Indonesia

GREETINGS……
After looking at all my previous post, a thought struck my mind. I have been talking about disaster management in Indonesia, mHealth and also rational drug usage policy of Indonesia, but I haven’t really talked about the actual health problems outline in diverse country.
Indonesia is the fourth most populated country in the world, with 300 ethnic groups speaking 350 languages spread over the country's 6,000 inhabited islands. For 30 years from 1967, Indonesia made remarkable progress. A period of economic growth raised per capita income from US$50 in 1968 to US$ 1,124 in 1996, despite an increase in population from 147 million in 1980 to 179 million in 1990, with a forecast of 210 million in the year 2000. Between 1980-1990 the annual population growth rate was 1.9%, with a Crude Birth Rate of 22.5 per 1000 and a Crude Death Rate of 7.4 per 1000 in 1998. The population pyramid grew towards an older population, with a life expectancy at birth of 64 years for males and 67 years for females (1996). As a consequence of better socio-economic development and improved preventive and curative services, the infant mortality rate declined from 142 per 1000 in 1968 to 50 per 1000 in 1998. The proportion of the population living in poverty dropped from 60% in 1970 to an estimated 11 -13% in 1996. Most of the poor lived in rural areas, in some of the remote islands or upland areas. By 1997 the literacy rate for those aged 10 years or more was 89%. These achievements received a severe set back in mid-1997 when the Indonesian economy collapsed. The value of the currency plummeted, prices increased, and unemployment rose dramatically. In addition, parts of the country suffered from long droughts and extensive forest fires. This sudden crisis resulted in political turmoil and, in 1998, a change of government. The ensuing political instability has had a direct impact on economic recovery. The proportion of population living in poverty increased from the estimated 11-13 % (1996) to 24.2%(1998).

Although the health status of Indonesians has not been affected drastically in the short term, the economic crisis has certainly slowed development of the health system. The Government of Indonesia is taking special steps to protect the health of its population through the modification of its Seventh Five-Year Plan (Repelita VII), but the pace of progress in solving health problems has been slow. The health status of Indonesia still lags behind neighboring countries. Maternal mortality in particular is very high at 334 per 100,000 live births (1997). Moreover, national figures mask considerable regional disparities in health indicators. For example, the infant mortality rate ranges from 27 per 1000 live births in Jakarta to 90 in West Nusa Tenggara(1998). In Indonesia, Communicable diseases are a major cause of morbidity and mortality in Indonesia. Technical strategies for communicable disease control have already been accepted, adapted to country-specific needs and adopted. However, implementation of these accepted strategies needs to be improved, particularly given the shift to a decentralized health system. Major problems include:

1. Tuberculosis which is the second highest cause of death and the primary killer among infectious diseases. An estimated 175,000 people die every year from tuberculosis. The DOTS strategy has been expanded to 225 districts (74.8%) out of a total at of 311 districts, covering 88 out of the 210 million people. Case finding is presently only 10% of the expected incident cases.
2.  Leprosy is on the verge of being eliminated. Current efforts focus on final campaigns.
3.  Dengue fever/dengue haemorrhagic fever usually occurs in epidemic proportions during the peak season, starting in November and peaking in May. In 1998, 30,000 cases were reported from cities and also from some rural areas.
4.  Malaria is still a public health problem. Approximately 1.5 million cases are detected annually. In 1997, the parasite incidence ranged from 0.12 per 1000 population in Java and Bali to around 40 per 1000 population, under 10 years of age, in the outer islands. In 1998, there were malaria outbreaks in the highlands of Irian Jaya and resurgence in Central Java.

Apart from that, Indonesians are increasingly exposed to health risks from environmental hazards. Cases of severe urban air pollution and massive air contamination of ground and surface water resources by industries and households are common. Many potentially harmful chemicals are readily available to the public and are regularly used at places of work in agriculture, industry and commerce. Food contamination of both microbiological and chemical origin is a major issue. The haze from the forest fires in Indonesia has had significant disruptive social and economic effects on people living in affected areas. However, there is little serious commitment to tackle these problems because of complexity of the issues, and a lack of clear responsibilities both in the public and private sectors. In addition Indonesia is currently facing a large number of complex emergencies arising from multiple natural disasters and many areas of civil unrest. Vast displacements of populations - amounting to about 1 million by the end of 2000 -have taken place in West Timor, Malukus, and Aceh provinces.

This is the diagram showing Indonesia and its location in the pacific Ring of Fire. It poses a risk of Indonesia being struck by natural disaster such as earthquake and volcano eruption.

As for this diagram, it shows the list of major volcano in Indonesia and also its respected location:

Fortunately, above all of the aforementioned health problems and disaster risk, Indonesia still maintains its image as one of the most friendly and beautiful country in South East Asia, which also have some other unique and exotic nation such as MALAYSIA, Philippines and Thailand.

Disaster and Emergency Management

GREETINGS…..
Okay, for my next entry, I want to talk about disaster and emergency management plan. It is also known as emergency management in some part of the world. WHO has defined disaster as sudden ecological phenomenon of sufficient magnitude to require external assistance. As for emergency, it is a situation that poses an immediate risk to health, life, property or environment. Emergency Management is the generic name of an interdisciplinary field dealing with the strategic organizational management processes used to protect critical assets of an organization from hazard risks that can cause disasters or catastrophes, and to ensure their continuance within their planned lifetime. Assets are categorized as either living things, non-living things, cultural or economic. Hazards are categorized by their cause, either natural or human-made. The entire strategic management process is divided into four fields to aid in identification of the processes. The four fields normally deal with risk reduction, preparing resources to respond to the hazard, responding to the actual damage caused by the hazard and limiting further damage (e.g., emergency evacuation, quarantine, mass decontamination, etc.), and returning as close as possible to the state before the hazard incident.

This is the conceptual framework of disaster:

In this diagram, I want to illustrate what really happen during the actual disaster management program.

In Indonesia, the organizational structure to manage disaster is as follows,

1. BAKORNAS PB is a national coordinating board for disaster management, chaired by Vice President.

2. SATKORLAK PB is provincial coordinating unit for disaster management, chaired by Governor in the respective area.

3. SATLAK PB is a district or municipal implementation unit for disaster management, chaired by Bupatior Mayor of the city.

Environmental Medicine

GREETINGS…….
Okay, this post will be about Environmental Medicine as part of Environmental Medicine. As usual, we will define Environmental Medicine first and foremost. Environmental medicine is a multidisciplinary field involving medicine, environmental science, chemistry and others. It may be viewed as the medical branch of the broader field of environmental health. The scope of this field involves studying the interactions between environment and human health, and the role of the environment in causing or mediating disease. As a specialist field of study it is looked upon with mixed feelings by physicians and politicians alike, for the basic assumption is that health is more widely and dramatically affected by environmental toxins than previously recognized.

Environmental factors in the causation of environmental diseases can be classified into:
 Physical
 Chemical
 Biological
 Social
 Any combination of the above
Environmental Health itself is a branch of public health that is concerned with all aspects of the natural and built environment that may affect human health. Other terms that concern or refer to the discipline of environmental health include environmental public health and environmental health and protection. WHO define environmental health as those aspects of the human health and disease that are determined by factors in the environment and it also refers to the theory and practice of assessing and controlling factors in the environment that can potentially affect health.

Environmental Health services as defined by WHO are those services which implement environmental health policies through monitoring and control activities. They also carry out that role by promoting the improvement of environmental parameters and by encouraging the use of environmentally friendly and healthy technologies and behaviors. They also have a leading role in developing and suggesting new policy areas. Environmental health practitioners may be known as sanitarians, public health inspectors, environmental health specialists or environmental health officers. In many European countries physicians and veterinarians are involved in environmental health. Many states in the United States require that individuals have professional licenses in order to practice environmental health.

The environmental health profession had its modern-day roots in the sanitary and public health movement of the United Kingdom. This was epitomized by Sir Edwin Chadwick, who was instrumental in the repeal of the poor laws and was the founding president of the Association of Public Sanitary Inspectors in 1884, which today is the Chartered Institute of Environmental Health.

So that is basically the general aspect of environmental medicine.
Thank You for tuning in. See u guys in the next post!!!!!

Rational Drug Usage

GREETINGS……….
My fellow readers, today my post will be about Rational Drug Usage and Management, or simply Evidence-based Pharmacy, in focus primarily of Indonesia.
As we all know, many countries all over the world especially the developing nations have developed national drug policies, a concept that has been actively promoted by the WHO. For an instance, Indonesia had drawn up its own National Drug Policy in 1983 which had the following objectives:
1. To ensure the availability of drugs according to the needs of the population.
2. To improve the distribution of drugs in order to make them accessible to the whole population.
3. To ensure efficacy, safety quality and validity of marketed drugs and to promote proper, rational and efficient use.
4. To protect the public from misuse and abuse.
5. To develop the national pharmaceutical potential towards the achievements of self-reliance in drugs and in support of national economic growth.
In order to achieve this entire objective in Indonesia, a lot of changes had to be made and implemented. The changes are as follows:
1. A national list of essential drugs was established and implemented in all public sector institutions. The list is revised periodically.
2. A ministerial decree in 1989 required that drugs in public sector institutions be prescribed generically and that pharmacy and therapeutics committees be established in all hospitals.
3. District hospitals and health centers have to procure their drugs based on the essential drugs list.
4. Most drugs are supplied by three government-owned companies.
5. Training modules have been developed for drug management and rational drug use and these have been rolled out to relevant personnel.
6. The central drug laboratory and provincial quality control laboratories have been strengthened.
7. A major teaching hospital has developed a program on rational drug use, developing a hospital formulary, guidelines for rational diagnosis and treatment guidelines for the rational use of antibiotics.
8. Generic drugs have been available at affordable costs to low-income groups.

So that is all the basic history of drug management policy in Indonesia. Hereby I attached the logistics cycle used in order to make the management policy more realistic and applicable.
Thank You for tuning in. See you all in my next post.

Mobile Health System

Hello and GREETINGS my fellow blog readers. As I promised in my last entry, today’s topic will be about mHealth. So, before we start digging further about mHealth and its usage in this modern era, let me answer the most basic question of all, What is mhealth?

mHealth or Mobile health information technology (mHealth) typically refers to portable devices with the capability to create, store, retrieve and transmit data in real time to improve patient safety and the quality of care. The flow of mobile health information is characterized by portable hardware coupled with software applications and patient data that travels across wireless networks. Data transmission is realized by technologies common in everyday life, including Bluetooth, cell phone, infra-red, WiFi, and wired technologies, all of which operate as part of a network. mHealth deployment is diverse. A clinician can use a mobile device to access a patient’s electronic health record (EHR), write and transmit prescriptions to a pharmacy, interact with patient treatment plans, communicate public health data, order diagnostic tests, review labs, or access medical references.

Mobile electronic health tools such as cell phones and telemedicine technologies are rapidly transforming the face and context of health service delivery around the world. At the same time, telemedicine’s role in clinical care, education, research and training in the health sector continues to grow from continent to continent. Mobile phone use, in particular, is exploding across the developing world, offering the opportunity to leapfrog other applications and services on both the health and technology fronts. As United Nations Foundation President Timothy E. Wirth emphasizes, the power of these technologies to improve health and the human condition cannot be underestimated: “Modern telecommunications, and the creative use of it, has the power to change lives and help solve some of the world’s biggest challenges.”

Telecommunications growth in developing countries over the past five years has been tremendous. In 1998, India and China had less than 1 million and 25 million mobile subscribers, respectively. By early 2008, both countries were adding 8 to10 million subscribers per month. This outpaces the United States, where growth is around 1.6 million subscribers per month, and Japan, where the corresponding figure is less than 1 million. In fact, the majority of mobile-subscriber growth over the next 10 years will come from the developing world. One of the most important areas that mobile technologies are primed to affect in both developing and developed countries is health care. Mobile technologies do two things well: compress time and distance. Thus, they connect, enable, and empower participants in the health care ecosystem to reduce costs and errors while increasing productivity, access, and efficiency.

Here in Indonesia, mHealth has been practiced and was used in Bandung. It is run by the Institute Teknologi Bandung, the Health and Medical Bureau, district authorities, three hospitals and 71 community health centers. The system utilized in this project employs existing Internet communication equipment and has been operating with the primary objectives of telediagnosis, remote consultation and the collection and recording of patient information. Medical instruments are installed and used depending on the differing needs of various locations and situations. In addition, the patient information system records the name of the disease and the findings of the physician, the diagnostic tests used to measure the grade of illness, the results of these tests and the type and method of treatment.

This ongoing pilot project has allowed people in rural areas and other locales far from hospitals to receive periodic medical examinations using cellular phones. Furthermore, the staff of small hospitals can now receive critical information formerly available only in larger medical settings, such as specialists’ diagnoses of rare diseases or advice about the treatment of advanced illnesses.

I hope a bit of this information will help you guys out there to have a bit of understanding regarding this matter.
Thank you.

An Insight into Public Health

GREETINGS…… ASSALAMUALAIKUM.
This is an introduction for all my respected viewers and readers. I assume we all have an idea on our own about Public Health. But really, what is Public Health by exact definitions?
Hurmmmmmmm…. Interested? Then allow me the honor to share a little bit of my knowledge about the facts and fun of PUBLIC HEALTH.

In 1920, Winslow stated that "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals". It is concerned with threats to the overall health of a community based on population health analysis. The population in question can be as small as a handful of people or as large as all the inhabitants of several continents (for instance, in the case of a pandemic). Public health is typically divided into epidemiology, biostatistics and health services. Environmental, social, occupational health, and behavioral are other important subfields.

The focus of Public Health intervention are primarily directed towards prevention rather than treating a disease through surveillance of cases and the promotion of healthy behaviors. In addition to these activities, in many cases treating a disease may be vital to preventing it in others, such as during an outbreak of an infectious disease. Hand washing, vaccination programs and distribution of condoms are all examples of public health measures. So basically, everything that we saw on television or other mass medias are all linked back to Public Health.

The goal of public health is to improve lives through the prevention and treatment of disease. The United Nation’s World Health Organization defines health as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity."

Now for the big question, what does Public Health has to do with healthcare? Actually, as well as seeking to improve population health through the implementation of specific population-level interventions, public health professionals also seek to improve population health by improving the contribution of medical care to life extension and quality of life. Such improvements could be identified by assessing what need for health services existed within the population, and also by checking all of these followings,
1. Assessing current services
2. Ascertaining requirements as expressed by professionals, public and other stakeholders
3. Identifying the most appropriate interventions
4. Considering the effect on resources
5. Agreeing and implementing any necessary changes

So that is basically all u need to know about Public Health in general so that you will have a better understanding about the general idea of Public Health, and why it existed in the beginning. Thank you for your kindness of lending me your most precious time, tune in next time for my eagerly anticipated topic, mHealth.