Sesi pembuka adang

INTERMEDIATE
PUBLIC HEALTH
adang@post.harvard.edu
THE OPENING

OUTLINE
 DUA BAGIAN SEBAGAI PEMBUKA
 Peta jalan mahasiswa IPH
 Strategic path for PH leaders

Sistem kelola sumber daya Virtual &
Real utk mata ajaran
Ekspektasi Luaran yang
dirasakan lgs masy
PROSES MENJADI PANDAI DAN ARIF
Interaktif-Blended-Self Learning-Group working-
Pipelining SEMUA SEC MANDIRI
Tata Kelola MK yg
Efektif Adaptif
Fasiltator &
experts
Dinamika Lingkungan Sosial, Ekonomi, dan Politik
Kesehatan Lokal-Nasional-Global
Scientific Journey & Breakthrough
Hubungan kausalitas Umpan Balik
DISRUPTIF UNTUK FOR LEADERS
DI ERA PANDEMI/ENDEMI/HIPERENDEMI
Adaptasi dari: E. Ostrom (2007).

5 MANFAAT ILMU TERELABORASI DI IPH
 DARI PALING RENDAH KE TINGGI
1. Publikasi ilmiah – Wajib utk kelulusan
2. Peer development
3. Specific health policy change
4. Broaden health policy changes
5. Broad social welfare changes

5 BAHAYA DALAM MENGEJAR ILMU
 SETIAP BAHAYA: HINDARI !
1. Proses deduksi dengan rujukan lama >> stigma no added value
2. No contextuality >> stigma copy paste
3. No comparison >> stigma wasting
4. Teoritisasi yg dangkal tdk tepat >> kerangka fikir salah
5. Metode riset tdk lengkap dan benar >> garbage

Intelektualisme Diharapkan Mel Disruptif
Dimensi Konvensional FUTURE LEADERS
Fokus diri Sekolah vs masy Link & Match: Menuju policy changes
Lingkup Masing2 keilmuan terkotak2 IPE pipelining menuju tesis bermanfaat
Waktu Paket mata ajaran konvensional SCL; blended; pipelining – self actualized
Metode belajar Fokus di kelas mengejar kognitif Interaktif kelas dan policy reform process
Klien Mhsw sendiri Mhs dan policy maker menuju menfaat
Tempat ilmu
bertumbuh
Di kampus Di kampus kmd di masy menuju perubahan
kebijakan sbg outcome (OBE)
Urutan
kemanfaatan
keilmuan
1. Segera lulus
2. Implementasi oleh lulusan
3. Inovasi & perubahan kebijakan
1. Implementasi oleh mhsw selagi sekolah
2. Inovasi sbg hasil pendidikan
3. Perubahan kebijakan sec dinamis
Model pendidikan Spesialistik, terkotak2, non IPE Terintegrasi dg ketrampilan spesifik &
mendalam

TEORI PEMBELAJARAN DIGUNAKAN
 Berdasarkan “keluasan ilmu Kesmas” dan MA ini adalah “Intermediate”,
maka proses pembelajaran TERSTRUKTUR SESUAI SILABUS FAKULTAS,
menggunakan pendekatan:
 Problem Based Learning for solution (PBL) dengan tema spesifik (Thematic
Learning); menuju luaran yg dirasakan manfaatnya (OBE)
 Student Centred Learning (SCL)
 Kerja bareng sbg ciri kesmas (TEAM WORK LEARNING IN THE FIELD)
 Memanfaatkan prior experiences (ADAPTIVE LEARNING)
 Menuju ke penyelesaian program studi (disertasi individu) (PIPELINING)
 ONE MORE (!): POSITIONING YOURSELF IN THE FUTURE AS LEADER

SESI M.A
SESI
1 DETERMINAN KESEHATAN
2 KEBIJAKAN KESEHATAN
3 HAK ASASI MANUSIA DAN KESEHATAN MASYARAKAT &ETIKA DALAM KESEHATAN
4 SISTEM INFORMASI DAN INTELIGENSIA KESEHATAN
5 PENDEKATAN EPIDMIOLOGI DALAM KESEHATAN
6 PENDEKATAN BIOSTATISTIK DALAM KESEHATAN
7 PENDEKATAN ILMU SOSIAL DALAM KESMAS
8 KESEHATAN LINGKUNGAN-KERJA DAN KES GLOBAL
9 MASALAH KESEHATAN UTAMA : GIZI, PTM, EMERGING DAN REEMERGING DISEASES
10 PENCEGAHAN DAN KONTROL BAHAYA KES PUBLIK
11 INTERVENSI PADA KELOMPOK KHUSUS
12 FUNGSI FUNGSI KESEHATAN MASYARAKAT

IPH THEMATIC LEARNING
Model Implementasi Kebijakan Kesmas (Van Meter dan Van Horn)
Mhsw mampu membangun system dinamis sisi data, arah analisis dan pengembangan kebijakan yg mampu
memenuhi kebutuhan kesehatan era pandemi

Peran Mhs IPH dalam
KINERJA KESMAS
 Determinan kesehatan adalah kunci
menuju menentukan program kebijakan
 Berbagai pendekatan dapat
dikembangkan dalam menyusun
kebijakan kesehatan
PERAN MHSW DLM KLS IPH
 Mhs menilai tk derajat kesehatan secara
obyektif suatu wilayah secara sistematis
dan komprehensif
 Mhs mampu memilih kebijakan kesehatan
pada makro dan mikro wilayah mulia dari
desa, organisasi masy sampai dengan
pusat
POLA ANALISIS & KEBIJAKAN KES

Peran Mhs IPH dalam
KINERJA KESMAS
 Tidak semua program kesehatan
dilaksanakan saat pandemic/endemi
karena (1) secepatnya pandemic/endemi
harus terkendali (2) Relokasi
sumberdaya untuk prioritas tsb (3)
Agilitas pelaksana alami detraksi
 Mhs mampu menyusun problem tree
permasalahan kesehatan yg menjadi
agenda di wilayah
 Mhw mampu menyusun prioritas masalah
dan upaya kendalikan masalah

Peran Mhs IPH dalam
KINERJA KESMAS
 Ketiga hal diatas digambarkan dengan
pendekatan epidemiologis yg shahih,
memanfaatkan data dengan pendekatan
biotatistik yg akurat, dengan
menggunakan bangunan data dan
informasi terstruktur, terukur, dan real
time
 Mhs mampu mengembangkan pisau
analisis yg efektif dengan berbagai
pendekatan kesmas sehingga kinerja
kesehatan terukur sistematis dan obyektif

Peran Mhs IPH dalam
KINERJA KESMAS
 Ketiga factor programming kesehatan
diatas memperhatikan pemenuhan
kebutuhan kesehatan dan etika
kesmas
 Mhs mampu mengembangkan konsep
kesehatan itu hak dalam koridor etika
kesmas
 Mhs mampu memahami penanggulan
wabah adalah prioirtas pertama untuk
mendukung pertumbuhan ekonomi

Peran Mhs IPH dalam
AKSEPTANSI PELAKSANA & MASY
 Pelaksana terdepan adalah masy itu sendiri
sampai ke desa: Sehat itu hak tetapi juga
kewajiban
 Fasilitator adalah tenaga di Puskesmas dan
Faskes lain yg perlu diketahui kapasitas dan
kapabilitasnya
 Lapisan selanjutnya adalah Dinkes dan
Pemda yg tergambar kapasitas dan
kapabilitasnya dalam mendukung sisyankes
garis depan
 Mhs mampu menguraikan peran masy
(misal di Desa) dan Organisasi Masy
lainnya untuk melaksanakan dan
memenuhi kebutuhan kesehatannya.
Diperlukan pendekatan social budaya yg
tepat sehingga pemenuhan kebutuhan
kesehatan terpenuhi dengan benar

Peran Mhs IPH dalam
 Fasilitator adalah tenaga di Puskesmas
dan FKTP lain serta Faskes rujukan yg
perlu diketahui kapasitas dan
kapabilitasnya (sisyankes paripurna)
 Lapisan selanjutnya adalah Dinkes dan
Pemda yg tergambar kapasitas dan
kapabilitasnya dalam mendukung
sisyankes garis depan
 Mhs mampu peran dan fungsi pokok
kesehatan masyarakat paripurna di semua
sisyankes yaitu (1)mendiagnosis situasi
kesmas; (2) ramifikasi masalah kesehatan; (3)
menyusun intervensi epidemiologis; (4)
intervensi edukatif; (5) dengan mobilisasi
semua pemangku kepentingan; (6) menyusun
kebijakan dan program; (7) memastikan
berjalan; (8) melakukan monev utk inovasi

Peran Mhs IPH dalam
 Pandemi dan situasi kebencanaan
kesehatan adalah bagian yg harus terus
diprediksi, diamati, disiapkan
kewaspadaannya dan ditangani dengan
cermat (prevent – detect – response)
 Agilitas pelaksana (garis depan termasuk
masy dan pendukung) adalah kata kunci
dalam pandemi. Dengan demikian tata
kelola agilitas pelaksana berfokus pada
tahapan yg efektif sisi mobilisasi dan
rekrutmen, penempatan, diklat, kinerja
terukur, system insentif dan mobilitas
pengembangan ketrampilan

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HEALTH
MIRACLE
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Asses Develop
Manage
Professionalism
SDM YANG AMANAH DAN
TERAMPIL (IQ-EQ=SQ=DQ)
SINERGI SEMUA
SEKTOR DALAM
KEPEMIMPINAN
KOLABORATIF
(HEALTH IN ALL
POLICIES_
AGILITY terbaik utk
kepentingan SEHAT-
TANGGUH-PRODUKTIF

Peran Mhs IPH dalam
ORGANISASI PELAKSANA
 Beban kerja faskes dalam era pandemi
bertambah besar dengan focus susun
prioritas adalah mutlak
 Konsep ketahanan kesehatan adalah
bagian dari ketahanan nasional yg perlu
difahami dan disusun berbagai intervensi
nya

Peran Mhs IPH dalam
ORGANISASI PELAKSANA
 Beban kerja faskes dalam era pandemi
bertambah besar dengan focus susun
prioritas adalah mutlak
 Organisasi pelaksana di garis depan
beragam mulai dari otonomi desa (modal
social desa) berbagai sector termasuk
Kemsos, Kemdesa, BKKBN dst. Keragaman
tsb terukur dinamis untuk pola siskes era
pandemic yg efektif cepat tepat dalam
pemenuhan kebutuhan kesehatan dasar
 Masing-2 organisasi pelaksana miliki
kinerja program kesehatan yang terukur,
komprehensif, real-time untuk pemenuhan
kebutuhan kesehatan era pandemi.
 Indikator program tersebut bersifat
saling melengkapi (non-overlap) dan
terkendali dalam sistem otoda yg
perlihatkan tusi Pusa-Daerah-Desa

Peran Mhs IPH dalam
KONTEKSTUAL 0RGANISASI PELAKSANA
 Pusat dan daerah tergambar utuh dalam
tusi masing2 yg saling melengkapi
untuk efektif memenuhi kebutuhan
kesehatan, terutama kepada
kelompok khusus/beresiko
 Organisasi pelaksana pembangunan kesmas
bersifat mutisektoral vertical, horizontal dan
diagonal. Berbagai pendekatan perlu difahami
seperti Health in All Policies (H1AP)
 Kebijakan bersumber dari berbagai sector
diperlukan termasuk melingkupi kebijakan
lingkungan hidup yg sehat dan kesehatan
global yg dapat menjadi ancaman

Peran Mhs IPH dalam
KOMUNIKASI PARA PIHAK
 Pencatatan dan pelaporan data berbagai
institusi dalam system yang terintegrasi
menjadi dasar informasi kesehatan
berbagai pihak untuk mengetahui situasi
kinerja dan kondisi pandemi
 Pola komunikasi dan koordinasi berbagai
pihak mengalami adaptasi dalam kondisi
pandemic. Semua komponen bangsa
(penta-helix) perlu terlibat termasuk
kelompok media (social)
 Pemahaman bahwa data kinerja
pemenuhan kebutuhan esensial kesehatan
bersumber dari berbagai pihak dapat
diakses oleh banyak pihak secara real time
utk kepentingan siklus kebijakan dan
programming

Peran Mhs IPH dalam
STANDAR DAN SASARAN KEBIJAKAN
 Pencapaian target sasaran pemenuhan
kebutuhan esensial kesehatan belum
terpenuhi dengan optimal terkait
dengan
 Struktur kebijakan, juklak juknis, dan
sasaran kerja
 Tata kelola yg efektif, bermutu dan
sustain
 Analisis kesenjangan kebijakan, standar
dan sasaran diperlukan untuk kemudian
upaya pengembangannya

Peran Mhs IPH dalam
SUMBERDAYA UNTUK PELAKSANAAN
 Keterbatasan sumber daya di faskes
untuk mengatasi pandemi dan
pemenuhan kebutuhan esensial
kesehatan
 Kapasitasi faskes primer dan sekunder
menjadi agenda kebijakan kesehatan
esensial
 Keterlibatan desa dalam perbantuan
pemenuhan sumber daya di faskes
khususnya puskesmas dan UKBM untuk
pemenuhan kebutuhan esensial kesehatan

FUTURE LEADERS
adang@post.harvard.edu

OUTLINE
 Driven factors for PH leaders (including Industrial
revolution4.0)
 4-Pillar Strategies for future leaders
 Professionalisms
 Measures of success

Emerging Global and Local Mega-Trends to 2030
1.Demographics
2.Economic
Power
3.Social
Media
4.Customers
5.Student Voice
6.Cloud, chains
& things
7.Sustainable
education
8.Cities
9. New Norms &
security
10. Gig Economy

 Children in Labor Force
 Neglected safety
 Overburden in work area
 Global migration and health hazard
 Un-sustained development and un-employment
POPULATION GROWTH IS RELATED TO

POPULATION GROWTH CONTROL
 Industrial health related to
 Family planning
 Improve health care
 Elevate the status of women
 Increase education
 Involve men in domestic family including parenting
 Reduce poverty
 Sustainability development, including new norms situations

LIFE ON LAND
AND PUBLIC HEALTH
 Tamankutty, Mehrabi, Waha:
 Trends in Global Agricultural Land Use: Implications for
Environmental Health and Food Security. Annual Rev. of
Plant Biology, 2018
 Including unsafe procedures in agriculture work settings

LIFE BELOW WATER
AND PUBLIC HEALTH
 Goldman L:
 Three Stages of Health Encounters over 8000 Human
Generations and How They Inform Future Public Health.
AJPH, 2018
 Prata JC:
 Plastic Litter in Our Oceans: A Case Study for Government
Action. Ocean Yearbook Online, 2018

Pemodelan transmisi dengue
(Iklim 1961-1990)

Pemodelan transmisi dengue
(Iklim 2085)

PERKIRAAN
KERUGIAN
$50M
$40M
$30M
$20M
$10M
91 02
94 98 2006
03 05
00
99 01
97
92 95
93 96 04
1990
BSE, UK
$10-13M FMD, Taiwan
$5-8M
Swine Fever, Nl, $2-3M
SARS,
Cina, HK, Kanada
$30-50M
Peny Mulut & Kuku
UK
$25-30M
Avian Flu, NL
$500Jt
BSE, Can
$1.5M
BSE, US
$3-5 M
Avian Flu, Asia
$8-12 M
HPAI, Italy
$400Jt
BSE, Jap
$1.5 M
Nipah, May
$350-400M
Source: Bio Economic Research Associates
Dampak Ekonomi WABAH

G7+ grouping:
Canada, France, Germany, Italy, Japan, the UK, and the US, plus Australia, South Korea and Spain
E7: the seven-largest emerging market economies
(Brazil, China, India, INDONESIA, Mexico, Russia, and Turkey).
2-NEW ECONOMIC POWERS

evolving
political economy realities
 US
 “America First” (with impact of divide of nation)
 Spain and others
 Federal autonomy-Independence (with impact of divide of nation)
 UK and others
 BREXIT (with impact of divide of EU)
 China
 Shifting of power of the world
 Indonesia
 Globalisation and thirst for foreign investment (with impact of divide of nation)

REDUCE INEQUITIES
AND PUBLIC HEALTH
 Daglish, Vogel, Bangkoyian, Hucho:
 Future Direction for Reducing Inequity and Maximising
Impact of Child Health Strategies. BMJ, 2018
 Ahonen
 Work as an inclusive part of populationa health in equities

NO POVERTY
AND PUBLIC HEALTH
 Ganz, Curry, Jones, Mead:
 Barriers to Mental Health Treatment Utilization in Wards 7 and 8 in
Washington DC: A qualitative Pilot Study. Health Equity, 2018
 Ichihara, Ramos, Reboucas:
 Area Deprivation Measures Used in Brazil: Revista de Saude, 2018
 Neal, Harvey:
 Trends in Adolescent First Births in Five Countries in Latin America
and Caribbean: Disaggregated Data From Demographic and Health
Surveys: Reproductive Health Journal, 2018

Kemiskinan
Kesakitan/
Kematian
Menurunnya:
• kualitas hidup
• produktivitas
• kemampuan belajar
• tabungan
Meningkatnya hutang,
dll
Meningkatnya
• faktor risiko personal &
lingkungan
• malnutrisi
Menurunnya :
• akses ke pengetahuan &
informasi
• kemampuan
mengakses pelayanan
Verifikasi empiris dlm disertasi Sirait, USU-2009

ZERO HUNGER
AND PUBLIC HEALTH
 Nguyen-Viet, Grace:
 Integrated Approaches to Tackling Health Issues Related to Agri-food.
Journal McDermott, 2018
 SN Assistance:
 Boxing up Food Poverty. Nature.com, 2018
 Rakotoniaina:
 How to Increase Fruit and Vegetable Consumption: A Multi-stakeholder
Approach to Improved Health Outcomes- A Report form the Alliance for
Food and Health. J of the Am Coll of Nutr, 2018
 McFee:
 Selected Epidemic and Emerging Pathogens. Disease-a-Month, 2017

RESPONSIBLE CONSUMPTION & PRODUCTION
AND PUBLIC HEALTH
 Boue, Cummins, Guillou:
 Public Health Risks and Benefits Associated with Breast
Milk and Infant Formula Consumption. Crit. Rev. in Food Sci.
and Nutr, 2018
 Hornik R:
 Public Health Education and Communication as Policy
Instruments for Bringing about Changes in Behavior. Social
Marketing, 2018

PEACE – JUSTICE
AND PUBLIC HEALTH
 Maziak W:
 Syria: Public Health Disasters in The Era of No World
Order. Internat. J, of Public Health, 2018

DECENT WORK AND ECONOMIC GROWTH
AND PUBLIC HEALTH
 Sayed Nordin, Kun:
 Investigating the Relationship on CO2, Energy
Consumption and Economic Growth: A Panel Data
Approach. Chem. Eng. Transactions, 2018.
 Wright:
 The Changing Nature of Work. Am. J. of Public Health, 2018

INDUSTRY INNOVATION AND INFRASTRUCTURE
AND PUBLIC HEALTH
 Harris, Viliani:
 Strategic Health Assessment for Large Scale Industry
Development Activities: An Introduction. Env. Impact Assmnt.
Rev., 2018
 Zhu, Andersen:
 User-driven Innovation and Technology-use in Public
Health and Social Care: A systematic Review of Existing
Evidence. J. of Innovation Mgmt., 2018

INDUSTRIAL REVOLUTION 4.0
NEEDS IQ-EQ-SQ with DQ

GOOD HEALTH & WELL BEING
AND PUBLIC HEALTH
 Fortune, Becerra-Porsada, Buss, Galvao:
 Better Health for Everyone. WHO Bulletin, 2018
 Lake, Rhynders:
 Preliminary Evaluation of an Adolescent Positive
Health Measurement Scale: A Salutogenic Health
Promotion Approach. Global Health Promotion, 2018
 Krause, Pargament, Hill, Ironson:
 Assessing the Role of Race/Ethnicity in the
Relationships Among Spiritual Struggles, Health and
Well-Being. Am. J. of Orthopsychiatry, 2018

Adverse Childhood Experience (ACE)
Kekerasan pd anak
 Kekerasan emosional berulang
 Kekerasan fisik berulang
 Kekerasan seksual
Lingkungan keluarga traumatik
 Adiksi Napza
 Perceraian
 Anggota keluarga depresi
 KDRT thd ibu
 Anggota keluarga dipenjara
 Kehilangan keluarga
Anak yg terabaikan
 Pembiaran fase tumbuh
 Kebutuhan fisik, sosial dan
emosional terabaikan
* Setiap jenis berkontribusi dalam skor
ACE
Trauma & Perilaku Beresiko akibat ACE
Efek Neurobiologis
 Pertumbuhan neurol tergg
 Kesulitan menahan amarah
 Halusinasi; Depresi
 Reaksi panik; Kecemasan
 Msalah somatik; Sulit tidur
 Lemah ingatan
 Memori menakutkan
 Disosiasi
Perilaku Beresiko
 Merokok
 Makan berlebihan
 Tdk mau beraktifitas
 Niat bunuh diri
 Alkohol - Napza
 Pasangan seksual berlebih
 Trauma ulangan - Melukai diri
 Gangguan makan
 Kekerasan thd org lain
Efek Jangka Panjang dr ACE
Penyakit & Kecacatan
 Penyajit Jantung Koroner
 Kanker;
 Peny Paru Kronis; Emfisema
 Asma
 Peny Hati
 Fraktur
 Kualitas kesehatan rendah
 STD; HIV/AIDS
Tekanan sosial
 Homelessness; Pelacuran
 Kekerasan, kriminalitas
 Tdk mampu bekerja
 Kekerasan berulang
 Kemampuan mengasuh kel tbts
 Kekerasan antar-generasi
 Ketergantungan pada yankes
kronis

Top
referred
Secondary
referred
Primary
curative care
3rd level prevention
Family counseling
Disease control at the
community
Community-based health care
Healthy family life style
Family welfare
SINERGIZING INDIVIDUAL HEALTH CARE
AND COMMUNITY HEALTH CARE
Effective 5 Level
Prevention

CLEAN WATER & SANITATION
AND PUBLIC HEALTH
 Vorosmarty, Osuna, Koehler, Klop:
 Scientifically Assess Impacts of Sustainable Investments.
Science, 2018

5-the community voice is getting
louder

CURE
SERVICE
CARE
SHIFTING PARADIGM
PENGOBATAN – Berbasis GEJALA dan TANDA;
Pendekatan INDIVIDU; Kolaborasi antar TENAGA
KESEHATAN secara terbatas
PELAYANAN KESEHATAN – 5-LEVEL PREVENTION:
Promotive, Specific protection, Early Diagnosis, Promptly
Treatment, Rehabilitative. Minimum IPC/IPE. Belum melihat
beyond health determinants
UPAYA KESEHATAN & KESEJAHTERAAN YANG
KOMPREHENSIF– Healthcare v3.0: Creating
capacities to achieve goals, satisfy needs, fortify
reserves

First era - 1.0: medical care and public
health services
(1850s to 1960s)
Second era - 2.0: health care system
(1950s to present day)
Third era - 3.0: health system
(going forward)
Definition of
health
Absence of acute disease Reduction of chronic disease Creating capacities to achieve goals,
satisfy needs, fortify reserves
Goal of h-system Improve life expectancy Reduce disability Optimize health
Model of health
and causation
Biomedical Prevent and manage chronic
disease
Promote and optimize health of
individuals and populations
Organizational
operational model
Diagnose and treat acute
conditions
Accountable care organizations
and medical homes
Community-accountable health
development systems
payment
mechanisms
Indemnity insurance; fee-for-
service
Prepaid health benefits;
capitation
Health trusts and management of
balanced portfolio
Role of health
sector
To protect from harm, cure the
sick, health the ill
To prevent and control risk, and
improve quality of care
To optimize health and well-being
Role of individual
and community
Inexperienced patient Activated partner in care Co-designers of health
Three Eras of Health and Health Care
N. Halfon, P. Long, D. Chang, J. Hester, M. Inkelas, A. Rodgers. “Applying a 3.0 Transformation Framework to Guide Large-Scale Health Systems Reform.” Health Affairs 33, No. 11 (2014)

“Co-Designing”
Definition of health Creating capacities to achieve goals, satisfy needs,
fortify reserves
Goal of h-system Optimize health
Model of health Promote and protect health of indiv and pop
Organz operationalz Community-accountable health devt systems
payment mechanisms Health trusts and management of balanced portfolio
Role of health sector To optimize health and well-being
Role of indv and comm Co-designers of health as human rights
Visi Kesmas Kedepan
N. Halfon, P. Long, D. Chang, J. Hester, M. Inkelas, A. Rodgers. “Applying a 3.0 Transformation Framework to Guide Large-Scale Health Systems Reform.” Health Affairs 33, No. 11 (2014)

6-clouds, chains
and internet things

7-Education & Health
contributes to sustainability

QUALITY EDUCATION
AND PUBLIC HEALTH
 Collignon, Beggs, Walsh, Gandra:
 Anthropological and Socioeconomic Factors Contributing to Global
Antimicrobial Resistance: A Univariate and Multivariable Analysis. Lance
Planetary Health, 2018
 Early, Bustillos:
 An Internet for Some Threatens Health for All: What Effects Could the
Repeal of Net Neutrality in the USA have on Individual and Population
Health? Global Health Promotion, 2018
 Permana:
 Preliminary Study of Health Literacy in High School Student in Malang.
ResearhGate, 2016

GENDER EQUALITY
AND PUBLIC HEALTH
 WHO:
 Gender and Health. WHO Fact Sheet, 2018
 USAID:
 Promoting Gender Equality through Health. 2018
 De Looze, Huijts, Stevens, Torsheim:
 The Happiest Kids on Earth. Gender Equality and
Adolescent Life Satisfaction in Europe and North
America. J of Youth and Adol. 2018

PARTNERSHIP FOR HEALTH
 Albright, Bundy:
 The Global Partnership for Education: Forging a Stringer
Partnership Between Health and Education Sectors to
Achieve SDGs. The Lancet Child and Adolescent Health,
2018

AHLI KESMAS FAHAM SOALAN INI
Income and social status - higher income and social status are linked to better
health. The greater the gap between the richest and poorest people, the greater the
differences in health.
Education – low education levels are linked with poor health, more stress and
lower self-confidence.
Physical environment – safe water and clean air, healthy workplaces, safe
houses, communities and roads all contribute to good health. Employment and
working conditions – people in employment are healthier-happier, particularly those
who have more control over their working conditions
67
Source : WHO (2015)

AHLI KESMAS SOALAN INI
Social support networks – greater support from families, friends and
communities is linked to better health. Culture - customs and traditions, and the
beliefs of the family and community all affect health.
Genetics - inheritance plays a part in determining lifespan, healthiness and the
likelihood of developing certain illnesses. Personal behaviour and coping skills –
balanced eating, keeping active, smoking, drinking, and how we deal with life’s
stresses and challenges all affect health.
Health services - access and use of services that prevent and treat disease
influences health
Gender - Men and women suffer from different types of diseases at different ages.
68

PREVENSI YANG KOMPREHENSIF
HOLISTIK,
INTEGRATIF,
TEMATIK
SPASIAL Contextual
Prevention

(MAMPU TANGANI) INEFFISIENSI SISKES
Misdirected & overheated personal care Neglected Promprev priorities
Budget
orientation
for curative
Educate
for
curative
only
Overloaded
hospital
care, anger
and critics
Limited
capacity for
healthy life
style
structures &
regulations
Social
determinants
of health
Unhealthy
life styles
Low capacity
for PHC
development
Limited
budget for
PHC
Non-vitalized
PHC
infrastructures
PHC
considered
not for profit
Limited synergy of Acad-
Buss-Govt for community
empowerment
Failure in
gate keeping
PHC system
Low
understanding
of community
efforts and
empowerment
AHLI K3 TAK MAMPU IPE/IPC
Low ability
in health
politics

SUSTAINABLE CITY
 Frederick, Riggs:
 Commute Mode Diversity and Public Health: A Multivariate
Analysis of 148 US Cities. Internat. J. of Sustainable
Transportation, 2018

AFFORDABLE AND CLEAN ENERGY
AND PUBLIC HEALTH
 Rosenthal, Quinn, Greishop, Pillarisetti:
 Clean Cooking and the SDGs: Integrated Analytical
Approaches to Guide Energy Interventions for Health
and Environmental Goals. Energy for Sustainable
Development, 2018

75
9-New Norms & Security matters
• The world is in a state of transition that will change who
are the winners, losers and power holders in the world
• Nation states will seek for political and economic
dominance. Some will play by the rules; others won’t
• Covid19 Pandemic – health is matter - will have more
influence

the world of work &
10-the gig economy is growing

AMATI YANKES DIGITAL MS DEPAN
 Masa depan
yankes yang akan
sangat berubah
karena:
 Teknologi Digital
 Genetics

Modifikasi dari: Dorman, U
THE
FUTURE
...
Public Health Genomics is the use of
genomics information to benefit Public
Health. This is visualized as more
effective preventive care and disease
treatments with better specificity,
tailored to the genetic makeup of each
individual. Public Health genomics is an
emerging field of study that assesses
the impact of genes and their
interaction with behavior, diet and the
environment on the population health.

DIGITALISASI SISYANKES
 Ahli kesmas yang
menguasai teknologi
digital disruptif melalui
proses pembelajaran yang
dinamis

DIGITALISASI SISYANKES
 Ahli kesmas yang
menguasai
teknologi digital
disruptif melalui
proses
pembelajaran
yang dinamis

Teknologi untuk provider & pengguna
 Teknologi Digital:
 Diagnostics/Imaging.
 Remote medical care.
 Even shorter hospital stays.
 Home monitoring/care
 Robotic medicine.
 Injectable chips and computers.
 Remote control by thought alone.
 Restore hearing, sight.
 Movement for paralyzed.

HUMAN SOCIETY 5.0
Arsip
Data
Information
Knowledge
Wisdom
HUMAN
DECISION
Tacit Structured Applied
Kuantitatif
Kualitaif
Terstruktur
Tidak
Terstruktur
Fisik Elektronis
 Interoperabilitas di sistem yang heterogen
 Beragam organisasi dapat bertukar
data/informasi
 Beragam teknologi dapat bertukar
data/informasi
 Dibutuhkan “central point” sebagai
penyelaras data/informasi
Practiced
Shared
Empowered

Future
Yankes
Glorecalisation Professionalism
Efficiency is
Accountable & Transparrant
Empowered
Network for engagement

1-GLORECALISATION
 Globally engaged PUBLIC HEALTH LEADERSHIP
SOCIAL
COMPLEXITY
REACH AND STRATEGIC SCOPE
Cross Cultural
Leadership
Operational
Leadership
Strategic
Leadership
Globally
Engaged
Leadership

GLOBALLY ENGAGED LEADERSHIP
 It is needed because of global dynamic changes.
 The dimensions are:
 (a) Global mindset, which has 4 components
 Pragmatic implementation: VUCA analysis
 Smart strategizing: VUCA primes
 Enthusiastic execution: agility capacity
 Progressive agent of change: empowering all (FISH
paradigm)

GLOBALLY ENGAGED LEADERSHIP
 (b) Expansive life experience, which has 2 dimensions
 level of challenging experience: NPS target
 level of supportive experience: Family support
 (c) Tactical versatility, i.e., ability to exploit and expand
 Agenda setting
 Building momentum
 Sustaining outcomes

ENGAGEMENT STRATEGIES(1)
1.Producer-Push Strategy
a. Sistem dan budaya kerja merupakan kebutuhan sisyankes
yg terus menerus dikembangkan
b. Mengembangkan program yankes yang menguntungkan
secara social dan ekonomi
2.User-Pull Strategy
a) Strukturisasi pelayanan yankes era AdapKebaru
b) Kesehatan adalah investasi dan bersifat Inter-Professional
Collab (IPC)

ENGAGEMENT STRATEGIES(2)
3. Interactive-Enlighten Strategy
• Pengembangan yankes dalam sistem organisasi kompleks
yang terus berkembang memenuhi kebutuhan users internal
dan eksternal
• Pemerintah-Akademisi-Profesi-Swasta-Masyarakat (Penta-
Helix) harus siap menjadi sentra pengembangan – uji coba
– evaluasi – pengembangan kebijakan yankes
• Hubungan multistakeholder menjadi penting
(Networking, Networking, Networking)
• Efektifitas diukur dengan fungsi2 diatas yang efektif
• Stakeholder pengguna berdaya merasa membutuhkan

DECISION MAKING FOR DYNAMICS
 Producer Push:
Innovasi program dan budaya kerja baik dari hasil Best-practices di
lapangan yang menguntungkan
 User Pull Model:
Akademisi dan profesi mengembangkan system kerja yg lebih
efektif-efisien dan sustain
 Exchange Model:
Penta-helix saling sinergis untuk pengembangan system K3 dan
budayanya (Peran profesi menjadi amat penting untuk advokasi
perubahan)

KNOWLEDGE UPTAKES
Faktor yang mempengaruhi
Acceptability
Feasibility
Social & political advantages

Rehab
Curative
2nd Prev
„ACCOUNTABLE RIGHTS OF INDIV-COMMUNITY WITHIN ORGANIZ“
Balanced portofolio, community engagement
3-EFFICIENT POLICY
1st Prev
Reserve potentials
HEALTHY PEOPLE
3rd Prev
Protection
For Wellbeing

Kerangka Pikir Digunakan
95
Modifikasi dari: Donabedian, W. Deming (Deming Cycle), WHO (Continous Quality Improvement)

GOV (PUSAT-DAERAH-ORGANISASI PEKERJAAN)
WORKERS &
COMMUNITY
PROGRAM K3
HC
SYSTEM
KEBIJAKAN MUTU & BUDAYA
SAFETY YG DINAMIS
PEMBINAAN MUTU &
BUDAYA SAFETY
INNOVATIONS
EMPOWERMENT &
CAPACITATION
SISTEM MUTU YANKES
LEMBAGA MUTU
DAN SAFETY

IDENTIFIED BARRIERS(1)
 WROKERS/DEMAND SIDE:
 Health illiteracy
 Culture of Silence, too shy or ashamed to seek care
 Company and/or Social Restriction
 Tradition Beliefs and Practices
 Cost of Occupational Health and Safety Care

IDENTIFIED BARRIERS(2)
 SUPPLY SIDE:
 Availability of Services and program
 Quality of Facilities
 Availability of Supplies
 Availability and Ability of staff
 Staff professionalism

WHO DEFINITION
 A good health system delivers quality services to all people,
when and where they need them. The exact configuration of
services varies from country to country, but in all cases requires
a robust financing mechanism; a well-trained and adequately
paid workforce; reliable information on which to base
decisions and policies; well maintained facilities and logistics to
deliver quality medicines and technologies

Biostatistics
Epidemiology
Social and
Behavioral
Sciences
Health Policy
and
Management
Environmental
Health Sciences
Interdicciplinary/Cross-cutting
Competencies
Communication and Informatics
Diversity and Culture
Leadership
Professionalism
Program Planning
Public Health Biology
Systems Thinking
Graphical Model

PH workers utilization
& empowerment
PH Professional
ethics & conduct
Health need & demand
(local, regional)
Credentialing
Licensing Certification
PROFESIONALISM
Professional education
OP
ROLES
Educational
System
Health Contexts
Dynamics
Medical-Health
Technology
Scope of
works for PH
workers
Peran Banyak Pihak dalam MUTU NAKES
PH workers
migration
National Public
Health Professional
Certification
University
Accreditation

Model Rekognisi Pembelajaran Lalu
 RPL adalah pengakuan professional atas capaian
kompetensi dalam pekerjaan sec sistematis dan terstruktur
 Konsep Rekognisi artinya
 Pekerja mampu unjuk kemampuan yang lengkap sesuai
standar sehingga dirasa layak menjalan tugas fungsi
keprofesiannya

Kompetensi dalam Sistem RPL
COMPETENCY
RPL
MILESTONES
COMPETENCY
MILESTONES
COMPETENCY
MILESTONES MILESTONES
COMPETENCY

Development Model
Time, Practice, Experience
Novice
Advanced Beginner
Competent
Proficient
Expert/
Master

Time, Practice, Experience
Novice (Asisten Nakesmas)
Advanced Beginner (AKM Pratama)
Competent (AKM Muda)
Proficient (AKM Madya)
Expert (AKM Utama)
MILESTONES
Competensy
Assessment
Competensy
Assessment
Competensy
Assessment
Competensy
Assessment
Competensy
Assessment
Development Model

Predisposing
KAP
Family background
Commitment
Reinforcing
Family support
Peer group
Social capital
Enabling
Access to healthcare
Community based care
Health &
Welfare
Work & Family
Bonding
• Emosional support
• Infomational support
• Instrumental support
• Appraisal support
Profession’s
supports
THE ROLES OF PH PROFESSION:
ENGAGEMENT
Modif fr Yunardi dissertation, 2018

ENGAGEMENT FOR SOCIAL CAPITAL
Orgnz. Asset Devt
Physical assets
Econ & fiscal assests
Env assets
Indiv assests
Social assets
Worker & Community
Participation Devt
Contributions
Workers & Comm organiz
Involvemnt & Engage
Health
Behaviour:
1Approp
2Accurate
3Procedural
4Consistent
Individual
KAP
• Knowledge
• Attitude
• Practices
Profession’s
supports for
Social Capital
Development
Modif fr Yudhia dissertation, 2016
Workers &
Family
Bonding

В
С
D
E
F
3-Detailed activities ensure
access, relevant, effectivity
quality, and sustainability
5-Strengthen
decentralization in politics,
administration & particip
1-Elaborated policies for
Medical-Health & Welfare
7-Information mgmt. that
strengthen capabilities
8-Research for innovation
2-Action plan with KPIs and
Costed activities
6-Empowering local
social capital including
academician/profession,
privates, and NGOs
4-Highly motivated and
adequate HRH with
performance based incentives

Belajar dari yang terbaik
(tanpa DENGKI)1)
Siklus INOVASI
Lbh cepat
PROBLEM-SOLVING sec
cepat 6)
Efek “SAPU LIDI”
Dlm Kerja 7)
Mampu BERBAGI
Apa saja dg teman
(Ihlas) 3)
Memahami KEBUTUHAN
Kerja teman
Sekeliling 4)
Ide ORISINIL -
Cepat diterima5)
Belajar & BERAMAL sampai
liang lahat 2)
Performansi
TERBAIK
Minimalisasi
DUPLIKASI 7)
Hati yg bersih Aktualisasi
Kelompok
Aktualisasi
Organisasi
Layani SESAMA dg
TERBAIK
Pemahaman
KOMPREHENSIF
PENGABDIAN
TERBAIK
UNTUK BANGSA
MODAL SOFTSKILLS

.
.
.
PUBLIC
HEALTH
MIRACLE
.
.
.
.
.
.
Asses Develop
Manage
Professionalism
Continuing Professional
skills development (Hard
& soft skills)
Synergism all sectors at
all level
(HEALTH IN ALL
POLICIES)
Activities that easily
access, effective,
efficient, hi quality, and
sustain

MANAJER
INOVATOR
RESEARCHER
APPRENTICER
COMMUNITARIAN
LEADER
EDUCATOR

 World Federation of Public Health Assocs (WFPHA) Panel on Oral Health Development, Expert Member
 Center for Health Administration and Policy Study (CHAMPS) Univ of Indonesia, Director
 2016 up to now: Harvard University- Kingg College UK: Senior Dental Leaders Programme - Consultant
 National Health Research Committee – Kemenkes, Expert Panel
 Dept of Health Policy & Administration, UI, Past Chairman; Advice & examine more than 200 PhD dissertations in
medicine, dentistry, nursing, public health, regional planning, and social sciences
 Year 2015 Recipient of APACPH Award for Public Health Achievement in Asia Pacific
 Year 2016 Recipient of AIPTKMI Award for Public Health Leadership
 Dokter (Dr.) 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
Most Recent Activities:
 Indonesian Public Health Association, Chairman of Advisory Board
 National Expert Panel on TB, Health Policy Spesialist
 Health Professions Coalition for Anti Smoking (KPK-AR), Chairman

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