This document discusses global health challenges and physician responsibility. It begins by noting that all humanity lives in the same world and should cultivate peace. It then discusses the Millennium Development Goals (MDGs) related to health, including targets and indicators for reducing child mortality, improving maternal health, and combating diseases. It analyzes Indonesia's progress in meeting health-related MDG targets compared to other ASEAN countries. The document also discusses remaining global problems, the shift from MDGs to the Sustainable Development Goals, and challenges of economic integration like AFTA as well as Indonesia's roadmap for achieving universal health coverage. Throughout, it emphasizes the importance of good governance and sustainability for addressing global health issues and the

1. Global Health and
Physician
Responsibility
VIERA WARDHANI

2. Meet your new partner
 Viera Wardhani
 Department of Public Health,
FKUB
 Postgraduate Program in Hospital
Management

3. Why?

4. We all live in the
same word
We are all member of a single
humanity inside our heart we all speak
the same, we all love our children and
our parents, we all live in the same
world…….(Mac Forne Malne)

5. We all live in the same
world
If civilization is to survive we must
cultivate the science of human
relationship the ability of all people
all kind to live together in the same
world at peace (Franklin D Rosevelt)

6. Global Health Challenges

7. Tujuan Pembelajaran
 Menjelaskan isi MDG dan Post MDG yang terkait dengan bidang
kesehatan
 Menyebutkan indikator dan target pencapaian MDG dan Post MDG
yang terkait dengan bidang kesehatan
 Menjelaskan pencapaian indikator dan target pencapaian MDG
bidang kesehatan di Indonesia dibandingkan dengan negara ASEAN
 Menjelaskan permasalahan dalam pencapaian indikator dan target
pencapaian MDG bidang kesehatan
 Mengidentifikasi peran dokter dalam sistem pelayanan kesehatan
untuk menjamin pencapaian MDG dan agenda post MDG
 Menjelaskan tantangan AFTA 2015 dan UHC dalam bidang kesehatan
dan peran aktif dokter.

8. What is MDG and current state
achievement

9. Topic 1-2
 Why MDG
 What is MDG

10. 4. Reducing Child Mortality
Indicator 1997 Target 2007 Comments
Under five
mortality rate/1000
81 32 40
Infant mortality
rate/1000
57 19 32

11. Child Mortality Health

12. Neonatal death causes

13. Infant mortality causes

14. U-5 Mortality causes

15. 5. Improving maternal health
Indicator 1990 Target 2007 Comments
Maternal
mortality rate per
100.000
390 110 300
Birth helped by
trained nurse
40.7% 100% 72.4
Married women
age 15-49 using
contraception
50.5% 100% 57.9

16. MMR Trend

17. Cause MMR

18. Three delay model

20. Making Pregnancy Safer Messages
All pregnancy is
intended (wanted)
All delivery is helped
by trained health
care attendance
All pregnancy
complication
managed with an
adequate health
1
2
3

21. 6. Combating HIV/AIDS and other
Diseases (TB, Malaria)
Indicator 1997 Target 2007
Prevalence of
HIV/AIDS
Control the
spread
5.6
Case of
Malaria/1000
8.5
Tuberculosis
prevalence
/100.000
786 262

22. Why HIV Epidemic?
PerempuanLaki-laki
3,1 Juta Pria
membeli Sex
(2-20% dari Pria Dewasa)
1,6 Juta
menikah
dg pria risiko
tinggi
230.000
penasun
800,000
GWL
230,000
Wanita
Pekerja seks
Anak-anak
Jumlah Penduduk Indonesia: 240 juta

23. ASEAN Human development index
Rank
Country ASEAN rank HDI Income
category
GDP
Group Rank Index
Singapore High High 25 0.992 High 29.663
Brunei High High 30 0.894 High 28.161
Malaysia Upper med High 63 0.811 Upper med 10.882
Thailand Upper med Medium 78 0.781 Lower med 8.672
Philippine Medium Medium 90 0.711 Lower med 5.137
Vietnam Medium Medium 105 0.733 Low 3.071
Indonesia Medium Medium 107 0.738 Lower med 3.843
Laos Lower med Medium 130 0.601 Low 2.039
Cambodia Lower med Medium 131 0.598 Low 2.727
Myanmar Lower med Medium 132 0.583 Low 1.027

24. ASEAN Human development index
Rank
Thai Mal Phil Indo Vietn. Cam Lao Myan.
Poverty A A A ?
Hunger A A A
Primary
education
A A
Gender
disparity
A A A
Under 5 M A A
MMR A A
HIV/AIDS A A
Infectious
disease
A A
Environment ? ?
Safe water,
sanitation
A A A

25. What are the remaining global
problems?
SUSTAINABILITY AND GOOD GOVERNANCE

26. From MDGs to Sustainable Development
Goals
8 GOALS MDGs
12 GOALS SDGs

27. Comparing MDGs and SDGs
MDGs 2000 - 2015
1. Menanggung Kemiskinan dan
Kelaparan
2. Mencapai Pendidikan dasar untuk
semua
3. Mendorong Kesetaraan Gender dan
Pemberdayaan Perempuan
4. Menurunkan Kematian Anak
5. Meningkatkan Kesehatan Ibu
6. Mengendalikan HIV dan AIDS, Malaria
& Penyakit Menular Lainnya (TB)
7. Menjamin Kelestarian Lingkungan
Hidup
8. Mengembangkan Kemitraan
Pembangunan Tingkat Global
POST 2015
1. Mengakhiri Kemiskinan
2. Memberdayakan Anak Perempuan, Kaum Perempuan
& Pencapaian Kesetaraan Gender
3. Meningkatkan Mutu Pendidikan & Penerapan Belajar
Seumur Hidup
4. Menjamin Hidup Sehat
5. Menjamin Ketahanan Pangan & Gizi Baik
6. Menjamin Tersediannya Akses Air Bersih & Sanitasi
7. Membangun Ketahanan Energi Berkelanjutan
8. Menciptakan Lapangan Kerja, Penghidupan
Berkelanjutan, & Pertumbuhan Berkeadilan
9. Mengelola Aset Sumber Daya Alam secara Berkelanjutan
10. Meningkatkan Penyelenggaraan Pemerintahan yang baik
dan efektif
11. Menjamin Kehidupan Bermasyarakat yang Aman dan
Damai
12. Menciptakan Lingkungan Global yang Kondusif sebagai
Katalisator Pembiayaan Jangka Panjang

28. Two Important Keys
 Good governance
 Sustainability

29. AFTA Challenges and Universal
Health Coverage

30. AFTA challenges
Global
Standard
Free
Trading
Global
Competition

31. Universal Health Coverage &
Sustainable Development

32. Health enables sustainable
development
Health is a
Right
Health is
socially
determined
Health
contributes to
growth &
development
Increase access
to health services
Improve level &
distribution of health
Outcomes
Better health
for citizen
Improve country
competitiveness
Inclusive &
sustainable growth
Healthy population mean
higher labor productivity
Higher return to household from
labor market participation
75% of health outcome is
highly depend on working
and living condition
The right of everyone to enjoy
the highest attainable
standard of physical and
mental health is globally
recognized

33. The contribution of health sector
Post 2015 Development Agenda : Wellbeing for All
Sustainable wellbeing for all: poverty
eradication, education, nutrition,
environment, security, etc
Healthy lives at all stages: child survival,
maternal survival, MDG6, adolescent
health NCD burden reduction
Universal Health Coverage; health
promotion, prevention, treatment,
financial risk protection
Health
Sector
Other
Sector

34. UHC Means
 All people can access the health service they need
without incurring financial hardship
Access
Financial protection

35. Road map of Indonesian
universal health coverage (UHC)
20% 50% 75% 100%
20% 50% 75% 100%
10% 30% 50% 70% 100% 100%
`Perusahaan 2014 2015 2016 2017 2018 2019
USAHA BESAR 20% 50% 75% 100%
USAHA SEDANG 20% 50% 75% 100%
USAHA KECIL 10% 30% 50% 70% 100%
USAHA MIKRO 10% 25% 40% 60% 80% 100%
2012 2013 2014 2015 2016 2017 2018 2019
Pengalihan Peserta JPK
Jamsostek, Jamkesmas, Askes
PNS, TNI Polri ke BPJS Kesehatan
Perluasan Peserta di Usaha Besar, Sedang, Kecil & MikroPenyusunan
Sisdur
Kepesertaan
dan
Pengumpulan
Iuran
Pemetaan
Perusahaan
dan
sosialisasi
Pengukuran kepuasan peserta berkala, tiap 6 bulan
Integrasi Kepesertaan Jamkesda dan askes
komersial ke BPJS Kesehatan
Pengalihan
Kepesertaan
TNI/POLRI ke
BPJS Kesehatan
Kajian perbaikan manfaat dan pelayanan peserta tiap tahun
Sinkronisasi Data Kepesertaan:
JPK Jamsostek, Jamkesmas dan
Askes PNS/Sosial -- NIK
Penduduk yang
dijamin di berbagai
skema 148,2 jt jiwa
111,6 juta
peserta dikelola
BPJS Keesehatan
60,07 Juta pst
dikelola oleh
Badan Lain
257,5 juta
peserta
(semua
penduduk)
dikelola BPJS
Keesehatan
Tingkat
Kepuasan
Peserta 85%
KEGIATAN:
Pengalihan, Integrasi, Perluasan
73,8 juta belum
jadi peserta
90,4juta belum jadi
peserta
Perpres Dukungan
Operasional
Kesehatan bagi
TNI Polri
86,4 juta PBI
35
72%
(2013)

36. National Health Security System
Regulator
BPJS
Participants Health
facilitiesAccess to Health service
Health Services
National policy for
regulation and implement
Regulation for , health
personal, medical equipment,
medicine formularies etc.
Regulasi Pricing of health
services/provider (TARIF)
KendaliBiaya&kualitasYankes
Government
Sistem Rujukan
Pembayar tunggal, regulasi, kesetaraan
Primary
Secondary Referral
Tertiary Referral
system

37. 2014 20202015 2019

38. Keep in mind