REFORMASI KURIKULUM

PENDIDIKAN KESMAS; sebuah

langkah awal meningkatkan

derajat kesehatan masyarakat

Prof. Dr. Veni Hadju

Fakultas Kesehatan Masyarakat

Universitas Hasanuddin

IPHSS, Depok, 14 Juli, 2011.

Sistematika Penyajian

Pendahuluan

Masalah Kesehatan di Indonesia

Kompetensi dan Tantangan Tenaga

Kesehatan

Reformasi kurikulum

Penutup

Apa masalah kita?

ADANYA GAP DALAM SDH (TINGKAT PENDIDIKAN,

PENDAPATAN, GENDER, KESULITAN MEDAN GEOGRAFIS,

TERSEDIANYA AIR BERSIH, KEBERSIHAN & KESEHATAN

LINGKUNGAN) DAN PELAKSANAAN SISTEM KESEHATAN

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National Average

Poverty by Province

Percent of population in quintile 1 and 2 Susenas 2007

DHS-1

DHS-2

Non DHS

DISPARITAS STATUS KESEHATAN DAN GIZI

MENURUT PROPINSI, 2007

Indikator Rata-rata

Nasional

Terendah Tertinggi Sumber

data

AKB 34 DIY (19);

Jateng(28)

NTB (72);

Sulbar (74)

SDKI

2007

AKI 228 SDKI

2007

TFR 2,6 DIY (1,8) NTT (4,2) SDKI

2007

Gizi

Kurang

18,4 DIY

(10,9)

NTT

(33,6)

Riskesda

s 20076

Pola penyebab kematian pada

semua Umur

No Penyebab Kematian

(n=4014)

%

1 Stroke 15.4

2 Tuberculosis 7.5

3 Hypertensive diseases 6.8

4 Cedera 6.5

5 Perinatal condition 6.0

6 Diabetes Mellitus 5.7

7 Neoplasm malignant 5.7

8 Diseases of the liver 5.1

9 Ischaemic heart diseases 5.1

10 Chronic lower respiratory diseases 5.1

Proporsi penyebab kematian

kelompok umur 0-6 hari dan 7-28 hari

No 0-6 hari (n=142) % 7-28 hari (n=39) %

1 Respiratory disorders 35.9 Sepsis neonatorum 20.5

2 Premature 32.4 Congenital malformations 18.1

3 Sepsis of newborn 12.0 Pneumonia 15.4

4 Hypothermia of newborn 6.3 Respiratory Distress

Syndrome

12.8

5 Haemorrhagic disorders and

neonatal jaundice

5.6 Premature 12.8

6 Postmature 2.8 Neonatal jaundice 2.6

7 Congenital malformation 1.4 Birth trauma 2.6

8 Tetanus 2.6

9 Nutritional deficiency 2.6

10 Sudden infant death 2.5

Proporsi penyebab kematian pada

umur 29 hari-4 tahunNo 29 hari-11 bulan (n=173) % 1-4 tahun (n=103) %

1 Diarrhoea 31.4 Diarrhoea 25.2

2 Pneumonia 23.8 Pneumonia 15.5

3 Meningitis/encephalitis 9.3 Symptoms and signs, NEC 10.7

4 Diseases of the digestive

system

6.4 Meningitis/encephalitis 8.8

5 Congenital malformation of the

heart and hydrocephalus

5.8 Dengue haemorrhagic fever 6.8

6 Sepsis 4.1 Measles 5.8

7 Tetanus 2.9 Drowning 4.9

8 Malnutrition 2.3 Tuberculosis 3.9

9 Tuberculosis 1.2 Malaria 2.9

10 Measles 1.2 Leukemia 2.9

Proporsi penyebab kematian pada

umur 5 tahun ke atas menurut tipe daerahNo Perkotaan (n=1515) % Perdesaan (n=1966) %

1 Stroke 19.4 Stroke 16.1

2 Diabetes mellitus 9.7 Tuberculosis 9.1

3 Hypertensive diseases 7.5 Hypertensive diseases 8.3

4 Tuberculosis 7.3 Chronic lower respiratory

diseases

7.1

5 Ischaemic heart diseases 6.5 Malignant neoplasm 6.6

6 Malignant neoplasm 5.8 Diseases of the liver 6.0

7 Diseases of the liver 5.5 Ischaemic heart disease 5.6

8 Symptoms and signs,

NEC

5.3 Symptoms and signs, NEC 5.4

9 Other heart diseases 5.1 Other heart diseases 4.7

10 Chronic lower respiratory

diseases

4.7 Diabetes mellitus 4.4

No Laki-Laki (n=1960) % Perempuan (n=1522) %

1 Stroke 17.4 Stroke 17.7

2 Tuberculosis 9.5 Hypertensive diseases 9.5

3 Hypertensive diseases 6.8 Carcinoma malignant 8.7

4 Ischaemic heart diseases 6.8 Diabetes mellitus 8.0

5 Chronic lower respiratory

diseases

6.7 Tuberculosis 6.9

6 Diseases of the liver 6.6 Chronic lower

respiratory diseases

5.7

7 Diabetes mellitus 5.6 Ischaemic heart

diseases

5.1

8 Other heart diseases 4.9 Others heart diseases 4.9

9 Carcinoma malignant 4.8 Diseases of the liver 4.7

10 Transport accident 4.4 Pneumonia 3.0

Proporsi penyebab kematian pada umur 5 tahun ke atas berdasakan jenis kelamin

Peringkat Penyebab Kematian

PM Dan PTM Pada Semua Umur

No Penyakit menular (n=1080)

% Penyakit tidak menular (n=2285)

%

1 Tuberculosis 27.8 Stroke 26.9

2 Diseases of the liver 19.1 Hypertensive diseases 12.3

3 Pneumonia 14.4 Diabetes mellitus 10.2

4 Diarrhoea 13.2 Carcinoma malignant 10.2

5 Typhoid 6.0 Ischaemic heart diseases 9.3

6 Malaria 4.0 Chronic lower respiratory diseases 9.2

7 Meningitis/Encefalitis 3.0 Other heart diseases 7.5

8 Dengue haemorrhagic fever

2.1 Gastric and duodenal ulcer 3.4

9 Tetanus 1.9 Congenital malformation 1.0

10 Septicaemia 1.2 Malnutrition 0.4

Hipertensi31.7%

Tidak

68,3 %

Terdiagnosis/Minum Obat

23,9%

Tidak

76,1%

Hipertensi: Prevalensi & Cakupan

Cakupan: Proporsi kasus terdiagnosis atau minum obat

8,7%

33,0%31,9%31,6%30,9%30,5%

8,0%7,4%6,7% 7,0%

0,0%

5,0%

10,0%

15,0%

20,0%

25,0%

30,0%

35,0%

Kuintil1 Kuintil2 Kuintil3 Kuintil4 Kuintil5

Prevalensi Didiagnosa Nakes

Hipertensi:Ekonomi & Cakupan Nakes

0,0

10,0

20,0

30,0

40,0

50,0

60,0

70,0

80,0

15-17 tahun

18-24 tahun

25-34 tahun

35-44 tahun

45-54 tahun

55-64 tahun

65-74 tahun

75+ tahun

Laki-laki Perempuan Total%

Hipertensi: Prevalensi &

Umur

Prevalensi DIABETES dan TGT

84,1%

10,2%

5,7%

Tdk DM TGT DM

Sudah Terdiagnosis

(1.5%)

Belum terdiagnosis

(4.2%)

TGT: Provinsi

DM & TGT: Umur

5,3

19,4

0,0

5,0

10,0

15,0

20,0

25,015-2

0

25.1

-30

35.1

-40

45.1

-50

55.1

-60

65.1

-70

persenum

ur

TGT TDM

DM & TGT: IMT

0

5

10

15

20

25

18.5 - < 23 23 - < 25 25-40

3,2 6,4 8,18,1

10,714,5

TGT

DM

P < 0,0001

ANALISIS AKAR MASALAH

1. Tingkat pendidikan dan pengetahuan

masyarakat

2. Kondisi lingkungan dan letak geografis

3. Kualitas petugas dan kerjasama antar

SDM Kesehatan

4. Kebijakan dan perhatian pemerintah

5. Partisipasi dan kepedulian masyarakat

6. Kerjasama dan keterikatan antar sektor

KOMPETENSI DAN

TANTANGAN TENAGA

KESEHATAN

24

What is a competency?

“A complex set of

measurable

behaviors made up of

knowledge, skills and

attitudes that can be

shown to predict and

measure effective

performance.”

Attitudes ValuesExperience

KnowledgeSkills

Source: Nelson JC, The Public Health Competency Handbook: Optimizing Individual & Organizational Performance for the Public’s Health, Atlanta, GA: Centre for Public Health Practice of the Rollins School of Public Health, 2002

25

Attitudes ValuesExperience

KnowledgeSkills

Competency Performance Behavior

Outcome

Competencies predict behavioral actions which, in turn, predict job performance outcome.

Uses advanced problem-solving skills to analyze performance problems, and take timely corrective actions to address problems.

Performance problems are addressed successfully and in a timely manner, ensuring achievement of objectives.

Importance of competency:

Tingkat kompetensi yang

dicapai

MENGINGAT

MEMAHAMI

MENGAPLIKASIKAN

MENGANALISA

MENSINTESA

MENGEVALUASI

KREATIF

HEALTH PROFESSIONAL

EDUCATION QUALITYPROJECT

EXECUTIVE SUMMARY

WORK

•Fatigue

•Boredom hazards

•Unemployment

•Retirement

Environmental

Hazards/disease

•Infection

•Injure

•Cancer

•Degeneration

•Smoking

•Overeating

•Alcoholism

Leisure activity

SOCIAL

FACTORS

•Neighborhood

•Housing

•Poverty

•Culture

•Education

FAMILY

•Spouse

•Children

•Parent

•Etc

THE INDIVIDUAL

• Genes

•Learning

•Handicaps

•Personality

•Expectation

•Self-image

EQUILIBRIA ASSOCIATED

with HEALTH

Marital Status, Marital Quality,

and Atherosclerotic Burden in

Postmenopausal Women

From SDSU/UCSD Joint Doctoral Program in Clinical Psychology, San

Diego State University (L.C.G.), the Department of Psychology

(W.M.T.), and the Graduate School of Public Health (L.H.K., K.S.T),

University of Pittsburgh, and the Departments of Psychiatry (K.A.M.)

and Medicine (D.E.), University of Pittsburgh School of Medicine,

Pittsburgh, PA.

Psychosomatic Medicine 65:952–962 (2003)

LINDA C. GALLO, PHD, WENDY M. TROXEL, MS, LEWIS

H. KULLER, MD, DRPH, KIM SUTTON-

TYRRELL, DRPH, DANIEL EDMUNDOWICZ, MD,

AND KAREN A. MATTHEWS, PHD

Hasil

Penelitan

A: Average IMT (in mm) according to marital status/quality

grouping at the first scan (N 372).

B: Average change in IMT (in mm) across 3 years (N 203)

according to marital status/quality grouping.

– Beratnya 1:200 miliar gram

– Lebarnya 1:500.000 mm– Panjangnya bisa

mencapai 3 m

Mengandung 3 miliar informasi (kode genetik)

Begitu kecilnya DNA itu, jika seluruh penduduk bumi dikumpulkan DNA nya hanya sebesar 1 butir beras

DNA yang mikroskopik menyimpan informasi genetik yang luar biasa banyaknya.

BERPIKIR POSITIF

MEMBANGUNKAN GEN-GEN

BERMANFAAT

Berpikir positif

Gen positif aktif

Mengurangi

proses entropi

Berpikir negatif

Gen negatif aktif

Peningkatan

proses entropi

PEMIKIRAN GENETIK

• Berpikir (+) > sulit pada keadaan musibah

REFORMASI

KURIKULUM

35

European Public Health Core

Competencies:

METHODSIN PUBLIC HEALTH

HEALTH POLICY, MANAG

EMENT AND ECONOMICS

HEALTH PROMOTION

AND PREVENTION

PHYSICAL, CHEMICAL AND BIOLOGICAL

ENVIRONMENT

SOCIAL ENVIRONMENT

AND HEALTH

CROSS-DISCIPLINARY

THEMES

The Public Health Net

International Standard of

Excellence

Morality

Ethics

Knowledge

Intellectual skills

Relationship between responsibility and

personnel

Analysis

Communication

Information technology

Prince Mahidol Philosophy

True success is not in the

learning but in its application to

the benefit of mankind

PENUTUP

Masalah kesehatan di Indonesia masih

begitu besar dengan berbagai hambatan dan

keterbatasannya.

Diperlukan Reformasi Kurikulum yang akan

menghasilkan Nakes Kesmas dengan

kompetensi yang baik dan kinerja yang

optimal.

Derajat kesehatan masyarakat dapat

ditingkatkan melalui kerjasama lintas disiplin

dan komprehensif.