Tag: no-sidebar

In The 8th Postgraduate Forum on Health Systems and Policy held at UGM, Rahmat Bahtiar on the second day revealed that the rate of detection of TB cases in the province of East Kalimantan is below the national target . On the other hand , in line with WHO in order to create a strategy that emphasizes strategies for develop case finding in patients with TB, in 2008 the provincial health authority has also made several interventions.

According to focus on the problems found, intervention efforts that have been made by the medical center did not show an increase in case detection. This is because the implementation of case finding is not consistent due to constrained by the resources ( budget ), lack of monitoring and evaluation in the implementation and the lack of feedback from the district health authorities. 

---

Unlike the previous speaker, Wienta Diarsvitri last speaker in the session as well Communicable Disease ( DC ) chose the theme of the risk of HIV among key populations. Research conducted at the Hospital Dr Ramlan Surabaya and Sidoarjo District Government Hospital as many as 70 HIV treatment. In males accounted for 51.4 %, the remaining women with a mean age of 34.4 years of age respondents Lowest 19 years.

Viewed from the perspective of education, Housewives have higher education while on Women Sex Workers ( FSW ) with a basic education. Yet both are only of 45.8 % that has the knowledge and aware of the risks of HIV infection in general. This fact is compounded by not wearing a condom during intercourse with a partner either permanent or casual. According to him , the people and the government should be more concerned about the risk group . Realizing all of this of course is very important to strengthen HIV prevention programs, especially at -risk groups need to increase education and counseling governing law.

 

PKMK-Yogyakarta. Oral presentations have taken place in the Main Conference of the Faculty of Yogyakarta, with the theme of non-communicable disease. This presentation as a continuation of the second day of the 8th Postgraduate Forum on Health Systems and Policy was moderated by dr. Fatwa Tetra Sari Dewi, MPH., Ph.D. Forum held with featuring five presentan are from Indonesia, Malaysia and Thailand.

Forum initiated by the presentation of this white elephant country with the title Prevalence of Diabetes Mellitus in HIV-Infected Thai patient. The results of the study Rungruangrong Seubmongkolchai, RN, M.Sc revealed an association with the use of antiretroviral drugs prevalence of Diabetes Mellitus (DM) in Thailand. A total of 205 809 AIDS patients in Thailand were infected during the 4:11 ± 2.72 years was diagnosed with DM 25.645 people.

The second presentation raised the issue of the rapid industry in Malaysia which have an impact on respiratory disorders , with the title of Relationship between Ambient Air Pollution in an Industrial Area and Respiratory Symptoms among School children in Malacca , Malaysia . Mohammad Adam Adman identify an association between air pollution and FeNO concentrations in middle school children . Researchers compared the concentration of the air in the school with a radius of 3 km from Malacca to control school in Putrajaya. FeNO is used to identify the presence of respiratory tract infections .

The third presentation by Supriyati ( Indonesia ) titled Multilevel Analysis of Social Determinants of Smoking Behavior in Indonesia . The data showed no significant relationship between social demographics such as sex, age, place of residence, education level, occupation, socioeconomic status and smoking behavior. Recommendations of this study suggest local governments issuing local regulations related to tobacco control.

Oral presentation sessions followed by Komang Yuni Rahyani of the island, with the title and Premarital Sexual Initiation among Adolescent Contraception Services Policy in Bali. Komang discloses the use of contraception among men is higher than women. Half of the sample of 121 women answered the initiation of premarital sex being forced, threatened, and raped by a spouse or boyfriend. This presentation attracted the attention of the audience to ask, that this study used birth control pills for women before intercourse and condom for men.

Presentations last closed S3 students from Malaysia, with the title of Factors Associated with Fall Injury at Home among Children Under 5 Years Old in Yemen. Al – Abed Ali Ahmed reveals about the culture of consuming khat leaves incidence risk children under five years fell. Cultural consuming khat leaves a problem in caring for children, it is certainly because there is no supervision from parents or caregivers .

From various research results from the three countries showed that policies can be set and evaluate existing policies and new policies made to welcome the migration of physicians in 2015.

The last session was closed with five participants shared photos oral presentation with dr. Fatwa Tetra Sari Dewi, MPH., Ph.D.

Oleh: Eva Tirtabayu Hasri S.Kep., MPH

Yogyakarta – PKMK . This session begins with a brief summary of the first day of the meeting from Prof. Laksono Trisnantoro , M.Sc. , P.hD. This session reminded the participants that there are different challenges in medical care and medical curriculum that needs to be developed in the two types of communities ( rural and urban ) ASEAN. At the end of the opening session, the class is very lively with some discussion and exposure of the audience about the picture of the migration of doctors in Japan.

Oral presentation session with the theme of Human Resources presented the six papers of four papers from Thailand, Malaysia and Indonesia each one paper. The following is his review:

Session 1 : The availability of health care professionals in Indonesia, its migration and the right to health

Presenter: Ahmad Fuady , Department of Community Medicine , Medical Faculty of Indonesia University

This session is unique to the digging of the right to health. Background of this study flicked that the right to health is not only limited to the right to be healthy. Further disclosed is no government obligation to fulfill the availability of health personnel to fulfill the right to health. In the other hand, migration is also seen enough help to fulfill the right to health. This study uses a method sytematic literature review of the 1998-2013 year, both locally and internationally . This study adopts the assessment guidelines of Hunt (2006 ) .

The study found the existence of inequality of health professionals, especially in rural areas. The main problem is the emptiness of primary care physicians as the leading services. The existence of health insurance as if it is less useful because this inequality. Looking to the upstrea, there are production problems doctors , especially in some pockets of the city physician. Inequality causes the migration of patients, so that migration is done with the promise of many professional incentive large enough to compensate for these conditions. The study concludes migration does not always improve the achievement of the right to the highest attainable standard of health.

Session 2 : Incentives to retain Physicians in public settings: the case of Phitsanulok province , Thailand

By : Pudtan Phanthunane, Naresuan University

This session identifies the type of incentive for physicians to maintain your health in general. Utilization of outpatient services and inpatient continues to increase, however, is not matched by the number of doctors who are willing to provide services in government hospitals into the background of the main points of this study. study design was cross-sectional. Respondents were physicians from teaching hospitals, private hospitals, community hospitals ( in Indonesian hospitals similar type D / C) and general hospitals .

Interesting finding of this study is the incentives become important factors that affect the decision. Incentive factor is also very important for male respondents. The study found there is a considerable gap between the incentives of private doctors and doctors of civil servants. the opportunity for career enhancement becomes important at teaching hospital. The creation of a good atmosphere between colleagues the safety of life and social recognition is also a non – financial reasons to retain doctors in government service. Unfortunately, a civil servant not a major factor . The study concludes incentives play an important role in maintaining the doctor, but the hospital has a limited budget can get around by creating a good social conditions among co-workers.

Session 3 : Demand for specialists in community hospitals : From finding to policy change

By : Pudtan Phanthunane , Supasit Panarunothai , Naresuan University

This study is motivated by the lack of in-depth exploration of the needs of specialist physicians include surgeons, pediatricians, obstetricians and gynecologists ( OG ) , and internists. This condition becomes unbalanced look at the demand of medical services continues to increase. Demand a specialist in community hospitals (community hospital ) is calculated based on the demand of health care providers (based disease classification refers to the DRG) and the time required of the working process and working hours. The analysis will result in the total hours required specialist who then added hours worked per person per year. These results will be referred to their specialist needs smasing.

Surprising findings of this study, the calculation of demand specialists with this method showed a great need for specialists to be filled. Thailand is still experiencing a shortage of surgeons in 1761 , 1170 and 640 pediatrician. This study captures one of the problems of lack of specialists graduate each year. The study concludes that the solution while providing effective recommendations to address the high demand for specialists is to produce a family physician who is able to provide comprehensive medical care in a community hospital .

Session 4 : The Current demand of Community nurse in hospitals in Thailand

By : Jiraluck Nontarak , Pudtan Phanthunane , Supasit Panarunothai

The issue of an increase in chronic diseases, the composition of the population movement towards the elderly population and the implementation of UHC gives additional workload, especially the nurses in Thailand. The condition is the reason behind this study to identify the demand for nurses at a community hospital. Requests need health nurse adopt demand method by Segal and combine with the calculation of the percentage of unmet need of the Department of Public Health and welfare Health survey in 2010, as well as the workload index are excluded from Thailand Nursing and Midwives Council.

This study describes the findings for active nurses need supply 36 271 nurses Supply of nurses will be different depending on the percentage of direct care nurses. The higher proposrsi full-time care, the demand decreases, an opposite correlation. The study concluded there was no change despite new nurse graduates continues to increase.

 

Session 5 : Labor Price Index for Physician in Thailand

By : Phatthanawilai Inmai , Pudtan Phanthunane , Supasit Panarunothai

Unlike other developed countries, such as America, Australia, New Zealand and Canada, Labour Price Index ( LPI ) has not been implemented in Thailand. There are no indicators that can monitor labor costs in the health sector in Thailand today. The reason is what lies behind this research . These studies aim at doctors in private and public sectors. Constructing LPI, the first estimate of aggregate weighted with sources from the Council of the National Economic and Social Development . Weight ratio of physicians per total wages wages in the public and private sectors and classification of hospitals into consideration in this calculation. Second , do the computation of LPI using Laspeyres per hour .

The findings of this study account for nearly 4-7 % increase in compensation. Weight difference between the public and private sectors can also be explained, there is a big weight difference. Weights reflecting the share of labor costs and the relative importance of physician ownership in the sector. This study presented a tendency LPI stagnant existence in the public sector and an increase in the private sector began in 2011-2013. Thus, policy makers can use LPI to estimate labor costs for the healthcare market in the next year. LPI for other health professionals need to be considered.

Session 6 : Evaluating local effects of Emigration of medical professions in South Asia

By : Syed Emdadul Haque , Jose Siri , Atsuro Tsutsumi , Anthony Capon , United Nations University – International Institute for Global Health ( UNU – IIGH ) , Malaysia

Inequality is the condition of being in the spotlight . Inequality in health personnel is directly proportional to the chances of migration , ” Brain Drain ” or ” Brand Gain “. Like a double-edged sword, migration can be a positive and negative impact locally . Conditions that lies behind this study. Using the methods of literature review, this study aimed to characterize trends in the migration of health workers in Asia sSlatan and contribute what is given in the development of the health system.

This study highlights three main points to explain the impact of migration in South Asia, including labor and financial losses, skill and remmitance. Migration of medical personnel created a crisis of skilled medical personnel in South Asia. The impact is seen in financial losses and have to face the health vulnerability of these conditions. On the other hand, migration is able to improve the skills of medical professionals and bring remmitance big enough for the state medical suppliers. Thus, decision makers need to better understand the costs and benefits of such emigration and their relative magnitudes.

 

Health economics has now become one of the important topics being discussed publicly , for initiating this Gadjah Mada University ( UGM ) in collaboration with the World Health Organization ( WHO ) moved to hold discussions on the show titled The 8th Postgraduate Forum on Health Systems and Policy ( Medical Doctors Migration and Health System Development in South East Asia : Implication for Medical Doctor and Specialists Education ) . In the second session held on Wednesday, May 14, 2014 this became the talk of health economics major by presenting five presentan from various countries as well as material that is not only limited to one sector only. In addition , this session was also attended by academics from various institutions and Professor Dato ‘ Dr . Syed Mohamed Aljunid as a health economist and chairman of the International Centre for casemix and Clinical Coding is the role of moderator .

Three presentan which is part of the Health Insurance System Research Office ( HISRO ) Thailand alternately submit material that is also the research they are doing , all three describe the state of health of the economy in their country . Utoomporn presentan Wongsin who became Thailand’s first discuss the estimated unit cost per day of long-term care for the elderly . With the same demographic background , Noble Tharachompoo as presentan similar material that exposes both the projected long-term care spending for the elderly . Unlike the others , Passakorn Suanrueang as third presentan from Thailand is focusing his research on measures promoting the use of drugs with high costs in hospitals associated with the medical benefits of civil servants .

” Noise causes hearing loss is a problem that is reportedly the highest in the industry and become a major economic burden , ” said Tahir Noraita who is the speaker of the United Nations University – International Institute for Global Health ( UNU – IIGH ) Malaysia . Point of view of the major health problems that occur in the work area becomes more attractive when he was associating with economic aspects . Promotion and prevention is the most appropriate way for the case relating to the occupational health .

In this event the international level , Haerawati Idris from Indonesia is also not to be outdone in expressing the results of research on the demand for evidence in Indonesian traditional medicine practice . Results of research conducted on 1,794 personal with over 40 years of age criteria is proving that the income and expenditure , education , activities of daily living , chronic disease , and age affect the demand for traditional medicine is now rife in Indonesia such as acupuncture , herbal medicine , to treatment based religion . Not only in Indonesia , both industrialized countries and developing countries , traditional medicine has now become an alternative solution for the community : 70 % Canadian , 40 % Chinese , 80 % African , 49 % French and 42 % American with a variety of treatment methods . When associated with the problems highlighted throughout presentan in this session , it is evident that economic health is not limited to certain sectors and activities is also expected to be a ‘ scolding ‘ for other institutions as well as the starting point for the public interest in sectors of the economy to health care .

Reporter: Triana Primadewi

 

 

Panelis:

1. Prof Dr. Hari Kusnanto, Dr.PH
2. Prof. Dato’ Dr. Syed Mohammed Aljunid, MD, MSc, PhD, FAMM, DSNS
3. Prof. Barbara McPake, BA, PhD

Moderator: Prof. Dr. Supasit Pannarunothai, DTM&H, MSc, PhD

Prof, Supasit explain that, this forum was a collaboration from three countries, Thailand, Malaysia and Indonesia about knowledge dissemination.

 

---

Prof. Dr. Hari Kusnanto, Dr.PH

“The Epidemiology in South-East Asia Countries Indonesia: The epidemiology trends in SEA countries, the environmental issues and the needs for integration policy.“

Today begins the presentation by Prof. Abdul Kusnanto with research citing Omran (1971), the three stages of modernization which are classified by cause of death: (1) Pestilence and famine; (2) receding pandemics; (3) degenaritve and man-made disease.

Hundreds of years ago the world was dominated by disease-related diseases such as diarrhea, pneumonia, malnutrition, tuberculosis and malaria, the disease has been reduced but still occurs in some parts of the world for some time. The story continues with a history of disease that had plagued the world like a plague and bulbonic pestis. The world is moving towards the direction of improvement that reduces the pandemic of these diseases. The improvement related to sanitation, personal hygiene, nutrition, antibiotics and the development of medical technology.

Shifting patterns of disease the world has shifted to the passage of time the diseases due to lifestyle such as diabetes, cardiovascular disease, and so on. Scientific articles by Olshanky and Ault (1986) also discussed, namely an explanation of the stages of human life expectancy and its threats as a result of his death, for example when a human life expectancy in the range of 30 years, the pattern of deaths from Pestilence and famine, while when the life expectancy in the range 70 years the mortality patterns ranging predominantly degenerative diseases.

Presentation of the movement continued life expectancy of Southeast Asian countries, where there is a demonstrated consistency and there that show upward movement. This was followed by an explanation of the actions of health interventions that need to be done, has shown benefit, and that cannot be used anymore.

At the end of the presentation, Prof. Hari Kusnanto explain the premature coefficient and life expectancy. Day explains some related studies and the positions of the countries of Southeast Asia related to it.

 

---

Prof. Dato’ Dr. Syed Mohammed Aljunid, MD, MSc, PhD, FAMM, DSNS

“The Increased Socio-economic status, the needs for universal health coverage and medical industry development.”

Presentation of Prof. Syed Aljunid describes how he observed UHC applications globally, which 192 countries have UHC implementation issues . He began with an explanation of what is UHC, in which he explains that the UHC is a society have equal access to health services. Then proceed with the three dimensional aspects of UHC and also aspects that affect UHC.

UHC three important aspects, among others : effective and efficient services, prevent uncontrolled spending and everyone gets equal access. Keywords UHC is not only achievable but also achieve sustainability. In the ASEAN region, Prof. Aljunid explained that the significant growth in developing economies over the last 10 years, but there are still economic disparities between countries .

Prof . Aljunid also explain the disparity in health systems where high standards but low service provision . Then also discussed the development of private health care providers.

Health-related industries are also discussed, where they play an important role in achieving UHC, for example, the discussion of UHC in positioning the private sector in SHI schemes, such as hospitals and private clinics that continue to grow with the profit motive.

Discussion on state expenditures for health are also being targeted by Prof. Aljunid, especially how different inter regional in the world, for example the difference between developed countries and developing countries.

In conclusion UHC is the target set by developing countries, health reform is still needed to achieve UHC and health financing is an important aspect of the UHC.

 

---

Prof. Barbara McPake, BA, PhD

“The tiers health care system: is it global phenomenon?”

The presentation begins with an explanation that health systems in low-income countries are generally fragmented and terstrata, while various sub populations using various kinds of access also to reach health care providers. More typical is the individual health care provider usually run more than one place of practice and health care providers in developing countries varies from very simple to modern. He also explained with examples, example in the target market of health services in Zambia,

Prof. Barbara continued the presentation by discussing a book that explores the issue of private health care providers. There are several categories including, among others : ( 1 ) involve the private sector with very minimal formal profit to moderate; ( 2 ) more portions for the formal and informal private sector in primary care, while the tertiary service sector dominated by the public; ( 3 ) significant involvement of hospital formal private hospitals; ( 4 ) the public sector to encourage private sector development.

Furthermore, Prof. . Barbara also discussed the issue of dual practice based schemes ‘ outside ‘ ( apart from the private practice of public practice ), ‘ beside ‘ ( eg Maputo central hospital there are special clinics that provide private services ) , ‘ inside ‘ ( private practice in public facilities ) , and ‘ integrated ‘ ( private practice integrated public facilities ) .

 

Discussion Session

Laksono Trisnantoro

In Jakarta, UHC good for society but not good for the people of Papua. Do we need to postpone the UHC to achieve equality of health service providers in both areas?

Then the second, Prof Syed Aljunid mention there stagnation in private healthcare providers, while private hospitals in Malaysia many target markets of Indonesian society, how did he respond?

Barbara

The idea of following the money, especially at State facilities health facilities is uneven, in fact not only in Indonesia. Obviously Indonesia needs acceleration sacret budget for health care, especially in remote areas.

Syed Al Junid

The private sector in Malaysia is different from Indonesia and Thailand. In Malaysia are not allowed to dual practice, should choose to work in the public or private sector. There is a target market, namely the rich, the second they are not satisfied with the health services provided by the government, and the latter targeting for medical tourism. They have to work hard and compete in quality and efficiency. One of the reasons is the material for cheaper production from Indonesia, who made a private hospital in Malaysia to compete, related to Malaysia very competitive prices.

Prof. Supasit

Inviting Wanichai to talk about the situation at the Siriraj hospital.

Prof. Wanichai

Siriraj Hospital is an academic hospital to Mahidol University. Siriraj Hospital also has private services where the profit generated divided to serve those who are poor in the public service. While the share of health care workers as well.

Prof. Supasit

What about the quality of the data generated from the ASEAN region ?

Prof. Hari Kusnanto

We have a problem related to the data, since the Suharto era, for example, different data regarding universal coverage for the immunization program. Statistical data are generally derived from the Central Statistics Agency (BPS) and Susenas. With UHC, Hari hopes of the poor can also enjoy the health services. There are a lot of issues, not only in Indonesia, such as in the U.S. there is the issue of restrictions on the use of certain anti-hypertensive drugs. If it’s done well in Indonesia is also very possible. My hope, the poor can also pursue a life expectancy .

Prof. Syed Aljunid

When we have reached UHC , what could be developed further? Growing problem in Malaysia today are chronic diseases are not contagious, for example, how to control diabetes. Other issues associated with information and IT use in the development of health services. We already have a blueprint of telemedicine has not been achieved yet.

Noraita, Farmasis, Malaysia

I had to buy Imodium in Indonesia, and to my amazement it costs around $ 1, it was sold per tablet and the price is much cheaper in Malaysia. We are in Malaysia have a generic drug policies that should exist in every pharmacy. We also do not have a dispensing separation, while in Indonesia and Thailand there , can tell the experience in Indonesia and Thailand?

Prof. Supasit

We also still have a problem with dispensing as Indonesia and Malaysia.

 

Reporter : Nandy Wilasto

This forum launched by Dean of Faculty Medicine, GMU, Prof. Dr. dr. Teguh Aryandono, Sp.BO (K). He highlighted the relationship between the recent findings in epidemiology and the future challenges in health sector. The challenges would be varied among ASEAN countries. Moreover, with the different international regulation on health personnels distribution, which have an important role in affecting the development of health systems and human health resource management. Therefore the postgraduate forum is very important as a media to share recent knowledge on health sectors, in particular: epidemiological transition, doctor supply, doctor migration, and various topics on health systems.

Reporter: Digna Purwaningrum

 

Sesi kedua dibuka oleh Prof. Laksono Trisnantoro, PhD menyampaikan terkait ideologi UU Pendidikan Kedokteran. Pendidikan kedokteran di Indonesia bersifat konservatif, sulit diubah, sangat dipengaruhi ikatan profesi. Ikatan dokter di Indonesia berbeda dengan yg diterapkan di Amerika Serikat dan Australia. Di Indonesia, tidak ada pemisah antara kolegium (AIPKI) dengan asosiasi profesi (IDI) yang membuat IDI seakan mempunyai kekuasaan yang besar dan cenderung monopoli pengaturan dokter di Indonesia. Kekuasaan tanpa check and balance system ini akan merugikan bangsa. Tujuan UU Dikdok adalah mengatur pendidikan kedokteran, meskipun belum berjalan dengan baik karena belum didukung oleh PP dan peraturan yang di bawahnya, namun diharapkan dapat memberikan kejelasan dan membawa pada peningkatan sistem kesehatan di Indonesia. Belum ada kurikulum yang mengarahkan distribusi dokter ke daerah rural. Arah kurikulum FK ini harus diperjelas sehingga lulusan dokternya pun siap menjadi peneliti, atau dokter di rural area, atau bersaing di internasional.

Pembahas pertama dari sesi ini adalah Prof. dr. Med. Tri Hanggono Achmad selaku ketua AIPKI. Beliau menyampaikan bahwa UU Dikdok ditujukan untuk menyuplai dokter ke seluruh wilayah Indonesia yang penentuan jumlahnya harus melibatkan Kemenkes. Langkah nyata dari tuntutan perbaikan sistem pendidikan kedokteran adalah dengan health system approach Medical Education (Health-Same) sebagai pencapaian akhir pendidikan kedokteran. Kunci untuk reformasi ini ada tiga aspek yaitu:

1. tranformative learning, yang berarti reformasi kurikulum
2. interdependent education, yang berarti reformasi institusi

Penerapan Health-Same ini berarti fakultas kedokteran bertanggung jawab dalam peningkatan sistem kesehatan di wilayah tersebut. Jika mampu, maka dapat membantu peningkatan kesehatan di wilayah lain yang belum ada FK-nya. Pendidikan kedokteran sebaiknya tidak hanya berhenti setelah lulus dari FK, melainkan terus setelah program internship. Diharapkan post internship, para dokter dievaluasi kembali untuk menyaring apakah menjadi dokter layanan primer, spesialis atau arah lainnya.

Tanggapan Prof. Tri Hanggono, tantangan yang pasti diatasi adalah pengelolaan institusi Fakultas Kedokteran serta meningkatkan peran FK tersebut untuk menguatkan sistem kesehatan karena kebanyakan institusi yang sudah punya basi internal yang kuat hanya memikirikan kemajuannya sendiri tapi kurang memikirkan daerah lain. Hal yang sedang diusahakan adalah program intership yang berdasarkan pada kebutuhan wilayah dan bukan untuk seluruh wilayah.

Hal ini serupa dengan pendapat dari dr. Purwadi yang menyampaikan bahwa perlu ada tujuan jelas dari setiap FK yang didirikan di setiap wilayah dan bukan saja hanya berorientasi materi saja. Outcome dari lulusan FK ini diharapkan bukan hanya IPK tapi kontribusinya terhadap penguatan sistem kesehatan setempat.

Dr. Hermanto dari Unair mempertanyakan tentang kurikulum rural medicine untuk Indonesia apa? Apakah sudah ada assessment-nya atau hanya karena mengikuti globalisasi saja? Tanggapan Prof. Laksono terhadap pertanyaan ini adalah bahwa assessment sudah ada dari data nakes yang sangat timpang sekali di rural area. Dr. Hermanto menegaskan bahwa maksud kurikulum rural medicine ini bukan merombak kurikulum yang sudah berjalan di daerah maju, namun untuk FK yang berada di daerah rural seperti di Papua atau daerah terpencil lainnya. Harapannya, FK di daerah rural mampu menerapkan kurikulum yang sesuai dengan kondisi kesehatan wilayahnya dan bukan bukan mengimpor kurikulum FK lain. Alasannya, karena akan sangat tidak cocok jika misal kurikulum dari FK UGM diterapkan di Univ. Cenderawasih karena perbedaan masalah kesehatan dan juga fasilitas kesehatannya.

Sesi terakhir yang membahas tentang kesiapan Fakultas Kedokteran untuk reformasi menghadirkan dosen perwakilan beberapa Fakultas Kedokteran, yaitu dr. Hendro Wartatmo Sp.B-KBD dan dr. Purwadi Sp.BA. Dalam sesi ini dibahas bahwa harus ada dedinisi operasional siapa saja dosen klinis (dosen klinis) tersebut dan juga siknkronisasi antara UU dikdok dengan UU guru dan dosen. Selain itu, perlu pasal khusus mengenai wahan pendidikan di RPP tentang dosklin. Peraturan ini pun juga harus diperjelas agar penafsiran tidak subyektif dan apakah berlaku untuk FK swasta dan FK di bawah kementerian lain juga.

Diskusi keempat ini bertemakan Reformasi Tenaga Kesehatan dan dihadiri oleh Tim dari PKMK UGM yang terdiri dari Prof. Dr. dr. Laksono Trisnantoro M.Sc, Ph.D, dr. Andreas Meliala, M.Kes, dr. Mushtofa Kamal dan mengundang kosultan WHO, perwakilan dari World Bank, Badan PPSDM, Ketua AIPKI, dan dosen dari FK di Indonesia. Pemateri pertama ialah dr. Andreasta Meliala yang menyampaikan bahwa banyak teori yang menyebabkan maldistribusi ini, seperti pembiayaan SDM, fasilitas kesehatan dan sosial yang kurang mendukung, ada halangan untuk penempatan ke daerah tersebut misal karena tidak ada permintaan dokter di tempat tersebut. Masalah-masalah tersebut berdampak terhadap tidak tercapainya universal coverage, dan juga semakin menciptakan iklim kompetisi Indonesia di Asia.

Ada beberapa skenario dalam pencapaian universal coverage, yang pertama adalah dengan asumsi adanya ketersediaan SDM yang memadai di daerah yang buruk diikuti dengan ada fasilitas yang mendukung. Skenario yang lain adalah daerah yang buruk bisa mengejar namun tidak bisa menyamai peningkatan kemajuan daerah yang baik yang berarti asas penyamarataan tidak tercapai. Kenyataannya adalah kemenkes tidak mampu membiayai pembangunan kesehatan di daerah terpencil. Dampak dalam kompetisi pasar internasional, Indonesia semakin kurang berpartisipasi dalam pelayanan medis internasional dan malah menjadi konsumen negara lain. Adanya kekurangan SDM ini kemungkinan malah menarik dokter dari luar negeri untuk membantu pelayanan kesehatan di Indonesia.

Pembahas pertama dalam sesi ini adalah dr. Untung Suseno, M.Kes selaku Kepala Badan PPSDMK. Beliau menyampaikan kenyataan sekarang ini Indonesia kekurangan dokter. Dengan program JKN, sangat daharapkan dokter pelayanan primer bisa mengelola dana kapitasi secara efektif dan efisien. Kurang ratanya persebarana dokter spesialis di daerah salah satunya karena pengaturan tersebut sangat tergantung dengan universitas (university based) dan kolegium dokter spesialis sehingga kolegium sebaiknya bersifat independen dan tidak dipengaruhi politik. Mengenai alokasi dana dari BPJS harus disesuaikan dengan kapadatan PBI setiap daerah. Hal yang harus diperjelas dari sistem JKN ini adalah define universal coverage yang ingin dicapai.

Materi dilanjutkan oleh dr. Puti Marzoeki dari World Bank yang menyampaikan bahwa inti dari setiap permasalahan kesehatan harus dikembalikan ke dasar dalam pembuatan kebijakan tersebut. Semakin tinggi demand diharapkan supply akan mengikuti. Namun ada variabel lain, yaitu bahwa semakin tinggi gaji yang diberikan maka akan menarik semakin banyak supply (SDM), sayangnya hanya sedikit yang bisa memberikan gaji besar tersebut.

Pembicara berikutnya adalah perwakilan dari WHO yang disampaikan oleh Haroen Hartiah. Beliau menyampaikan isu-isu yang di-highlight terkait SDM kesehatan selain aspek kualitas dan kuantitas serta distribusi dokter dan tenaga kesehatan (nakes) lainnya adalah kompetensi klinis dan critical thinking dari SDM tersebut. Ada aturan dari WHO yaitu Global Code of International yang mengatur negara pengirim dan negara penerima tenaga kesehatan terkait semakin tingginya iklim kompetisi internasional terhadap tenaga medis. Sementara mengenai universal coverage, harus ada peningkatan kurikulum nakes terkait dengan pelayanan di masyarakat dan juga ada interprofesional education untuk mendukung pencapaian universal coverage tersebut.

DISKUSI

Dr. Mulyo dari RSSA Anwar mengusulkan untuk sister hospital sebaiknya dibuat grup misal untuk Indonesia timur disuplai dari Unair dan unibraw yang menugaskan residen ke daerah tersebut. Sementara Dr. Purwadi Sp.BA berpendapat bahwa tidak ada keseimbangan antara supply dan demand terkait nakes dikarenakan tidak ada koordinasi/komunikasi antara institusi pendidikan (produsen) dengan Kemenkes (user). Harapannya WHO dapat memfasilitasi antara produsen dengan konsumen sesuai dengan EBM internasional.

Prof. Laksono menanggapi bahwa residen seharusnya diperhitungkan sebagai suplai SDM nakes spesialis yang sesuai dengan kompetensinya sehingga dapat mengurangi maldistribusi tenaga spesialis. Mengenai perubahan UU, harus ada evidence terlebih dahulu sebelum bisa mengusulkan untuk perubahan.

Dr. Untung menambahkan bahwa usulan untuk meningkatkan pendapatan dokter PTT membutuhkan perjuangan karena seringnya ditolak oleh pemerintah pusat. Mengenai kekurangan nakes, harus ada peraturan jelas dari kemenkes mengenai jumlah peserta pendidikan nakes yang dibutuhkan sehingga kekurangan dapat diatasi.