Children Health Care

System
In Indonesia

Problem Based Approach

Dian Kesumapramudya N.
Kobe University-Graduate School of Medicine
Department of Community Medicine & Social Health Care
Japan
Department of Pediatric, Gadjah Mada University,
Indonesia

INDONESIA IS An
ARCHIPELAGIC COUNTRY
Located : at South East Asia
NUSANTARA ( Nusa = continent , antara = betwee )
Between Asia continent and Australia Continent,
Hindian and Pasific ocean
6 hours from Osaka (KIX) to Bali (Ngurah Rai International
Airport)

INDONESIA

230 millions people as its citizens (2010). Growth

1,49%
Consists many tribes ( ) ~ + 268 tribes
With different local languages, cultures, behaviour,
Population pyramid of
Population pyramid of
etc
Indonesia
, year 1995
Indonesia , year 2010
75+
70-74
65-69
60-64
55-59
50-54
45-49
40-44
35-39
30-34
25-29
20-24
15-19
10-14
5-9
0-4

14 12 10 8 6 4 2 0 2 4 6 8
10 12 14 In million

14 12 10 8 6 4 2 0 2 4 6 8
10 12 14 In million

Source : Indonesian Statistic Bureau, 2010 Data Base

INDONESIA NATIONAL CHILD

HEALTH PROBLEMS
High IMR/CMR

(34/1000)

Nutrition
Problems

Education
Participation level
Knowledge
Poverty & GDP
15% poor,
49% income below
2$/d)
Population growth

coverage
of
Immuniz
ation

Economic
, Social ,
and
Culture
Problems
Sanitation
Infectious
& Behaviour
Disease

Source : Indonesian Statistic Bureau Research, 2010 &

MDGs 2010 Achievement. Ministry of Health, Republic of

Children Health Problems in

Indonesia
Nutrition Problem

Short
NWB
Short
NBW
NBH
& Thin
short
NBH
NBH
Obesity
Source : Indonesian Basic Health
Riset (RISKESDAS)
Nutrition
Status
2010

short
Obesity

Children Health Problems in

Indonesia
Nutrition Problem

Normal Body
obesity

Short stature

slim body

Source : Indonesian Basic Health Riset (RISKESDAS)

2010
Ministry of Health, Republic of Indonesia

Children Health Problems

in Indonesia
Infectious Disease
Each area of Indonesia may vary in the degree
and in the characteristics
The largest in National Scale
1. Rotaviral diarrhoea
2. Pneumonia and tuberculosis ( & )
3. Malaria
4. Dengue Fever and Dengue Haemmorhagic
fever
5. Typhoid fever

Children Health Problems

in Indonesia
Disease Distribution Profile among
Children

Malaria

Diarrhoea, typhoid fever and

dysentriae ( , )
Source : Ministry of Health, Republic of Indonesia Data

Children Health Problems

in Indonesia
Disease Distribution Profile among
Children
TBC ( )
HIV &
pneumonia

Dengue Fever and

Dengue Hemmoraghic Fever

Source : Ministry of Health, Republic of Indonesia Data

Children Health Problems

in Indonesia
Sanitation & Healthy Behaviour
- Vary among area
Mostly influenced by traditional customs
( )

Government programe of PHBS (Clean and Healthy

Live Program) had been launched since 2006

PROBLEM :
The result is still unmeasurable yet

The recent chalenge :
A. City Trash management
B. Culture and customs change

Children Health Care System

in Indonesia
PROBLEMS :
a. Vast area along with various geographic and
demographic features
b. Various cultures, especially languages and customs
c. Pediatricians number are not enough and not well
distributed ( at 2010 , the ratio = 1 : 8.900).
(Discrepancy and inequality )
d. Various disease prevalence among regions
e. Various condition of health fascilities with limited
resources , officers and infrastructures

Outline of Children Health Care System

in Indonesia

Structure of Children Health Care System

in Indonesia
(multistep referral approach)

a. Preventif,
Promotif&
Supportif
b. Community
Based

a. Curative
b. Referral
c. Spesialized
base

Primary
Health
Care

a. Curative
b. Referral
c. Spesialized
base

Tertiary
Health
Care

Seconda
ry
Holistic Approach (
Health ) Paradigm
Care ( )
1.
2.
3.
4.

Children as a children,
Family
Environment
Insurance And Private
Based payment

Health Care Cost & Payment in

Indonesia
Insurance Based
JAMKESMAS (National Insurance for Poor
People)
managed by Government via Askes corp.
In the year 2010 = Rp 5,1 trillion (
51.000.000.000)
ASKES (National Health Insurance )
managed by Government via Askes Corp.
self sustained (monthly payment) the same with
Japan
Private Health Insurance

Private Payment

Primary Health Care

Network System

Primary Health Care Center

(Puskesmas)

Primary Health Care

Focus :
Preventive,promotive and supportive therapy

Place :
Public Health Center (Pusat Kesehatan Masyarakat )
1st line of defense
a. Government own
b. Private
c. General practitioners
d. Pediatrician private practice
PROBLEM : Limited resource and standardization
not all Health Care Center work

Primary Health Care

Service Standards and Targets
11 basic minimum standars of good practice health service
a. Pregnant woman visit coverage (K4) : 95%
b. Obstetric service coverage: 80 %
c. Coverage of labor service helping by health provider : 90%
d. Coverage of post partum (childbirth after) service : 90%
e. Coverage of Neonatal health care with complication 80%
f. Coverage of Infant visit: 90 %
g. Coverage of Child imunization (Universal Child Immunization): 100 %
h. Coverage of Under 5 YO Child (BALITA) Health care 90 %
i. Coverage of Breastfeeding Food Supplementation : 100 %
j. Coverage of Malnutrition Baby Health Care : 100 %
k. Coverage of Routine Health Screening of Elemetary School Student

Primary Health Care

Working Program
Nutrition Health Service
Routine baby screening
Investigation and intervention of nutrition problem in
community
PROBLEM : low participation level due to culture
nutrition problem due to lack of knowledge ,
economic and culture problem
Imunization Administration
Routine vaccination for baby 0-1 years in
Baby screening
PROBLEM : Culture Various differences
Knowledge & Resistance ( )

Primary Health Care

Working Program
Nutrition Health Service
Imunization
Administration

Primary Health Care

Working Program
Imunization Administration

Source : Indonesian Pediatric Association (IDAI) , 2009.

Primary Health Care

Working Program
Integrated Management of Childhood Illness
(MTBS) Protocol
1. Administration of MTBS Programme
Disease focus :
a. diarrhea and rehidration c. Dysentriae
b. Pneumoniad. malariae
2. Neonatal visit by midwifes every week
3. Efforts of Integrated Health Check to Young infant and
below 5 YO children
Primary Treatment Care
Medical treatment
Nursing treatment
Simple rehabilitation treatment

Integrated Management of Childhood Illness

(MTBS) Protocol ( )

Integrated Management of Childhood Illness

(MTBS) Protocol

Integrated Management of Childhood Illness

(MTBS) Protocol

Primary Health Care

Working Program
SCHOOL JOINT PROGRAMME
1. Growth & Development Early Intervention
Examination of Children Growth & Dev. In Pre-School
PAUD (Early Education of Children)
Growth and Development Response Check
2. School Heatlh Unit and School Dentist Unit
Counselor and Guiding
Special Treatment and Rehabilitation (In certain Special Schools selected)
Training of Junior Doctor / Kid Doctor
3. Teenager (Youth) Health Care Service
Counseling about Reproductive and Sexual Health in The School or
Boarding School Health Post
Mentoring and Counseling about Youth Psychology Problem

Secondary Level of
Children Health Care System
Curative and Treatment Care
- In The Primary Health Care Center
- private clinic and private practice
- Regional Hospital (Class D,C)

Tertiary / Third Level of

Children Health Care System
Curative (Treatment) & Rehabilitation Care
- Referral or Central Hospital
(Class B or A)
- Medic Rehabilitation Center
- Center of Nutrition Rehabilitation

Referral System in Medical

Treatment Service
Primar
y
Health
Care
-Public Health
Care Center
-Private Clinic
-Private
Practice

Regional
Hospital

- Type D or
Type C
Regional
Hospital
- Small

Center
Referral
Hospital

- Type B or
Type A
Hospital
- Research

Children Health Care in Hospital

(Sardijto General Hospital, UGM, Yogyakarta)
Educational Based Referral HOSPITAL (Type A)

13 Sub Department
Functional Medics Staffs of Pediatrics
1. Endocrinology,
2. Gastro-hepatology
3. Nutrition,
4. Hemato-oncology
5. Immunology
6. Tropical Infection
7. Cardiology
8. Nephrology
9. Neurology
10.Respirology
11.Social Pediatric (Growth & Development)
12.Perinatology
13.Emergency Unit of Pediatrics & Intensive Care Unit

In Alliance with several Network Hospital Around Yogyakarta

Kinds of Health Care

Service

Outpatient Service
Emergency & Intensive Care Unit
In patient Service
Medic Rehabilitation & Occupational Therapy
Service
Additional Service
Education & Research Fascility (incorporated
with Faculty of Medicine, UGM)
Center of Leukemia Study of South East Asia

Additional Service
Oral Rehidration Room
Pediatric Integrated USG and EKG

Examination Room
Spirometry (Lung function test) room
Skin Prick test examination room (allergy
test)
Pharmacy service (pharmacy satellite)
Integrated Laboratory Satellite
Playing room
Library
Children Psychology Consultation

Outpatient Service
General Outpatient Policlinic
Outpatient Policlinic with appointment
(VIP)
Growth and Development Policlinic

Pediatric Polyclinics

Policlinic with Appointment

Distribution Rate of The

Outpatient Type visitors in
2010
visit rate
new patient
10.83

old / control

89.17

Source : Sardjito Pediatric Dept.Data

Patient Profile in the Outpatient Clinic

2010
Sub.Departmen
t

Mean
Visits

Source : Sardjito Pediatric Dept.Data

GROWTH & DEVELOPMENT

POLYCLINIC

GROWTH & DEVELOPMENT

POLYCLINIC
Services provided in the policlinic
1.
Early Detection and Screening for Growth and

Developmental Delay
2.
Basic and Advanced Immunization
3.
Early Stimulation and Intervention in Children
with special needs
Collaboration with
a. Neurology sub department
b. Medic rehabilitation
c. Center of Nutrition Rehabilitation

(RPG)

GROWTH & DEVELOPMENT

POLYCLINIC
Case Distribution

Autism

ADHD (Attention Deficit Hyperactivity

Disorder)

ADD (Attention Deficit Disorder)

Pervasive Development Disorder (speaking

disorder)

Learning Development Disorder.

Emotional Disorder

Additional Service
Simple USG room

Oral Rehidration

Satellite Laboratory

IN PATIENT HEALTH CARE

SERVICE

Inpatient Ward
capacity

In Patient Ward
VIP Room

1st class room

In Patient Ward
2nd Class

In Patient Ward
3rd Class

In patient Ward
playing room

Problems in Inward Patient

Management
1. Limited Bed Capacity
2. Job Distribution
3. Integrated and holistic patient management approach

already established but needs to be improved

a. Doctor
b. Nurse
c. Health Therapist
d. Psycholog and psychiatrist
e. Researcher from University or Research Fascility

4. Limited Resource for Research Development

5. Limited advance medical equipment

Summary & Future Chalenge

1. Diversity in culture becomes threat in the Future
Health management if it is not well managed
2. Children health problem management complexly
related and integrated with other sector policy
a. Economic growth
b. Education
c.Infrastructure
3. Need to revitalization of rural health care center
(Puskesmas) and redistribute the health officer to
equalization
4. The Need to achieve the target of MDGs 2010

Thankyou For
Your Attention