MINISTER OF HEALTH
Nila F. MoeloekMinister of Health of the Republic of Indonesia
ASEAN REGIONAL UNION OF PSYCHOLOGICAL SOCIETIES CONGRESSBALI, 21 FEBRUARY 2018
THE ROLE OF PSYCHOLOGIST IN
COMMUNITY HEALTH SERVICES
IN INDONESIA
‘TACKLING PROBLEMS IN HEALTH SECTOR’
MENTERI KESEHATANREPUBLIK INDONESIA
3
‘Science’
began as soon as man started to ask
question’
MENTERI KESEHATANREPUBLIK INDONESIA
FA MOELOEK
4
?Man starts to
think
(The approach is
through scientific
methods)‘Products’
(Science)
Differences
between human
beings and
animals
MENTERI KESEHATANREPUBLIK INDONESIA
FA MOELOEK
FA MOELOEK 5
Philosophy
Love for Wisdom
(Thales)
Love for Truth
(Plato)
MENTERI KESEHATANREPUBLIK INDONESIA
Indonesian Demographic Structure and Youth Potential
±64.6
million
Youths
±157 million at
productive age
Indonesia has a
population ±258 million
people1 in 4
Indonesian
people is youth
The youths of today are the main actors of social and
economic development toward 2050
Productive age
group (15-55 years)-
60%
Non-productive –
40%
FACT: Life Portrait of the People
In womb,
low nutrient
intake by
mother
During under-
five age,
nutrient
intake is not
balanced
During
school age,
they have
difficulties in
learning and
in making
progress
Entering
productive age,
they have
difficulties in
pursuing good
career
Poor life quality,
unhealthy lifestyles,
Developing non-
communicable
diseases at young
age
At old age,
developing
degenerative
diseases
Undernourished
mother
Inadequate nutrient
intake and poor diet
Non-optimal brain
development
At school, stunted
children have
difficulties in learning Poor diet which continues into
adulthood causes poor health
Low productivity
&
Low income
Tend to develop
non-communicable
diseases at adult
age
Financially incapable
&
Not able to provide
good nutrition for
family
Youth in Life Cycle
Brain develops rapidly
from gestation period to 5
years (golden age)
Malnutrition during
golden age has impacts
until adulthood
Normal Stunted
Development of cerebral nerve cells
Nutrition and Growth and Development
12
Physique of under-nourished children is reversible, but impeded brain
development, poor intellectuality, learning capacity and productivity
are irreversible.
Brain conditions of stunting
Rank 1990 2015 2040
1 Upper respiratory
tract infection
1 Stroke ?
2 Tuberculosis 2 Traffic accident ?
3 Diarrhea 3 Ischemic heart disease ?
4 Stroke 4 Cancer ?
5 Traffic accident 5 Diabetes mellitus ?
6 Birth
complications
6 Tuberculosis ?
7 Iron deficiency
anemia
7 Upper respiratory tract
infection
?
8 Malaria 8 Depression ?
13 Ischemic heart
disease
9 Asphyxia and birth trauma ?
16 Diabetes mellitus 10 Chronic obstructive
pulmonary disease
?
Source: Global burden of diseases (2010) and Health Sector Review (2014)
Our disease burden in 25 years’ time
Diabetes
Non-communicable diseases (NCDs) in Indonesia
• The 4th leading cause of death
• 2 in 100 diabetes patients age
between 25 and 34 years
• No.1 cause of death
• Cause of 4 out of 10 deaths
• 39% patients with heart diseases age <44
years
• 12% of children under-five years of age
are obese
• 8 in 100 children are obese
Heart
disease
s
Obesity
Death caused by NCDs
Mortality Rate %
Changes in behavior and
consumption which lead to high
carbohydrate and high fat intake
contribute to the high prevalence of
degenerative diseases.
Pattern of food expenditure 2016
Cigarettes 13.80
Cereals 14.02
Prepared food
and beverages
29.05
Human Development Index and components (2016)
Life expectancy rate at
birth
Length of school stay
Average of school stay
Per capita expenditure
Adjusted (Rp/person/year)
Human Development Index
2017
?
?
Proporsi penduduk yang hidup di bawah garis kemiskinan nasional, tahun 2011 – 2017
Source : Badan Pusat Statistik
Proportion of population living
under national poverty line
(2011-2017)(INDONESIA)
• URBANIZATION &
INDUSTRIALIZATION
• GLOBALIZATION OF
COMMERCE,
• TRANSPORTATION &
INFORMATION
• CLIMATE CHANGE
• POVERTY
• DISASTER
• VIOLENCE
• DRUGS
• HIV-AIDS
RISK FACTORS OF PSYCHOSOCIAL PROBLEMS
MINISTER OF HEALTH
• SUICIDE
• JUVENILE DELINQUENCY
• HUMAN TRAFICKING
• STREET CHILDREN
• PORNOGRAPHY ADICTION
• GAME ON LINE
ADDICTION
• DiVORCE
• BAD PARENTING etc.
Roadmap of HEALTH DEVELOPMENT
3 PILLARS HEALTHY INDONESIA
Nati
on
al M
ed
ium
-Term
De
velo
pm
en
t P
lan
2015
-2019
PROGRAM• MAINSTREAMING OF
HEALTH INTO DEVELOPMENT
• STRENGTHENING OF PROMOTIVE-
PREVENTIVE EFFORTS
• COMMUNITY EMPOWERMENT.
PROGRAM• EXPAND TARGETS AND BENEFITS
• FINANCING SYSTEM: INSURANCE – MUTUAL COOPERATION-BASED
• QUALITY CONTROL & COST CONTROL
• TARGETS: PBI & NON PBI
HEALTHY INDONESIA CARD
PROGRAM• INCREASE ACCESS TO HEALTH
SERVICES AT PRIMARY HEALTH FACILITIES
•OPTIMIZATION OF REFERRAL SYSTEM
• IMPROVE QUALITY WITH CONTINUUM OF CARE APPROACH AND HEALTH RISK-BASED INTERVENTION
HEALTHY FAMILY
PILLAR
1HEALTH
PARADIGM
PILLAR
2 HEALTH SERVICES
STRENGTHENING
PILLAR
3National Health Insurance
(JKN)
PILLAR1 HEALTH PARADIGM
PROMOTIVE PREVENTIVE
CURATIVEREHABILITATIVE
HEALTHY LIFECOMMUNITY MOVEMENT
Including the role of psychology in the community.
Presidential Instruction
No. 1 Year 2017
(Healthy Life Community Movement -GERMAS)
A well-planned and systematic action performed
collectively by all nation’s components, with
awareness, will and ability to lead a healthy life in order to
improve life quality.
HEALTH DELIVERY SYSTEM
IN INDONESIA
NATIONAL REFERRAL
HOSPITAL (1)
PROVINCE (20) & REGIONAL
HOSPITALS (110)
DISTRICT/MUNICIPAL
HOSPITALS (561)
HEALTH CENTERS (9.729)
SUB HEALTH CENTERS (1.450)
VILLAGE HEALTH POSTS (17.605)
Personal
Health
Care
Community
Health Care
& Personal
Health Care
POSYANDU (124.249)/
POSBINDU (7.225)
The
psychologists
have their role in
personal health
care as well as in
community
health care,
particularly in
counseling
services,
psychotherapy,
and change of
lifestyle `
MINISTER OF HEALTH
STRATEGIC ISSUES IN MENTAL HEALTH
1. To provide protection and guarantee efforts/ mental health services based on human rights
– Integrated and sustainable manner
– Since fetal phase, children, adolescents, adults and elderly
– Promotive, preventive, curative and rehabilitative
2. To ensure the availability and affordability of resources in mental health efforts
3. Integration of mental health services at primary health care facilities and strengthening of refferal systems
4. Strengthening promotive and preventive efforts for the general public and at risk population
5. Strengthening community involvement and cross sectoral coordination in the field of mental health
MINISTER OF HEALTH
CLINICAL
PSYCHOLOGISTDOCTORS /
DENTISTS
NUTRITIONIST
NURSE
PHARMACISTPUBLIC HEALTH
SPECIALISTSANITARIANBIOMEDICAL
TECHNICIAN
PHYSICAL
THERAPIST
MEDICAL
TECHNICIAN
TRADITIONAL
HEALTH
SPECIALIST
OTHER HEALTH PROFESSIONAL
CLINICAL PSYCHOLOGIST BELONGS TO ONE OF THE HEALTH PROFESSIONALS
IN INDONESIA. AT PRESENT THERE ARE 1521 CLINICAL PSYCHOLOGISTS IN THE COUNTRY.
IDEALLY THERE SHOULD BE AROUND 40,000 OF THEM
HEALTH PROFESSIONALS
IN INDONESIAMINISTER OF HEALTH
MIDWIFE
Antenatal
Care
Delivery,
Postnatal, and
Neonatal
Services for
infants
Services for
underfives
Services of
primary school
children
Services of junior and
senior high-school
stundents and
adolescents
• Mental health
early detection
of pregnant
mothers
• Stimulation of
fetus in the
womb
• Mental health early
detection of
mothers after
delivering baby
• Mothers during
postnatal period
Bufas dan
lactating mothers
•
• Child rearing
pattern and
growth
• Early detection of
children with
growth disorders
• Monitoring of
child growth
• Early detection of
Child Mental
Health
Early detection
of school age
mental health
• Adolescence
mental health
• Counseling:
Addiction and
HV/AIDS
• Life skill of
Adolescence
• Mindfulness
• Premarital
counselling
Services of
Women of
Child Bearing
Age
Elderly
• Early
Detection
of mental
health
among
elderly
• (dementia/
depressio
n,)
THE ROLE OF PSYCHOLOGIST IN
CONTINUUM OF HEALTH CARE
AND VULNERABLE GROUPS
Sustainable towards all stage of
human life
MINISTER OF HEALTH
P F
Prevalence of Mental Emotional Problems*) Age > 15 years based on provinces, 2013
1.2
6.0
11.6
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
La
mpun
g
Jam
bi
Be
ngkulu
Kalb
ar
Pabar
Ke
p.R
iau
Ria
u
Kalteng
Kaltim
Sultra
Papua
Bali
Sum
ut
Su
mbar
Su
msel
Jate
ng
Go
ronta
lo
Malu
ku
Bante
n
Kals
el
Malu
t
DK
I
Sulu
t
Babel
Ind
onesia
Sulb
ar
NT
B
Jatim
Aceh
NT
T
DIY
Jabar
Suls
el
Sulteng
*) Based on Self Reporting Questionnaire-20, RISKESDAS 2013
27
MINISTER OF HEALTH
MENTAL PROBLEMS / DISORDER
DECREASING QUALITY & PRODUCTIVITY OF HUMAN RESOURCES
• DECREASING HUMAN DEVELOPMENT INDEX
• HIGH BURDEN OF HEALTH PROBLEMS
MINISTER OF HEALTH CHANGES OF THE
BEHAVIOR OF
INDIVIDUALS,
FAMILY,
COMMUNITY
TOWARDS HIGHER
RISK OF
1. “Pasung” CasesHuman rights issue, extreme condition of unmet needs of mental health services, great impact and burden
2. Depression and AnxietyLarge prevalence, great burden, great loss of work productivity (DALYs)
3. Substance AbuseLarge prevalence, great impact and co-morbidity problems, and even mortality
4. Mental Health Problems at DisasterLarge prevalence, frequent disaster in Indonesia due to geographic condition
5. SuicideAn important issue due to mortality which actually can be prevented
5 TOP PRIORITIES OF
MENTAL HEALTH PROBLEMS IN INDONESIAMINISTER OF HEALTH
• Includes efforts to maintain and improve the health and well-being of individual psychological or community groups
PROMOTIVE
• Includes efforts to prevent or minimize the chances of any such problems or psychological disorder present either individually or in community
PREVENTIVE
• Psychological or psychotherapeutic interventions that aim to address the problems of psychological disorders or that is being experienced by individuals and community groups
CURATIVE
• Recovery efforts include again psychological functioning kilien individual or society from the problems or psychological disorders and prepare to serve back in the community
REHABILITATIVE
COVERAGE OF PSYCHOLOGICAL SERVICES
MINISTER OF HEALTH
The role of psychologist is very important
in strengthening the implementation of
promotive and preventive measures in
health development, particularly in
psychological aspects of the community
MINISTER OF HEALTH
THE ROLE OF PSYCHOLOGIST
1. To increase the psychological conditions of the individual;
2. To solve the problems or disorders of psychological/
psychiatric conditions;
2. To build an intrapsychyst dynamics of psychological, social,
and as the cause of a problem or psychological disorders;
3. To reinforce positive personality and overcoming the
personality disorder;
4. To increase the potential of the psychological ability of the
individual and of his manifestation;
5. To strengthen psychological help individuals to legal interests
MINISTER OF HEALTH
THE ROLE OF PSYCHOLOGIST
CONCLUSIONS
• Indonesia continues to improve and strengthen mental health resources, especially to provide psychologists with best possible opportunities to carry out their role.
• Indonesia integrates access to mental health services at Puskesmas and General Hospitals
MINISTER OF HEALTH
Objective ofGERMAS
Protected health
Productive
Clean environment
Decreased medical costs
WITH IMPACTS:
HEALTHY LIFE
COMMUNITY
FAMILY-BASEDAPPROACH
Toward Healthy and Sustainable Future
Freedom from fear, anxiety and depression to develop better human
resources.Each person in the world has the right to obtain the best
possible health conditions, both physically and psychologically..
NATIONALHEALTHINSURANCE(JKN)
MENTERI KESEHATANREPUBLIK INDONESIA
MENTERI KESEHATANREPUBLIK INDONESIA
WITH FAMILY-BASED
APPROACH (PIS-PK)
& HEALTHY LIFE
COMMUNITY
MOVEMENT
(GERMAS)
HEALTHY
INDONESIA PROGRAM
HEALTHY INDONESIA PROGRAM
IMPROVE THE LIFE QUALITY OF
INDONESIAN PEOPLE
HEALTH
PARADIGM
Health Service
Strengthening National Health Insurance
41
Thank you!
MENTERI KESEHATANREPUBLIK INDONESIA
