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HEALTH SYSTEM AND MEDICAL
  EDUCATION IN INDONESIA
           Jelita Artha Purba
        Novita Gemalasari Liman
          Shela Putri Sundawa
HEALTH SYSTEM IN INDONESIA
INDONESIA
        • 33 provinces
        • 98 municipalities
        • 399 districts
        • 6,598 sub-districts
        • 75,638 villages
        • 237,641,326 people
        • State of Law




Ministry of Health Republic of Indonesia. Indonesia Health Profile 2010, Jakarta; 2011.
ORGANIZATIONAL HEALTH SYSTEM




World Health Organization. Indonesia National Health System Profile. 2007
http://www.searo.who.int/en/Section313/Section1520_6822.htm
PRIMARY HEALTH CENTRE
        • Technical implementation unit of regency’s public
          health service responsible for health development in
          one or part of district




Ministry of Health Republic of Indonesia. Indonesia Health Profile 2010, Jakarta; 2011.
MANDATORY HEALTH EFFORT




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




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




Mustika R. Explanation of PHC Visit. Presentation Slide. 2011.
LONG TERM DEVELOPMENT PLAN IN
    HEALTH 2005-2025
    Target                             2005                2025
    Life expectancy         69                             73,7
    Infant Mortality Rate   32,3/1000                      15,5/1000
                            live births                    live births
    Maternal Mortality Rate 262/100.000                    74/100.000
                            live births                    live births
    Under-five malnutrition 26%                            9,5%



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




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




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



Rencana Pembangunan Jangka Panjang di Bidang Kesehatan 2005-2025. Jakarta:
Departemen Kesehatan RI; 2009.
HEALTH STATUS IN INDONESIA
MORTALITY




Infant mortality rate/1000 live births         Under-five mortality rate/1000 live births



                                             Crude Death Rate (2007) 6,9 / 1,000

                                             Life excepetancy at birth (2009) 69.21



                                                       Ministry of Health Republic of
Maternal mortality rate/100000 live births        Indonesia. Indonesia Health Profile
                                                                2010, Jakarta; 2011.
MORBIDITY




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




             Ten Main Diseases in Hospital Outpatients

Ministry of Health Republic of Indonesia. Indonesia Health Profile 2010, Jakarta; 2011.
MORBIDITY

                                                                                  Nu
                                                                                  triti
                                                                                  on
                                                                                  al
                                                                                  Sta
                                                                                  tus




    Communicable Diseases (Malaria, Pulmonary TB, HIV/AIDS,
      Pneumonia, Leprosy, Yaws)
    Preventable Diseases through Immunization
    Potential Outbreak Disease
Ministry of Health Republic of Indonesia. Indonesia Health Profile 2010, Jakarta; 2011.
MEDICAL EDUCATION IN INDONESIA
Medical Student in Indonesia


                                   Status                       Amount of Student
Universitas
          Area
                            Public       Private
Indonesia                                              UG       PG        Doctoral       Profession
                          Universities Universities
 Sumatera                      9            11        11.156      123           36            2.411

 Jawa                          9            24        22.104      190          506            8.239

 Bali, Nusa Tenggara           3            2           1.312        78         26              415

 Kalimantan                    3            0            884          -              -           42

 Sulawesi                      4            2           2.630         -          8              924

 Maluku, Papua                 2            0            394          -              -                -

 Total                        30            39        38.480      391         576          12.031
 Source: EPSBED, 4 Okt 2010
GROWING OF MEDICAL EDUCATION INSTITUTION



                                    Year
  Field of Study
                      2006   2007   2008   2009   2010
Medical Education      52     52     52    67      70




 Source: DGHE, 2009
Insitution Accreditation


                    Accredited Accredited
 Program                                  Acredited C    Total
                        A          B
Medical
                           16                  19   11    46
Education




  Sumber: www.ban-pt.depdiknas.go.id (21-08-2010)
STANDARD OF MEDICAL
              DOCTOR COMPETENCE
Diagnosis                1   2   3A   3B   4
Acute Bronkhitis                           X
TB with HIV                                X
Hepatic cirrhosis            X
Acute synusitis              X
Fatty liver                                X
Condiloma acuminata                        X
Bartholin Cyst                             X
Esophagus Varices            X
Cluster headache                           X
Impetigo                                   X
Hodgkin Lymphoma         X
Mastytys                         X
FACULTY OF MEDICINE UNIVERSITAS INDONESIA
FACULTY CURRICULUM 2005

                            Integrated          Problem Based
                            curriculum             Learning
•     Academic staff  tutor/facilitator  act as ctivator or provocateur that motivates
      the students to learn
•     Length of study:
   1 year pre-medicine
   2 years of pre-clinic
   2 years of clinic                                                6 years
   1 year of internship
•     1st year education

       ODD SEMESTER
    •English                                             EVEN SEMESTER
    •Bahasa Indonesia                                     •Cell and Genetic
    •Religion                        Progress
                                                          •Biology                    Progress
    • Art                              test
                                                          Moleculare                    test
    •                                                     •Neuroscience
    •Research
    •Empathy
PRE-CLINICAL YEAR
2 YEARS OF PRE-CLINIC
•   2nd year education

           Odd Semester                 Even Semester
    •Growth and Development          •Gastrointestinal System
    •Dermatology and Suppoting       •Renal System
                                 P   •Cardiovascular system     P
    Tissue
                                 r   •Respiratory System        r
    •Musculosceletal System
                                 o                              o
                                 g                              g
                                 r                              r
•   3rd year education           e                              e
                                 s       Even Semester          s
                                 s    •Special Sense            s
           Odd Semester               •Infection
    •Metabolic Endcoricology     t    •Immunology               t
    system                       e    •Hematology and           e
    •Reproductive system         s    Oncology                  s
    •Neuropsychiatry             t    •Community Medicine       t
PROBLEM BASED LEARNING IN PRE-CLINIC
• Lecture
• Group Discussion 1 (9-10 student, 1 facilitator)
 Case Scenario as trigger
 Home assignment based on trigger (each student have
  different assignment)
• Group Discussion 2
 Presentation from home assignment
 Discuss the answer of the question by compiling home
  assignment
 Preparing presentation
• Plenary Session (80 - 180 students, 1 moderator, 3-5
   resource person)
 Each group present the result of their discussion
• Laboratory Practice
• Basic Clinical Skill (7-8 students, 1 tutor)
• Exam
 Lab exam
 Written exam
    Formative 1 and 2
    Summative 1 and 2
EXAMPLE OF: CASE SCENARIO
• Mr. Petra, 70 years old is a fisherman who came with
  complain of scab in the tip of the nose since 4 months
  ago. In the beginning, it was a peanut size lump which
  getting bigger and bigger. It was not painful and itchy.
  Mr. Petra often used his nail to scratch the lump until it
  became wound and scab. In the other part of his face,
  there were also so many skin thickening like ward dark
  in color with various size (diameter ½-1 cm). He had
  applicated antibiotic ointment but the scab didn’t get
  any better
STEP IN GROUP               STEP IN GROUP
  DISCUSSION 1                DISCUSSION 2
1. Define keyword             1. Present the home assignment
2. Identify the problem       2. Discuss the assignment to answer
                                 the question and hypothesis
3. Analyze the problem
                              3. Make the conclusion
4. Define clinical question
                              4. Prepare the group presentation
5. Make hypothesis
6. Develop questions for
   searching
7. Divide the home
   assignment for everyone
                                   PLENARY SESSION
BASIC CLINICAL SKILL
• Held since 2th year until 3rd year
• Twice a week
• 1 group concist of: 7-8 students, 1 tutor
• Based on modul, for example
 Pap smear skill is taught in reproductive sytem module
BASIC CLINICAL SKILL EXAM (OSCE)
• Held in the end of third year  required to enter clinical
  year
• Content of exam
 Eye examination (visual acuity, funduscopy, tonometry)
 ENT examination
 Obstetric examination and delivery
 Gynecology examination (Acetic Acid Visual Inspection, Pap
  Smear)
 Heart examination
 Lung examination
 IV line access
 Injection
 Abdominal and renal examination
 Prescription
 Neurology examination
 Breaking bad news
 Counseling
 Psychiatric interview
 Urine catheter administartion
 Rectal touche
 Pediatric examination
 Basic surgery skill
 Isolation Precaution
 Head and Neck examination
 Nasogastric tube administration
CLINICAL YEAR
• 4th year education
                                P                                      P
     ODD SEMESTER               r                                      r
    (5 of the following         o                                      o
       department)              g                                      g
   Emergency Medicine           r                                      r
      Ophtalmology              e                                      e
            ENT                 s               EVEN SEMESTER          s
       Dermatology              s    (6 of The Remaining Department)   s
        Psychiatry
      Cardiovascular            t                                      t
       Respiratory              e                                      e
        Neurology               s                                      s
      Aging Medicine            t                                      t
    Forensic Medicine
     Anaesthesiology


              Sarjana Kedokteran  Bachelor of Medical Science
• 5th year education

                          P                                    P
                          r                                    r
                          o                                    o
    ODD SEMESTER
                          g                                    g
   (2 of the following
                          r           EVEN SEMESTER            r
      department)
                          e          (2 of the remaining       e
         Surgery
                          s       department) + Community      s
   Internal Medicine
                          s       Medicine +Elective Posting   s
       Obs & Gyne
        Pediatric
                          t                                    t
                          e                                    e
                          s                                    s
                          t                                    t



                         Medical Doctor
PROBLEM BASED LEARNING IN CLINICAL YEAR
• Lecture
• Out Patient Department
• In-patient department
• Case Presentation
• Mini CEX
• Night Duty in Ward or Emergency Department
• Examination
 Written
 Face to face
 OSCE
FINAL EXAM
• Comprehensive Exam
 Face to Face exam
• Doctor Competence Exam (held nationally)
 Written
 OSCE
INTERNSHIP
• Practice medicine in PHC or General Hospital
• Under supervision
• 8 months in General Hospital
• 4 months in PHC
• Get monthly salary



Letter Permission to Practice as Medical Doctor from Indonesia Medicine Council

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Health system & medical education in indonesia

  • 1. HEALTH SYSTEM AND MEDICAL EDUCATION IN INDONESIA Jelita Artha Purba Novita Gemalasari Liman Shela Putri Sundawa
  • 2. HEALTH SYSTEM IN INDONESIA
  • 3. INDONESIA • 33 provinces • 98 municipalities • 399 districts • 6,598 sub-districts • 75,638 villages • 237,641,326 people • State of Law Ministry of Health Republic of Indonesia. Indonesia Health Profile 2010, Jakarta; 2011.
  • 4. ORGANIZATIONAL HEALTH SYSTEM World Health Organization. Indonesia National Health System Profile. 2007 http://www.searo.who.int/en/Section313/Section1520_6822.htm
  • 5. PRIMARY HEALTH CENTRE • Technical implementation unit of regency’s public health service responsible for health development in one or part of district Ministry of Health Republic of Indonesia. Indonesia Health Profile 2010, Jakarta; 2011.
  • 6. MANDATORY HEALTH EFFORT Mustika R. Explanation of PHC Visit. Presentation Slide. 2011.
  • 7. EXPANSION • Public health care • School health care • Mental health care • Occupational health care • Sport health care • Eye health care • Elderly health care Mustika R. Explanation of PHC Visit. Presentation Slide. 2011.
  • 8. SUPPORTING Mustika R. Explanation of PHC Visit. Presentation Slide. 2011.
  • 9. LONG TERM DEVELOPMENT PLAN IN HEALTH 2005-2025 Target 2005 2025 Life expectancy 69 73,7 Infant Mortality Rate 32,3/1000 15,5/1000 live births live births Maternal Mortality Rate 262/100.000 74/100.000 live births live births Under-five malnutrition 26% 9,5% Rencana Pembangunan Jangka Panjang di Bidang Kesehatan 2005-2025. Jakarta: Departemen Kesehatan RI; 2009.
  • 10. STRATEGIES • Health-based national development • Local and community empowerment • Development of health efforts and financing • Development and empowerment of human health resources • Health emergency response Rencana Pembangunan Jangka Panjang di Bidang Kesehatan 2005-2025. Jakarta: Departemen Kesehatan RI; 2009.
  • 11. RESOURCES’ REQUIREMENTS • Human health resources • Health financing • Pharmacy, medical devices, and foods • Health information system Rencana Pembangunan Jangka Panjang di Bidang Kesehatan 2005-2025. Jakarta: Departemen Kesehatan RI; 2009.
  • 12. CHALLENGES • Increasing population • Epidemiology transition • Decentralization • Knowledge, attitudes, and behaviors of societies • Regional inequities in health care and access • Drug addictions • Millennium Development Goals Rencana Pembangunan Jangka Panjang di Bidang Kesehatan 2005-2025. Jakarta: Departemen Kesehatan RI; 2009.
  • 13. HEALTH STATUS IN INDONESIA
  • 14. MORTALITY Infant mortality rate/1000 live births Under-five mortality rate/1000 live births Crude Death Rate (2007) 6,9 / 1,000 Life excepetancy at birth (2009) 69.21 Ministry of Health Republic of Maternal mortality rate/100000 live births Indonesia. Indonesia Health Profile 2010, Jakarta; 2011.
  • 15. MORBIDITY Ten Main Diseases Hospital Inpatients (2010) Ministry of Health Republic of Indonesia. Indonesia Health Profile 2010, Jakarta; 2011.
  • 16. MORBIDITY Ten Main Diseases in Hospital Outpatients Ministry of Health Republic of Indonesia. Indonesia Health Profile 2010, Jakarta; 2011.
  • 17. MORBIDITY Nu triti on al Sta tus Communicable Diseases (Malaria, Pulmonary TB, HIV/AIDS, Pneumonia, Leprosy, Yaws) Preventable Diseases through Immunization Potential Outbreak Disease Ministry of Health Republic of Indonesia. Indonesia Health Profile 2010, Jakarta; 2011.
  • 18. MEDICAL EDUCATION IN INDONESIA
  • 19. Medical Student in Indonesia Status Amount of Student Universitas Area Public Private Indonesia UG PG Doctoral Profession Universities Universities Sumatera 9 11 11.156 123 36 2.411 Jawa 9 24 22.104 190 506 8.239 Bali, Nusa Tenggara 3 2 1.312 78 26 415 Kalimantan 3 0 884 - - 42 Sulawesi 4 2 2.630 - 8 924 Maluku, Papua 2 0 394 - - - Total 30 39 38.480 391 576 12.031 Source: EPSBED, 4 Okt 2010
  • 20. GROWING OF MEDICAL EDUCATION INSTITUTION Year Field of Study 2006 2007 2008 2009 2010 Medical Education 52 52 52 67 70 Source: DGHE, 2009
  • 21. Insitution Accreditation Accredited Accredited Program Acredited C Total A B Medical 16 19 11 46 Education Sumber: www.ban-pt.depdiknas.go.id (21-08-2010)
  • 22. STANDARD OF MEDICAL DOCTOR COMPETENCE Diagnosis 1 2 3A 3B 4 Acute Bronkhitis X TB with HIV X Hepatic cirrhosis X Acute synusitis X Fatty liver X Condiloma acuminata X Bartholin Cyst X Esophagus Varices X Cluster headache X Impetigo X Hodgkin Lymphoma X Mastytys X
  • 23. FACULTY OF MEDICINE UNIVERSITAS INDONESIA
  • 24. FACULTY CURRICULUM 2005 Integrated Problem Based curriculum Learning • Academic staff  tutor/facilitator  act as ctivator or provocateur that motivates the students to learn • Length of study:  1 year pre-medicine  2 years of pre-clinic  2 years of clinic 6 years  1 year of internship • 1st year education ODD SEMESTER •English EVEN SEMESTER •Bahasa Indonesia •Cell and Genetic •Religion Progress •Biology Progress • Art test Moleculare test • •Neuroscience •Research •Empathy
  • 26. 2 YEARS OF PRE-CLINIC • 2nd year education Odd Semester Even Semester •Growth and Development •Gastrointestinal System •Dermatology and Suppoting •Renal System P •Cardiovascular system P Tissue r •Respiratory System r •Musculosceletal System o o g g r r • 3rd year education e e s Even Semester s s •Special Sense s Odd Semester •Infection •Metabolic Endcoricology t •Immunology t system e •Hematology and e •Reproductive system s Oncology s •Neuropsychiatry t •Community Medicine t
  • 27. PROBLEM BASED LEARNING IN PRE-CLINIC • Lecture • Group Discussion 1 (9-10 student, 1 facilitator)  Case Scenario as trigger  Home assignment based on trigger (each student have different assignment) • Group Discussion 2  Presentation from home assignment  Discuss the answer of the question by compiling home assignment  Preparing presentation • Plenary Session (80 - 180 students, 1 moderator, 3-5 resource person)  Each group present the result of their discussion
  • 28. • Laboratory Practice • Basic Clinical Skill (7-8 students, 1 tutor) • Exam  Lab exam  Written exam  Formative 1 and 2  Summative 1 and 2
  • 29. EXAMPLE OF: CASE SCENARIO • Mr. Petra, 70 years old is a fisherman who came with complain of scab in the tip of the nose since 4 months ago. In the beginning, it was a peanut size lump which getting bigger and bigger. It was not painful and itchy. Mr. Petra often used his nail to scratch the lump until it became wound and scab. In the other part of his face, there were also so many skin thickening like ward dark in color with various size (diameter ½-1 cm). He had applicated antibiotic ointment but the scab didn’t get any better
  • 30. STEP IN GROUP STEP IN GROUP DISCUSSION 1 DISCUSSION 2 1. Define keyword 1. Present the home assignment 2. Identify the problem 2. Discuss the assignment to answer the question and hypothesis 3. Analyze the problem 3. Make the conclusion 4. Define clinical question 4. Prepare the group presentation 5. Make hypothesis 6. Develop questions for searching 7. Divide the home assignment for everyone PLENARY SESSION
  • 31. BASIC CLINICAL SKILL • Held since 2th year until 3rd year • Twice a week • 1 group concist of: 7-8 students, 1 tutor • Based on modul, for example  Pap smear skill is taught in reproductive sytem module
  • 32. BASIC CLINICAL SKILL EXAM (OSCE) • Held in the end of third year  required to enter clinical year • Content of exam  Eye examination (visual acuity, funduscopy, tonometry)  ENT examination  Obstetric examination and delivery  Gynecology examination (Acetic Acid Visual Inspection, Pap Smear)  Heart examination  Lung examination  IV line access  Injection  Abdominal and renal examination  Prescription
  • 33.  Neurology examination  Breaking bad news  Counseling  Psychiatric interview  Urine catheter administartion  Rectal touche  Pediatric examination  Basic surgery skill  Isolation Precaution  Head and Neck examination  Nasogastric tube administration
  • 35. • 4th year education P P ODD SEMESTER r r (5 of the following o o department) g g Emergency Medicine r r Ophtalmology e e ENT s EVEN SEMESTER s Dermatology s (6 of The Remaining Department) s Psychiatry Cardiovascular t t Respiratory e e Neurology s s Aging Medicine t t Forensic Medicine Anaesthesiology Sarjana Kedokteran  Bachelor of Medical Science
  • 36. • 5th year education P P r r o o ODD SEMESTER g g (2 of the following r EVEN SEMESTER r department) e (2 of the remaining e Surgery s department) + Community s Internal Medicine s Medicine +Elective Posting s Obs & Gyne Pediatric t t e e s s t t Medical Doctor
  • 37. PROBLEM BASED LEARNING IN CLINICAL YEAR • Lecture • Out Patient Department • In-patient department • Case Presentation • Mini CEX • Night Duty in Ward or Emergency Department • Examination  Written  Face to face  OSCE
  • 38. FINAL EXAM • Comprehensive Exam  Face to Face exam • Doctor Competence Exam (held nationally)  Written  OSCE
  • 40. • Practice medicine in PHC or General Hospital • Under supervision • 8 months in General Hospital • 4 months in PHC • Get monthly salary Letter Permission to Practice as Medical Doctor from Indonesia Medicine Council

Notas do Editor

  1. Referral health care Community health insurance Diseases control and prevention (polio, pulmonary TB, acute respiratory infection, HIV/AIDS & STI, DHF, Malaria, Leprosy, Filariasis, vector surveillance) Referral health care Community health insurance Diseases control and prevention (polio, pulmonary TB, acute respiratory infection, HIV/AIDS & STI, DHF, Malaria, Leprosy, Filariasis, vector surveillance)
  2. Morbidity mortality nutri status Imr-> health care n economy