;
(4) supervision, investigation and follow up of sanitation and environmental health
impact analysis (ADKL);
(5) formation of fora, cadets and work groups;
(6) supply and development of instruments and media for instructions; and
(7) development of environmental health information system.

2.5. Water Sanitation Program

This program is aimed at to increase safeguarding of water quality for various needs and
human life for all the people at rural or urban areas.

Targets to be reached through this program are:

(1) increase in coverage of clean water utilization at urban to 100% and at rural to 85%;
and
(2) achievement of bacteriologic quality of potable water to 80% and clean water
bacteriologic quality to 70%.

Activities of this program consist of:

(1) regulation and standardization of water quality;
(2) water quality supervision;
(3) water quality improvement;
(4) increase of participation of water consumer society;
(5) increase of capability of environmental health management personnel;
(6) supply and development of instruments;
(7) development of methods and tests for water sanitation; and
(8) development and consolidation of water sanitation information system.

Water quality supervision activities are also aimed at doing surveillance of water quality
including pollution sources by various types of water (ground water, surface water, waste
water) and other substances influenced by water pollution.

Innovative efforts to be done in accelerating the achievement of program’s targets are

through: clean rivers, sanitation clinics, sanitation weeks; clean Friday movement (GJB);
water quality examination using H2S method; correction and construction of clean water
facilities and environmental sanitation (SAB-PL) at religious education places/ pesantren,
at isolated community dwelling places; at social sanctuary at post outbreak areas, at
puskesmas; environmental health model village (DPKL), participatory hygiene and
sanitation transformation (PHAST); and Village Sanitation Work Force (TSD).

3. Health Efforts Program Principle

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The aim of health effort program principle is to improve the equality and quality of
health efforts which are successful and effective and accessible by all members of the
society.

Target of this program is the availability of basic and referral health services from either
the government or the private, which are supported by society participation and
prepayment system. The main attention is given to development of health efforts with
high leverage towards improvement of health level.

Programs included in the health efforts program principle are among others as the
following:

3.1. Contagious Disease Eradication and Immunization Program

a. Contagious Disease Eradication

This program is aimed at decreasing morbidity, mortality and disability from contagious
diseases and preventing dissemination and decreasing social impacts of diseases so they
would not become health problems.

Targets to be reached through this program are:

(1) decline in morbidity of DHF at endemic sub-districts to less than 20 per 100.000
persons and nationally to 5 per 100.000 persons, and its CFR at the hospital
declines to less than 1%;
(2) decline in morbidity of malaria (API) in Java-Bali-Binkar-Lombok-Industrial tourism
areas to less than 1 per 1000 persons and decline of its mortality by 75%;
(3) achievement of cure rate of more than 85% and coverage of lung TB case finding
more than 70%;
(4) prevention of the increase of HIV infection to not more than 1%, decline in
prevalence of syphilis to less than 1%, and decline in gonorrhea incidence to 10%
among the high risk groups;
(5) decline in mortality from pneumonia among under 5 years old from 5 per 1000 to 2
per 1000, and decline in morbidity by 50%;
(6) decline in mortality from diarrhea among the under 5 years old from 2,5 to 1 per
1000 of the under-5 years old;
(7) more significant decline in morbidity and mortality from other contagious diseases as
leprosy, helminthiasis, rabies, fillaria, schistosomiasis, anthrax, plaque;
(8) prevention of outbreaks; and
(9) increased knowledge and awareness of the society in regards of contagious diseases
so that they would increase participation in their eradication.

Activities of this program consist of:

(1) case finding and treatment either actively or passively and case management in all
units of health services;
(2) prevention and management of risk factors and management of disability;
(3) management of early warning system and settlement of focus and outbreaks;
(4) increased skills of personnel in puskesmas and hospitals in case management;
(5) instruction, survey and operation-research; and
(6) increased information dissemination (KIE) about contagious diseases.
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b. Immunization

This program is aimed at prevention against the occurrence of contagious diseases and
decreasing the morbidity and mortality from diseases preventable by immunization
(PD3I) so they would not become public health problems.

Targets to be reached through this program is the decrease in morbidity and mortality
rates from diseases preventable by immunization among all levels of society with priority
on infants, school aged children, reproductive aged women (including pregnant women)
and other high risk groups.

Activities of this program consist of:

(1) standardization and implementation of immunization of polio, measles, diphtheriae,
pertusis, tetanus, BCG, hepatitis B, and other diseases which already have vaccines;
(2) observation and management of post immunization sequelae;
(3) development of immunization operationally and development of immunization with
new vaccines; and
(4) monitoring and evaluation of program and result of immunization program.

3.2. Non-contagious Disease Prevention Program

This program is aimed at decreasing the incidence and prevalence of non-contagious

diseases including dental illness so they no longer become public health problems.

Targets to be reached through this program are:

(1) significant decrease in incidence and prevalence of heart disease, diabetes mellitus,
cancer, injuries, and dental illnesses including decayed mixed filled teeth (DMF-T)
and caries and periodontal diseases;
(2) availability of information about risk factors of various non contagious diseases;
(3) achievement of optimal dental health level; and
(4) development of public participation through local community’s organization in
promoting healthy life style related to non contagious diseases.

Activities of this program consist of:

(1) observation of non contagious diseases, among others cardiovascular diseases,
diabetes mellitus, cancer, injuries and dental diseases;
(2) collection, compilation and dissemination of information about risk factors of non
contagious diseases;
(3) prevention and settlement of risk factors and management of disability;
(4) caring and curing dental diseases which are of basic emergency, general or
specialistic nature;
(5) organizing local society participation in promoting healthy life style related to
prevention of non contagious diseases including dental diseases; and
(6) monitoring and evaluation.

3.3. Disease Curative and Health Rehabilitative Program

a. Basic Health Care Program

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This program is aimed at increasing, consolidating, maintaining the coverage and even
distribution as well as increasing quality of puskesmas health service and increasing
utilization of puskesmas services by the society leading to the improvement of optimal
public health level.

Targets to be reached through this program are:

(1) compilation of policies and concept of program management supporting
decentralization;
(2) increased service quality and public satisfaction toward puskesmas health service;
(3) decreased morbidity and mortality;
(4) compilation of improvement in program managerial procedure and puskesmas
management;
(5) increased utilization of puskesmas health service facilities by the public;
(6) increased quality and equality of health services;
(7) accessibility of the society living in special regions and health susceptible regions.

Activities in this program consist of:

(1) compilation of basic concept of improvement in puskesmas health efforts and policy
consolidation as well as management of basic health service program supporting
decentralization;
(2) development of quality assurance program and rational treatment program;
(3) increased mechanism and support to referral activities;
(4) increased reach of services to health susceptible social groups e.g. the community at
urban slum areas, isolated societies, poor people, etc. and to the communities in
special regions e.g. remote areas, new settlement, border zones etc.;
(5) work force training;
(6) development of public institution in health sector and public empowerment in health
development;
(7) increased role of NGO and business community in health development;
(8) monitoring and evaluation.

b. Referral Health Service Program

This program is aimed at increased consolidation and maintenance of the reach and
equality as well as quality of referral health service toward the optimal public health level
improvement.

Targets to be reached are:

(1) all hospitals have the ability to offer holistic comprehensive service in line with their
respective class hence they can face regional and global demand;
(2) realization of hospitals as a place for human resource development in health sector,
for research, screening and application of health science and technology and as
pioneer of development with health concerns according to their respective class;
(3) development of ability and consolidation of hospitals’ autonomy in referral health
services, including medical referral, health referral and managerial referral; and
(4) realization of hospitals as motivators of society so they can protect, maintain and
improve the health of individuals, families, and society.

Activities of this program consist of:

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(1) formulating the revision of the basic concept of referral health efforts and policy
consolidation as well as management of referral health service program, to support
hospital autonomy and decentralization;
(2) development and consolidation of quality assurance program and rational treatment
in the hospitals;
(3) increased coverage of services to the poor people through development and
application of policy of subsidy that is accurately targeted;
(4) education and training of health manpower;
(5) research and screening of medical technology;
(6) motivating public participation in protection, maintenance, and improvement of
health; and
(7) monitoring and evaluation.

3.4. Supportive Health Service Program

This program is aimed at increasing productivity, capability, quality, reach, effectivity

and efficiency in supportive health services, increasing referral and supportive health
service facilities in order to increase public health level.

Targets of this program are:

(1) availability of supportive facilities and infrastructures and BPFK;

(2) workers in places with high risk conditions do not suffer from occupational diseases
and accidents;
(3) realization of national referral health laboratory for service activity and development
of health laboratory technology;
(4) development of public health laboratory in all districts to support health improvement
efforts and prevention of diseases;
(5) increased laboratory service capability at puskesmas, hospitals, health laboratory
office and other health laboratories according to programs needed in the region;
(6) development of health laboratory information system.

Activities of this program consist of:

(1) identification of K3;

(2) increasing the ability and institution of BPFK;
(3) development of efforts in safeguarding, maintaining, testing and calibrating basic and
referral health service facilities;
(4) doing preventive program in the form of early examination for workers;
(5) formation of national referral health laboratory;
(6) compilation and determination of standard and method of laboratory service;
(7) accreditation of health laboratory and quality assurance in all aspects for all areas of
laboratory examinations and reaching all types of laboratories in all service levels;
(8) renovation and rehabilitation of buildings and facilities for service and safety of
laboratory at puskesmas, hospitals, health laboratory office and other health
laboratories;
(9) increased maintenance, utilization of laboratoric instruments at puskesmas, hospitals,
health laboratory office and other health laboratories;
(10) supply of technical manpower and laboratory expert manpower;
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(11) technical training for laboratoric manpower in various areas and types of expertise
for various types and grades of laboratories;
(12) supply of simple laboratoric kit for midwife at village and to optimize midwife’s
role at village in health laboratoric service;
(13) supply of laboratory operational materials for examination, quality assurance and
safety of laboratories at puskesmas, hospitals, health laboratory office and other
health laboratories;
(14) implementation of inspection activity by gradation for public laboratory service,
clinical laboratory, and up grading of science and technology, doing technical
cultivation by laboratory in higher service grade to those below it, and from more
capable laboratory to those less capable; and
(15) increase in health laboratoric information system.

3.5. Cultivation and Development of Traditional Treatment Program

This program is aimed at increasing the utilization of traditional medicines and methods
which have been proved safe and effective either by itself or being combined in a
comprehensive health service, and protecting the society from negative effects of
traditional treatment.

Targets of this program are:

(1) increased public autonomy in terms of overcoming health problems using traditional
treatment efforts;
(2) expansion of exploration, study, research and testing of various traditional treatments;
(3) increased utilization of various traditional medicines and treatment methods which
have been proven safe and efficacious either through health service network (from
household, society, puskesmas and hospital) or individual; and
(4) consolidated cultivation of traditional treatment at each administrative level.

Activities of this program consist of:

(1) Formation and cultivation of the Center for Development and Application of
Traditional Treatment (Sentra P3T). The activities include consolidating the
functions of study, research, testing, education, training and service of traditional
treatment;
(2) Selection, testing, certification, registration/ licensing traditional treatment
manpower;
(3) Standardization of the traditional methods which have been proven safe and
effective;
(4) Standardization and licensing of traditional treatment practices and expansion of
usage scope of traditional treatment methods which have been proven safe and
effective as self effort and through health service facilities (puskesmas, hospital,
and the like);
(5) Development of information network and documentation of traditional treatment;
(6) Utilization of medicinal plants from TOGA (household medicinal yard);
(7) Inventory, screening, clinical testing, utilization and evaluation of traditional
medicine;
(8) Exploration, analyzing, documentation of traditional medicines from the national
precious inheritance in various regions in Indonesia;
(9) Compilation of laws on traditional treatment;
(10)Training of health and non-health manpower and educating graduates and post-
graduates in traditional treatment; and
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(11)Compilation of information system and dissemination of information on traditional

treatment, and guidance-control-supervision.

3.6. Reproductive Health Program

This program is aimed at increasing the health level of mothers, children, adolescents, the
reproductive age, and elderly so as to create an optimal reproductive health.

Targets of this program are:

(1) birth attendance done by health worker reaches 90%;
(2) management of obstetric cases/ complications at least 12% of all labors;
(3) contraceptive service on 60% of reproductive age couples, cultivation of neonatal
health reaches 90%;
(4) cultivation of the under 5 years old children and preschool children reaches 80%;
(5) cultivation of school health efforts at primary school (SD) and Madrasah Ibtidaiyah
reaches 100%, at secondary school (SLTP) and Madrasah Tsanawiyah reaches 50%
of the schools and at senior high school (SLTA) and Madrasah Ahliah reaches 45%
of the schools;
(6) 50% puskesmas offer health service for shcool age children and adolescents outside
the school (the study club, ‘pondok pesantren’, study group); and
(7) 60% puskesmas do cultivation of the elderly health.

Activities of this program consist of:

(1) arrangement of maternal health efforts;
(2) arrangement of children and adolescents’ health efforts;
(3) arrangement of the reproductive age’s health efforts;
(4) arrangement of elderly’s health efforts.

3.7. Nutritional Improvement Program

This program is aimed at increasing the society’s and institution’s nutritional state in
order to increase autonomy, intellectuality and productivity of human resources.

Targets of this program are:

(1) declined prevalence of total protein energy deficiency (KEP) to at most 16% of the
projected achievement of Pelita VI i.e. 30%;
(2) prevalence of disturbance due to iodine deficiency (GAKY) based on total goiter rate
(TGR) declines from 18,0% to 13%, and new cretinism case is not found;
(3) prevalence of nutritional anemia among pregnant women drops to 20%, among the
under 5 years old to 16% and among female workers to 13%;
(4) society is freed from vitamin A deficiency problem;
(5) at least 80% nursing women breast feed exclusively;
(6) 80% adolescents in urban area and 70% adolescents in rural area have normal body
height;
(7) increased number of population consuming balanced nutrition and decreased number
of population suffering from malnutrition or over nutrition; and
(8) increased variability in food consumption towards food self-sufficiency.

Activities of this program consist of:

(1) public nutrition instruction, settlement of KEP and chronic energy deficiency (KEK);
(2) settlement of GAKY;
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(3) settlement of iron deficiency anemia; settlement of vitamin A deficiency;

(4) settlement of micro nutrients;
(5) settlement of over nutrition;
(6) cultivation and improvement of nutritional state; and
(7) consolidation in implementation of food and nutrition surveillance system.

3.8. Dimensional Health program

This program is aimed at increasing awareness, willingness and ability of individuals in

facing dimensional conditions which change significantly, so as they remain survive in
their life and do their activities, and can overcome problems autonomically without
depending on others’ help.

Targets of this program are:

(1) increased number of individuals and social groups capable of survival in their healthy
conditions and in the changing dimensional conditions either in the sea, under the
sea, in the space as well as in the field; and
(2) the recovery of enviromental conditions and dimensional aspects toward their normal
situations after unwanted changes.

Activities of this program consist of:

(1) Dissemination of information and education on dimensional health to related sides
and the society;
(2) Preparation of resources including manpower (healthy and non health, and skilled
community);
(3) increased early warning system by all sides including the public; and
(4) Recovery efforts through intervention either toward environmental condition or the
human being.

3.9. Epidemiologic Surveillance Development Program

This program is aimed at preparing information for planning, executing, monitoring,

evaluation of health program and improving awareness at all levels of health
administration.

Target to be reached through this program is the availability of information to all health
programs either promotive, preventive, curative or rehabilitative.

Activities of this program consist of:

(1) collecting and processing as well as analyzing data systematically and continually;
(2) presenting and disseminating analysis results and surveillance interpretation to those
requiring them; and
(3) development of surveillance system.

3.10. Humanity Aids and Disaster Settlement Program

This program is aimed at to avoid human and environment from aftermath of disaster
caused by human behavior or natural cause, through surveillance effort, disaster
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prevention and settlement which are done integrally with active participation from the
society.

Targets of this program are:

(1) increased number of individuals of society groups being able to survive in their
healthy condition after being exposed to disaster condition; and
(2) maintenance and recovery of environmental condition and dimensional aspects
toward normal condition after disaster.

Activities of this program consist of:

(1) increasing the early warning system;
(2) transfer of information and identification of needs;
(3) environmental and food sanitation;
(4) monitoring local area (PWS) including observation of diseases;
(5) medical intervention and care;
(6) immunization;
(7) evaluation and referral;
(8) rehabilitation;
(9) registration and reporting.

4. Health Resource Program Principle

This program principle is aimed at to increase the number, quality and dissemination of
health manpower, to increase the number, effectivity and efficiency in using health fund,
and to increase supply and production of qualified and safe raw materials and finished
drugs.

Targets of this program principle are:

(1) availability of various health manpower according to the policies of health paradigm;
and
(2) development of prepayment system in the form of JPKM and availability of qualified
and safe raw materials and finished drugs according to needs.

Programs included in this program principle are among others the following:

4.1. Health Manpower Planning, Utilization, Education and Training Program

This program is aimed at to create health manpower that is expert and skilled according
to progress of science and technology, faithful and devoted to The Only God, and tightly
keeping dedication to the nation and state as well as the professional ethics in adequate
number and quality so as to be able to implement the health development.

The main target of this program is availability of various health manpower from the
society including the private and government that can fully implement health efforts
based on health paradigm where health maintenance and promotion and disease
prevention are being prioritized.

The main objective of this includes 3 targets as the following:

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(1) existence of policy and plan in health manpower development from the society and
government in all levels, that can offer direction regarding the implementation of
development in a specific, integrated and continuous way;
(2) utilization of existing health manpower and progression of career cultivation of all the
health manpower; and
(3) functioning of the education and training of health manpower that puts priority on
development of the educational participants in order to improve professionalism.

Activities of this program consist of:

(1) planning and evaluation of health manpower includes:

(a) increased planning capability of health manpower at all levels, either those
from government or society elements;
(b) increased interaction, interrelation and interdependence among elements of
development of health manpower from the society and government; and
(c) increased health manpower information system integrally and utilization
for the development of health manpower as a whole;
(2) management of health manpower includes:
(a) increased managerial capability of health manpower in all levels either
those from the government or the society’s elements, especially in relation to
the program of decentralization, globalization and modernization of managerial
administration of health manpower;
(b) increased arrangement of the required health manpower distribution
together with professional and social organizations; and
(c) development of career cultivation and it is gradually matched between
both; and
(3) education and training of health manpower includes:
(a) change in the approach of education and training of health manpower from
the society including the private and government so as to produce educational
participants that are able to support health development based on the health
paradigm;
(b) increased cultivation and educational resources and training for all health
manpower that are directed to improve quality of education and training; and
(c) increased education and training efforts that can support career cultivation
of all health manpower.

4.2. Public Health Maintenance Assurance (JPKM) Development Program

This program is aimed at assuring health maintenance of each people by being member of
a JPKM effort, either that run by the government or private.

Targets of this program are:

(1) increased percentage of population that become members of JPKM;
(2) increased number of corporates (government/ private) conducting JPKM efforts;
(3) availability of qualified comprehensive health service provider network, either from
the government or private, according to JPKM needs;
(4) increased number of family physician service networks as the organizer of JPKM
health service that offers qualified and comprehensive services; and
(5) realization of cultivation and supervision upon JPKM organization.
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Activities of this program include:

(1) development of participation through socialization of JPKM to all layers of the
society;
(2) development of Executing Bodies (Badan Pelaksana) through promotion of JPKM to
the business community so as to take part in JPKM development;
(3) development of health service organizers (PPK) through promotion of JPKM to
health service networks so as to increase quality of service as the PPK of JPKM;
(4) development of family physicians as PPK at level I for services that are more oriented
to promotive and preventive in order to increase family health of JPKM
participants; and
(5) consolidation of cultivation and preparation of resources in order to support JPKM
development.

4.3. Health Inventories and Facilities Development Program

This program is aimed at to increase availability of health facilities and inventories in

order to improve, consolidate and maintain the reach and equality as well as quality of
health service to the society.

Targets to be reached through this program are among others:

(1) availability of basic, referral health service facilities with the service supports that are
equal, accessible and being utilized by the society;
(2) availability of health instruments either medical or non-medical ones that are truly in
line with society’s needs for health service; and
(3) availability of adequate health inventories in types or number that are suitable to local
problems and society’s needs for health service.

Activities of this program consist of:

(1) physical realization/ construction and improvement of health facilities for basic,
referral health services and their supports;
(2) supply of health instruments either medical or non-medical ones that are required in
the implementation of health service for the society;
(3) improvement/ consolidation in administration of equipment and management of
instruments to support accreditation effort of health service facilities; and
(4) supply of health equipment that fulfill the needs for health service including
medicines, vaccines, insecticides, reagents and other consumables.

5. Program Principle of Medicines, Foods, and Dangerous Substances

This program principle is aimed at to protect the society from:

(a) danger of abuse and misuse of medicines, psychotropics, narcotics, addictives
(NAPZA) and other dangerous substances; and
(b) usage of pharmaceuticals, foods and health instruments that do not meet quality or
safety requirements.

Targets of this program principle are:

(1) prevention and safeguarding the distribution of pharmaceuticals, foods, and health
instruments that are illegal;
(2) assuring quality, safety and efficacy of pharmaceuticals, foods, and health
instruments that are permitted to be marketed; and
(3) increasing concerns of the society regarding risks of their usage.
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Programs included in Program Principle of Medicines, Foods, and Dangerous Substances

are as follow:

5.1. Program of Safeguarding against the Danger of Misuse and Abuse of

Medicines, Narcotics, Psychotropics, Other Addictives and Other Dangerous
Substances

This program is aimed at to safeguard the society from abuse and misuse of Medicines,
Narcotics, Psychotropics, other Addictives (NAPZA) that are permitted for marketing
and to prevent risks of poisoning from dangerous substances used by the society.

The target of this program is controlled production and distribution of medicines and
NAPZA, and stabilization of managerial system of dangerous substances.

Main activities conducted include among others:

(1) surveillance of illegal products;
(2) taking samples and laboratoric testing;
(3) safeguarding/ withdrawal from market;
(4) development of follow up system according to prevailing laws with related sector(s);
(5) development of standards of regulation and supervision according to progress in
science and technology;
(6) development of PPNS education with related sector(s);
(7) development of standardization in managing and safeguarding dangerous substances
at work place cross-sectoraly;
(8) motivating activities of coordination forum for the management and safeguarding of
chemicals cross-sectoraly;
(9) development of Poisoning Information System network in 27 provinces; and
(10) dissemination of information on toxicity and side effect of dangerous substances.

5.2. Program of Safeguarding and Supervision of Foods and Food Additives

(BTM)

This program is aimed at to assure the safety and quality of food products distributed in
the society and to protect the society from foods and food additives that do not meet
public health requirements.

Target of this program is to consolidate the system and to implement food safeguarding
so that food products in the society, including food products of home industries, are
assured in quality and safety.

Main activities to be done include among others:

(1) compilation and development of evaluation criteria and registration standards;
(2) regulation and supervision according to progress in science and technology including
supervision of genetic engineering in food production;
(3) evaluation of quality and safety of foods and food additives in the context of
registration;
(4) surveillance of the use of food additives in food products;
(5) taking samples and laboratoric testing of food products marketed throughout
Indonesia;
(6) safeguarding food products that do not meet requirements;
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(7) inspecting catering services;

(8) cultivation and supervision of the application of safe and qualified food production in
the home industries; and
(9) development of food safety system through the ‘food inspectors’ at districts/
municipalities.

5.3. Program of Drugs, Traditional Medicines, Cosmetics and Health

Instruments Supervision

This program is aimed at to assure quality, safety, efficacy of Drugs, Traditional

Medicines, Cosmetics and Health Instruments that are permitted to be marketed, to
prevent dissemination of product information that are not objective and to increase the
professional ability of food and drug testing laboratory in 27 provinces.

The target are that all products in the market meet the requirements according to those
permitted in the context of registration, that the public is avoided from dis-information
and that the PPOM/ BPOM laboratory’s testing ability is recognized by the international
accreditation system.

The main activities to be done include among others are the following:
(1) compilation and development of evaluation and registration criteria standards;
(2) evaluation on the efficacy, safety, quality testing and registration that is centralized;
(3) periodic re-evaluation of products already being registered;
(4) evaluation on the pre-marketing labeling, advertising information and promotion
claim;
(5) development of harmonization of regional and international registration;
(6) realization of good manufacturing/ production method implementation;
(7) certification of PBF distribution facilities;
(8) development of drugs’ side effects monitoring system;
(9) examination of products and distribution facilities either of private or governmental
sector;
(10) taking samples and laboratoric testing of pharmaceutical products, foods and health
instruments marketed in 27 provinces;
(11) investigating counterfeit cases, black market and violation in production and
distribution;
(12) examination of advertisement/ promotion materials;
(13) training personnel in investigation, examination of production and distribution
facilities;
(14) training of testing personnel;
(15) accreditation of province wide testing laboratories for drugs and foods;
(16) referral service laboratories; and
(17) supply of instruments, standard raw materials and testing animals.

5.4. Rational Drug Use Program

The aim of this program is to increase safety, benefit of drug use and optimize drug’s
efficacy to cost ratio.

The target of this program is the achievement of medical objective of drug use effectively
and safely; as well as efficacy in drug cost spending nation wide.
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Main activities to be implemented include among others the following:

(1) socialization of essential drugs concept;
(2) application and socialization of generic drugs use;
(3) empowerment of the pharmaceuticals and treatment committee in the hospitals;
(4) development and application of rational treatment guidelines in various service levels;
(5) arrangement of continuous education and training for health manpower;
(6) motivating the implementation with various related sides;
(7) implementation of supervision and cultivation systematically on essential drugs
concept and implementation; and
(8) motivating the eradication of unethical drug promotion.

5.5. Essential Drugs Program

The aim of this program is to assure the availability and accessibility of drugs nation
wide according to medical needs of the majority of population and individuals, and to
assure adequacy of generic essential drug needs for basic health service in governmental
sector.

Target of this program is the availability of drugs that are qualified, safe and effective
according to medical needs of the society and fulfillment of drugs for basic health
services and efficiency in drugs spending nationally.

Main activities included in this program are among others:

(1) to develop, monitor, evaluate and revise the tables of essential drugs periodically;
(2) to apply concept and to prepare drugs according to Essential Drugs Tables at the
health service facilities of governmental sector.
(3) to encourage private sector to apply essential drugs concept;
(4) to motivate application of essential drugs concept;
(5) to develop drug and health instrument’s needs master plan for various health
programs integrally;
(6) to determine prices’ ceiling and structure as a guide in drug purchase at the
governmental sectors;
(7) to compile and implement the essential health instrument tables concept for the basic
health services;
(8) to develop drug purchase guidelines for governmental sectors;
(9) to monitor and control essential drug stock at districts/ municipalities nationally;
(10) to prepare buffer stock at national level and very essential drugs for basic health
services;
(11) to develop drugs management system at districts/ municipalities; and
(12) to apply training and cultivation of drug management continually.

5.6. Indonesian Indigenous Drug Development and Cultivation Program

The aim of this program is to develop and increase Indonesian indigenous drugs which
have high quality and safety as well as have real efficacy that is strictly tested, and which
have been used widely for self treatment by the society or used in the formal health
services.

The target of this program is Indonesian indigenous drugs (OAI) to be developed and
utilized widely primarily in the formal health services and for export.
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The principle activities included in this program are:

(1) standardization of simplicia including the extracts of OAI;
(2) development of agri-medicine and cross-sectoral cooperation;
(3) leading the use of OAI phytopharmaceuticals in hospitals and puskesmas;
(4) mapping OAI and ethno-pharmacognoxy;
(5) construction of OAI information center;
(6) increasing export of OAI; and
(7) development of cooperation network between OAI industries and research institution
in environment.

5.7. Pharmaceutical Industries Cultivation and Development Program

The aim of this program is to strengthen the structure and competitiveness of Indonesian
pharmaceutical industries so as to be able to fulfill domestic drug needs and for export at
reasonable price and with international standard of quality.

The target of this program is to increase autonomy of the national pharmaceutical

industries including those producing medicinal raw materials that are economic and
efficient by using domestic resources.

The main activities included are among others the following:

(1) to restructure pharmaceutical industries by strengthening the interrelation and synergy
between the up-stream and down-stream industries;
(2) to develop business climate that is conducive with healthy competition;
(3) to offer various facilitation and incentives in order to increase export;
(4) strategic alliance of national pharmaceutical industries with multi national industries
to expand export; and
(5) to increase efficiency and competitiveness of pharmaceutical industries through
dynamic deregulation.

6. Program Principle of Health Policy and Management Development

In order to organize health efforts according to the vision, mission and strategies that
have been determined requires effective and efficient policies and management of
resources, so that an equal and qualified service can be reached. The resources consist of
manpower, finance, facilities, knowledge, technology and information. The supporting
resources required to reach the vision, mission and strategies are from the government
and society, including the private.
Programs included in the health policy and management development are among others
as the following:

6.1. Health Policy Development Program

This program is aimed at to develop national health policies that can response to the
public needs in reaching Healthy Indonesia 2010. Health policies in the future should be
based on facts and real situation in the society, policies that support cross-sectoral
cooperation by taking into consideration the efficiency and effectivity of intervention
programs, so that an efficient, effective, qualified and everlasting health system can be
achieved.

Targets of this program are:

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(1) the creation of health policies that can assure the achievement of health system that is
efficient, effective, qualified and everlasting, and at the same time attend to the
basic values of society empowerment, individual rights to get health service;
(2) the creation of health policies that go in line with the change in the state organization
and governance system in general and that support reform in all sectors, especially
the health sector; and
(3) availability of human resource in health sector that is capable of doing various
investigations on the existing health policies as a base for a political development.

Activities of this program consist of:

(1) institutionalization of health policy development either at the national or regional
level;
(2) increased ability of health policy development at national and regional levels;
(3) investigation of impacts of national development policies especially health policies
upon public health; and
(4) development of health policies at national and regional levels.

6.2. Health Development Management Developmental Program

This program is aimed at to increase the utility of health apparatus in supporting health
efforts implementation.

Specifically this program is aimed at:

(1) to increase planning and evaluation functions of health development;
(2) to increase management of financial administration and equipment;
(3) to increase organization and implementation of government’s general tasks and
development; and
(4) to increase the function of supervision, control and inspection.

Targets of this program are:

(1) the increasing perfectness of health planning system through area and sectoral
approach;
(2) changes in the organization and execution at various levels of administration
according to the principles of decentralization and good governance;
(3) organized financial and equipment administration that is efficient and flexible at all
health rows; and
(4) the creation of control supervision mechanism at all health rows.

Activities of the program consist of:

(1) to arrange area and sectoral health planning system;
(2) to increase the capability of health manpower in health planning especially manpower
in the districts/ municipalities;
(3) to make investigation on regional ability in the implementation of health
decentralization;
(4) to arrange the organization at government’s health rows;
(5) to arrange cross-sectoral cooperation system at health sector and to rearrange
government-private roles in health development according to health paradigm
concept;
(6) to perfectionate financial administration toward the creation of financial autonomy of
health facilities;
(7) to perfectionate equipment administration according to decentralization principle; and
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(8) to perfectiionate supervision and control mechanism, especially to strengthen civil

society’s role in supervising health development.

6.3. Health Laws Development Program

The health laws development program is aimed at to increase the role of laws in health
sector so that the health development toward Healthy Indonesia 2010 can run smoothly.

Targets of this program are:

(1) compilation of various legal wares in health sector comprehensively either those
related to health efforts or health resources;
(2) realization of inventories, academic investigation and analysis of all legal wares
related to organization of health efforts and health resources;
(3) availability of documentation in health legal sector and other sectors in one Legal
Documentation Network System;
(4) realization of dissemination of legal programs in health sector; and
(5) availability of instruments for the implementation of litigation and mitigation process
in the settlement of legal conflicts in health sector.

Activities of this program consist of:

(1) increasing the awareness of laws among health apparatus so the implication of health
efforts is according to prevailing rules and regulations;
(2) motivating public participation in the implementation of various health efforts;
(3) making various legal products to overcome health financing problems through JPKM;
and
(4) re-organization of various laws that are able to overcome barriers in the support of
reform programs of health sector, among others are the health manpower, health
facilities and hospitals.

6.4. Health Information System Development

This program is aimed at to develop health information system in order to create a health
information system that is comprehensive, effective, efficient in support of health
development toward Healthy Indonesia 2010.

The main target of this program is the availability of information that is accurate, timely,
complete and according to needs as a material for the process of decision making to
formulate health programs’ policies, planning, implementation, actuation, control,
supervision and evaluation at all levels of health administration.

Activities of this program consist of:

(1) consolidation and development of health information system management including
the regulation of health information system that is comprehensive through rules and
regulations as the stepping stone, organization of the reporting and registration
system of health services and resources in health sector, consolidation and
development of procedures for data collection and processing, as well as
stabilization and development of specifications of the hard and soft wares;
(2) consolidation and development of cooperation network that is dynamic, cross-
program and cross-sectoral, covering organization, coordination of structural or
functional data and information management, development of data and information
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communication network, construction of data base at each health administrative

level; and
(3) consolidation and development of data processing, analysis and information
presentation as well as its dissemination and utilization.

6.5. Surveillance and Epidemiology Development Program

This program is aimed at to prepare information for planning, implementation and

evaluation of health program at all health administrative levels.
The target to be reached through this program is the availability of information for all
health programs, i.e. promotive, preventive, curative and rehabilitative.
Activities of this program consist of:
(1) collection and processing as well as analysis of data systematically and continually;
(2) presentation and dissemination of the analysis results and surveillance data
interpretation to those requiring them; and
(3) development of surveillance system.

7. Program Principle of Health Science and Technology Development

Research and development program in health sector is aimed at to offer knowledge as

well as science and technology to support health development and especially to support
policy formulation, help health problem solving and overcome troubles in health program
implementation. Health research and development will be developed continually and be
decentralized so as to become part of the regional health management system.
Targets of this program are:
(1) further development of science and technology that is pushed to increase health
service, nutrition, drug utilization, contagious disease eradication and
environmental improvement;
(2) further development of research related to health economics in order to optimize
utilization of health funds either originating from the government or private, and
increase governmental contribution to health funding which is still limited; and
(3) implementation of research in social cultural field and healthy living behavior in
order to develop healthy life style and to decline existing public health problems.
Programs included in the program principle of health research are among others the
following:

7.1. Behavioral Improvement and Public Empowerment Research and

Development Program

This program is aimed at to offer input of science and technology in order to support
health development mainly in the support of policy formulation, help solve problems and
overcome troubles in the implementation of the behavioral improvement, public
empowerment and autonomy program.

Target to be reached through this program is to identify factors affecting communication

between health manpower and the public, types of information needed by society, and aid
model, cultivation and protection for the society so they can practice healthy and clean
life.

Activities of this program consist of:

(1) research on factors affecting communication between health workers and the society;
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(2) development of information package on balanced nutrition and healthy behavior for
the society;
(3) development of model of aids, guidance and protection for the society so they are
able to practice healthy behavior;
(4) development of modules on nutrition and health instruction toward healthy behavior;
(5) development of food package that is nutritious and safe for health;
(6) development of instruction modules on anti tobacco, alcohol and hashish;
(7) development of model on the prevention of (traffic) accidents and injuries;
(8) development of model on public participation; and
(9) development of model on health funding by the society.

7.2. Healthy Environment Improvement Research and Development Program

This program is aimed at to offer science and technology input in order to support health
development mainly to support policies formulation, help problem solving and overcome
obstacles in the implementation of environment health improvement program.

Target to be reached through this program is the identification of factors affecting living
environment’s quality, beside the willingness and ability of government and society
including the private in planning and implementing development with health concerns.

Activities of this program consist of:

(1) research on factors affecting disease contagiousity such as the cause, contagiousity
and source (agent, vector, reservoir);
(2) research on substances that pollute the environment (water, air, soil) and their impacts
to health;
(3) development of model of domestic and industrial waste processing;
(4) development of model of healthy environments such as the settlement areas,
industrial complexes, public places, tourism resorts, houses and buildings;
(5) research on the impacts of development and change of the ecosystem on health;
(6) development of applied technology, preparation of sanitary facilities in problematic
areas such as the coastal or swamp areas, moss fields, etc.;
(7) research on natural substances that are toxic and harmful to health;
(8) research on drug residu, dangerous substances, heavy metals in foodstuffs; and
(9) research on the impacts of climate change on health, mainly in the anticipation of
malnutrition caused by insufficiency of food production.

7.3. Health Effort Improvement Research and Development Program

This program is aimed at to offer input of science and technology for the support of
health development, especially to support policies formulation, help problem solving and
overcome obstacles in the implementation of quality improvement and health effort
equality program.

Target to be reached through this program is the identification of factors affecting quality
and equality of health efforts primarily in the basic health efforts at puskesmas and helper
puskesmas.

Activities of this program consist of:

(1) research on the need for health service among village society;
(2) development of model of puskesmas and hospital’s self-funding (‘swadana’);
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(3) research on intensification of immunization program;

(4) research on the control of contagious and non-contagious diseases, including newly
emerging diseases and re-emerging old diseases;
(5) development of model and standardization of basic, referral and supportive health
services that are qualified, accessible and equal;
(6) research on reproductive health;
(7) development of model of disaster management;
(8) development of model of policy analysis in health efforts;
(9) development of model of good drug service to support the rational drug use; and
(10) development of model of standardization of occupational health service.

7.4. Health Resource Improvement Research and Development Program

This program is aimed at to offer science and technology input to support health
development mainly to support policy formulation, help problem solving and overcome
obstacles in program implementation.

The target to be reached through this program is identification of factors affecting

management of various health resources such as manpower, health fund, drugs,
traditional medicine and other pharmaceutical inventories as well as foods and beverages
so they can be used optimally and evenly by the society.

Activities of this program consist of:

(1) research on factors affecting knowledge, attitude and behavior of technical as well as
managerial health workers;
(2) investigation on health manpower requirement;
(3) research on factors affecting acceptance of JPKM by the society;
(4) development of model of drug planning based on rational drug use;
(5) research on toxicology of foods, cosmetics, and health instruments;
(6) research on medicinal plants, drugs and Indonesian indigenous treatment;
(7) research and development of participation of traditional healers in overcoming health
problems; and
(8) longitudinal study on the implementation of social safety net in health sector in the
effort to overcome crisis.

7.5. Health Policy and Developmental Management Research and Development

Program

This program is aimed at to offer input of science and technology in order to support
health development, mainly to support policy formulation, help problem solving and
overcome obstacles in health policy and developmental management.

The target to be reached through this program is identification of factors affecting the
policy development and health developmental management to make them effective and
efficient.

Activities of this program consist of:

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(1) research on policy formulation pattern in health sector;

(2) research on data and information utilization in the regulation formulation in health
sector;
(3) development of health developmental management model that is effective and
efficient;
(4) development of model for surveillance, data and information collection through the
use of information technology;
(5) development of health indicators;
(6) research on analysis and evaluation of rules and regulations in health sector;
(7) development of research network and national health development as a cross-sectoral
cooperation forum in health development.

7.6. Basic and Applied Science in Health Sector’s Research and Development
Program

This program is aimed at to find and master health science and technology in order to
reduce dependence on science and technology from abroad.

The target to be reached through this program is the production of new science and
technology in health and medical sector that is basic and applied in order to support
health development, mainly to support policy formulation, help problem solving and
overcome obstacles in the implementation of developmental programs.

Activities in this program consist of:

(1) research on the development of vaccines through molecular biologic technology;
(2) development of early diagnostic method for various diseases;
(3) research on genetics of various disease vectors;
(4) exploratory research on drug’s raw materials in order to find new drugs from natural
substances;
(5) research in the field of medicine and biotechnology;
(6) research on phylosophy and methodology of Indonesian indigenous drugs/ treatment;
(7) research on monoclonal antibodies to detect fastly and accurately various diseases;
and
(8) development of model to overcome wastes using high technology.

Prioritized Health Program

Realizing the limitation of the available resources and adjusting it to the priority of health
problems found in the society and its trend in the future, so in order to further accelerate
improvement in public health level that is regarded important to support the success of
national developmental program, the following 10 prioritized programs are determined:
1. Health policy, health finance and health laws program.
2. Nutrition improvement program.
3. Contagious disease prevention program including immunization.
4. Healthy living behavior improvement and mental health program.
5. Settlement area, clean water and air program.
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6. Family health, reproductive health and family planning program.

7. Occupational safety and health program.
8. Anti tobacco, alcohol and hashish program.
9. Drugs, dangerous substances, foods supervision program.
10. Prevention of accidents and injuries, including the traffic safety program.

Health Resource Requirements

For the implementation of health development toward Healthy Indonesia 2010, the
availability of adequate health resources is necessary. As for what is meant by resources
in this respect it covers manpower resource, fund resource and health facility resource.

A. MANPOWER RESOURCE

1. Manpower Requirement

The implementation of national development with health concerns and health

development needs various types of health manpower that has the ability to execute
health efforts with the health paradigm, i.e. prioritizing promotive and maintenance
efforts as well as disease prevention. The need should be arranged in a health manpower
requirement plan according to the national target of intermediate term health
developmental program year 2010. Then the need is calculated mainly against the work
load that should be born by the health manpower in order to achieve the goal of health
efforts in the year 2010, it is then divided by the ability of the manpower to execute the
related efforts until year 2010.

At present health manpower in Indonesia is around 769.832 workers, which consist of

364.916 society’s workers and 384.916 governmental workers. The trend in manpower
supply by 2010 is about 1.399.624 workers which consist of 699.812 society’s workers
and 699.812 governmental workers. By observing the need of health program such as
that stipulated in health developmental plan toward Healthy Indonesia 2010, and the
possible projected supply and empowerment of the workers, it is planned that health
manpower throughout Indonesia by 2010 is 1.305.000 workers. Totally it seems that the
number needed and the supply of health manpower in 2010 is in enough balance. But
when it is perceived more specifically the supply in several categories of worker is still
lacking in the effort to fulfill the need of the manpower, i.e. mainly of general
practitioners, specialists, nurses, and midwives, as well as public health scholars.

Detailed picture of health manpower requirement from the society and the government,
as well as according to the types of manpower and respective program principles,
according to the types of manpower and place of duty can be seen on table 13 and table
14.

2. Supply of Manpower

In order to fulfill manpower requirement that has been planned, an upgrading in

education and training as well as management of existing manpower is needed.
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Supply of health manpower is done through manpower administration and training that is
organized by the society and government. Government decides the policy of manpower
preparation for civil servants, which covers education and training as well as organization
of education and training for health manpower that is strategic.

Health manpower education and training, being an integral unity, should be developed as
a whole and related to the following matters:

1) Students
In the future the professional health manpower that will be developed is health
manpower with medium and scholar grade. This policy is determined because of the
ever increasing quality of manpower needed and the ever increasing number of
graduates equivalent to senior high school being produced.

2) Educators
With the increasing quality of health manpower needed, it needs educator manpower
that has high knowledge and skill beside having reliable ability to educate based on
the teaching technology.

3) Educational Institutions
Educational institutions in the future should be accredited and improved inquality so
as to be able to play the role as health technical source beside as health manpower
supply source.

4) Soft Wares and Hard Wares

Soft wares and hard wares are inseparable elements in education activity. Hence both
will be developed harmoniously.

5) Health Manpower Career Development

Health manpower career development will be based on career system and work
performance. Education and training should be directed to the development of health
manpower’s career.

3. Health Manpower Utilization

Health manpower utilization will be the most important element in the development of
health manpower in the future. Hence ability to utilize manpower at all levels should be
increased.

The career development of health manpower either from private or government is vital to
be improved continually and matched gradually. In this respect, government applies the
policy of civil servant cultivation at central and regions that covers among other things
regulation of facilities, standards and procedures of workmanship and career
development. Professionalism of manpower will be increased continually and done
through the application of state of art science and technology and through the application
of moral values and ethics.

B. FACILITY RESOURCE
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1. Health Facility Need

One of the important components in implementation of health development is health

facilities that are able to support various health service efforts either at individual or
society level. At present there are 7.243 puskesmas, about 25.000 helper puskesmas, 522
government’s general hospital of various classes, 42 government’s special hospitals, 351
private hospitals and 616 private clinical laboratories outside the hospital. Beside that
there are also available regional office (Kanwil) and Duty Office (Dinas) at each province
and district, municipality, training and educational facility, POM bureau, district
pharmaceutical warehouse, and environmental health technique bureau.

For the future the need for health facility will be arranged by observing several basic
assumptions as the following:
(1) the shift in governmental role from being a dominant service organizer to become a
policy and regulation compiler by keeping attention on the services needed by the
poor people.
(2) the increasing potential of private sector in providing health services, especially that
of curative and rehabilitative ones; and
(3) the settlement of economic and political crises in not too long time.

With the above basic assumptions and limitation of available governmental resources at
present, and the willingness to increase service efficiency, then in general the number of
health facilities of governmental sector in the future will not differ much from now. New
health facility construction in governmental sector will be avoided as far as possible.
Developmental activity will be prioritized on quality improvement of the physical facility
and its service ability, e.g. up grading the state of helper puskesmas to become
puskesmas, while puskesmas to become puskesmas with in-patient caring beds. And then
puskesmas can also be up graded in its function into a general hospital according to the
public’s need. Also should be attended the needs of urban society which is different from
rural society, beside the fast wave of urbanization which should also be taken into
attention while calculating health facility need in the future.
Beside that, capability of the private sector’s health service is hoped to grow too, either in
number or in capacity.

2. Health Facility Establishment

Establishment of health facilities is done altogether by the government and private by

attending to the efficiency and accessibility by the poor people and special groups such as
infants, the under 5 years, and pregnant women.

3. Health Facility Management

Health facility management is very important, especially with the increasing complexity
of health service management in the future. Increased managerial, professional ability in
the government and private sectors, supported by improved technical ability of service
provider’s technical manpower is very necessary to be given attention in order to assure
the success and everlasting of health service efforts nationally. Specifically the capability
of regional leaders in doing advocation and building partnership with other sectors and
private sector should be improved.
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In line with the decentralization effort in health sector, special attention will be directed
to cost burdening, management, accountability of the resources following it. Flexibility in
doing managerial innovation will be further expanded. Specifically the balance of
funding between central and regional government is one of the strategic policy that needs
attention especially in regions with still low indigenous regional income. Conducive
climate for the organization of health facility in private sector will be further expanded in
order to push the growth of private sector. Various new regulations will be created in
order to regulate this matter.

C. FUNDING RESOURCE

1. Funding Need

The organization of health program needs the development of funding system that
originates from the government and society including the private that can produce ready
to use and adequate fund. Experience so far has shown the emergence of efficiency in
the utilization of governmental and private budget. Hence in the future will be striven for
the more efficient use of fund that can be reached through the compilation of funding
system that puts attention to equality, efficiency, and continuity and that can assure the
availability of qualified services.
The use of governmental fund hitherto is still directed more to health service efforts that
are curative and rehabilitative at the basic and referral health service levels. Therefore
mentioned funding system can hopefully be shifted to the promotive and preventive
services by observing the continuity of the existing available services especially those to
the poor people. With the imminent decentralization process, the funding sources of
central and regional governments will be developed optimally and proportionately, either
between health programs, regions or sectors.
Public direct spending to get health service is the biggest portion of national health
expenditure which will be directed to become pre payment system (JPKM), so as to make
it more efficient. So far JPKM has not run well and hence will be improved by preparing
professional field workers and creating conducive climate for its development. The
development of this system will take long enough time in order to cover most of the
people.
On the other side, the state economy at present is not yet bright and various other crises
are not sure yet when they will resolve, that makes calculation on fund requirement hard
to be done. The fact that health sector is one of the sectors that receives great attention
during crisis, beside education and social, is an opportunity that should be used optimally
to increase health sector’s budget portion in the future.
The macro picture of governmental budgetary need for health sector is hoped to rise from
only 2.5% to 5% in the future, it is followed by reallocation of budget to various
programs that are ‘cost-effective’. On the other side, in the short run we still have to take
into consideration funding need for arranging the social safety net in health sector which
is estimated to continue several years to come. This situation is very much dependent on
mobilization effort of public resources in the form of development of JPKM system and
its equipment.

2. Fund Raising

Resource for the implementation of health development originates from the government
and public/ private funds. Since the economic crisis, there is a great dependence on off
shore fund. It is estimated that the off shore fund will decline in the coming several years
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so exploration of the public’s funding source become an attempt that should be started
and implemented in the coming years.
It should be observed that in the future the role of regions become prominent in health
development funding as a logic consequence of decentralization process.

3. Funding Management

Management of fund is directed to achieve the highest efficiency level, either in

allocation efficiency or in technical efficiency at program, area or institutional levels.
Ability of the region’s health office in advocation to the regional government about the
importance of regional health development will be increased continually. Beside that
good governance is a precondition for the creation of good system of funding.
Management of public fund that is striven through the mechanism of the third party
(JPKM) is hoped to become more efficient. This situation can be realized soon if
supported by JPKM managerial manpower that is professional and the availability of
supporting rules and regulation.

General
Implementation of national health developmental activities needs a broad and careful
management in various levels of administration of the government and the society itself.
Aside from that, the dynamics and rapid change in domestic situation and abroad should
also be watched. Beside that attention should also be given to the challenge from global
competition, the execution of regional autonomy, economic balance between central and
the regions, public participation, equity and justice, and potential and diversity of each
region.

Going in line with health developmental strategy in order to realize Healthy Indonesia
2010, it should be underlined that health development can not just rely on health sector’s
activity alone, but also on the developmental activities that are done synchronously and
efficiently from various related sectors. It has been realized since long that cross-sectoral
and cross program co-operations is one of the main keys of developmental success, that
has in fact so far received inadequate attention.
Activating the execution of various health programs is meant to make the health service
providers, consumers and other sides acting as supporters and supervisors can implement
the various health programs as perfect as possible.

The progress so far shows that the inter-dependence among human being is increasingly
felt. For the success of a program, communication and cooperation are needed between
various groups or working units. Beside that a high motivation and renewal in value
orientation which needs support from awareness on the importance of preparation and
utilization of data and information dissemination also needs to be grown.

Actuation of program implementation includes organizing, work force filling, public

motivating and task in order to increase public participation, intra and inter-sectoral co-
operation and cultivation.
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Organizing

In order to support health developmental implementation, health efforts need to be

implemented through organizational structural pattern. The main task of the Ministry of
Health is to organize a part of the governmental general task and developmental task in
health sector. Hence, a health program principle is always being adjusted to efforts
including the general governance implementation, either with routine activities or
developmental effort activities that are restricted in time and target. The routine and
developmental activities of a program principle is very much influencing the magnitude
of an organizational unit, hence an organizational structure will always change.
What should be considered in the implementation actuation is the already ratified act
number 22/ 1999 about Regional Government and the act number 25 on Economic
Balance of the Central and Regional Governments. The organizational picture that will
be described below has as far as possible absorbed various aspirations that have
developed in the discussion on the elaboration of both acts.

1. Health Organization at Rural Level

a. Rural Society Tenacity Institution (LKMD)

In the governance at rural level, health developmental efforts of rural society is an

integral part of the development of rural society, it is implemented by the Health and
Family Planning Section of the LKMD that is responsible to the Rural Head and Rural
Representative Body.

b. Helper Puskesmas (Pustu)

Pustu is an integral part of puskesmas and it does the function of puskesmas at the rural
level. At certain regions, in accordance to need, pustu and puskesmas encourage the
formation of health posts by the society which is coordinated by the rural governance.

2. Health Organizations at Subdistrict Level

a. Puskesmas

Puskesmas is an operational unit of health office at the district/ municipality and is

responsible to health office of district/ municipality.
Puskesmas has the task to implement the health efforts at sub-district area, whose matters
have been delegated to the (autonomous) region and the assisting task.

b. Technical Executing Unit (UPT)

An UPT is formed when needed and its task is to arrange one of the health efforts
separately.

c. Organization of Private Health Effort

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The organization of private health effort is a society organization including the private
that organizes health effort according to the rules and regulations as well as professional
standards and other regulations as determined by the government together with the
professional organization.

3. District/ Municipal Regional Health Organization

a. District/ Municipal Regional Health Office

District/ Municipal Regional Health Office is an operational unit of district/ municipal

regional government under and being responsible to the district/ municipal regional chief,
its task is to implement part of the household affairs of the region in health sector.
Health apparatus at district/ municipal level, i.e. district/ municipal health office holds the
broad decentralization authority in health sector and assisting task. It means that all
health efforts that are not yet fully executable by the society become the task of district/
municipal health apparatus to implement it, by holding on the policy standards and rules
already determined by the Ministry of Health. The district/ municipal health office also
implements various assisting tasks in health sector such as outbreak management and
surveillance of contagious diseases.
So, district/ municipal regional government can form various types of UPT in health
sector, so far as the primary coverage of the working area is the relevant district/
municipality. The UPT can be for example the puskesmas, district/ municipal hospitals,
pharmaceutical warehouses, health laboratories, etc.

b. Hospitals

The regional general hospital is an organic unit of regional government that has the task
to implement health services, especially the curing of patients and rehabilitating
disabilities of body and mind. Service at the hospital is prioritized on referral service.
Hospital’s organizational structure is based on the type and class of service being offered
by the respective hospital.

c. Technical Executing Unit (UPT)

This unit is formed according to need in order to implement one field of task in the
support of the principle task of its chief. The organizational structure of an UPT is
adjusted to organize pattern of UPT as determined by governmental regulation. One
example of UPT at the district level is the district/ municipal pharmaceutical warehouse
that is located in the circle of district/ municipal health office.

d. Private Health Enterprise

Health effort of the society/ private at district/ municipal level can be in the form of
hospital or other service unit. The organizational structure and work order of the private
health enterprise is arranged according to the prevailing regulation. Private hospital can
also be a network of foreign hospitals that has met the conditions for operation in
Indonesia.

4. Provincial Regional Health Organization

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According to the act number 22/ 1999 about Regional Government, the health
developmental implementation at the provincial level is the Provincial health Office that
holds two kinds of authority or task i.e.: (1) limited decentralization authority or task,
and (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
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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
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.
 Page 70 of 84

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 • Bappenas • Secretary general

Policy, Health • Dept. of Internal affairs
Funding and Health • Bappeda
Laws • Financial Dept.
• Justice Dept.
• Coord. Min. of Developmental
Supervision/ State Apparatus
Organizing
• Private health insurance
• Universities
• Planning bureau
• Public & legal bureau
• Economic bureau
• Organizational bureau
• All directorate generals
• Health R&D Body
• JPKM develop. body
• Health data center
 Page 71 of 84

2. Nutritional • Bappenas • ‘Binkesmas’

improvement • Public welfare Coord. Min. • Dit. of Public Nutrition
program • Dept. of internal affairs • Dit. ‘Kesga’ (family health)
• Financial Dept. • Planning bureau
• Social Dept. • Nutrition research center
• Dept. of educ. & culture
• Dept. of agriculture
• Dept. of food and holticulture
• Dept. of female roles

3. P2M (Contagious • Bappenas • P2M

disease eradication) • Dept. of internal affairs, PKK
Program including • Dept. of finance
immunization • Dept. of edu & culture
• Dept. of information
• Dit. Immunization
• ‘Binkesmas’ (public health
cultivation)
• BUKP
• Planning bureau
• Contag. Disease research center
• Medical service/ Yanmed
• Dit. Public Participation

4. Healthy Living • Bappenas - KSKG • Public health instruction center

Behaviour and • Dept. of internal affairs • ‘Binkesmas’
Mental Health • Dept. of finance • BUKP
Improvement • Dept. of information • Planning bureau
Program • Dept. of social • Dit. Mental health
• Dept. of religion
• Dept. of edu & culture

Program’s Name Related Sectors Related Units

5. Program of • Bappenas • P2M – PLP

Residential areal • Dept. of internal affairs
Environment, • Dept. of finance
Healthy Water and • Dept. of public works
Air • 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
• 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

6. Family health, • Bappenas • Binkesmas

Reproductive health • Dept. of internal affairs • Kesga
and Family planning • Dept. of population affairs • Yanmed/ Medical services
Program • Dept. of finance • Public health instruction center
• Dept. of social • Planning bureau
• Dept. of religion
• Dept. of female roles
• Dept. of edu & culture
• Dept. of youth & sports
• Universities
• Professional organizations:
 Page 72 of 84

POGI, IBI, IDI, PKBI.

• Population affairs’ NGOs

7. Health and • Bappenas • Binkesmas

Occupational Health • Dept. of labours • PSM
Program • Dept. of industry & trade • Public health instruction center
• Health insurance • Planning bureau

8. Anti Tobacco, • Bappenas • Public health instruction center

Alcohol and • Dept. of internal affairs • Binkesmas
Hashish Program • Dept. of finance • Yanmed/ Medical services
• Dept. of education & culture • POM (drug & food supervision)
• Dept. of social • Dit. mental health
• Dept. of information • Planning bureau
• Dept. of religion
• Dept. of industry & trade
• Universities
• Professional organizations
• NGOs
• Dept. of justice
• Attorney general
• Police dept.

Program’s Name Related Sectors Related Units

9. Supervision of • Bappenas • POM

Drugs, Dangerous • Dept. of internal affairs • ‘Binkesmas’
Substances, Foods • Dept. of finance -- Customs • Yanmed/ medical services
& Beverages office • P2M - PLP
Program • Dept. of industry & trade • POM clinic
• Dept. of justice • Puslabkes (health labor. center)
• Dept. of information • Planning bureau
• Attorney general
• Police dept.
• Professional organization
• NGOs

10. Accident and Injury • Bappenas • Public health instruction

Prevention, • Dept. of internal affairs • Yanmed
including Traffic • Dept. of finance • Dit. mental health
Safety Program • Dept. of transportation • Binkesmas
• Dept. of educ. & culture • Health R&D body
• Dept. of justice • Planning bureau
• Dept. of female roles
• Attorney general
• Police dept.
• Universities & NGOs

Cultivation
 Page 73 of 84

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

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 institution(s) 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 side(s),
before being reported to the one giving authority to manage the state owned resources.
 Page 74 of 84

Supervisory Pattern and Mechanism

1. The policy that needs to be acted in the area of supervision can be differentiated
into 5 groups as the following:
1) The policy of securing the supervisory system of state economy in order to
achieve efficiency in the state and developmental execution which is directed to
realize integrity and consistency in adhering supervision, functional supervision
and public supervision.
2) Supervision is needed in order to rectify governmental control and the
execution of development in general to prevent and to take action against
authority misuse, lavishness and leakage.
3) Supervision is expected to monitor the situation accurately so that an early
action can be taken, and hence opportunity can be grasped to overcome the newly
emerging problems.
4) Supervision is expected to be able to give information that is useful for
management or person in charge of a program, both for the current fiscal period
or for the next period.
5) Supervision is prioritized at improving efficiency of governance in general
and development.

2. The Planning of Supervision

In order to reach optimal supervisory result, then the supervisory target and scope
should be decided selectively based on accurate criteria, by focusing on programs
with large contribution to the realization of Healthy Indonesia 2010.

In compiling the supervisory plan, an integrated supervisory planning system should

be developed in order to achieve a synergistic supervision, by attending to the
following things:
1) Formulation of supervisory planning that is done by the Ministry, it is coordinated
by Coordinating Minister of State Apparatus Utilization and Developmental
Supervision.
2) The supervisory plan should push the development of supervision by the direct
superior starting from the highest echelon to the lowest one.
3) Supervisory plan in the region should be developed along with that which is done
by Apparatus Supervision at the central level.

3. The Implementation of Supervision

1) The Path of adhering Supervision

The aim of the adhering supervision (‘waskat’) is to create a condition that
supports smooth and exact implementation of general governmental tasks and
development, policy, plan and prevailing laws that are conducted by the Direct
Superior.
In order that adhering supervisory activity can achieve a real and result and target,
the chief of institution is obliged to:
a) Improve and revise the implementation of adhering supervision in
accordance to the main task, function, plan and working program of each
working unit.
 Page 75 of 84

b) Compile the program for improving the implementation of annual

adhering supervision of each working unit.

2) The Path of Functional Supervision

The implementation of functional supervision (‘wasnal’) is still strategic enough
though the adhering supervision is being up graded.
For the working/ project unit being supervised, it is a supervision from outside,
not withstanding that from the whole organizational view it is an internal
supervision. The result of functional supervision should become an input for the
superior in order to implement adhering supervision and also an effectiveness
indicator of adhering supervision.

3) The Path of Public Supervision

The supervision from the public (‘wasmas’) or social control is the supervision
done by the society itself upon the implementation of governance and
development. The public supervision should be cultivated so that to become a
supervision that is effective and efficient. The aim of the development of public
supervision that is positive and healthy is the increasing and growing
responsibility and participation of the public in implementation of general tasks of
the government and development. In this context the governmental apparatus is
obliged to always open the opportunity so that the society can and will execute
social control at its best. Regardless of how small the value of information from
the social control it should be attended.

4. The Result of Supervision

1) It should be able to give indications as a base for decision making that will
be done by Minister of Health.
2) It should present report with a constructive nuance and not a destructive
one.
3) It should be able to push public participation in development i.e. by
providing understanding through instruction about development that is executed
by the government and the role of supervision in the development.

Controlling and Evaluation

Controlling and evaluation of performance of an organization/ institution is done

according to the pattern of institutional performance measurement, which is applicable on
both the central institution and the regional institution. The pattern of institutional
performance measurement is started with strategic planning, performance measurement
and its evaluation.

Generally the strategic planning includes:

1) Environmental analysis to determine specific obstacles and opportunities.

2) Assessment to decide ability and main resources that can be used to develop
competitive strategy under the existing situation.
 Page 76 of 84

3) To integrate the capability and resources that are special with specific chance within
the environment of the related institution.

4) To decide clear aims and targets.

5) To create several policies, plans, programs and principle tasks of the Department in
order to achieve the aims and targets that have been determined.

By considering the prevailing State Administrative System that is valid upon general
governmental and developmental administration, a performance measurement pattern that
is realized in the following consecutive steps can be used:

1) Definition of mission

2) Determination of objective and target, and expected outcome

3) Deciding strategy and policy

4) Determination of activity or task execution.

5) Measurement of performance (performance indicator).

Indicators of Health Development

An indicator is some thing that is made as a measure to know the success in the
implementation of a program. Hence indicators of a program are decided based on the
targets that want to be reached through the program. Based on the above matter, then
indicators of the health development that is intended to achieve Healthy Indonesia 2010
are measures of success that will be used for each of the following sectors:
1. Cross-sectoral cooperation
2. Autonomy of the public and private partnership
3. Healthy living behavior
4. Healthy environment
5. Health effort
6. Health developmental management
7. Health level

Closure

Closure
 Page 77 of 84

As for other developmental documents, this document of ‘Health Developmental Plan

toward Healthy Indonesia 2010’ will be reassessed and reviewed after the new
government has been formed. This document is compiled and developed under the
situation that the GBHN (National Guidelines) has not been decided by the MPR (the
People Advisory Assembly). None the less, this document has been compiled with the
consideration of basic values that prevail in the society, public health situation as well as
regional and global development.

Realizing that there are many factors affecting the execution of health development,
including the implementation of this Health Developmental Plan, then its execution can
be done through cross-sectoral and cross program approaches, as well as public the
empowerment toward Healthy Indonesia 2010. Beside that, it is realized that changes in
state administration, decentralization will strongly affect the implementation of health
development in the future. The availability of resources which experience contraction
due to the economic and political crises will also strongly affect the implementation of
programs that have been arranged. Even so, there is a common hope that this document
would be able to act as a base for the compilation of health developmental programs in
the provincial level and district/ municipal level in welcoming the decentralization era.

Lists of Tables and Appendices

TABLE 1
INFANT MORTALITY RATE PER 1,000 LIVE BIRTHS
Source: Health Data Center, Health Profile year 1998.

TABLE 2
ESTIMATES OF LIFE EXPECTANCY DURING YEAR 1967-97
Source: Health Data Center, Health Profile year 1998.

TABLE 3
MATERNAL MORTALITY RATE PER 100,000 LIVE BIRTHS
Source: Health Data Center, Health Profile year 1998.

TABLE 4
THE UNDER-5 YEARS’ MORTALITY RATE PER 1,000 LIVE BIRTHS
Source: Health Data Center, Health Profile year 1998.

TABLE 5
CRUDE DEATH RATE PER 1,000 PEOPLE
Source: Health Data Center, Health Profile year 1998.

TABLE 6
THE PREVALENCE OF THE UNDER-5 YEARS SUFFERING FROM ENERGY
& PROTEIN MALNUTRITION
(Result of Nutritional Status Monitoring through Posyandu, 1994-1997)
Source: Health Data Center, Health Profile year 1998.

TABLE 7
 Page 78 of 84

ESTIMATED TOTAL BIRTH RATE PER REPRODUCTIVE AGED WOMAN

Source: Health Data Center, Health Profile year 1998.

TABLE 8
RATIO OF TRAFFIC ACCIDENT VICTIM AND DEATH PER 100,000 PEOPLE,
1994-1997
blank: Victim
solid: Death
Source: Police Head quarter (1998)

TABLE 9
HEALTH FACILITIES

No. Health Facilities Total

1 Existing puskesmas 7,243 units

2 Puskesmas with beds (among the existing puskesmas) 1,676 units
3 Mobile puskesmas 6,849 units
4 Helper puskesmas 21,115 units
5 Lung disease treatment clinic (BP4) 21 units
6 Public eye health clinic (BKMM) 7 units
7 Puskesmas visit including helper puskesmas 108 visits
8 Coverage of K-1 (first pregnancy examination) 87.6%
9 Coverage of K-4 (forth pregnancy examination) 68.6%
10 Posyandu with active cadets 1,078,208 persons 243,783 units
11 Rural delivery hut (polindes) 20,880 units
12 Rural medicinal post (POD) 15,828 units
13 Occupational health effort post (Pos UKK) 1,853 units
14 Grade A general hospital 4 units
15 Grade B general hospital 54 units
16 Grade C general hospital 213 units
17 Grade D general hospital 71 units
18 Private general hospital 335 units
19 Government’s special hospital 77 units
20 Private special hospital 139 units
21 Total beds 120,000 units
22 Health laboratory clinic (BLK) 27 units
23 Food and Drug Supervision Clinic (BPOM) 27 units
24 Environmental health technical clinic (BTKL) 10 units
25 Private clinical laboratory in 27 provinces 599 units
 Page 79 of 84

26 District/ municipal pharmaceutical ware house (GFK) 314 units

27 Private dispensary throughout Indonesia 5,724 units

Source: Health Data Center, Health Profile year 1998.

TABLE 10
HEALTH MANPOWER (1997)

No. Health Manpower Total

1 Doctors (including specialists) about 13,633 persons

2 Dentists about 6,972 persons
3 Pharmacists about 7,646 persons
4 Nurses with various level of education, about 150,419 persons
5 Midwives (including 52,040 persons of rural midwives) 61,003 persons
6 Public health manpower (with various expertise) 15,557 persons
7 Nutritionists (among the public health manpower) 8,975 persons
8 Total health manpower working in the Health Dept. and 400,000 persons
regional governments throughout Indonesia by 1998, about
9 Health servants in central among the other health manpower 302,947 persons
10 Regional government’s health servants (the remaining), about 90,000 persons

Source: Planning bureau of the Health Dept. (Processed from data of CHS/ Dept. of
education & culture, Health manpower education center (Pusdiknakes), Personnel bureau
and Health Profile 1998)

TABLE 11
MEDICINES AND HEALTH INVENTORY (1997)

No. Health Inventories Total

1 Total pharmaceutical industries consisting of 4 state owned 224 units

corporates, 35 foreign investments and 185 national private
 Page 80 of 84

162 units
2 In 1996 there are recorded pharmaceutical industries that are
already able to produce finished products according to GMP
(‘CPOB’)
4 units
3 Generic drug production is done by: 60 units
- state owned corporates
- private pharmaceutical industries 678 units

4 Indigenous drug industries:

- small scaled industries of indigenous drugs (IKOA), 602 units
- indigenous drug industries (IOA), 76 units

Source: Dit. Gen. of Food and Drug Supervision, Health Dept.

TABLE 12
HEALTH FUNDING

No. Health funding Total

1 Health budget of 1987/88 from total governmental expenses 2.32%
2 Health budget of 1997/98 from total expenses 4.55%
3 Contribution of private sector and the public in health funding, 65%
about
4 The peoples that become members of health insurance 14%
5 Until the end of 1998:
- Askes (health insurance) of civil servants and pensioners covers 17.2 millions
- Askes for health manpower and families covers 1.6 millions
- Private Askes covers 600 thousands
- Health fund in ca 15,000 villages covers 22 millions
6 Executing body (Bapel) of JPKM with license 19 units
7 In order to implement JPSBK program there are (dispersed in all 326 Bapel
districts/ municipalities)
Source: Planning bureau of Health Dept.

TABLE 13.
MANPOWER REQUIREMENT –
ACCORDING TO THE KIND OF AND PRINCIPLE PROGRAM

No KIND OF Program Program Program Program Program Program Program Total

MANPOWER Principle Principle Principle Principle Principle Principle Principle
1. Specialist doctor
2. General doctor
3. Practitioner
Nurse (S1/ scholar)
4. Nurse (D3/ 3 years
diploma)
5. Assistant nurse (SPK)
6. Midwife (D3)
7. Midwife (D1)
8. Dentist
9. Dental nurse (D3)
 Page 81 of 84

10. Dental nurse

11. Dental technician (D3)
12. Public health scholar
(S1/S2)
13. Sanitarian (D3)
14. Assistant sanitarian
(D1)
15. Nutritionist (S1)
16. Nutritionist (D3)
17. Assistant nutritionist
(D1)
18. Pharmacist
19. Assistant pharmacist
20. Analyst
21. Others
TOTAL
Source: Planning bureau, Health Dept. 1999
(Modified from the proposal of manpower requirement to support health program toward
Healthy Indonesia 2010)

TABLE 14
MANPOWER REQUIREMENT –
ACCORDING TO KIND AND PLACE OF DUTY

NO. KIND OF MANPOWER CENTRAL PROV. DISTRICT/ PUSK TOTAL

MUNICIPAL

1. Specialist doctor
2. General practitioner
3. Nurse (S1/ scholar)
4. Nurse (D3/ 3 yrs diploma)
5. Assistant nurse (SPK)
6. Midwife (D3)
7. Midwife (D1)
8. Dentist
9. Dental nurse (D3)
10. Dental nurse
11. Dental technician (D3)
12. Public health scholar (S1/S2)
13. Sanitarian (D3)
14. Assistant sanitarian (D1)
15. Nutritionist (S1)
16. Nutritionist (D3)
17. Assistant nutritionist (D1)
18. Pharmacist
19. Assistant pharmacist
20. Analyst
21. Others

TOTAL

Source: Planning bureau, Health Dept. 1999

(Modified from the proposal of manpower requirement to support health program toward
Healthy Indonesia 2010)
 Page 82 of 84

TABLE 15
PROJECTED REQUIREMENT FOR HEALTH MANPOWER
UPTO 2010 AND THE TREND OF HEALTH MANPOWER SUPPLY
PER ‘5 YEAR DEVELOPMENT’ (PELITA)
AND ITS PROJECTED SUPPLY UNTIL YEAR 2010

ordinate: Persons; absisca: Pelita

diamond sign: Requirement; solid box sign: Supply

Appendices

TEAM COMPILER OF THE HEALTH DEVELOPMENT PLAN TOWARD

HEALTHY INDONESIA 2010 AND INDICATORS OF HEALTHY INDONESIA
2010

1. TEAM COMPILER OF THE HEALTH DEVELOPMENT PLAN TOWARD

HEALTHY INDONESIA 2010

Cultivator Prof. Dr. FA Moeloek; Minister of Health RI

Chief Prof. DR. Dr. Azrul Azwar, MPH; Director General of
Community Health
Deputy Chief Prof. Dr. Umar Fahmi Achmadi, MPH, PhD; Head of
Resource & Development Health
Secretary Dr. Dadi S. Argadiredja, MPH; Head of Planning Bureau
Members 1. Dra. Hj. Zurmiati Bahrunsyah; Secretary of
Inspectorate General
2. Dr. Wibisono Wijono, MPH; Secretary of Dir. Gen. of
Community Health
3. Dr. Ingerani, SKM; Secretary of Dir. Gen. For Medical
Care
4. Dr. H. Haikin Rachmat, MSc; Secretary of Dir. Gen.
of Contagious Disease Eradication and Settlement
Enviromental Health
5. Dra. Mawarwati Tedjo; Secretary of Dir. Gen. of Food
and Drug Supervision
6. Drs. I.B. Indra Gotama, SKM, MSi; Secretary of
Health Resource & Development Body
Resource Person 1. Dr. E. Sutarto, SKM; Secretary General
2. Dr. Rusmono, SKM; Inspector General
3. Dr. Sri Astuti S. Suparmanto, MSc(PH); Director
General for Medical Care
4. Dr. Achmad Sujudi, MHA; Director General for
Contagious Disease Eradication and Settlement
Environmental Health
5. Drs. Sampurno, MBA; Director General for Food and
 Page 83 of 84

Drug Supervision
6. Dr. Nardho Gunawan, MPH; Expert Staff of Minister
of Health in Environmental Health
7. Drg. Ibnu Effendi, DDPH; Expert staff of Minister of
Health in Organization and Institution
8. Dr. Brotowasisto, MPH; Consultant to Crisis Center
9. Dr. HR Hapsara, DPH; Consultant to Planning Bureau
10. Dr. Stephanus Indrajaya, PhD; Consultant to Planning
Bureau
11. Dr. Sofyan Mukti; Consultant to Planning Bureau
12. Representative of Bappenas
13. Representative of Department of Internal Affairs
14. Representative of Professional
15. Representative of Universities
16. Representative of Statistics Central Bureau
17. Representative of State Minister of Environmental
Health’s Office
18. Representative of Woman’s Role Office
Secretariat Team
Chief Dr. Gunawan Setiadi, MPH; Head of General Planning
Division
Secretary Drs. Teguh Budi Santoso; Head of Long- and
Intermediate-term Planning Compilation sub-Division
Technical 1. Dr. H. Setiawan Soeparan, MPH; Head of
Secretariat Developmental Program Planning and Compilation
Division
2. Dr. Bambang Sardjono, MPH; Head of
Developmental Program Planning and Compilation
Division
3. Drs. Johan Arief; Head of Health Resource Plan
Division
4. Mardiah Mawardi, MPH; Head of Evaluation &
Report Division
5. Drs. Abdurachman, MPH; Head of Program and
Report Compilation Division, Dir. Gen. of Community
Health
6. Dr. Ali Alkatiri, MSc; Head of Program and Report
Compilation Section, Dir. Gen. for Medical Care
7. Dr. H. Wan Alkadri, MSc; Head of Program and
Report Compilation Division, Dir. Gen. of Contagious
Disease Eradication and Settlement Environmental
Health
8. Farida Nurbaiti, SKM; Head of Program and Report
Compilation Division, Dir. Gen. of Food & Drug
Supervision
9. Drs. Tri Djoko Wahono; Program and Report
Compilation Division, Health Resource & Development
Body.
10. Dr. Tarufie Alhayas; Head of Program and Report
Compilation Division, Inspectorate General
11. Ir. Herwanti Bahar, MSc; Head of Health Technology
 Page 84 of 84

Transfer and Plan sub-Division

12. Isti Ratnaningsih, MA; Staff of Planning Bureau
13. Drg. Sigit Wardoyo, Msc; Staff of Planning Bureau
14. Syahrial Ahmad, SKM; Staff of Planning Bureau
Administrative Staff 1. Suparianto, SE; Staff of Planning Bureau
2. Achmad Iriansjah; Staff of Planning Bureau
3. Supratikto; Staff of Planning Bureau
4. Marice B. Marpaung; Staff of Planning Bureau

MEETINGS ORGANIZED IN THE CONTEXT OF COMPILATION OF

DEVELOPMENTAL PLAN TOWARD HEALTHY INDONESIA 2010
...
total: 31,751 words