DARI

MDG MENUJU SDG

Adang Bachtiar
Ketua Umum IAKMI Pusat
2014
Download site: Facebook IAKMI.PUSAT
Born in Cirebon, West Jawa
Dokter from UNIVERSITAS INDONESIA
Master of Public Health (MPH): HARVARD-USA
Doctor of Science (DSc): JOHNS HOPKINS-USA
Post Doctoral in Statistics: UNIV of MICHIGAN-USA
Current Activities:
Indonesian Public Health Association, President
Global Fund TB at FPH-UI, Director
Health Professions Coalition for Anti Smoking (KPK-AR), Chairman
National Expert Panel on TB, Health Policy Spesialist
MoH-Community trial for Mothers Compliance Improvement on ARV Treatment, Head of Team
Komnas Penelitian & Pengkajian Penyakit Infeksi (PINERE) Litbangkes -Kemenkes, Expert Panel
Indonesian MCH-Nutrition Eval Team-Ministry of Health, Head of Team
Dept of Health Policy & Administration, UI, Past Chairman; Advice & examine more than 150 PhD dissertations, in
medicine, dentistry, nursing, public health, regional planning
National Health Research Committee, Expert Panel
The development of RPJMN Kesehatan 2015-2019, Expert Panel
The development of Oral Health Strategic Plan of MoH, Expert Panel
BERBAGAI KENDALA MENCAPAI
MDG
Indonesia memulai lebih lambat daripada banyak negara lain
Peta jalan efektif belum dijalankan sepenuhnya
Kendala struktural termasuk dukungan politis di daerah, pertumbuhan
ekonomi dan kapasitas fiskal yang terbatas, serta kapabilitas pelaksana yg
terbatas
Guncangan ketidakstabilan termasuk keamanan, bencana, ekonomi dan
epidemi penyakit (misal HIV)
Kepemimpinan
Di Puskesmas
Perencanaan
Puskesmas
Pemenuhan Target
disesuaikan kebutuhan
(Need) Masy
Kapasitasi SDM
Puskesmas
Implementasi
Pelayanan di
Puskesmas
Pencapa
ian
Indikator
Puskes
mas
Kemampuan SIK utk
Added Value
FAKTOR KONTEKSTUAL:
SUPRASTRUKTUR-KAWASAN
PEMBANGUNAN-KEMANDIRIAN MASY
.
Time to access 1
st
ANC
56% akses
1
st
ANC
compliance
Mothers w/ =<12
mo. babies
w/ 12-60mos.
Babies
Total
n % n % n %
Yes 482 37,1 662 38,4 1144 37,9
No 816 62,9 1060 61,6 1876 62,1
DECREASING QUALITY OF MIDWIVES
4
th
ANC
compliance
Mothers w/ =<12
mo. babies
w/ 12-60mos.
Babies
Total
n % n % n %
Yes 75 5.8 133 7.7 208 6.9
No 1223 94.2 1589 92.3 2812 93.1
PHC SUSTAINABILITY
LOCAL GOVT BUDGETING FOR HEALTH Means (7 provs)
PR.1 Public Health Programs 6.58%
PR 1.1 MCH 0.70%
PR 1.2 Nutrition 0.97%
PR 1.3 Immunization 0.12%
PR 1.4 TBC 0.06%
PR 1.5 Malaria 0.30%
PR 1.6 HIV/AIDS 0.03%
PR 1.7 Diarea 0.00%
PR 1.8 Pneumonia 0.01%
PR 1.9 Dengue 0.06%
PR 1.10 Other infectious diseases 0.15%
PR 1.11 Non-infectious diseases 0.03%
PR 1.12 Family Planning 0.57%
PR 1.13 School Health Programs 0.07%
PR 1.14 Reproductive Health 0.01%
PR 1.15 Environmental Health 1.20%
PR 1.16 Health Promotion 0.41%
PR 1.17 Disaster Program 0.02%
PR 1.18 Surveillance 0.05%
PR 1.19 Other Public Health Programs 1.83%
Gani, 2011
MDG ACCELERATION FRAMEWORK
(MAF)

Diagnostic, scaling-up proven interventions
PHC approach
Local-level initiative
Academic-Business-Govt for empowerment
Protecting public expenditures
Mencegah lbh murah drpd mengobati
FOKUS PENYELESAIAN MDG
Rencana Aksi Berbiaya di Propinsi dan Kab/Kota

Fokus pada under-target, termasuk
Ibu-anak, dengan pendekatan Continuum of Care
HIV/AIDS

Monev indikator pencapaian dan akuntabilitas

RENCANA AKSI BERBIAYA
Mendorong kapasitasi Propinsi dan Kab/Kota untuk capai target prioritas MDG
dg susun Rencana Aksi 2014-2015
Sinergi Akademisi-Masy tmsk swasta-Pemerintah
Melalui Musrenbang
Membangun Task-force
Indentifikasi sumberdaya masyarakat untuk kesadaran kepentingan
kesehatannya
Continum of Care
HIV/AIDS
FOKUS PADA UNDER-TARGET
Kes Ibu dan Anak
Menekan jumlah ibu meninggal
HIV/AIDS
Berfokus juga pada mereka yang sehat
Memberdayakan setiap unsur masyarakat untuk mencegah mengobati dan
rehabilitasi


68
57
46
35
34
32
24
23
0
20
40
60
80
1991 1995 1999 2003 2007 2012 2014 2015
Target RPJMN
Capaian
Target
MDGs
SASARAN INDIKATOR STATUS
PENINGKATAN KUALITAS PELAYANAN
KESEHATAN IBU DAN BAYI
1. Penurunan tingkat kematian Ibu (AKI)
2. Penurunan tingkat kematian bayi (AKB)
3
3
Target dan Capaian
ANGKA KEMATIAN IBU DAN ANGKA KEMATIAN BAYI
ANGKA KEMATIAN BAYI
Masih tingginya Angka Kematian Ibu dan Bayi (AKI dan AKB) terutama karena :
Cakupan persalinan oleh tenaga kesehatan terlatih sudah mencapai 88,64 persen namun kualitas pelayanan dan
kompetensi tenaga kesehatan belum sepenuhnya sesuai standar pelayanan.
SDKI 2012 melaporkan cakupan imunisasi dasar lengkap meliputi HBV, BCG, DPT, Polio, dan Campak baru mencapai 66
persen, meskipun khusus imunisasi campak sudah mencapai 80,1 persen.
390
334
307
228
359
118
102
0
50
100
150
200
250
300
350
400
450
1991 1997 2003 2007 2012 2014 2015
ANGKA KEMATIAN IBU
Target dan Capaian
Target RPJMN
Target MDGs
Impact
Outcome

Persalinan aman
KAP ttg persalinan
normal dan beresiko

Output

UKBM yg efektif utk
desa siaga bumil-
bulin-buteki
Nakes terlatih siap
tugas
Akses yang membaik
Prosedur dipatuhi

Process Input
I. Faktor Pemungkin
ANC & Persalinan
Persalinan o nakes
Penanganan kompilkasi
UKBM
Sistem transport
Pembiayaan
Donor darah
Ibu dan
anak
selamat
II. Kebjakan dan advokasi
Kebijakan untuk akses-
ketersediaan-mutu-sustain
III. Emergensi Obstertri
PONED dan PONEK
Pelatihan nakes
Anggaran
Sarana
Prasarana
Transportasi
SDM
SPO
Dukungan
politis
FOKUS PD
EKOLOGI
SDA dan Kapasitas
Ekologis
FOKUS PD
EKONOMI
Sistem2 Ekonomi
FOKUS PD
SOSIAL
Modal Sosial &
Tujuan Kesejahteraan
AGENDA PEMBANGUNAN POST 2015
SUMBER DAYA ALAM (DATA DUNIA)
Sumber air bersih:
1M penduduk tidak akses air bersih
2,5M (1/3 total penduduk dunia) tdk miliki sanitasi dasar
Udara bersih
Hampir semua kota besar tidak miliki udara bersih
Tanah
Lahan terkontaminasi
Hutan gundul
Desertifikasi (lahan menjadi gersang)
50% SDA (fossil fuels, minerals) habis dikonsumsi
DAMPAK KERUSAKAN
LINGKUNGAN
Pemanasan global
Deplesi lapisan ozon
Kerusakan biodiversitas
Hujan asam
Etrofikasi
Human and eco-toxicity
MASALAH SOSEK (DATA DUNIA)
Jumlah penduduk tidak terkendali:
Menuju 10M di abad ini

Ketimpangan ekonomi dan kemiskinan
Proporsi 20% penduduk terkaya miliki 83% pendapatan ekonomi
Sedangkan 20% termiskin miliki 1.4% pendapatan dpl. < $1/hari
Hampir 50% jumlah penduduk (3M) hidup dengan $2/hari
Lebih lanjut: 790juta pendudukan dalam kelaparan dan tidak miliki
pangan yang cukup
AGENDA PEMBANGUNAN POST 2015
Objective Enablers/Pre-requisites
A sustainable Post 2015
Development Agenda

Peace and Security
Good Governance and transparency
Strengthened institutional capacity
Strengthened access to justice and
information
Human rights for all
A credible participatory process with
cultural sensitivity
Enhanced statistical capacity to measure
progress and ensure accountability
Objective Enablers/Pre-requisites
A sustainable Post 2015
Development Agenda

Growth oriented macro-economic policy
A developmental state
Means of implementation and monitoring
Domestic resource mobilization;
Social inclusiveness and equality
Infrastructure development
Reliable access to energy
Global cooperation and partnerships.

AGENDA PEMBANGUNAN POST 2015
Goal Indicators
Economic
transformation and
inclusive growth
Employment creation
Rural development
Value addition of primary commodities
and resources
Food security
Fair trade, markets and regional
integration and investment
Prioritize sustainability and support
inclusive green economy initiatives
Goal Indicators
Innovation and
technology
transfer

Quality education at all levels with emphasis on
science and technology
Vocational training and adult education
Market relevant curricula and placements
Technology for sustainable development
technology transfer
Investment in research and development

Goal Indicators
Human
development
Gender parity: women and youth empowerment
Access to social protection for vulnerable groups
Health for all, with special focus on women and
child health
Empowerment of elderly and disabled
Strengthened capacity to implement disaster risk
reduction and climate adaptation initiatives
Adequate shelter and access to water, sanitation
and hygiene

AGENDA POST-2015 YANG TERKAIT BIDANG KESEHATAN
3. Provide quality
education and
lifelong journey
3a. Increase by x% the proportion of children able to access and
complete pre-primary education
4. Ensure Healthy
Lives
4a. End preventable infant and under-5 deaths
4b. Increase by x% the proportion of children, adolescents, at-
risk adults and older people that are fully vaccinated
4c. Decrease the maternal mortality ratio to no more than x per
100,000
4d. Ensure universal sexual and reproductive health and rights
4e. Reduce the burden of disease from HIV/AIDS, tuberculosis,
malaria, neglected tropical diseases and priority non-
communicable diseases

BACK TO BASIC
Sehat merupakan nilai kemanusiaan yg mendasar keberadaannya,
melekat pd setiap insan, melingkupi, mengakar dan merupakan
interaksi dinamis dari berbagai kekuatan sosial yang dihargai
sepanjang sejarah kemanusiaan (Health is seen as embedded in social
relations of power and historically inscribed contexts)
SEHAT HARUS DILIHAT DARI
NILAI KATA SEHAT SECARA SOSIAL
Labonte, 2005
Dengan demikian setiap upaya menjaga dan memperbaiki status
sehat harus untuk kepentingan masyarakat yang sedang alami
persoalan kesehatan (...should be shaped by the interests of those
communities who carry the greatest burden of disease).

Labonte, 2005
Cara-cara dalam upaya menjaga dan memperbaiki status sehat
tersebut harus melibatkan, mengikutsertakan, memberdayakan
masyarakat dan kelembagaannya sebagai unsur aktif dalam setiap
proses upaya perbaikan (... methods should engage community
constituencies as active agents in the process of research)

Labonte, 2005
Efektifitas kolektif dalam upaya untuk tetap sehat
Keberhasilan (perseptif) baik individu, keluarga, organisasi dan masyarakat
luas terkait pengendalian untuk tetap sehat
Tekanan dan pengaruh sosial yang efektif untuk tetap sehat
Perubahan dan peningkatan kehidupan keseharian, norma, sumber dan
kondisi sosial untuk tetap sehat
UKURAN KEBERHASILAN
PEMBERDAYAAN
Modifikasi dari: Becker, 1992
o Sense of self-worth (berharga-dihargai-menghargai)
o Right to have and to determine choices (pilihan hidup efektif)
o Right to have access to opportunities and resources (meraih cita2)
o Right to have the power to control their own lives (kendali & hak hidup)
o Ability to influence the direction of social change (including family
health) to create a more just social and economic order, nationally and
internationally (kemampuan saling pengaruhi utk lebih baik)
5 KOMPONEN KEBERDAYAAN
Domain Pertama:
PERLU KETRAMPILAN
.
.
.
1b.Diagnosis &
Investigasi
7.Mgmt
System
8.Riset
Libatkan
end-user
Kembangkan & diseminasi
strategi program
Libatkan stakeholders dlm
tiap proses
Tetapkan
Goal &
tujuan
Rumuskan
Proses
Kerja
Implem
Keg &
Aliansi
Hasil
Langsung
(direct)
Outcome
(Hasil tdk
lgs)
Domain dampak dari produksi Aliansi:
Kapasitasi sisyan kesehatan
Kebijakan kesehatan berbasis data
Perbaikan mgmt program
Peningkatan skills staf
Domain Kedua:
Keterkaitan dg Users
Domain Ketiga:
ALIANSI MENGELOLA
PENGETAHUAN
4-Kapasitasi
Mengelola
Pengetahuan
1-Kapasitasi
Kebijakan &
Pemograman
3-Kapasitasi
Partisipasi
Kel & Masy
2-Kapasitasi
Aliansi
Kapasitas Dekonsentrasi
Kapasitasi NSPK
Global Opportunity
Governance
Stewardship
Financial
Capacity building
benchmarking
Standarization
Stewardship
Governance
Financial
Capacity building
Benchmarking
Standards
Kinerja
staf
Predisposing
Reinforcing Enabling
Kapasitas Otonomi Daerah
Policy Capacity
Hlth Mgtm capacity
HRD capacity
Financial capacity
IS & Knowl mgmt
Media & nerworks
Knowl management & network
International funding
Health Devt Policy & communication
Capacities devt
Modif: Bachtiar 2009
1-Mengelola pengetahuan s/d skala global
Community Empowerment
G
l
o
b
a
l
-
r
e
g
i
o
n
a
l

,

K
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a
n

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4-Mengelola Pengetahuan Oleh Kaum
Berpengetahuan
PT & ORGANISASI PROFESI
IPTEK
Learning-KnowledgeInnovation
Peran Profesi
(bersama PT)
adalah mencipta
pengetahuan dan
ketrampilan
(KNOWLDEGE
CREATION &
PRESERVATION)
sehingga
bermanfaat bagi
SEMUA
Suplai
YANKES
Modal Sosial Masy
ORGANISASI PELAKSANA (PEM & MASY)
PELKESMAS
Tacit&embedded knowl
Peluang &
Ancaman
OUTCOME KESEHATAN
DAPAT DIBERIKAN OLEH
Kaum Berpengetahuan
Adaptasi dari Hughes-Tuohy 2003 & Hicks & Mishra 1993
Kelembagaan
ALIANSI yg kuat
Sumberdaya
aksi/power
Mobilisasi
Sumberdaya
Ketrampilan
Sumberdaya
Pengetahuan
SOLIDITAS ALIANSI
Advokasi Healthy Public Policy
Kekuatan politik (pol pressure)
Kekuatan advokasi
Kapasitasi sistem
Fasilitasi kebijakan
Fasilitasi Perenc&mgmt
Fasilitasi evaluasi
Kemampuan regulasi&kebijakan
Kemampuan Perenc&mgmt
Kemampuan evaluasi
MIRACLE BRAND
M
MANAGING PUBLIC HEALTH POLICY& PROGRAM
EFFORTS
I
INNOVATING APPROACHES METHODS AND
PARADIGM
R
RESEARCHING COMPREHENSIVE EVIDENCES
A
APPRENTICING (OBSESSION) FOR PERFECTION
C
COMMUNITARIAN (LIVE WITH-FROM-TO-BY)
L
LEADING FOR A PUBLIC HEALTH VISION
E
EDUCATING ALL FOR SELF RELIANCE IN HEALTHY
LIFE
PROFESSIONAL
VISION
FOR PUBLIC HEALTH
GRADUATES
PUBLIC HEALTH GRADUATES MUST
HAVE_1
Knowledge-driven practices
Adequate knowledge and skills to understand health
problems, at all levels, ie, individual and community

Problem-solving attitudes
Adequate professional skills to solve public health
problems
Interactive ability
Adequate softskills for implementing public health
solutions within social economic development
frameworks and perspectives

Enlightenment capacity
A comprehensive involvement in social cultural,
poltical and economic development for the sake of
peoples health
PUBLIC HEALTH GRADUATES MUST HAVE_2
.
.
SOFT
SKILLS
MIRACLE
P.H
SKILLS
BASIC PUBLIC HEALTH SKILLS
1. Analysis and Assessment
2. Policy development and program planning
3. Communication skills
4. Cultural competency/local wisdom
5. Community dimensions of practice
6. Basic public health sciences
7. Financial planning and management
8. Leadership and systems thinking/total system
Source: IPHA academic draft for PH Competencies, 2011
"TELL ME,
I'LL FORGET.
SHOW ME,
I MAY
REMEMBER.
BUT INVOLVE ME
AND
I'LL
UNDERSTAND."
Confucius,
Ancient Chinese Philosopher
A FOUR PHASE EDUCATIONAL
MODEL
PHASE 1 P.H COMPETENCIES DEVELOPMENT
Depts Participating All PH Departments in the School of PH
Who Participates PH Practitioners, Professors & Students
What 8 PH Competencies
Where School and PH fields
Funding University Funding; Student Tuition
PHASE 1
A FOUR PHASE EDUCATIONAL
MODEL
PHASE 2 INDIVIDUAL OR GROUP PROBLEM BASED LEARNING
Dept. Related to course topics
Who Practitioners, Profs. & Students
What PH mini case report on PH situation in surrounding
Where In-class and PH fields
Funds University, Tuition
PHASE 2 PHASE 1
A FOUR PHASE PROCESS MODEL
PHASE 3 DESCRIPTIVE & QUALITATIVE INDIVIDUAL RESEARCH
Dept. Related to research topic Other depts within school
Who Practitioners, profs, candidate Practitioners, profs, students
What Translational descrip research Multi dept contribution to res.
Where Faculty Project location(s) Faculty Project location(s)
Funds Dept funds, Private, Grants University, Tuition, Grants
PHASE 2 PHASE 1 PHASE 3
A FOUR PHASE PROCESS MODEL
PHASE 4 SUSTAINABLE TRANSLATION & DISTRIBUTION
Dept. Related to research topic
Who Practitioners, profs, candidate
What Thesis exam and publication in journal
Where PH seminars
Funds Dept funds, Private, Grants
PHASE 2 PHASE 1 PHASE 3 PHASE 4
.
STRUCTURING
THE
COLLABORATION
UNIVERSITY ROADMAP
(Continuing)
PH
education
progr
Impact to
Hlth System

Evidence based
policy
Improved Hlth
capacity
Hlth Devt
Leadership
Health systems
effectiveness
Internal univ
networks
External networks
with PH Professions
Globally
External network
with donors
External networks
with reserachers
MONEV & CONTINUOUS IMPROVEMENT
Knowledge Creation
Translational research, policy devt
Knowledge brokering and
codification
Knowledge warehousing
Publications, seminars, workshops
Knowledge Preservation
Knowledge exchange & portal
Policy analysis
Knowledge internalization and
use
Teaching/training
Practice guidelines/tools
Evaluation studies
EFFECTIVE ALLIANCES:
FRAMEWORK USED
Social media & PH
education
technology
Strategy &
Process for PH
education
quality
Social Capital
including market
and users
VIRTUALISATION
GLOBAL
HARMONIZATION
PH COMPETENCIES
THE IPHA ACTIONS
Further actions are planned as follows:
Strengthening local PH professional
organizations
Continuing PH Education
Aliances
Empowering stakeholders
Shift the IPHA as holding organization for all
professional health organizations with similar
goal to achive healthy people
CLOSING
REMARKS
Membangun Ketahanan Sosial
Pasien & Keluarga
O - Output terukur
U - Utamakan budaya sehat-pemulihan & ancamannya
T - Training menuju kemandirian pasien dg fasilitasi UKM-UKP yg terpadu
R - Rancang mobilisasi sumberdaya tmsk jenjang keluarga
E - Eratkan partisipasi semua anggota keluarga, lingk, tempat kerja dll
A - Adopsi dan adaptasi rencana kerja sesuai kebutuhan
C - Cerahkan stakeholders (pasien/kel/dll) mel komunikasi-komunikasi-komunikasi
H Himpun-pelajari sukses & tahapan2nya untuk adopsi-adaptasi
Being attentive along the journey is as important as
the destination