Day 6: Primary Health Care in Indonesia

Alright… Before this, I’ve mention about Primary Health Care (PHC) in general and about Declaration of Alma-Ata. So, I’ve decided that we should recognize the PHC around ourselves, in this case Indonesia.

Actually, prior to Declaration of Alma-Ata in 1978 regarding PHC, Indonesia has already developed various forms of PHC in some regions. Based on research in 1976, it is noted that 200 community-based health activities (CBHA) have been implemented and carried out within the community. Along that time, PHC has developed rapidly in various forms of CBHA and one of it as Posyandu (Integrated Service Post), which activities covers 5 major programs: family planning, maternal and child health, nutrition improvement, immunization and diarrhea prevention. Besides Posyandu, there is village maternity home (VMH) which is managed by village midwife as a way to make maternal and child health services close to the community. However, in 1997, the CBHA went into a decline during monetary crisis which resulted in multi-dimension crises.

Various services provided by Posyandu

Indonesia experienced a political reform following the 1997 monetary crisis. One form of the change in health sector was the issuance of Health Minister Decree number 128/Menkes/SK/II/2004 regarding the basic policy of health care.

There are 3 functions of PHC:

• Center for health development
• Center of community empowerment
• Center of health service at primary level which divided into:
• Individual health service
• Public health service

Day 5: Declaration of Alma-Ata

Ehem... Hi again! Actually this post was supposed to be a Day 6 post. But due to my problem with the internet connection yest, my earlier post on Day 5: Primary Health Care was just posted earlier this morning... And that's why this is still a Day 5 post...

[Ps: Sorry if I confused you on this. But that's ok... That's not the point here.]

Let's go to the main topic of this post...

What do we know about Declaration of Alma-Ata? Is it important?

Truly it is! If not, I wouldn’t bother to share anything about it here…

First of all, I would like to share a little something about the history of Alma-Ata declaration.

In September 1978, the International Conference on Primary Health Care (PHC) was held in Alma-Ata, USSR (now known as Almaty, Kazakhstan). The Declaration of Alma-Ata was co-sponsored by the World Health Organization (WHO), is a brief document that expresses the need for urgent action by all governments, all health and development workers, and the world community to protect and promote the health of all the people of the world. It was the first international declaration stating the importance of PHC and outlining the world governments’ role and responsibilities to the health of the world’s citizens.

Declaration of Alma-Ata in September 1978

So, what are the contents in this conference that is so important?

The Declaration of Alma-Ata is a ten point statement calling for urgent and effective national and international action to develop and implement PHC throughout the world.

Day 5: Primary Health Care

What do we understand about Primary Health Care (PHC)?

As the name implies, PHC is the first level of health care (first point of contact with the health system) that is easily assessable to the community. This means that effective PHC must be locally based, in proximity to the places where people live and work. Geographic barriers may be overcome by locally situated services; to be universally assessable; PHC services must also be free from financial barriers.

Access to PHC can be elaborate in term of: availability, accessibility, affordability, accommodation and acceptability (Penchansky and Thomas; 1981).

1. Availability – the total number of service from which user can make their choice. It refers to the extent to which a system provides facilities (structural form) and services (process) that meets the needs of people. It also deals with access to specific gender of medical personnel, access to medical stores, laboratory or other equipment. Campbell, Roland et.al., 2000 stated that organizational access can be seen as sub-component of availability. This means even if people have adequate physical access to the facility, there might be other factors creating barriers like length of time in getting appointments, waiting in time before getting treatment or sometimes language barrier with the facility professionals.  

2. Accessibility – related to travel impedance (time or distance) between spatial location of user and services. It is most commonly related with the geographic location of patient to the location of facilities. Measures like spatial distance, travel time, mode of transportation used to reach the facility, type of road network and etc. are considered assessing physical accessibility of people. 3 components of physical accessibility are thus: people, activities or services and mode of transport to link them. However, this accessibility varies according to the characteristic of each of these components and it is influenced by the relationship between socioeconomic characters of people, users and spatial dimensions. Another also important component deals with the moment of time the service is available (opening hour of PHC facility) or at which people are able to participate (working hour of people).

3. Affordability – related to cost/financial component. There might be adequate number of health facilities or medical personnel in an area, but these facilities might not be affordable to the people. In this dimension, affordability can be view directly as in the cost of doctor’s fee and indirectly costs like travelling cost, which have effect on overall access to healthcare. Other factors included here are: possession and coverage of health insurance, public supports such as subsidized rate provided for certain group of people.

4. Accommodation/Adequacy (Obrist, Iteba et. al., 2007 later change the term ‘accommodation’ to ‘adequacy’) – it is seen in two ways: quality of service provided and personal treatment by the service providers. Opinion about the medical treatment whether people trust the medical ability provided by the facility or not, if they are satisfied with the quality of service or personal behaviour of all facility personnel.

5. Acceptability – related to cultural and religious factors of people. Other factors like age, gender, education level, race or ethnicity also determines the level of acceptability of service provision. This also depends upon the personal perception of people that might vary within a same religion or gender.

PHC plays a central role in health care systems worldwide. It offers families cost-effective services close to hole, and thus eliminates costly trips to specialists and hospitals. In developing countries, community health centers usually offer a broad range of services including prenatal care, immunizations, treatment of childhood illness, treatment of malaria and other common infectious diseases, and other basic medical care.

However, the coverage and effectiveness of primary care services are limited by insufficient resources and staff, erratic drug supplies, and faulty equipment. Governments increasingly recognize that adequate delivery of primary care services is fundamental to the effective functioning of health systems, to keeping families healthy, and to achieving national health goals. Therefore, improvements in access to PHC pave the way for advancement in the quality of people’s life.

Day 4: Health Financing

Hello every1!! 

Sorry I've been quiet this whole time... I was sick with fever n flu... But don't worry! Coz I'm feeling much better now.

Alrite... Since I'm up n well, I've been reading something interesting about... Health Financing! 

That time when I was sick, I went to see doctor and get my medications. You see, I went to see 2 doctors (I know it’s not advisable but that’s not the point here); one a doctor from private hospital (it was Sunday evening, there's no other available clinics at that time) and the other was a clinic doctor.

I was prescribed: 

• panadol for fever; 
• loratadine for my flu; 
• Curam, an antibiotic to prevent secondary infection; 
• lozenges for sore throat and 
• lotion aid for my mouth ulcers 

You can see that there are 5 different medicines prescribed here. How much do you think it costs? It's not very cheap, that's for sure. And I'm paying it from out-of-pocket. However after 3 days, my sore throat getting worse and my mouth ulcers are not healing and they are very painful. So, my dad decided to bring me to see the other doctor, the one he always consults.

A new ulcer medication is prescribed, Kanolone. However, this time we didn't have to pay for the medication because it is covered by insurance.

Okay... Enough with my story. We shall proceed to the actual topic, health financing. 

If you have read earlier bout my story, you'll notice that I've mention two types of payment: (1) out-of-pocket and (2) insurance.

Here I'll elaborate more about it...

Day 3: Volcanic Eruptions

In accordance to the recent Mount Merapi disaster that have affected many locals and Malaysian students studying in nearby Universities, I would like to share something on Disaster.

Disaster is another main topic that we're going to learn in Block 4.2: Health System and Disaster. Because of the recent Merapi eruptions, I thought I can share something bout Disaster Medicine and Volcanoes Disasters.

First, what criteria defined 'disaster'? Is it the number of victims involved? 

According to definition by WHO, disaster is known as:

1. A serious disruption of the functioning of a community or a society causing widespread human, material, economic or environmental losses which exceed the ability of the affected community or society to cope using its own resources (ISDR). 
2. Situation or event, which overwhelms local capacity, necessitating a request to national or international level for external assistance (CRED). 
3. A term describing an event that can be defined spatially and geographically, but that demands observation to produce evidence. It implies the interaction of an external stressor with a human community and it carries the implicit concept of non-manageability. The term is used in the entire range of risk-reduction activities, but it is possibly the least appropriate for response.

And according to the United Nations Disaster Management Training Programme (UNDMTP), the definition of disaster is:

                "A disaster is a serious disruption of the functioning of a society, causing widespread human, material or environmental losses which exceed the ability of the affected society to cope using only its own resources."

In the mid-1980s, Disaster Medicine evolved from the union of (1) disaster management and (2) emergency medicine.

All disasters follow a cyclical pattern known as the disaster cycle, which describes 4 reactionary stages:

• Preparedness
• Response
• Recovery
• Mitigation/prevention

Ok... Enough with the topics on disaster. I will share this in my future posts dedicated especially to Disaster Medicine.

Right now, I'll share information of volcanic eruptions, in conjunction to Mount Merapi disaster during late October-early November...

Day 2: Health System

This is the continuation of the introduction.

Here, I'll b explaining more on the definitions before going into details bout the health system...

Before defining what health system, 1st what do we understand bout 'System'?

System is an organized collection of parts (or subsystems) that are highly integrated to accomplish an overall goal.

Here are some various examples of systems:

1. Biological systems (heart)
2. Mechanical systems (thermostat)
3. Human/Mechanical systems (riding a bicycle)
4. Ecological systems (predator/prey)
5. Social systems (groups, friendship)

Systems consists of 4 parts/subsystems:

1. Objects - the parts, elements or variables within the system
2. Attributes - the qualities or properties of the system and its objects
3. Internal relationships among its objects
4. Systems exist in an environment

Since we have an idea about the concept of system, now lets move on to health system. 

So,  what is Health System?

A health system consists of all the organizations, institutions, resources and people whose primary purpose is to improve health. 

In the World Health Report 2000, health systems are defined as comprising all the organizations, institutions and resources that are devoted to producing health actions. 

A health action is defined as any effort, whether in personal health care, public health services or through inter-sectoral initiatives, whose primary purpose is to improve health.

A good health system delivers quality services to all people, when and where they need them. 

The exact configuration of services varies from country to country, but in all cases requires:

• a robust mechanism;
• a well-trained and adequately paid workforce;
• reliable infromation on which to base decisions and policies;
• well maintained facilities and logistics to deliver quality medicines and technologies.

A well functioning health system responds in a balanced way to a population’s needs and expectations by:

• improving the health status of individuals, families and communities
• defending the population against what threatens its health
• protecting people against the financial consequences of ill-health
• providing equitable access to people-centred care
• making it possible for people to participate in decisions affecting their health and health system

According to WHO 2010, the key components of a well functioning health system are:

Day 2: Introduction on Block 4.2: Health System and Disaster

Today, I'll b introducing bout the contents of Block 4.2: Health system and Disaster... 

BLOCK 4.2: HEALTH SYSTEM AND DISASTER TOPICS

Ps: I'll be very pleased if you can leave some feedback or comments on my blog. I'll try improve any parts that need improving... Thank u!! ^_^

Day 1: The birth of my new blog

Today will be the birth of my blog especially dedicated to Block 4.2: Health System and Disaster.

There are many things going on during this block that caused unnecessary delayed in starting up this blog.

Therefore, I'll try my best to keep this blog as useful and updated as possible... ^_^