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Indonesia

VIEWS: 8 PAGES: 21

									      Draft Proposal for Global Fund Round 7

 Strengthening of the Planning and Management
  of Human Resources for Health Development
in Support of HIV/AIDS, Malaria and TB Control




(Programs in Kalimantan, Sulawesi and Other Parts of Indonesia)


                 Gemala R. Hatta & Siti Pariani
                                                              1
            Over 17.000 Islands, 33 Provinces
Major Islands: Java, Sumatra, Kalimantan, Sulawesi, Papua
Total Population: 224.000.000(Java Population : 120.000.000




                                                              2
  Human Resources for Health

● Government Health Personnel
● Private
● Volunteers (TB, HIV-AIDS)
● NGOs
● Worldwide organizations

                                3
    New Platform for Health System Reform:
       4 pillars of national initiatives (1)

• Social mobilization & community empowerment:
  promotion of active participation of individuals &
  communities in their own health care and the
  preparation of village preparedness program
• Improvement of health system performance
  through the strengthening of health care
  services through implementing QA and
  improving access and quality of human
  resource for health (HRH)                     4
 New Platform for Health System Reform:
    4 pillars of national initiatives (2)


• Improvement of monitoring and HIS
• Improvement of health sector financing




                                            5
    EMERGING infectious DISEASES

    Re-emerging infectious diseases:
     Malaria
     Tuberculosis
     Dengue hemorrhagic fever
     Polio
    New emerging infectious diseases:
     HIV/AIDS
     Avian influenza
     SARS

6
    HRH Challenges
1. Decentralization
2. HRH planning has not functioned
   optimally
                                       Inefficiency
3. Mal-distribution
                                      Ineffectiveness
4. Less quality & quantity
5. Inadequate HRH information          Low quality
6. Limited resources to support HRH
   development




7
       Health care provider data – estimation HRH
        needs in 2007 – 2010
        (table below)




8
9
                Challenges of HRH

     ● Limited HRH mobility between districts after
       decentralization system of the government
       which affects the availability of the up-to-date
       HRH data
     ● Lack in numbers of skilled HRH to conduct
       surveillance, early diagnosis and prompt
       treatment
     ● Problems on recruitment/deployment
     ● Difficult to retain health personnel in remote
       areas
10
8000

7000                CUMULATIVE AIDS CASES                                                                   6987
                              Up to the End of September 2006
6000                                                                                             5321
5000

4000

3000                                                                                     2682     2638
                                                                                                         1756
2000                                                                              1487
                                                                     1171                 1195
                   258        352        607          826
1000   198                                                                         316
                         60                     255         219           345
              44                    94
  0
       1997        1998        1999      2000         2001            2002        2003    2004    2005   2006

                                                      AIDS            Kumulatif
                                                                  Cumulative
     AIDS CASES:       by Sex
 Up to the End of September 2006


              Unknown
            Tak Diketahui
 Female
Perempuan
                 2%
   16%




                             Male
                            Laki-laki
                              82%
                    RISK FACTORS OF AIDS CASES
             By Mode Of Transmission Up To September 2006



             60
                                        52.6
             50
Persentase




             40               37.2

             30

             20

             10     4.5                                                      4.2
                                                   0.1         1.4
             0
                  Homosex   Heterosex   IDU       Transf
                                                 Transfusi   Perinatal   Unknown
                                                                         Tak diketahui

                                         Risk factor
                                         Faktor Risiko
       ESTIMATION CUMULATIVE
          AIDS CASES BY 2010
                    93.968 – 130.000


 159
       5392
                            2040       253
          4099                                 410
     573    1263     3296
               2338                 230      294
       292 3615              302
                                                     1396
            639                         61
               25678
           2621     3620         1377
                         12850
             13884 924
                          5088 136    554
                                                     16
14
       TBC Control Program
Number of Case Detection 1987-2005

 300000                                                                                       253506
                                                                                 214658
 200000                                                  155188             177662            154508

                                      77840   89706                 92516            128981
 100000   33216    39277
                              73049
                                                            76230
                              49121   49878      53780
           25420      29541
     0
          1997 1998 1999 2000 2001 2002 2003 2004 2005

                                      AFB Pos            All Cases
                                AFB : Acid Fast Bacillus
                            MALARIA ENDEMICITY DISTRIBUTION
                                         2005


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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               #                # # #
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                ####
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  #                     #       #
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        #
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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Non
                                                                           >. 75 /1000                                                                                                                                                          25-75/1000                                                                                                                                                                                                                                      0-25/1000                                                                                                                                                                                                                                                                           Endemic
     HRH Intervention Stategies

        Commitment building through advocacy to
         stakeholders at all administrative levels for political
         and financial supports.
        Involvement of community health cadres/informal
         leaders
        Capacity building for health personnel at all levels
        Technical assistance
        Synergies of HIV/AIDS, malaria, and TB
         interventions with other health interventions, e.g.
         nutrition.

17
     Strategic Interventions Needed

    Improvement of HRH equitable distribution: evaluating,
     redesigning, pilot testing and formulating/developing
     alternative policies for health workforce distribution,
     especially in underserved (remote, unattractive) areas 
     inventive schemes (financial, shortened service period)

    Refresher training of health personnel to response the need
     for the development of village preparedness program 
     12,000 villages in 2006  69,000 by the year 2009

    Develop national training models in all aspects (HIV/AIDS,
     TB, malaria)
18
     Strategic Interventions Needed

        Advocacy to local government and other local
         stakeholders (legislative, politicians, informal leaders,
         etc).
        Improvement of surveillance, monitoring and HIS at all
         administrative levels
        Technical assistance and budget support to local
         government
        Facilitate the establishment of educational institutions in
         eastern part of Indonesia
        Self-regulatory of health professional body  e.g.
19       medical/dental council
     Strategic Interventions Needed


        Capacity building in the management and technical
         aspects of HIV/AIDS, TB, and malaria control
         program for central (Ministry of Health) and local staff
         (provincial and district health offices, primary health
         centers and/or community health cadres): e.g.
         through the provision of fellowships for relevant
         degree or non-degree programs.
        Inter-sector and international collaboration for
         technical and financial support (GFATM, etc.)

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Foto : Wamena-Jaya Wijaya (2007)

								
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