IMPLEMENTATION OF HEALTH PROGRAMS IN THE DECENTRALIZATION ERA AT BANGKA BELITUNG ISLANDS PROVINCE BY : drg. MULYONO SUSANTO, MHSM Head of Health Department Bangka Belitung Islands Province

1. INTRODUCTIONS 2. NATIONAL AND REGIONAL HEALTH DEVELOPMENT ACHIEVEMENT 3. RESOURCES ENDORSEMENT OF HEALTH DEVELOPMENT 4. CHALLENGES & STRATEGIC STEPS TO ACCELERATE HEALTH DEVELOMENT 5. BEST PRACTICES 6. NATIONAL HEALTH INSURANCE 3

1. INTRODUCTIONS

 Geographic and population - Total Population : Ecological zones : Tropical climate, and archipelagic geography

 The issue of decentralization in the post-reform Indonesia emerged around It was signed with the enactment of Law No. 32 of 2004  Emergence of Law 32 0f 2004 on Regional Govermenthas brought a new wind the Indonesian goverment from centralizedto the decentralized  With a decentralized model of Health, local government is given full authority to regulate the sector of regional health systems.  In the process, the local government is highly dependent on several factors; the financial support, cooperation, coordination across sectors, etc. in the success of the health system in the region.  Bangka Belitung has officially ratified on 09 February 2001 when Indonesia has entered the era of decentralization.  PP 38 of 2007 on the division of power between central and regional government as well as covering the field of Health.

MINISTRY OF HEALTH DEPARTMENT OF HEALTH PROVINCE DEPARTMENT OF HEALTH DISTRICT COMMUNITY HEALTH CENTER / PKM HEALTH VILLAGE POST (POSKESDES)/ SECOND COMMUNITY HEALTH CENTER (PUSTU) Cadre HOSPITAL CENTER REGIONAL HOSPITAL PROVINCE DISTRIC

2. NATIONAL AND PROVINCE HEALTH DEVELOMENT ACHIEVEMENT

9 Ket : 1) SDKI, 2007; 2) Riskesdas, 2010; 3) SDKI, 2012; 4) Sensus Penduduk,2010; 5) Profil Kesehatan; 6) Program Terkait NumbINDICATORS STATUS ACHIEVEMENTS TARGET 2014 STATUS Beginning TRW I 1Life expectancy (years)70,770,971,1 n.A 72,0 2 The maternal mortality rate per 100,000 born alive ,2 5) ) 137,6 5) ) ) The percentage of births attended by skilled health personnel. 84, ) ) ) ) ) 90 4 The infant mortality rate per 1000 live births ) 8.4 5) 9.7 5) ) ) 24 5Total Fertility Rate (TFR)2,62,4 4) n.A2,6 3) n.A 2,1 6 Percentage of population with access to drinking water quality. 47, ) ) ) ) n.A68 7 Percentage of population 15 years and over who have knowledge of HIV and AIDS. 66,2 1) 57,5 2) n.A 79,5 3) n.A 90 8Annual Parasite Index (API)1, ) ) ) ) ) 1 9 Percentage of population with health insurance. n.a ) ) 100 5) ) n.A80,10

10 MDG’s 2015 : ≤ 23/1000 KH

11 Source : Ditjen P2PL, 2013

12 Source : Report of the Director General Nutrition, Ministry of Health, Update 11 Januari 2013 Renstra’s Target : 75%

Source :Diit.PPBB –Ditjen PP dan PL, Ministry of Healt MDG’s Target : 1/1000 of Population

3. SUPPORT RESOURCES FOR HEALTH DEVELOPMENT 14

DOCTOR RATIO PER 100,000 POPULATION IN 2012 Source : Pusdatin 15

MIDWIFE RATIO PER 100,000 POPULATION IN 2013 Souce : Pusdatin Rasio Bidan : 100 / penduduk 16

Sumber : Data dan Informasi Prop. Kep. Babel CENTRAL GOVERMENT PROVIDES DOCTORS, DENTIST AND MIDWIVES TO BE WORK IN REGENCY / MUNICIPALITY IN RURAL AREA Nu mb Dist/City DOCTORDENTISTMIDWIVES BTSTJMLBTSTJMLBTSTJML 1 KAB. BANGKA KAB. BELITUN G KAB. BANGKA BARAT KAB. BANGKA TENGAH KAB. BANGKA SELATAN KAB. BELITUN G TIMUR KOTA PANGKAL PINANG JUMLAH

18 NOSOURCE COSTTOTAL 1DECONCENTRATION 18,934,837,000 2Co-TASK / TP 9,006,000,000 3 BASIC SERVICES PUBLIC HEALTH INSURANCE 984,525,000 4 PUBLIC HEALTH INSURANCE REFERRAL SERVICE 508,888,000 5LABOR INSURANCE (JAMPERSAL) 6,711,698,250 6SALARY & INCENTIVES OF PTT 3,402,350,000 7VACCINE AND DRUG PROGRAM 8,420,702,850 8SPECIAL ALLOCATION FUND (PURE) / DAK 38,299,060,200 9TPG KIT and Dacin 335,125,000 10LOANS / GRANTS FOREIGN (PHLN) 11,324,748,072 TOTAL BUDGET HEALTH 97,927,934,372 97,927,934,372 / 163,916,444,689 out of total = %

19 Revenue and Expenditure Budget of Local Government (APBD)TOTAL PROVINCE 51,878,637,393 DISTRICT / CITY 112,037,807,296 TOTAL 163,916,444,689

21 K4 National’s Target 2015: 95% PN National’s Target 2015: 90% Still below target K4 Upper target PN

22 Source : Data and Information of Babel Province2013

23

MAP OF MALARIA IN BANGKA BELITUNG PROVINCE Malaria still an endemic disease in Bangka Belitung Province

25 Number of Cases of Malnutrition Bangka Belitung: 95 Cases

PROBLEMSSTRATEGIC STEPS Disparities in access to maternal and child health services (facilities, personnel, health services limited warranty). 1.Strengthening health services in regions A, B, C 2.Improving access and quality of health services : Community health centers PONED Hospital PONEK Assurance processes of birth (Jampersal), BOK Linakes Skilled Preventive and promotive efforts really not optimal Increased promotive-preventive: Program Planning & Childbirth Complications Prevention: ANC - KB & exclusive breastfeeding Mothers movement - exclusive breastfeeding PP 33/2012 Integrated health posts (posyandu) and sub-village active standby Fully immunized management of health services is too weak Improved management of health services: The integrated system of vital registration, Accreditation & referral network optimization. System of maternal and child health services (KIA) which meet the criteria continum of care. 26

ProblemsStrategic Steps 1.New infections continue to rise, more extensive transmission area. Prevention Efforts (condoms, IHS, PDB, PPIA), early diagnosis (PITC) and early treatment (CD4 350) should be increased. 2. Promotive-preventive GTT HIV and AIDS at the age of years. Increased knowledge pd age 15 years upwards on HIV and AIDS. Campaign, “I Know I'm Proud”. 3. The percentage of people living with HIV who received antiretroviral treatment is still low (44.2 percent). The increase in the percentage of people living with HIV who get antiretroviral treatment to 50 percent. 27

EDUCATION PREVENTION Prevention of Sexual Transmission Through (PMTS) Bad effects of drug prevention (PDBN) Prevention of transmission through the Maternal and Child ( PPIA) PREVENTION Prevention of Sexual Transmission Through (PMTS) Bad effects of drug prevention (PDBN) Prevention of transmission through the Maternal and Child ( PPIA) TREATMENT Expansion Testing STI patients injecting drug users HIV + Pregnant Women serodiscordant couples TB Coinfection Patients with Hepatities B & C Early initiation of antiretroviral drugs on key populations, pregnant women, TB, Hepatitis B & C co- infection TREATMENT Expansion Testing STI patients injecting drug users HIV + Pregnant Women serodiscordant couples TB Coinfection Patients with Hepatities B & C Early initiation of antiretroviral drugs on key populations, pregnant women, TB, Hepatitis B & C co- infection KONDOM TES HIV LASS L K B P “PERKUAT JEJARING INTERNAL” “PERKUAT JEJARING EKSTERNAL” P “PERKUAT JEJARING INTERNAL” “PERKUAT JEJARING EKSTERNAL” KPA Health-care facilities communites MORAL RELIGION REPRODU CTIVE HEALTH DANGER OF NAPZA MORAL RELIGION REPRODU CTIVE HEALTH DANGER OF NAPZA IPWL 28

5. BEST PRACTICE 29

ADULT ELDERLY TEEN  SMS GATEWAY Service Post (posyandu ) CHILD  CLASS MOM -Elderly  Gymnastics PREGNANT PTM BABY  P4K Integrated Service Post :  KB Neonatus visits early childhood education (PAUD) School Health Unit (UKS)  HOME VISITE BY MIDWIFES TO PREGNANT WOMEN TWICE IN A MONTH immunization Basics BKBPKPR  PARTNERSHIP MIDWIFE and shaman Integrated Management of Childhood Health (MTBS) SDIDTK Clean and Healthy Behavior (PHBS)  PONED/PONEK VILLAGE ALERT JKNJKN JKNJKN

Maternal health services Health Services nursing mothers For child health services Family planning services The discovery and disease management Primary Health Care Developing Enterprises Bersum Kes-powered mobi (IHC, Clinics, Drug Pos Village, health fund, Standby husband, etc.) Encouraging surveillance (observation / monitoring, Quick Reporting, Prevention & mitigation, Mortality Reporting) Community Empowerment Knowledge and awareness, community awareness and preparedness, nutrition- conscious families and health behavior, environmental health, self-sufficient community capacity in health Clean and Healthy Behavior Alert Village BEST PRACTICES

1.MTBS Stand for Integrated Management of Childhood Illness or Integrated Management of Childhood Illness (IMCI in English) is an integrated approach / integrated in the management of sick children with a focus on the health of children aged 0-5 years (toddlers) thoroughly. 2.UKS abbreviated school health is an effort made to help school pupils and the school community who are sick in the school environment. UKS is usually done in a school nurse's office. 3.Adolescent Health Care Services (PKPR) is a Youth Care Health Services, serving all of the youth in the form of counseling and various things related to adolescent health. Here teenagers do not need to hesitate and worry for vent / counseling, getting the right information and the right to a variety of things to know teenagers. 4.ANTE Natal Care (ANC) health examination given to pregnant women on a regular basis that is four times during pregnancy. 5.CLASS OF PREGNANT WOMEN (Kelas Ibu Hamil) Pregnancy Class is a study group of pregnant mothers with gestational age between 20 weeks s / d 32 weeks with a maximum number of 10 participants. In this class of expectant mothers will learn together, discuss and exchange experiences on Maternal and Child Health thorough and systematic and can be done on a scheduled basis and continuously..

6. Integrated Service Post is a neighborhood health center providing primary health services, integrated with early childhood activities, BKB and SDIDTK. 7. Early childhood education (PAUD/ECD) is the level of education before primary education which is an effort aimed at the development of children from birth to the age of six, which is done through the provision of educational stimulation to assist the growth and development of the child's physical and spiritual so has the readiness to enter further education, which was held in formal, non-formal, and informal. 8. Detection of Early Intervention Stimulation of Growth (SDIDTK) is to make an effort monitoring the growth and development of children. 9. PHBS is a set of behaviors that is practiced on the basis of consciousness as a result of learning that makes a person or family can help themselves in the field of health and play an active role in creating public health..

6.NATIONAL HEALTH INSURANCE 34

The National Health Insurance (JKN) is part of the National Social Security System (Navigation) held by the Social Security Agency (BPJS) using the mechanism of social health insurance which is compulsory (mandatory) based on Law Number 40 Year 2004 on National Social Security System with the aim of to meet the basic needs of a decent public health given to every person who has paid dues or dues paid by the Government.

BASIC OPERATION LAW OF JKN  1945 Article 28 H paragraph (1), (2), (3)  1945 Article 34 paragraph (1), (2)  Law No. 40 of 2004 on National Social Security System (Navigation).  Act No. 24 of 2011 of the Social Security Agency (BPJS)  Regulation No 101/2012 on the Recipient Contribution (PBI)  Presidential Decree No. 12/2013 on Health Insurance  Regulations and other provisions there are 14 product regulation

JAMINAN KESEHATAN NASIONAL 37 Contribution OBLIGATIO N lABOURLABOURRER NON LABOUR INDIVIDUAL POVERTY/ POOR GOVERMENT MEMBERSHIP

AMOUNT OF CONTRIBUTIONFACILITIES CARE CLASS LEVEL 3 CARE CLASS LEVEL 2 CARE CLASS LEVEL 1

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