The document discusses the health system and medical education in Indonesia. It provides details on Indonesia's organizational health system structure including primary health centers and mandatory health efforts. It also outlines Indonesia's long term health development plan from 2005-2025. Regarding medical education, it describes the growing number of medical institutions in Indonesia and notes that most have received accreditation. It provides details on the curriculum used at the Faculty of Medicine at Universitas Indonesia which follows an integrated and problem-based learning model from the pre-clinical to clinical years of study.

1. HEALTH SYSTEM AND MEDICAL
EDUCATION IN INDONESIA
Jelita Artha Purba
Novita Gemalasari Liman
Shela Putri Sundawa

2. HEALTH SYSTEM IN INDONESIA

3. INDONESIA
• 33 provinces
• 98 municipalities
• 399 districts
• 6,598 sub-districts
• 75,638 villages
• 237,641,326 people
• State of Law
Ministry of Health Republic of Indonesia. Indonesia Health Profile 2010, Jakarta; 2011.

4. ORGANIZATIONAL HEALTH SYSTEM
World Health Organization. Indonesia National Health System Profile. 2007
http://www.searo.who.int/en/Section313/Section1520_6822.htm

5. PRIMARY HEALTH CENTRE
• Technical implementation unit of regency’s public
health service responsible for health development in
one or part of district
Ministry of Health Republic of Indonesia. Indonesia Health Profile 2010, Jakarta; 2011.

6. MANDATORY HEALTH EFFORT
Mustika R. Explanation of PHC Visit. Presentation Slide. 2011.

7. EXPANSION
• Public health care
• School health care
• Mental health care
• Occupational health care
• Sport health care
• Eye health care
• Elderly health care
Mustika R. Explanation of PHC Visit. Presentation Slide. 2011.

8. SUPPORTING
Mustika R. Explanation of PHC Visit. Presentation Slide. 2011.

9. 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.

10. STRATEGIES
• Health-based national development
• Local and community empowerment
• Development of health efforts and financing
• Development and empowerment of human
health resources
• Health emergency response
Rencana Pembangunan Jangka Panjang di Bidang Kesehatan 2005-2025. Jakarta:
Departemen Kesehatan RI; 2009.

11. RESOURCES’ REQUIREMENTS
• Human health resources
• Health financing
• Pharmacy, medical devices, and
foods
• Health information system
Rencana Pembangunan Jangka Panjang di Bidang Kesehatan 2005-2025. Jakarta:
Departemen Kesehatan RI; 2009.

12. CHALLENGES
• Increasing population
• Epidemiology transition
• Decentralization
• Knowledge, attitudes, and behaviors of
societies
• Regional inequities in health care and access
• Drug addictions
• Millennium Development Goals
Rencana Pembangunan Jangka Panjang di Bidang Kesehatan 2005-2025. Jakarta:
Departemen Kesehatan RI; 2009.

13. HEALTH STATUS IN INDONESIA

14. MORTALITY
Infant 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 of
Maternal mortality rate/100000 live births Indonesia. Indonesia Health Profile
2010, Jakarta; 2011.

15. MORBIDITY
Ten Main Diseases Hospital Inpatients (2010)
Ministry of Health Republic of Indonesia. Indonesia Health Profile 2010, Jakarta; 2011.

16. MORBIDITY
Ten Main Diseases in Hospital Outpatients
Ministry of Health Republic of Indonesia. Indonesia Health Profile 2010, Jakarta; 2011.

17. MORBIDITY
Nu
triti
on
al
Sta
tus
Communicable Diseases (Malaria, Pulmonary TB, HIV/AIDS,
Pneumonia, Leprosy, Yaws)
Preventable Diseases through Immunization
Potential Outbreak Disease
Ministry of Health Republic of Indonesia. Indonesia Health Profile 2010, Jakarta; 2011.

18. MEDICAL EDUCATION IN INDONESIA

19. Medical Student in Indonesia
Status Amount of Student
Universitas
Area
Public Private
Indonesia 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

20. GROWING OF MEDICAL EDUCATION INSTITUTION
Year
Field of Study
2006 2007 2008 2009 2010
Medical Education 52 52 52 67 70
Source: DGHE, 2009

21. Insitution Accreditation
Accredited Accredited
Program Acredited C Total
A B
Medical
16 19 11 46
Education
Sumber: www.ban-pt.depdiknas.go.id (21-08-2010)

22. STANDARD OF MEDICAL
DOCTOR COMPETENCE
Diagnosis 1 2 3A 3B 4
Acute Bronkhitis X
TB with HIV X
Hepatic cirrhosis X
Acute synusitis X
Fatty liver X
Condiloma acuminata X
Bartholin Cyst X
Esophagus Varices X
Cluster headache X
Impetigo X
Hodgkin Lymphoma X
Mastytys X

23. FACULTY OF MEDICINE UNIVERSITAS INDONESIA

24. 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

25. PRE-CLINICAL YEAR

26. 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

27. 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

28. • Laboratory Practice
• Basic Clinical Skill (7-8 students, 1 tutor)
• Exam
 Lab exam
 Written exam
 Formative 1 and 2
 Summative 1 and 2

29. 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

30. STEP IN GROUP STEP IN GROUP
DISCUSSION 1 DISCUSSION 2
1. Define keyword 1. Present the home assignment
2. Identify the problem 2. Discuss the assignment to answer
the question and hypothesis
3. Analyze the problem
3. Make the conclusion
4. Define clinical question
4. Prepare the group presentation
5. Make hypothesis
6. Develop questions for
searching
7. Divide the home
assignment for everyone
PLENARY SESSION

31. 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

32. 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

33.  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

34. CLINICAL YEAR

35. • 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

36. • 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

37. 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

38. FINAL EXAM
• Comprehensive Exam
 Face to Face exam
• Doctor Competence Exam (held nationally)
 Written
 OSCE

39. INTERNSHIP

40. • Practice medicine in PHC or General Hospital
• Under supervision
• 8 months in General Hospital
• 4 months in PHC
• Get monthly salary
Letter Permission to Practice as Medical Doctor from Indonesia Medicine Council