Referral health care Community health insurance Diseases control and prevention (polio, pulmonary TB, acute respiratory infection, HIV/AIDS & STI, DHF, Malaria, Leprosy, Filariasis, vector surveillance) Referral health care Community health insurance Diseases control and prevention (polio, pulmonary TB, acute respiratory infection, HIV/AIDS & STI, DHF, Malaria, Leprosy, Filariasis, vector surveillance)
Morbidity mortality nutri status Imr-> health care n economy
Health system & medical education in indonesia
HEALTH SYSTEM AND MEDICAL EDUCATION IN INDONESIA Jelita Artha Purba Novita Gemalasari Liman Shela Putri Sundawa
INDONESIA • 33 provinces • 98 municipalities • 399 districts • 6,598 sub-districts • 75,638 villages • 237,641,326 people • State of LawMinistry of Health Republic of Indonesia. Indonesia Health Profile 2010, Jakarta; 2011.
ORGANIZATIONAL HEALTH SYSTEMWorld Health Organization. Indonesia National Health System Profile. 2007http://www.searo.who.int/en/Section313/Section1520_6822.htm
PRIMARY HEALTH CENTRE • Technical implementation unit of regency’s public health service responsible for health development in one or part of districtMinistry of Health Republic of Indonesia. Indonesia Health Profile 2010, Jakarta; 2011.
MANDATORY HEALTH EFFORTMustika R. Explanation of PHC Visit. Presentation Slide. 2011.
EXPANSION • Public health care • School health care • Mental health care • Occupational health care • Sport health care • Eye health care • Elderly health careMustika R. Explanation of PHC Visit. Presentation Slide. 2011.
SUPPORTINGMustika R. Explanation of PHC Visit. Presentation Slide. 2011.
LONG TERM DEVELOPMENT PLAN IN HEALTH 2005-2025 Target 2005 2025 Life expectancy 69 73,7 Infant Mortality Rate 32,3/1000 15,5/1000 live births live births Maternal Mortality Rate 262/100.000 74/100.000 live births live births Under-five malnutrition 26% 9,5%Rencana Pembangunan Jangka Panjang di Bidang Kesehatan 2005-2025. Jakarta:Departemen Kesehatan RI; 2009.
STRATEGIES • Health-based national development • Local and community empowerment • Development of health efforts and financing • Development and empowerment of human health resources • Health emergency responseRencana Pembangunan Jangka Panjang di Bidang Kesehatan 2005-2025. Jakarta:Departemen Kesehatan RI; 2009.
RESOURCES’ REQUIREMENTS • Human health resources • Health financing • Pharmacy, medical devices, and foods • Health information systemRencana Pembangunan Jangka Panjang di Bidang Kesehatan 2005-2025. Jakarta:Departemen Kesehatan RI; 2009.
CHALLENGES • Increasing population • Epidemiology transition • Decentralization • Knowledge, attitudes, and behaviors of societies • Regional inequities in health care and access • Drug addictions • Millennium Development GoalsRencana Pembangunan Jangka Panjang di Bidang Kesehatan 2005-2025. Jakarta:Departemen Kesehatan RI; 2009.
MORTALITYInfant mortality rate/1000 live births Under-five mortality rate/1000 live births Crude Death Rate (2007) 6,9 / 1,000 Life excepetancy at birth (2009) 69.21 Ministry of Health Republic ofMaternal mortality rate/100000 live births Indonesia. Indonesia Health Profile 2010, Jakarta; 2011.
MORBIDITY Ten Main Diseases Hospital Inpatients (2010)Ministry of Health Republic of Indonesia. Indonesia Health Profile 2010, Jakarta; 2011.
MORBIDITY Ten Main Diseases in Hospital OutpatientsMinistry of Health Republic of Indonesia. Indonesia Health Profile 2010, Jakarta; 2011.
MORBIDITY Nu triti on al Sta tus Communicable Diseases (Malaria, Pulmonary TB, HIV/AIDS, Pneumonia, Leprosy, Yaws) Preventable Diseases through Immunization Potential Outbreak DiseaseMinistry of Health Republic of Indonesia. Indonesia Health Profile 2010, Jakarta; 2011.
Medical Student in Indonesia Status Amount of StudentUniversitas Area Public PrivateIndonesia UG PG Doctoral Profession Universities Universities Sumatera 9 11 11.156 123 36 2.411 Jawa 9 24 22.104 190 506 8.239 Bali, Nusa Tenggara 3 2 1.312 78 26 415 Kalimantan 3 0 884 - - 42 Sulawesi 4 2 2.630 - 8 924 Maluku, Papua 2 0 394 - - - Total 30 39 38.480 391 576 12.031 Source: EPSBED, 4 Okt 2010
GROWING OF MEDICAL EDUCATION INSTITUTION Year Field of Study 2006 2007 2008 2009 2010Medical Education 52 52 52 67 70 Source: DGHE, 2009
Insitution Accreditation Accredited Accredited Program Acredited C Total A BMedical 16 19 11 46Education Sumber: www.ban-pt.depdiknas.go.id (21-08-2010)
STANDARD OF MEDICAL DOCTOR COMPETENCEDiagnosis 1 2 3A 3B 4Acute Bronkhitis XTB with HIV XHepatic cirrhosis XAcute synusitis XFatty liver XCondiloma acuminata XBartholin Cyst XEsophagus Varices XCluster headache XImpetigo XHodgkin Lymphoma XMastytys X
FACULTY CURRICULUM 2005 Integrated Problem Based curriculum Learning• Academic staff tutor/facilitator act as ctivator or provocateur that motivates the students to learn• Length of study: 1 year pre-medicine 2 years of pre-clinic 2 years of clinic 6 years 1 year of internship• 1st year education ODD SEMESTER •English EVEN SEMESTER •Bahasa Indonesia •Cell and Genetic •Religion Progress •Biology Progress • Art test Moleculare test • •Neuroscience •Research •Empathy
2 YEARS OF PRE-CLINIC• 2nd year education Odd Semester Even Semester •Growth and Development •Gastrointestinal System •Dermatology and Suppoting •Renal System P •Cardiovascular system P Tissue r •Respiratory System r •Musculosceletal System o o g g r r• 3rd year education e e s Even Semester s s •Special Sense s Odd Semester •Infection •Metabolic Endcoricology t •Immunology t system e •Hematology and e •Reproductive system s Oncology s •Neuropsychiatry t •Community Medicine t
PROBLEM BASED LEARNING IN PRE-CLINIC• Lecture• Group Discussion 1 (9-10 student, 1 facilitator) Case Scenario as trigger Home assignment based on trigger (each student have different assignment)• Group Discussion 2 Presentation from home assignment Discuss the answer of the question by compiling home assignment Preparing presentation• Plenary Session (80 - 180 students, 1 moderator, 3-5 resource person) Each group present the result of their discussion
• Laboratory Practice• Basic Clinical Skill (7-8 students, 1 tutor)• Exam Lab exam Written exam Formative 1 and 2 Summative 1 and 2
EXAMPLE OF: CASE SCENARIO• Mr. Petra, 70 years old is a fisherman who came with complain of scab in the tip of the nose since 4 months ago. In the beginning, it was a peanut size lump which getting bigger and bigger. It was not painful and itchy. Mr. Petra often used his nail to scratch the lump until it became wound and scab. In the other part of his face, there were also so many skin thickening like ward dark in color with various size (diameter ½-1 cm). He had applicated antibiotic ointment but the scab didn’t get any better
STEP IN GROUP STEP IN GROUP DISCUSSION 1 DISCUSSION 21. Define keyword 1. Present the home assignment2. Identify the problem 2. Discuss the assignment to answer the question and hypothesis3. Analyze the problem 3. Make the conclusion4. Define clinical question 4. Prepare the group presentation5. Make hypothesis6. Develop questions for searching7. Divide the home assignment for everyone PLENARY SESSION
BASIC CLINICAL SKILL• Held since 2th year until 3rd year• Twice a week• 1 group concist of: 7-8 students, 1 tutor• Based on modul, for example Pap smear skill is taught in reproductive sytem module
BASIC CLINICAL SKILL EXAM (OSCE)• Held in the end of third year required to enter clinical year• Content of exam Eye examination (visual acuity, funduscopy, tonometry) ENT examination Obstetric examination and delivery Gynecology examination (Acetic Acid Visual Inspection, Pap Smear) Heart examination Lung examination IV line access Injection Abdominal and renal examination Prescription
Neurology examination Breaking bad news Counseling Psychiatric interview Urine catheter administartion Rectal touche Pediatric examination Basic surgery skill Isolation Precaution Head and Neck examination Nasogastric tube administration
• 4th year education P P ODD SEMESTER r r (5 of the following o o department) g g Emergency Medicine r r Ophtalmology e e ENT s EVEN SEMESTER s Dermatology s (6 of The Remaining Department) s Psychiatry Cardiovascular t t Respiratory e e Neurology s s Aging Medicine t t Forensic Medicine Anaesthesiology Sarjana Kedokteran Bachelor of Medical Science
• 5th year education P P r r o o ODD SEMESTER g g (2 of the following r EVEN SEMESTER r department) e (2 of the remaining e Surgery s department) + Community s Internal Medicine s Medicine +Elective Posting s Obs & Gyne Pediatric t t e e s s t t Medical Doctor
PROBLEM BASED LEARNING IN CLINICAL YEAR• Lecture• Out Patient Department• In-patient department• Case Presentation• Mini CEX• Night Duty in Ward or Emergency Department• Examination Written Face to face OSCE
FINAL EXAM• Comprehensive Exam Face to Face exam• Doctor Competence Exam (held nationally) Written OSCE
• Practice medicine in PHC or General Hospital• Under supervision• 8 months in General Hospital• 4 months in PHC• Get monthly salaryLetter Permission to Practice as Medical Doctor from Indonesia Medicine Council