1. health and fitness

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4th Edition: January 2014
Jaminan Kesehatan
Nasional (JKN):
What benefits
and how to
access?
Human Resources
for Health:
What is still lacking?
Accuracy in Health
Financing System,
Changes in Health Systems
and Implementation of JKN
an Important Key to
better Health
Services
require Puskesmas
Revitalisation
Australia Indonesia Partnership
for Health Systems Strengthening
(AIPHSS)
Sharing Stories
from The Field
Australian
Aid
Kementerian Kesehatan
Republik Indonesia
g
Foreword
T
he Australia Indonesia Partnership for Health Systems Strengthening
(AIPHSS) Program was officially launched early January 2013 in two
selected provinces of the program, East Nusa Tenggara and East Java.
The moment marked the beginning of AIPHSS point in implementing its
activities fully.
A number of activities as included in the work plan were implemented
intensively during the year of 2013 which included several supporting activities
outside the national, provincial and district work plans. The AIPHSS program
also supported other efforts of the Ministry of Health in strengthening the
health systems such as activities related to the implementation of the National
Health Insurance System ( JKN) in early 2014. All of these activities have
confirmed AIPHSS strong commitment and significant contribution to the
health systems strengthening in Indonesia.
The achievement of AIPHSS targets during 2013 both at national level and at
sub-national levels (province and district) cannot be separated from
contributions of various parties through strong and effective coordination and
cooperation. For all this achievement, we, from AIPHSS program, express our
sincere thanks to all who have been part of this achievement.
We hope in 2014 the existing cooperation could continue and improve to
achieve the ultimate goal of AIPHSS, namely the strengthening of health
systems in Indonesia, particularly related to the improved quality and
distribution of health human resources, improved quality of health financing,
and better delivery of primary health care.
Once again, thank you and good luck in 2014, the year of the National Health
Insurance ( JKN) commencement. Hopefully, some stories during the first year
of AIPHSS program in this edition could give an idea of the effectiveness of the
programs and cooperation developed with all parties.
Enjoy reading!
drg. Tini Suryanti Suhandi, M.Kes
Head of Bureau of Planning and BudgetingSecretariat General of the Ministry of Health, Republic of Indonesia
aiphss
kabar
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Jaminan Kesehatan Nasional
National Health Insurance (JKN)
officially launched
What benefits
and how to access?
W
e should be grateful that starting
--1 January 2014 our country has had the
National Health Insurance Program
( JKN) as a realization of the National Social Security
as mandated by Law Number40 of 2004 on National
Social Security System (SJSN). Through this program,
every citizen will get comprehensive health care
covering promotive, preventive, curative and
rehabilitative services with affordable cost through
the insurance system.
By participating in the JKN a patient, at the time of
treatment, only needs to follow established
procedure and show a membership card to receive
needed health service.
The procedure is, every participant who needs health
care should first consult a primary health care
facility, such as Puskesmas, a private clinic, or a
TNI-Polri clinic which has a collaboration with the
Social Security Administration Agency (BPJS) for
Health. Health service of a higher level facility such
as a hospital can be accessed on the basis of referral
from the primary health care facility, except for
emergency. If this procedure is not followed, JKN will
not cover the cost incurred.
1
and h
“
to acc
Remember!!! If you
need health care, go to a
primary health care facility.
Don’t go straight to a
hospital, EXCEPT FOR
EMERGENCY.
”
Health services at a
primary health care
facility are as follows:
What b
•
•
•
•
medical examination, treatment,
and medical consultancy;
medical treatment that is not
included in the field of specialist
competency;
blood transmission in accordance
with medical requirement;
first level laboratory diagnostic
supporting examination;
in-patient care according to
medical indications.
However, not all health
services are covered by
JKN, for example:
•
Members of Polri and Civil
Servants under Polri and their
family members;
Participants of ASKES (the
Indonesian Health Insurance);
All civil servants and their family
members;
Participant of JAMSOSTEK (Social
Security for Employees) and their
family members;
Recipients of Health Insurance
Premium Assistance (PBI).
and h
•
If a patient’s condition requires
further health care, the primary
health care facility will refer the
patient to a higher level health
facility, that is a hospital which has a
collaboration with BPJS Health.
Health services at a
hospital are as follows:
•
•
•
•
medical examination, treatment
and medical consultancy with a
specialist doctor
medical treatment from a
specialist in accordance with
medical indication;
medical rehabilitation and blood
transfusion;
in-patient care either in a nonintensive or intensive room.
2
•
•
•
•
•
•
•
health services which do not
follow the procedure set;
health services in health facilities
which do not cooperate with
BPJS;
health services abroad;
health services to obtain child;
health services for beauty
purpose;
health disorders or diseases
caused by drug addicts and/or
alcohol, and;
alternative medicine.
Participants of JKN for the first phase
are:
•
Members of TNI and Civil
Servants under Defense Ministry
and their family members;
•
•
•
•
For participants other than the above
five groups; i.e. private employees,
non-salary employees, nd nonemployees, they can do the
registration by themselves at the
nearest BPJS Health office.
How to do that? Come to
the nearest BPJS Health Office to
complete a registration form. BPJS
Health will give you information on
how
cess?
•
•
Second, Rp 42,500 per person per
month to get service in a hospital
ward class II.
Third, Rp 25,500 per person per
month to get service in a hospital
ward class III.
Requirements which must be
submitted on the registration:
•
First, the registration form which
is available at BPJS Health office
and already completed;
• Second, KTP/SIM/Passport and
family card (original and copy);
• Third, coloured 2 photographs size
3 x 4 cm;
• Fourth, valid Askes or Jamkesmas
or JPK Jamsostek card (especially
for those who participate in Askes
or Jamkesmas or Jamsostek).
benefits
“
For more information about the
National Health Insurance ( JKN),
please visit the website www.jkn.
kemkes.go.id or contact Halo Kemkes
at 500 567 or Halo Askes at 500 400,
or visit nearest BPJS Health/Askes
office.
how
Every Indonesian citizen is
entitled to JKN program. Therefore,
use your rights to obtain the
benefits of health maintenance and
protection by enrolling immediately
starting from 01 January 2014.
virtual account. Then, you can make a
payment to BANK BNI46 or BRI or
Mandiri or to a Post Office using the
virtual account. After that, return to
BPJS Health office for payment
confirmation and you will receive a
membership card of JKN.
The poor and the needy are
recipients of health insurance
premium assistance (PBI) whose
”
premium is paid by the
government.
There are three categories of
JKN premium to choose at
the time of
registration:
•
First, Rp 59,500 premium per
person per month to get service
in a hospital ward class I.
Immediately
register yourself
and your family to
become JKN
participants...
because illness can
happen to you and
your family
anytime.
3
T
hrough various activities and events throughout the year 2013, the
Minister of Health of the Republic of Indonesia, Dr Nafsiah Mboi,
SpA, MPH has often underlined problems of quality and quantity of
human resources for health. According to her, although the nationwide
people’s access to primary health care has increased, which is marked by
the increased number of primary health care facilities such as puskesmas
and poskesdes in each village as well as the commencement of the National
Health Insurance ( JKN) on 1 January 2014, the statistics of the Ministry of
Health shows inequality in the distribution of skilled health workforce
according to the type and nature of work.
From the data available, nationwide, the number of health workers has not
met the target per 100,000 people. The number of new specialists is 7.73 of
the target 9 and general practitioners, 26.3 of the target 30. The number of
new nurses is 157.75 of the target 158; and midwives, 43.75 of the target 75
per 100,000 population. With this condition, we can imagine the
availability of health personnel in Disadvantaged, Remote, Border and
Islands Regions (DTTPK) such as East Nusa Tenggara and Papua. However,
Building
Block
Human Resource
for Health
Human
Resources
for Health:
What is still
lacking?
4
this issue does not stand alone but is
closely related to various factors such
as geography, transport,
infrastructure and the principal one
is regulations related to the quantity
and quality of and equitable
distribution of health personnel.
At of the launch of the Distance
Learning Program (PJJ) in July 2013,
the Minister of Health confirmed that
there was still a gap between the
mandate of Law No. 12 of 2012 and
the conditions of human resources
for health in the field, especially
nurses and midwives. Pertaining to
the minimum level of education of
health workers, as many as 146,542
active nurses and midwives have yet
to meet the minimum qualification
equal to Diploma III level.
According to the Minister of Health,
Distance Learning Program (PJJ) is
one of the best solutions taken by
the central and local governments to
address the issue of disparity and
quality of health workforce. Through
PJJ Program, nurses and midwives,
especially those who serve in
Disadvantaged, Remote, Border and
Islands Regions (DTTPK) can get the
opportunity to improve the quality of
their qualifications online without
having to leave their workplaces. And
currently, PJJ related activities have
started in East Nusa Tenggara (NTT)
province with funding support from
the AIPHSS Program.
To support PJJ program, the Agency
for Development and Empowerment
of Human Resources (BPPSDM) has
developed the Recognise Prior
Learning (RPL) for D. III Nursing and
Midwifery. This activity aims to get a
reference to nursing and midwifery
education institutions in determining
the time and quantity of learning
that learners will have to take. In
addition, Comprehensive Assessment
of Education and Training for Health Workforce is also
conducted to study the situation of the education and training
of health workforce at national level and at local health
educational institutions.
In terms of regulation, the Ministry of Health with support of
AIPHSS Program is conducting a review of Kepmenkes No.81/
MENKES/SK/1/2004 on the Guidelines for Preparation of
Human Resources for Health (HRH) Planning at Province,
District/City and Hospital. The review is to determine the
implementation of Kepmenkes 81/2004 including the issues
and factors that influence the implementation to further
devise a method of planning of HRH need within local
governments.
Coinciding with the review of Kepmenkes 81/2004, the
Information System of Planning and Empowerment of Health
Workforce is also designed to enhance the implementation of
the revised Kepmenkes. The information system will serve as
a reference to Health Workforce Planning at the Centre for
Planning and Empowerment (Pusrengun) of Human Resources
for Health, the Ministry of Health. (SN)
5
Building
Block
Delivery of Primary
Health Care
Changes in Health
Systems and
Implementation of JKN
require Puskesmas
Revitalisation
R
egulation of health systems and
the National Health Insurance
( JKN) program provide a large
and strategic responsibility to
puskesmas by making it “gate keeper” of
primary health care delivery. This means
that puskesmas become the first contact
for patients within the formal health
services and functions as a filter of
referral in accordance with the standard
of medical services. The questions: is the
capacity of puskesmas ready to meet the
changing needs of health systems and to
welcome the implementation of the
National Health Systems ( JKN)? Is the
capacity of puskesmas ready to
implement the functions and roles as
stipulated under the Indonesian Minister
of Health Decree (SK) no. 128 of 2004?
With such a large and strategic role and
referring to the face of current
Puskesmas, the revitalisation of
6
puskesmas is undoubtedly an
important agenda to strengthen the
health systems in Indonesia. The
central government and regional
governments are of the same opinion
that puskesmas revitalisation is an
important requirement and a priority
for changes in health systems and
implementation of JKN starting 01
January 2014.
Responding to this, the Ministry of
Health (MoH), along with AIPHSS
program since late 2012 has actively
encouraged the revitalisation of
puskesmas which includes ten major
elements namely strengthening of
the institutional system,
strengthening of the puskesmas role
as a gate keeper, organisational
structure reform related to
puskesmas functions, increasing of
health workforce for puskesmas,
logistic arrangements, strengthening
of puskesmas information system
(SP2TP), financial management of
puskesmas, support for puskesmas
stratification, and the
implementation of clinical guidelines
and implementing guidance for
puskesmas role as a provider of
individual health efforts (UKP).
In terms of institution, several efforts
are underway nationally, among
others are the implementation of
activities to improve the technical
competency of regional health
officials through the preparation of
the Technical Competency Standards
for Regional Health Officials, and
Education and Training (Training) for
Technical Competency.
Additionally, in an effort to
implement puskesmas functions and
strategies for achieving an integrated
program, it is necessary to conduct
strengthening of the functions and
services through drafting of health
minister regulation (permenkes) on
puskesmas implementation in an
integrated program. Preparation of
draft guidelines on the
implementation of puskesmas aims
to review the details of individual
health efforts (UKP) and public
health efforts (UKM).
AIPHSS program also supports the
Ministry of Health in the discussion
and revision with the Ministry of
Home Affairs (MOHA) against some
of the Government Regulations (PP),
among others, PP no. 41 of 2007 on
Regional Government’s Structure of
Organisation and PP no. 38 of 2007
on Division of Affairs among CentralProvincial-District/City Governments.
Within MoH itself, puskesmas
revitalisation is an interrelated effort
among various agencies within the
Ministry of Health, among others,
Primary Health Care Agency (BUKD),
Agency for Development &
Empowerment of Human Resources
(BPPSDM), Centre for Financing and
Health Insurance (PPJK) and the
Bureau of Planning and Budgeting
(ROREN). (SN)
7
Building
Block
Health
Financing
Accuracy
in Health
Financing
System, an
Important Key
to better
Health
Services
8
Operating Costs (BOK) and other
sources of State Budget and Regional
Budget.
The principle of health financing is
fairness in funding contribution and
protection against financial risk
based on the assumption that
households should be able to pay
their part of the contribution without
exacerbating their financial situation.
The indications of fair will depend on
the normative estimation from the
society and how the health system
can afford to finance.
T
he state is obliged to meet the
needs of health care financing
appropriately, for curative,
preventive and/or promotive
services. The implementation of the
National Health Insurance system
( JKN) enables the source of funding
for curative services to be covered
under JKN scheme. Meanwhile, for
preventive and promotive health
financing will come from Healthcare
To assist the National Government of
National, Provincial and District
Government in conducting evidencebased financial planning (evidencebased health financing), AIPHSS
Program provides funds for activities
related to the preparation of Health
Accounts at national level (NHA),
province (PHA) and district (DHA), in
particular PHA and DHA at AIPHSS
selected locations. Health Accounts is
simply a systematic, comprehensive
and consistent way of monitoring the
use and flow of funds/financing on
health systems (health spending).
The main purpose of the Health
Accounts is to measure the flow of
existing expenditure in each of the
level so that health financing in the
following year can be projected
appropriately to meet the right
targets and benefits.
Meanwhile, to support the improved
services of hospitals, the national
government represented by the
Ministry of Health has set the
Indonesian Case-Based Group (INA
CBGs) as a payment system in JKN.
The INA-CBGs is a system of
classification/grouping of several
types of diseases and procedures/
actions in a hospital service with
financing associated with the quality
and effectiveness of the service to
patients. This system can also be
used as a standard use of the
resources required to provide health
services at the hospital. In other
words, the INA-CBGs is a range
equalization system relating to the
quality of health care which becomes
one element in the health financing.
The INA-CBGs system actually is not
something new, but has been applied
as a payment method for health
services in JAMKESMAS program at a
referral-level health facility and will
then be used in JKN program.
Therefore, this system has been
updated and adapted to follow the
health pattern in JKN.
Renewal of the INA-CBGs obviously
needs socialization on the right time
and to the right target, especially to
the non-PPK JAMKESNAS hospitals
which will collaborate with BPJS
Health, PPK JAMKESMAS hospitals
and representatives from the
Indonesian Hospital Association
(PERSI). Regarding the INA-CBGs
socialization, AIPHSS Program has
supported funding for four stages of
socialization which already took
place during December 2013. (SN)
9
Sharing
Stories
from
Field
The
Excerpts of some stories below were sent directly
from locations AIPHSS program locations, especially
during October to December 2013. Most of the stories
came from provincial and district partners who
practically started their activities in September or
several months after the work plan was agreed and
endorsed, when the staff of AIPHSS program or
known as Program Management Unit (PMU) started
to be posted in their respective regions.
10
g
d
Sharing
Stories
BPPSDMK
Developing a Capacity
of Human Resources
for Health to Support
Achievement
of National Health
Insurance and the
Millennium Development
Goals on Health
W
hile the national
achievement of the
millennium
development goals on health has
been in line with expectations, some
health issues remain, among others:
reduction of maternal mortality rates,
prevention of transmission of new
infections of HIV, expanding access
to clean water and drinking water for
urban and rural communities as well
as a decrease in population growth.
All still need serious attention and
require the hard work of all parties.
In this case, Human Resources for
Health (HRH) is seen as a key
component to drive the development
of health which aims to increase
awareness, willingness and ability of
healthy life for every person to
realize optimal health status. The
HRH issues become increasingly
strategic in line with the
implementation of the National
Social Security System to meet
proper basic life needs, including the
provision of health insurance for the
entire population in Indonesia. The
implementation of the National
Health Insurance commencing on 1
January 2014 requires the availability
of HRH in adequate amount, type
and quality and even distribution.
Challenges in HRH are very complex
and the Ministry of Health cannot
address the challenges alone.
Support, cooperation and good
coordination of relevant stakeholders
in the long term are absolutely
necessary, both at the central and
regional levels. And this can only be
achieved through political
commitment at the level of leaders
who can raise efforts related to HRH
development from various
stakeholders, including the private
and public.
from
TheField
Considering this condition, since
2010 the Government has
established a Coordination and
Facilitation Team for HRH
Development consisting of cross
ministries /institutions,
representatives of professional
organizations, association of health
education, association of health
facilities, and representatives of
international agencies, under the
coordination of the Coordinating
Ministry for Social Welfare and the
Ministry of Health.
National Workshops on the
Development of Human Resources
for Health (HRH) in 2011 and 2012
resulted in commitments in the form
of Document of HRH Development
Plan for 2011-2025. This document
will serve as a reference for
stakeholders to support the
implementation of the HRH
development. Meanwhile, the
11
National Workshop on the
Development and Empowerment of
Human Resources for Health in 2013
was expected to result in
commitments at political and
technical levels to implement the
HRH development. In addition, the
forum could also provide the room
for dialogues between between
stakeholders at national and regional
levels, as well as serve as a
momentum for the stakeholders to
initiate concrete actions to
strengthen human resources for
health.
The National Workshop (LokNas) on
the Development and Empowerment
of Human Resources for Health in
2013 which took place in Jakarta on
29-31 October 2013 addressed the
increasing of synergies between
stakeholders at national and regional
levels in developing and empowering
HRH to prepare for the National
Health Insurance and accelerated
efforts towards the health
millennium Development Goals. Two
expected outputs expected from
Loknas were:
1. strategic and practical efforts in
the development and
empowerment of HRH including
opportunity for best practice
replication;
2. agreement/ commitment to the
implementation of the
recommended steps for HRH
strengthening and joint
monitoring to support the
achievement of JKN and MDGs
on health.
#National workshop (Loknas) on the
Development and Empowerment of
HRH in 2013, BPPSDMK#
12
B
D
O
BON
DOW
OSO
Sharing
Stories
from
TheField
Jaminan Kesehatan Nasional
Bondowoso District
Health Office
conducts a
socialization
meeting on the
National Health
Insurance (JKN)
H
ealth Care Affairs of
Bondowoso District Health
Office in collaboration with
PT Askes (Persero) of Banyuwangi
branch office, East Java conducted a
socialization meeting on JKN. The
socialization meeting was attended
by about 80 participants
representing the leaders and staff
within the district health office,
directors of the hospitals,
professional organizations, heads of
the Puskesmas throughout the
district, Bappeda, military and police
hospitals in the district, and AIPHSS
team of Bondowoso district.
The acting Head of Bondowoso
District Health Office, Dr Muhammad
Imron, M.Mkes in his speech said
that the socialization aimed to
prepare and support the
implementation of JKN commencing
in January 2014 and PT Askes
preparation to be transformed into
the Social Security Provider (BPJS) for
Health.
“We hope that this
socialization could
enlarge the
perceptions of health
workers in
Bondowoso
concerning the BPJS
system, which would
further enhance the
services for the
community to obtain
health services”, he
said. In the future, he added, there
were still some challenges to be
tackled by Puskesmas immediately,
such as Puskesmas in Botolinggo
which had no general practitioners;
the number of family physicians
which were not proportional to the
amount of participants; lack of
implementing and technical
guidelines from the central level.
Solutions to the problems should be
sought immediately. Thus, it is the
expected that Puskesmas and
hospitals could implement excellent
services and operations in providing
health services to the community.
Meanwhile, the Head of Bappeda for
Social and Culture, Bondowoso
District, Ida Susanti, SH, asserted
that verification of the number of
participants was necessary to avoid
confusing data, because she said,
Bondowoso District still referred to
the data of the 2008 Regional Health
Insurance ( Jamkesda), where the
regional budget (APBD) allocated
approximately five billion rupiahs per
year with the premium tariff of IDR
19,925 per person. Through the
verification, the plan of the
government to implement JKN
starting in 2014 would provide more
obvious targets, changes and
benefits for the community.
The JKN socialization meeting
concluded at 12:30 local time after a
question and answer session
between the participants and the
Head of PT Askes (Persero) of
Banyuwangi branch office, Adi
Sunarno, Apt. The participants raised
some questions such as: capitation
tariff at every Puskesmas, treatment
for health insurance and non-health
insurance participants, the extent to
which the mechanism and readiness
of midwives in developing a network
with primary health care facilities in
the region as well as the presence of
the lab and pharmacy, and the role of
private hospitals in the region.
(Samuri & Bondowoso Team)
13
BONS
DOWB
OSOD
Sharing
Stories
BONDOWOSO
The District Government
supports AIPHSS through
the Appointment of Chief
Implementing Unit and
Technical Working Group
B
ondowoso, known as the city
of “tape” (pronounced
“tah-peh” fermented cassava)
which is about 200 km from the
capital city of Surabaya, is one of the
four districts in addition to Sampang,
Bangkalan and Situbondo as target
locations of AIPHSS program in East
Java Province. AIPHSS itself is an
Australia Indonesia Partnership for
Health Systems Strengthening aimed
to improve access to and quality of
primary health care. The program is
funded by the Australian
Government, and at district level, the
program is managed directly by the
district health office. The program is
in line with one of the Bondowoso’s
development priorities, particularly
to improve community health status
in the district.
As a response and support for
cooperation with donors, the Head of
District (Bupati) of Bondowoso Drs H.
Amin Said Husni, recently issued a
decree (SK) on the Appointment of
the Head of Bondowoso District
Health Office as the Chief
14
Implementing Unit of AIPHSS
program in Bondowoso District. The
decree is based on considerations
such as Government Regulation No.
10 of 2011 concerning Procedures for
Foreign Loans and Grants, and the
Minister of Finance Regulation (PMK)
No. 191/PMK.05/2011 regarding
Mechanisms of Grant Management.
Through the decree of Bupati, it is
expected that the Head of
Bondowoso District Health Office
(DHO), Dr Muhammad Imron, M.
MKes will soon establish a Program
Management which consists of
Program Manager from Echelon III
Officials within the DHO, and
Program Management Unit (PMU) in
the district recruited by
Implementing Service Provider (ISP)
to support the program.
In addition, to strengthen the
existence of the district in
implementing AIPHSS program,
Bupati of Bondowoso also
established a Technical Working
Group (TWG) through the Decree of
from
TheField
Bupati No. 188.45/l382/430.6.2/2013.
The TWG, which is chaired by the
Head of District Health Office, has a
membership comprising Echelon III
and IV officials of the District Health
Office, District Planning and
Development Agency (Bappeda),
District Civil Service Board (BKD),
and Women Empowerment and
Family Planning Agency (BP2KB).
The duties and functions of the
Technical Working Group, one of
them is to provide technical advice
and direction for the program, as
well as to oversee and evaluate
management of the program grant in
Bondowoso District. The 10-person
group has a regular meeting at least
four (4) times a year.
The two (2) decrees of Bupati as legal
framework for AIPHSS program in
Bondowoso will enable the program
to be more widely known, and to
support the Bupati’s vision to realize
a faithful, empowered and dignified
community.
(Samuri & Bondowoso Team)
NSITU
WBON
ODOS
Sharing
Stories
from
TheField
SITUBONDO
Socialization and
Establishment of
Situbondo
DHA Team
T
he socialization and
establishment of Situbondo
District Health Accounts Team
(DHA) took place at Restu
Restaurant, Jl. PB. Sudirman. This
event aimed to provide an initial
overview of the importance and
benefits of DHA to local stakeholders.
The target audiences were the
elements from District Health Office,
Bappeda, Puskesmas, Central Agency
of Statistics (BPS), BKKBN, DPPKAD,
District Hospital of DrAbdoer Rahem,
Elizabeth Hospital, and House of
Representatives of Bondowoso
District.
15
SITUB
D
BON
O
DOS
The Head of Situbondo District
Health Office, Dr Abu Bakar Abdi,
Apt., Msi. in his opening remarks
said that the District Health Office
required DHA assistance to see
how the condition of health
expenditure in the district. For
Situbondo District Health Office,
this event was the first one
supported entirely by AIPHSS. It is
expected that this event would
become the door for upcoming
assistance process in improving
health system in the district.
The event presented two (2)
resource persons, one from the
province, Siti Haripi, SKM. M.Kes,
and the other one was AIPHSS TA
Consultant for East Java Province,
Dr Frankie Hartanto. The first
resource person presented
experiences and best practices
related to the implementation of
DHA at the provincial level.
Meanwhile, the AIPHSS TA
Consultant presented the
difference between health
budgeting and health financing,
and why DHA is important for the
District Health Office and relevant
partners at the district level.
The socialization concluded with
establishment of the core team of
DHA comprising 5 persons. They
were representatives from the
District Health Office (2 persons),
Bappeda (1 person) Hospital (1
person) and the Central Agency of
Statistics (1 person). The Situbondo
DHA Team will be trained in the
province on 16-20 December 2013
prior to performing duties, i.e.
collecting and analysing DHA data.
(Bovi Villa & Situbondo Team)
16
UBON
DOW
N
OSO
Sharing
Stories
from
TheField
BONDOWOSO
Strengthen
Referral
System with
Partnership
Program
I
n accelerating the implementation of the National
Health Insurance ( JKN) in accordance with Law
No. 40 of 2004 on the National Social Security
System (SJSN) and Law No. 24 of 2011 concerning the
Social Security Organizing Agency (BPJS), the District
Health Office of Bondowoso conducted a workshop
on the strengthening of standard operating
procedures for referral.
The participants of the workshop were Heads of Puskesmas
and Emergency Units, and hospitals throughout
Bondowoso. The activity which took place at Ijen View
Hotel, Bondowoso, was a cooperation between the
Government of Australia and Government of Indonesia
through the Ministry of Health. The program at district level
was managed by District Health Office.
The event which was inaugurated by the acting Head of
Bondowoso District Health Office, Dr Mohammad Imron, M.
MKes, who presented two resource people from East Java
Provincial Health Office: Mirza Esvanti, S.KM, M.Kes, staff
of special referral services and Dr Tri Maharani, M.Si SP.EM.
As many as 60 participants attended the workshop. They
were representatives of related SKPD (regional government
working units), and Police. In the opening remarks, Dr
Imron said that the number of referrals in Bondowoso
reached 24%, whereas the minimum standard was only
“We realize that the structural
quality and infrastructure quantity
were not optimum. However, let’s
keep providing the best service,
because the public demands are
increasing, and this becomes a
15%.
17
response to this referral, we require
an established and organized SOP in
each puskesmas”, added Mirza.
OND
challenge as well
as a control for
Puskesmas and
hospitals”, he
asserted.
Meanwhile, according to the
Head of Puskesmas Development
and Referral of Bondowoso
District Health Office, Yanti
Nurhayati, S.Kep, Ns, M.MRS, the
workshop is expected to result in
proper understanding on the
referral concept. Referral system
is one of the important parts to
be optimized in order to provide
the patients with appropriate,
quick, cheap and safe health
care. Therefore, this forum serves
an effort to build stakeholder
commitment to the health facility
units in realizing the referral
system in accordance
with the existing
standard operating
procedures.
The resource person,
Mirza Esvanti who is
also a staff of the
Special Referral
Service Section of
Bondowoso District
Health Office,
provided information
that there are 960
Puskesmas in East
Java province at
present. From such a
number, about 19 Puskesmas do
not have general practitioners
yet. Therefore, through the
issuance of the Minister of
Health Decree Number 71 of 2013
on Health Services in the
National Health Insurance ( JKN),
the issues concerning human
resources should be addressed
together. “To make a rapid
18
On the other hand, according to Ifan
Rizky from the Public Relation and
Legal Section of Mitra Medika
hospital, the referral issues occurring
are more on communication and
Human Resources. The District
Health Office is expected to do more
to socialize the referral system so
that people will have better
understanding.
The second resource person, Tri
Maharani said, “The problem is that
many people want to be directly
admitted to the hospital, whereas the
Social Security requires a tiered
referral service. Therefore, the
strengthening of referral system in
Bondowoso should apply a more
communicative
approach,
instead of the
medical one.”
Socialization can
use brochures,
leaflets, or
booklets to
different targets.
Tiered, serial,
and continuous
messages are
more effective
and efficient to
be delivered to the village apparatus,
community/religious leaders in order
to re-explain to the family. “The art
of communication could be a
solution which is able to change the
communication pattern in the
community to the referral issue”,
explained the former Head of Pakem
Puskesmas, Bondowoso. In addition,
with the existing mind set,
information needs to be
communicated well with family, so
that they understand that it’s enough
for them to get any treatment at
Puskesmas”, added the doctor
graduated from Brawijaya University.
“In terms of human resources, it
would be better if they understand
the concept of Triage, as a measure
of grouping patients according to the
severity of the case, life expectancy
and the level of success that will be
achieved in accordance with
standard of emergency services
owned, because the basic logic of the
referral is to improve healing and
reduce mortality”, she concluded the
discussion session.
At the end of the session, a follow-up
plan of activities was presented, that
is a socialization plan with the
technical staff of Puskesmas and
hospitals dealing with referral on the
next 16 December.
(Samuri & Tim)
N
D
G
NGA
DAN
GAD
NGADA
Technical
Working
Group (TWG)
Meeting
A
Sharing
Stories
from
TheField
IPHSS Team of Ngada
District facilitated the
Technical Working Group
(TWG) meeting to formulate
recommended activities for 2014
Work Plan. Through this meeting, the
AIPHSS Technical Working Group of
Ngada District recommended 38
activities to be proposed at the 2014
Work Plan. The activities were
believed to contribute to the
achievement of AIPHSS program
indicators.
Work Plan. For the draft of
2014 Work Plan which has
been prepared, the technical
team will provide inputs
according to the guidelines
of the Ministry of Health
(read: AIPHSS Performance
Framework) and please share
these guidelines to our
friends in the team to ensure
our activities refer to the
guidelines”, he said in his
speech.
The TWG meeting was attended by
the Head of Bappeda as the
Chairperson of AIPHSS TWG of Ngada
District and by the TWG members
from various sectors: Bappeda,
Bajawa district hospital, District Civil
Service Board (BKD)-Training, District
Health Office, and AIPMNH and AIPD
as observers. In his speech, Hillarius
Sutanto, as the TWG Chairperson,
recalled TWG function to guard the
AIPHSS activities in by providing
required cross-sector supports.
The moderator of the meeting, Yak
Jos Mawo, the Secretary of the
District Health Office which is also
the Secretary of Ngada District TWG,
invited all participants of the TWG
meeting to identify and analyse all
activities both in the 2013 Work Plan
and 2014 Work Plan, and make sure
to avoid double funding for the same
activity from other funding sources
such as APBD and AIPMNH. He also
encouraged all participants to
consider the proposed new activities
deemed appropriate with the AIPHSS
Program indicators.
“In accordance with the
decree on the TWG set by
Ngada Bupati (Head of
District) No. 31.B/KEP/
DINKES/2013, we will provide
inputs related to the AIPHSS
2013 Work Plan and 2014
“Do not be too eager to avoid
collisions with existing activities at
the District Health Office, notice the
time and human resources so that all
activities can be carried out well”,
added the Chairperson of the TWG
during the discussion.
One of the proposed activities in the
TWG meeting came from the
Secretary of BKD-Training of Ngada
District who suggested that through
AIPHSS Program, the implementation
of Employee Performance
Assessment could be adjusted to the
policy of the National Civil Service
Board (BKN), Perka. BKN No. 01 of
2013 concerning Civil Servant Job
Performance Assessment, since the
implementation of the new policy is
believed to be able to encourage the
improvement of the quality of all
employees in Ngada, particularly in
within the District Health Office of
Ngada. Every civil servant will be
assessed based on the Employee Job
Target previously prepared, and
therefore every employee would be
encouraged to reach the target.
“The Regulation of Head of BKN,
Perka 01/2013 concerning Civil
Servant Job Performance Assessment
with the technical reference of the
Government Regulation (PP) No.
46/2011. Starting in 2004, the
assessment format will be different.
The assessment weight for the
employee job target is 60% while for
the behavior is only 40% behavior.
So far there’s only an assessment of
the employee behavior not on the
performance”, Christian Haning said
in the discussion.
Through this meeting, they agreed to
cancel nine activities, carry over five
activities from the 2013 Work Plan
and propose 13 new activities in the
2014 Work Plan. The results of Ngada
TWG meeting will be forwarded as
inputs to the TWG meetings at the
provincial level of NTT and at the
central level (Hery Firdaus & Team).
(Hery Firdaus & Ngada Team)
19
SAM
SAMPANG
Structuring of
Referral System
Sharing
Stories
from
TheField
PAN
GSA
S
tructuring of the Individual Health Referral System at Primary Health
Care Level is an important issue to prepare for the implementation of
the National Health Insurance ( JKN) commencing in January 2014. To
anticipate the implementation of JKN, the District Health Office of Sampang,
conducted an Individual Referral System Setup at Primary Health Care level
through the establishment of a Referral System Structuring Team on 28
November 2013 at the Grand Restaurant Camplong.
The event was attended by all echelon III officials, Heads of Sections related to
Health care and referral service, Sub division of Planning & Budget of
Sampang DHO, district hospital (RSUD) and representatives from Puskesmas
Kamoning and Omben. The AIPHSS Technical Assistance (TA) Team consisting
of Prof. Dr Ascobat Gani, Dr Sandi Iljanto, Dr Frankie joined as resource
persons. PME Officer of BUKD, East Java PPMU Coordinator and Team of
DPMU Sampang also attended the meeting.
The Head of Sampang District Health Office, Dr
Firman Abadi, MM. in his opening remarks said
that in Sampang, there was still no Standard
Operating Procedure (SOP) for referral, only a
SOP for Midwifery is available. Thus, it is very
important to structure the individual referral
system in anticipation of the JKN/BPJS in 2014.
The SOP needs to be prepared by mutual
agreement and should be known by public.
The meeting continued with a discussion session on the implementation of
individual referral starting from individuals, puskemas and its network, to a
hospital level. The participants took an active part in the discussion.
Individual referral system focused on the facilities of puskesmas as the centre
for Community Empowerment, as the Centre for Health oriented
Development, and as the Centre for Health Services.
The root of the referral problem in Sampang is the culture, in which the
referral upon own request is still high at 30%. Therefore, the preparation of
guidelines for Referral System should consider existing issues:
20
• Criteria of referral, such as when
a patient should be referred
• Improved capacity of Puskesmas,
Puskesmas PONED,
• Networking related to
transportation, ambulance,
• Community-based referral
• Dimensions of culture: three (3)
lates: late in decision making,
late in transportation, and late in
handling.
The event concluded with the
establishment of Referral System
Structuring Team through Bupati
decree (SK), and upon the advice of
Prof. Dr Ascobat, the Team would be
put together with DHA Team and
Human Resource Team under a
Working Group (Pokja) of Health
System Strengthening. The referral
system team, along with the
technical assistance for referral, will
carry out managerial diagnostic that
is to prepare technical analysis,
conduct desk analysis, field visits,
prepare initial draft of individual
referral system, and conduct a
seminar on the draft individual
referral system and finalisation of
model of individual referral system in
Sampang District.
Through the establishment of the
Individual Referral System
Structuring Team at Primary Health
Care, it is expected that a model of
individual referral system in
Sampang district would be developed
to anticipate the implementation of
JKN in the next January.
(Titien Irawati & Sampang Team)
MTTU
T
he North Central Timor (TTU)
District Program Management
Unit of AIPHSS Program
facilitated the first TWG coordination
meeting in the district. The meeting
was attended by participants from
cross sectors, such as from Bappeda,
RSUD Kefamenanu, Legal Division of
SETDA, and TTU District Health Office
comprising Head Department and
Head of Sub Division, and staff of
AIPMNH. The meeting took place at
the hall of Litani Restaurant,
Kefamenanu.
TTU
The meeting was opened by the
acting Head of TTU District Health
Office, Frans Tas’au SKM, M.Kes, who
also serves as Head of PPSMPL. In his
opening remarks, he said the support
from TTU District government to
AIPHSS Program could be seen from
the establishment of AIPHSS
Technical Working Group (TWG)
through the Bupati Decree Number
372 of 2013 dated 11 November 2013.
The decree stipulated the duties and
functions of TWG. The Technical
Working Group provides technical
advice and direction, and oversees
and evaluates planning and
implementation of programs, and
conducts cross sector coordination
related to programs through meeting
at least 4 times a year.
established through a Bupati Decree
(SK) in the district, and Governor
Decree (SK) in the province. I also
congratulated TTU District, because
TWG establishment process in the
district is the fastest of the other
AIPHSS selected districts”, said the
Coordinator of CPMU in his speech. “In
this meeting, the TWG is expected to
provide advice and guidance in
discussing the 2014 proposed activities
by considering program achievement
indicators in AIPHSS Performance
Framework”, he added.
Sharing
Stories
from
TheField
Technical
Working
Group Coordination
Meeting
NTTU
ATTU
In this meeting there were some
important points such as technical
direction from Central PMU
Coordinator, Budi Perdana,
concerning the implementation of
TWG at district level, and explanation
on how to complete matrix of
proposed activities for 2014, via
teleconference, and discussion on
matrix for AIPHSS proposed activities
in 2014.
“On this occasion, I would like to say
that the TWG is the first technical team
The CPMU Coordinator mentioned
that one of the proposed activities
discussed in the TWG meeting was
concerning Puskesmas reform. The
activity changed into Puskesmas
Revitalization, and the guidance is
still prepared by the Program
Technical Specialist along with the
team chaired by Prof. Ascobat Gani.
“The concept of
Puskesmas
revitalization is a
great concept to
prepare Puskesmas to
face JKN and vertical
coordination with the
central level is
required. This concept
is piloted in the
AIPHSS Program, and
it is our responsibility
to prepare and
implement this “, said
Dr Hartono, the Program
Manager of AIPHSS from
TTU District Health
Office.
Nineteen (19) new activities were
proposed by the TTU District Health
Offices and had been observed in the
TWG meeting. The activities were
considered to be able to answer
Component Objectives, Intermediate
Outcome Indicators and Output
Indicators in AIPHSS Performance
Framework. There were 11 activities
cancelled, because they could not
meet the indicators. Thus, the
activities to be implemented in 2004
are 34 activities from 2013 and 2014
Work Plans, and 19 new proposed
activities which will be discussed
further at provincial and central
levels. (vp)
(Tim PME DPMU TTU)
21
FLOF
S
TIMT
B
FLO
FLOTIM
Sharing
Stories
from
TheField
Managerial Improvement
Training for Puskesmas Team
(PML Puskesmas)
skills required, but also good
management, quick, accurate and
quality service delivery to help improve
the quality of health.”
“T
here is a difference
between being a leader
and being the head of
an agency. Anyone can become the
head of an agency through a formal
appointment decree, but does not
necessarily have leadership skills. Being
a leader takes more than just a
decisional letter. A good leader must be
able to protect, guide and empower the
members he/ she leads to become
better and even teach other candidates
to become a leader” not only are the
22
The Head of East Flores (Flotim)
District Health Office, Dr Usen Joseph
Aman, delivered the expressions in
his speech on the Managerial
Improvement Training for Puskesmas
Team (Puskesmas PML) which took
place on 16 to 27 November 2013 in
the Rumah Khalwat Susteran Weri,
Larantuka. The event was the
collaboration between Flotim District
Health Office and the Australia
Indonesia Partnership for Health
Systems Strengthening (AIPHSS) to
support health systems
strengthening in Indonesia,
particularly in East Flores (Flotim)
district.
For information, there are 20
Puskesmas in the district which
spread over three islands: Flores,
Adonara and Solor Islands. There are
about 8 Puskesmas with inpatient
facilities and 12 others with
outpatient care. So far, there is only
one district hospital (RSUD), in
Larantuka. A new RSUD will be built
in Adonara for patient care and
referral (in Emergency situation).
Seen from the distribution, it is
expected that the services provided,
personnel, and human resources
would meet the requirements and
standard already defined at the
district, provincial and national
levels.
The Managerial Improvement
Training for Puskesmas (PML
Puskesmas) was divided into 2
groups and attended by 60
participants from 20 puskesmas
throughout the district. Each
Puskesmas sent 3 participants
consisting of Head of Puskesmas,
Administrative staff/ SKM midwife/
coordinator nurse. Person in charge,
resource persons, facilitators were
from BAPELKES of NTT province and
Flotim District Health Office.
The materials presented during the
training were Building Learning
Commitment/BLC, Heal
Development Policy, Basic Policy of
Puskesmas, Team Building, Planning
at Puskesmas level (Micro Planning),
Communications and Motivation,
Advocacy and Negotiation, Mini
Workshop on Puskesmas, Puskesmas
Performance Assessment, Public
Service Performance Measurement,
Supervision Techniques, Technical
OFLO
SUM
MTIM
BAS
O
Guidance, Facilitation and
Management of Finance.
On another occasion, Dr Yosep Usen
Aman also expected that the
facilitator who had followed the ToT
Management would be able to apply
structured management to improve
the quality of primary services, able
to prepare a Proposed Activity Plan
(RUK), able to carry out a mini
workshop both cross-program and
cross-sector, and able to conduct
performance assessment at their
respective Puskesmas. These would
be helpful for Puskesmas to prepare
RUK and Performance Assessment
Document which can later be used as
an internal evaluation of Puskesmas
in particular and also the District
Health Office of East Flores.
For the internal District Health Office
itself, there are some action plans
after the activity, such as:
1. To conduct a workshop on the
establishment of performance
indicators and operational
definitions for each variable
decided in the training. The
results of the workshop will be
developed in the form of the
Head of District Health Office
Decree (SK) and Bupati Decree
(SK).
2. To conduct technical guidance
(Bimtek) periodically on the
implementation of performance
appraisal in existing
mechanisms, such as Mini
Workshop, Monthly, Quarterly,
and 6 Monthly Meetings.
The first AIPHSS activity in
collaboration with the East Flores
District Health Office is expected to
be a good start for the next events in
the district.
(AIPHSS Flotim Team)
­
Sumba Barat Daya
Technical Working
Group Meeting
T
he Technical Working Group
(TWG) Meeting of South West
Sumba (Sumba Barat Daya
(SBD)) district took place in the
District Secretariat room of the
Bupati’s office. The venue and time
of the meeting had been agreed by
SBD District Health Office and
AIPHSS DPMU of SBD with the
expectation that the District
Secretary representing the district
government as the official who was
requested to invite cross sector
stakeholders could open the event as
well as monitor the process of
discussion.
This first TWG meeting in the district
was officially opened by the
Secretary of SBD District. (Drs A.
Umbu Zaza, MSi) and attended by
officials and staff of related cross.
The membership of TWG in the
district will be established by a
Decree (SK) of Bupati. The meeting
was to discuss activity plan for 2014.
During the Introduction /
Implementation guidelines, Budi
Perdana (CPMU Jakarta) initially
facilitated the session through a
teleconference and assisted by
DPMU SBD (Gerson Rigo, PME
Officer) as a co-facilitator. The next
session was an explanation /
discussion on the process of
completing the matrix of proposed
annual activities which were
associated with Component
Objectives, Intermediate Outcomes
and Output Indicators in the
Sharing
Stories
from
TheField
Performance Framework. The draft of
2014 Activity Plan which had been
distributed to the participants was
discussed to decide on which
activities to be carried over from
2013, which ones to be deleted, and
which new activities were proposed
for 2014. The discussion process was
quite dynamic and the participants
took active part in providing
suggestions and inputs to fill out the
matrix of 2014 proposed activities
referring to the Component
Objectives, Intermediate Outcomes
and Output Indicators.
On the occasion, the District
Secretary (Drs A. Umbu Zaza, M.Si)
provided directions and inputs so
that the planned activities should
23
SUMB
D
BAS
NTTO
­
consider local needs, especially
regarding Health Financing, Human
Resources for Health (HRH) and
Primary Health Care at puskesmas.
The Secretary further said that most
of the existing human resources in
puskesmas (midwives, nurses, etc.)
were still below the level / standard
of D-III education. This issue needs to
be addressed so that in the future
there will be solution to one of the
district challenges in terms of
primary health care at the
community level (puskesmas).
The Secretary of the District Health
Office (Drg. Yulianus Kaleka)
representing the Head of District
Health Office, said actually the
AIPHSS Program has been planned
since 2012 which means that the
planning process at the central level
has been long enough. Therefore, so
we should support it seriously
especially in the district to enable the
program to be implemented in 2014.
Further he added that we should pay
attention / take into consideration
the local needs for more maximum
health services supported by a
system of maximum health as well,
especially if it is associated with the
situation and condition of the SBD
District as a new district (split from
West Sumba district) which was only
about 5-6 years.
Nusa Tenggara Timur
Pre-Technical Working
Group NTT
“P
erformance Framework
should become a
reference for planning.
There are currently a number of
activities in 2013 which have not run,
and will be carried over to 2014 and
coupled with 2014 planned activities.
Thanks a lot to AIPHSS PMU which has
provided us with a matrix of activities
to enable us to filter our activities so
that the activities are in accordance
with the program objectives listed in
the Performance Framework”. The
Head of Sub Division (Kasubbag) for
Program, Data and Evaluation of the
Provincial Health Office said in his
presentation and directions when
represented AIPHSS Program Manager
at Pre-TWG meeting which was
conducted on 10 December 2013 in the
meeting room of NTT Provincial Health
Office
The outputs of the TWG meeting
were proposed activities for 2014 in a
matrix form with the details; 22 new
activities in 2014, two activities
carried over from 2013, two activities
which were “deleted” because they
did not meet the required criteria,
and 3 proposed new activities. Thus,
there are 27 activities proposed in
2014. In principle, these activities
were proposed by SBD district, which
would still have to be discussed
again at the next TWG meeting by
considering the input of PTS / and
related TA.
(Gerson Rigo & SBD Team).
Sharing
Stories
from
TheField
and inputs for planning so that the
planning would not only focus on the
work program which already existed
but also bring new program
initiatives which can address the
program objectives as listed in the
Performance Framework.
NTT
24
The pre-TWG meeting involving
cross-sector and programs aimed to
discuss activities which will be
implemented in 2014. The meeting
took place amid tight activities at the
end of the year and was attended by
representatives of cross programs in
the NTT provincial health office
including Public Health –MCH Sector,
sub division of PDE, Medical Services
and Human Resources for Health
Development.
Representatives of PPMU NTT and
Technical Advisor provided directions
As many as 24 activities have been
reviewed to enable them to be
implemented in 2014. A Technical
Working Group meeting inviting
representatives of 4 districts of
AIPHSS will take place in the near
future to follow up this pre TWG
meeting.
(Ois Saudila & NTT Team)
MBON
DOW
S
TOSO
­
T
Sharing
Stories
from
TheField
BONDOWOSO
Tiered referral remains a challenge
for Bondowoso District Health
Office to prepare for SJSN
“L
ooks like children in
PAUD (early childhood
education), sticking
pieces of papers” said Istri Rusnawati,
a coordinator of Inpatient Care
Puskesmas of Tlogo, during group
presentation session to identify
referral problem in. “anyway, we
become more enthusiastic and don’t
feel sleepy”, added Rita Irawati, a
nurse from Curahdami.
The coloured papers (metaplan)
revealed; man, money, material,
machine, method and market or well
known as 6 Ms, and these remain a
challenge for a number of Puskesmas
in the implementation of referral so
far.
The above conversation and coloured
papers stuck were among the
discussion activities in the
socialization workshop on tiered
referral system to coordinators of
emergency units and inpatient care
of all Puskesmas, pubic hospitals,
and private hospitals. The event was
conducted by Bondowoso District
Health Office and took place at Palm
Hotel, Bondowoso.
The event was also intended as a
forum to discuss and share
experiences about their best
implemented referral service. Clarity
of referral is fundamental and
obligatory to be followed by
Puskesmas as health care providers,
and by the community as health
service recipients which will then
become national health insurance
( JKN) participants.
“I’m happy to discuss with my friends
from hospitals, and through a meeting
like this we could have common
understanding on the referral,” said
Rita Irawati. On the other hand, a
representative from Prajekan
Puskesmas, Maskup said that so far,
discussion process has been done,
but only limited to cross-program
coordination meetings, and there has
been no common concept.
From the socialization and discussion
process, the participants eventually
understood that the government has
actually set the Individual Health
Care Referral System through the
Minister of Health Regulation
(Permenkes) number 001 of 2012.
While the definition of health care
referral system itself is the health
care delivery which sets the
delegation of tasks and
responsibilities of health care
services on a reciprocal basis both
vertically and horizontally to be
implemented in stages as medical
needs arise, and starting from the
first (primary) level of health care.
This means that the main public
service to access basic health
services lies at Puskesmas.
From the sharing of opinions and
discussions above, it can be
concluded that In Bondowoso, sick
people in general tend to have
selected Puskesmas for health
treatment. This consideration is
25
BONS
DOWB
OSOD
­
­
mainly due to socio-economic
conditions or the patient’s family
incomes. Geographically, Puskesmas
are more easily accessible from the
community’s homes. However, in
some particular cases the patient’s
family refuses if a family member
who is ill should be referred to
hospital. Their reasons make sense,
because the patient’s family should
spend and bear the cost of
transportation to the hospital or they
have to spend some expenses while
waiting on the patient
“When talking about referral to
hospital, usually we should be able to
convince the family, and it takes some
time to do so. Because when
hospitalized, the costs spent tend to
be higher, e.g. for transportation, for
meals when waiting on the patient “,
said Rusnawati who have served in
Puskemsas for more than 15 years.
Learning from the experience above,
the Head of DHO Heath Care who is
also the District Program Manager of
AIPHSS Bondowoso, Pasidi Sidiq, Kes
explained that the district health
office had sought to conduct
socializations with various parties to
optimize the quality referral and
provide the best health services for
the community. Thus, for the
strengthening and stabilization of
referral system, the District Health
Office, in collaboration with AIPHSS
program develops Standard
Operating Procedures (SOP) and
holds joint activities such as
socialization, workshops, and later
will be followed up by monitoring
and evaluation of referral
implementation in all Puskesmas,
public hospitals, and private
hospitals in the district in January
next year to ensure readiness for
SJSN implementation.
26
Finally through the meeting, they
had been able to prepare 16 SOPs on
referrals ranging from; admission
procedures at the counter, patient
anamnesis, physical examination,
until the ways to make a good
referral report based on the problems
and experiences encountered during
the duty. Finally, the challenge faced
by Bondowoso District Health Office
in the future is commitment of
Puskesmas and hospitals staff in
implementing existing SOP. On the
one hand, there should be efforts to
educate and convince people
concerning referral, so that the
implementation of the upcoming
SJSN is a certainty. On the other
hand, Puskesmas should find the way
to convince community on the role of
general practitioners and Puskesmas
which are able to provide primary
health care for them, so that national
health insurance in Bondowoso can
be more effective and efficient have
better quality.
(Samuri & Bondowoso Team)
NSITU
WBON
ODOS
­
SITUBONDO
Technical
Working
Group
(TWG)
U
nfriendly weather didn’t discourage the enthusiasm of
participants to attend the Technical Working Group (TWG)
meeting in Situbondo on Thursday, 12 December 2013. In
a small hall of Situbondo District Health Office (DHO), already
assembled all members of the TWG, such as: the Head of District
Health Office, Head of Bappeda, Director of Abdoer Rahim District
Hospital (RSUD), representatives of the District Personnel Agency
(BKD), representatives of DHO Organizational Affairs, Head of
DHO Health Community Empowerment (PKMK), Head of DHO
Health Care, Head of DHO Human Resources Development and
Empowerment (PPSDM), AIPHSS TA Consultant, dr. Frankie
Hartanto and AIPHSS Team of Situbondo.
This important event was opened at 09.00 am by the Head of
Situbondo District Health Office, Drs Abu Bakr Abdi, Apt., MSi.
Following the opening, there was a teleconference with the
AIPHSS Central Program Management Unit (CPMU) guided directly
by Pak Sawidjan Gunadi. On that occasion, Pak Sawi, that’s his
nickname, provided directions and guidance on how TWG process
should take place and what outputs are expected at this meeting.
This was the first TWG meeting conducted by Situbondo District
Health Office. Socialization of TWG team at district level and work
plan of the district health office – AIPHSS 2014 were discussed in
the meeting. TWG main duties and functions were the
socialization material presented in the discussions, in addition to
Sharing
Stories
from
TheField
the work plan. The work plan of district health
office - AIPHSS which was discussed in the
meeting was the result of pre TWG meeting on 4
December 2013, which had reviewed the work
plan activities in 2013 and became a proposed
draft for 2014. The proposed draft received
assistance from TA PTS Consultants, Dr Sandy
Ilyanto and Dr Nida Harahap and was discussed
at the meeting on 6 December 2013 in Surabaya.
The work plan of the district health office –
AIPHSS 2014, having been through several
process, was brought to the TWG meeting to
gain inputs and approval, and will further be
submitted to DFATvia Ministry of Health. This is
in line with the main duties and functions of
Situbondo TWG as a joint cross-sector forum to
support, direct and monitor the implementation
of AIPHSS which is a partnership program
between the Ministry of Health and DFATin
order to strengthen health systems. This forum
is the highest forum in the program decisionmaking at each level, so that the
implementation needs to be confirmed by the
policy brief at each level (ministerial decree,
governor decree, bupati decree, etc.)
The TWG meeting finally decided final draft of
the work plan for 2014 in accordance with the
priority and capacity of the district health offices
and related cross sector.
(Bovi Villa & Situbondo Team)
27
BANB
KALS
ANBB
­
BANGKALAN
Sharing
Stories
Socialization
& Establishment
of DHA Team
P
resentation of Prof. Dr
Ascobat Gani, MPH
concerning District Health
Accounts in the event of
“Socialization and DHA Team
Building” at Wisma PKPN Bangkalan
district, Friday, 29 November 2013
raised awareness of all participants
about the importance District Health
Accounts (DHA).
The increased health development
funding in Bangkalan every year in
fact has not been followed by
effectiveness of its utilization.
Disasters can happen any time with
this condition, for example: more
poor people.
“So far, we are weak and our funding
tends to be donor-driven. We have not
seen what actually the primary health
need of the community in the district is
and how much it costs. Funds are
always not enough, not effective, and
consumables for things that are not
directly related”, said Prof. Dr Ascobat
Gani, MPH.
He continued that based on the
results of statistical surveys in East
Nusa Tenggara, more managed funds
were spent on indirect and
operational expenditures. The poor,
for example, spent more on
cigarettes than on health
maintenance and education. “What
about Bangkalan?” he asked.
28
Regarding our/ Puskesmas readiness
to face JKN program, he said that
BPJS with the capitation system
actually gave up the load / total risks
to Puskesmas. Are you as Heads of
Puskesmas ready to face all of this?
He further asked. On the whole, the
presentation of Prof. Dr Ascobat
Gani, MPH was able to encourage
enthusiasm of the participants. There
were some questions raised as to
how the health budget in Bangkalan
today? Is it the same as in NTT or
worse?
At the event, the Head of SocioCultural Affairs of Bappeda,
Bangkalan district, Drs Nasrudin also
recalled the importance of health
sector as success indicator of the
development. Bangkalan life
expectancy is 63 years or below the
average life expectancy of East Java
province which is 65 years. Together
with Sampang, Bangkalan is the
district with the lowest life
expectancy in East Java. Reflecting on
this data, does DHA become a
necessity?
“DHA is essential for
effective planning for
the contribution of
the health sector in
Bangkalan district
budget (APBD). DHA
Team can certainly
from
TheField
provide the data to
the parties associated
with the policy, either
to Bupati, Bappeda,
or to local
government working
units (SKPD),”said
Nasrudin.
The event ended with the
establishment of the 5-person
Bangkalan DHA
­
Chairperson : Bappeda
Secretary : District Health
Office (DHO)
– Resources
Empowerment
(PSD)
Members : Hospitals, DHO
– Resources
Empowerment
(PSD) and
Central Agency
for Statistics
(BPS)
Finally, enjoy working and good luck
DHA team. Hopefully the meeting
would be a good start for the
improvement of health development
budget in Bangkalan district. Come
on Bangkalan……you can do that!!!
(Yos & Bangkalan Team)
NBPP
LSDM
BBPP
­
Sharing
Stories
BPPSDM
Coordination
Meeting of PJJ
(Distance
Education)
Implementation
T
he coordination meeting of
PJJ (distance learning)
implementation which took
place at Swiss-Bell Hotel – Kupang,
NTT on 6 - 8 December 2013 aimed
to synchronise perceptions and
strengthen the preparation of PJJ
implementation at MoH Health
Polytechnics (Poltekkes) Kupang. In
addition, through this meeting it was
expected that there would be full
supports from the local government
and provincial personnel agency
(BKD) to develop health workforce
and meet the availability of health
workforce in accordance with the
required qualifications, especially in
the areas where access to education
is limited and where the learning
participants cannot leave their
workplace.
The coordination meeting was
attended by representatives from
Centre for Health Workforce
Education and Training
(Pusdiklatnakes), TA Consultants,
Poltekkes Kupang and units of
distance learning sources (USBJJ),
NTT Provincial Health Office, District
Health Offices of Flotim, Ngada, TTU
and SBD, lecturers and learning
assistance officers (PLBB).
from
TheField
The Head of Centre for Health
Workforce Education and Training
(Pusdiklatnakes) – BPPSDMK, Dr
Donal Pardede who opened the
meeting, delivered some points in his
speech:
•
The increasing demands and
needs of the community for
health services should be
addressed by professional
development of health workforce
as mandated in the regulations
related to health workforce
which imply that in the future
health professionals will be
developed at least at diploma
and undergraduate level.
• In addition, to face globalization
era, the improvement of Human
Resources for Health especially
for secondary education level
and higher education level of
Diploma 1 (D1) who work at
service unit is a must for health
development.
• However, there are still a lot of
health workers who graduated
from secondary education and D1
levels have yet to get
opportunities to attend Diploma
III education through regular
programs, especially in remote
areas, borders, and islands,
(DTPK) approximately 143,901
people.
• Advice from the Directorate
General of Higher Education that
PJJ Program refers to the
Regulation of the Ministry of
Education Regulation
(Permendikbud) No. 24 of 2013
on the Implementation of
Distance Learning (PJJ) at Higher
Education.
• In the implementation, all
stakeholders should adhere to
the principles set out in the
implementation guidelines of PJJ
for Diploma III Health Study in
accordance with the duties and
functions, but also should be
realistic according to the capacity
of human resources, the
availability of adequate
infrastructure, funds and other
resources.
After the opening, Head of Nursing
Study of Poltekkes, M.MARGARETHA
U.W, SKp, MHSc delivered her
presentation, and continued with
presentation from the Head of
Midwifery Study, Bringiwatty
Batbual, Amd.Keb, Skep, Ns, Msc.
Their presentations were about the
Readiness of Poltekkes Kupang to
prepare for the implementation of
distance learning for D-III Nursing
and for D-III Midwifery.
The meeting which started on Friday
afternoon 6 December, lasted until
22:00 local time, and continued the
following day with the same
enthusiasm, and involved uninvited
participants from Nagekeo district.
They expressed their interests to
become the students of midwifery
and nursing programs. They hoped
that they would get attention and
opportunity to follow the PJJ.
(Allam & BPPSDM Team)
29
www.aiphss.org
Kontak kami:
Implementing Service
Provider (ISP) Office
Gedung Graha Irama 8th Floor, Room H
Jl. HR Rasuna Said Blok X-I Kav. 1-2
Jakarta Selatan, INDONESIA 12950
Telp +62 21 526 1289
Fax + 62 21 368 20064
Email: [email protected]
aiphss
kabar
Program Management Unit
(Central PMU)
Kementerian Kesehatan
Republik Indonesia
Gedung dr. Adhyatama blok A. Lt. 9
Jl. HR Rasuna Said Blok X.5 Kav. 4-9.
Jakarta Selatan, INDONESIA. 12950
Website:
www.aiphss.org
Australia Indonesia
Partnership for Health Systems
Strengthening (AIPHSS)
The AusAID-funded program AIPHSS is a
partnership program between the
Government of Australia and the Government
of Indonesia focusing on strengthening of
health financing systems & capacity building
of health human resources in order to improve
access to and quality of basic health services.
AIPHSS Program is managed directly by the
Government of Indonesia through the Ministry
of Health at National level and through
Provincial/District Health Offices at sub
national level.
www.aiphss.org