Profesi Kesmas Dalam TROPICAL DISEASES Adang Bachtiar adang@post.harvard.edu Ketua Umum PP IAKMI 2007-2010; 2010-2013- 2013-2016

Adang Bachtiar Current Activities: Dokter (Dr.) from UNIVERSITAS INDONESIA Master of Public Health (MPH): HARVARD-USA Doctor of Science (DSc): JOHNS HOPKINS-USA Post Doctoral in Statistics: UNIV of MICHIGAN-USA Current Activities: Indonesian Public Health Association, President, for 3rd period consecutive National Expert Panel on TB, Health Policy Spesialist Health Professions Coalition for Anti Smoking (KPK-AR), Chairman World Federation of Public Health Assocs (WFPHA) Panel on Oral Health Development, Expert Member Committee on Hospital Research Ethics – Premier Hospital Networks, Expert Panel Komnas Penelitian & Pengkajian Penyakit Infeksi (PINERE) Litbangkes -Kemenkes, Expert Panel National Health Research Committee – Kemenkes, Expert Panel Dept of Health Policy & Administration, UI, Past Chairman; Advice & examnine more than 200 PhD dissertations in medicine, dentistry, nursing, public health, regional planning, and social sciences Year 2015 Recipient of APACPH Award for Public Health Achievement in Asia Pacific

POIN PENYAJIAN ss

Neglected Tropical Diseases (WHO) Buruli Ulcer Chagas disease (American trypanosomiasis) Dengue/dengue haemorrhagic fever Dracunculiasis (guinea-worm disease) Fascioliasis Human African trypanosomiasis Leishmaniasis Leprosy Lymphatic filariasis Neglected zoonotic diseases Onchocerciasis Schistosomiasis Soil transmitted helminthiasis Trachoma Yaws

Kelompok 10 Penyakit Tropikal KATEGORI-1 African Trypanosomiasis. Dengue. Leishmaniasis. KATEGORI-2 Malaria. Tuberculosis. Schistosomiasis KATEGORI-3 Onchocerciasis. Leprosy. Chagas disease. Lymphatic filariasis

Klasifikasi didasarkan kepada… KATEGORI-1: Emerging or uncontrolled disease. KATEGORI-2: Control strategy available but disease burden persists. KATEGORI-3: Control strategy proven effective, disease burden falling, and elimination planned.

Proyeksi Angka Kematian Berdasarkan Sebab & Pendapatan, 2004 to 2030 Intentional injuries Other unintentional Road traffic accidents Other NCD Cancers Cardiovascular dis. Maternal/perinatal/nutr Other infectious HIV, TB, malaria http://www.who.int/entity/healthinfo/global_burden_disease/GBD2004ReportFigures.ppt, data from WHO Global Burden of Disease Report 2004

Dengue Hemorrhagic Fever

Jumlah Kasus DBD Dilaporkan ke WHO: 1955-2005 Number of Cases

Global Distribution of Dengue Virus Serotypes, 1970

Global Distribution of Dengue Virus Serotypes, 2006

Aedes aegypti

Dengue Virus Causes dengue and dengue hemorrhagic fever Arbovirus Transmitted by mosquitoes Composed of single-stranded RNA Has 4 serotypes (DEN-1, 2, 3, 4) 3

Dengue Viruses Each serotype provides specific lifetime immunity, and short-term cross-immunity All serotypes can cause severe and fatal disease Genetic variation within serotypes Some genetic variants within each serotype appear to be more virulent or have greater epidemic potential 4

Climate Change and Health Implications

Varian Terbaru: Zika

Malaria: 20 Negara Endemis Termasuk Indonesia SEAR countries WPR countries 2012 (WMR 2013) SEAR WPR Estimated # malaria cases 26.8 mio (21.7-32.5) 1.4 mio (1.2-1.7 mio) Estimated # malaria deaths 42 000 (25 000-60 000) 3 500 (2 100 – 5 200) Population at risk (high and low transmission areas) 1.6 billion 711 million

Malaria: Countries projected to achieve >75% decrease in incidence of microscopically confirmed cases by 2015 SEAR WPR India, Indonesia and Myanmar (SEAR), Papua New Guinea (WPR), Pakistan (EMR) cannot be projected to achieve the 75% decrease by 2015 In the SEAR, 3/10 countries, and in the WPR, 2/10 are in pre-/elimination phase World Malaria Report 2013

MASALAH DAN TANTANGAN Investasi dan programming yang terhambat karena Pembiayaan tidak menentu Kekampuan pelaksanaan yang menurun Political will kemudian ikutan turun Gangguan wilayah karena industri Artemisinin resistance Disebabkan logistic obat yang tidak optimal, obat palsu dll Migrasi penduduk dan sulit terjangkau sehingga pengobatan tidak sempurna Sektor lain tak acuh

Tuberculosis: Distribution of Prevalent TB Patients, by Region 2012 Estimates SEAR WPR TB Cases (all forms) 3.4 mio 1.6 mio TB Deaths 450,000 110,000 Multi-drug resistant TB 90,000 74,000 HIV-associated TB 170,000 24,000 Source: Global Tuberculosis Control 2013, WHO

TANTANGAN TB Algoritme Dx kurang sensitive dalam deteksi dini TB; TB terkonsentrasi pada populasi beresiko yang sulit terjangka; Multi-drug resistant TB: hanya sebagian kecil dapat dijangkau (di Dx dan di Tx); Pendanaan internasional semakin menciut.

FAKTOR PENYEBAB DINAMIKA PENYAKIT Pengabaian, tak ada political will Pertumbuhan penduduk Urbanisasi Pemanfaatan lahan Peternakan Mobilitasi penduduk, mahluk hidup lain dan barang Dinamika perilaku dan gaya hidup Adaptasi mikroba termasuk karena perubahan iklim Bencana termasuk dengan sengaja

AGENDA 2050 PEMBANGUNAN SUSTAINABEL FOKUS PD EKOLOGI SDA dan Kapasitas Ekologis Modal Sosial & Tujuan Kesejahteraan Sistem2 Ekonomi FOKUS PD EKONOMI FOKUS PD SOSIAL Memerlukan “HEALTH IN ALL DEVELOPMENT POLICY” untuk HEALTHY CONSUMERISM

TRANSISIONAL(1) DARI: KEARAH: Tata ruang destruktif unbalanced Bahan material kehidupan menuju konsumtif boros Energy poverty, inaccesible& tdk merata Mobilitas penduduk ineffective & unsafe Keamanan pangan terganggu akibat kerusakan ekologis tmsk climate change Yankes non-comprehension ineffective Menuju tata-ruang sehat kearifan sosial Recycling economy yg efisiensi berdayakan Sosial justice energy use Mobilitas aman adaptif ekologis Food safety yg efektif dlm healthy biosphere Healthy consumerism 5-level prevention

TRANSISIONAL(2) DARI: KEARAH: Pembelajaran lamban tidak merata Sistem2 ekonomi pertahankan ketidak- seimbangan “Utara-Selatan” Pembangunan sosial terabaikan Daya dukung ekologis terdegradasi Tata hubungan internasional eksplotatif Teknologi tinggi dg cultural competencies Ekon low-carbon, low raw-material, ekologi & persaingan sosial sehat & adil Caring society yang inklusif Menumbuhkan biodiversitas Tata hub egaliter saling menguntungkan yang berbudaya tinggi

STRATEGI PROFESI KEDEPAN?

Berdaya & Transparansi 4-PILAR STRATEGI Glorekalisasi IHR2005; GOARN BWC Efisiensi = Berdaya & Transparansi Nakes Profesional (Uji kompetensi; UU Nakes) P2M Mitigatif & Adaptif

Glorekalisasi

International Health Regulations 2005 From three diseases to all public health threats From passive to pro-active using real time surveillance/evidence From control at borders to detection and containment at source

Operationalizing the IHR in the 21st century: partnership for global alert and response to infectious diseases WHO Regional & Country Offices WHO Collaborating Centres/Laboratories Epidemiology and Surveillance Networks Countries/National Disease Control Centres Military Laboratory Networks UN Sister Agencies GPHIN NGOs Electronic Discussion sites FORMAL INFORMAL Media

WHO Alert, Preparedness, and Response Operations Project Management Coordination Monitoring Reporting Resource mobilisation Administration Alert & Response Ops IHR Contact Point Intelligence Verification Risk assessment Risk communication Notification Response IHR Bodies & Procedures IHR Focal Points Roster of experts Emergency Committee Review Committee National legislation WHO Alert, Preparedness, and Response Operations Project Management Specific threats influenza polio smallpox SARS Chemical/Radionuclear others IHR Communication information education advocacy National Core Capacity Country Alert & Response IHR NFP Operations National ARO Laboratory training / support Epidemiology training / support National system assessment Response preparedness -Social mobilization -Case management Points of Entry Ports Airports Ground crossings

DARI IHR2005 MENUJU GLOBAL SECURITY Individual Health Security: Access of persons to health care and to medicines/vaccines and other health goods; removal of obstacles to good health Public Health Security: Activities required to minimize vulnerability to public health events that endanger the health of populations Global Public Health Security: Collective activities required to protect the public health of populations living across geographical regions and international boundaries

IHR DAN BWC International Health Regulations (IHR) of the World Health Organization The Biological Weapons Convention (BWC)

Global Outbreak Alert and Response Network: Regional Collaboration APEC GPHIN Pacific Public Health Surveillance Network (PPHSN) Mekong Basin Disease Surveillance (MBDS) SEAMIC SEANET Flu Net ASEAN EIDIOR + Red Cross, other NGOs

Tanpa Global Linkage-Regional Collab-Local Empowerment First case Late reporting Delayed response 90 Lost opportunity for control/ risk of international spread 80 70 60 CASES 50 40 30 20 10 1 4 7 10 13 16 19 22 25 28 31 34 37 40 DAY

Dengan GLOREKALISASI Early reporting Rapid response Potential cases prevented/ international spread prevented 90 80 70 60 50 CASES 40 30 20 10 1 4 7 10 13 16 19 22 25 28 31 34 37 40 DAY

Mitigatif & Adaptif

MITIGATIF-ADAPTIF

GER-MAS HIDUP SEHAT Merupakan gerakan multisektor termasuk swasta dan masyarakat sebagai subyek (bukan obyek) untuk kegiatan2 mitigatif dan adaptif bencana Program terstruktur masing2 sector dengan indicator terutama kesehatan keluarga Mendorong nilai-kepercayaan dan budaya hidup sehat dan bugar Mendorong best practices (keberhasilan) setiap sektor dengan branding yang kuat terkait “Hidup sehat dan bugar” Target komunikasi “reach out and touch them” Menu kegiatan yang mencakup perubahan perilaku menuju hidup sehat bagi individu – keluarga – masyarakat - kelembagaan Menciptakan mekanisme penguatan (incentive system) agar masyarakat terus menjaga kesehatan dan kebugarannya Ukuran kemandirian masyarakat sangat penting

Indikator Keluarga Sehat Program Gizi, Kesehatan Ibu & Anak: 1 Keluarga mengikuti KB 2 Ibu bersalin di faskes 3 Bayi mendapat imunisasi dasar lengkap 4 Bayi diberi ASI eksklusif selama 6 bulan 5 Pertumbuhan balita dipantau tiap bulan B Pengendalian Peny. Menular & Tidak Menular: 6 Penderita TB Paru berobat sesuai standar 7 Penderita hipertensi berobat teratur 8 Gangguan jiwa berat yang diobati / tidak ditelantarkan C Perilaku dan kesehatan lingkungan: 9 Tidak ada anggota keluarga yang merokok 10 Keluarga memiliki/memakai air bersih 11 Keluarga memiliki/memkai jamban sehat 12 Sekeluarga menjadi anggota JKN/askes

GERMAS HIDUP SEHAT PROPINSI SEHAT KOTA SEHAT KELUARGA SEHAT

. MIRACLE Germas Sehat MUTU YANKES JAMINAN KESEHATAN 2.SINERGI & BAGI PERAN MASING2 3. KESAMAAN KEPENTINGAN DALAM 1.GOAL: MIRACLE Germas Sehat 5. KOMUNIKASI & KERJASAMA 4. MENYUSUN RENCANA AKSI PARADIGMA SEHAT (HiAP) HiAP=Health in All Policies

Softskills- Softskills- Softskills Managing Use process excellence to fulffill Health Needs & Satisfy Community Educating Showing paths for healthy life styles Innovating new PH ideas and develop capabilities to make them a reality Softskills- Softskills- Softskills Leading Inspire and develop people & sectors for healthy consumerism Researching for rational PH decision s & new technolgy Communitarian Live with; for benefit of and establish self reliance community Apprenticing for perfection PH values and norms

Nakes Profesional

Health Contexts Dynamics IAKMI ROLES PH Educational System Health Contexts Dynamics Professional Educ Health Need & Demand (Local & Abroad) National Board for PH Competency Exams CREDENTIALING Licensing Certification Health Technology PH Professional Ethics & conduct Scope of Works for PH workers Universities Accreditation PH workers Utiliz & Empowerment PROFESIONALISM PH workers Dynamics Bachtiar 2008

Efisiensi SisKes

WHO, Everybody’s Business: Strengthening Health Systems to Improve Health Outcomes, WHO’s Framework for Action (2007)

BERUBAH,,,,(1) Individual care providers Collaborative teams of providers

BERUBAH,,,,(2) Treating individuals when they get sick Keeping groups of people healthy

BERUBAH,,,,(3) Emphasizing mitigation with adapatation Emphasizing adaptation Emphasizing mitigation with adapatation

Applying appropriate levels of care at the right place BERUBAH,,,,(4) Maximizing the use of resources & assets Applying appropriate levels of care at the right place

BERUBAH,,,,(5) Offering care at sites convenient to patients Offering care at centralized facilities Offering care at sites convenient to patients

BERUBAH,,,,(6) Customizing healthcare for each patients Treating all patients the same Customizing healthcare for each patients

BERUBAH,,,,(7) Avoiding the sickest chronic patients Creating venues to provide special chronic care services

BERUBAH,,,,(8) Being responsible for those who seek our services Being responsible for the needs of the community

BERUBAH,,,,(9) Best efforts High reliability provider

HARMONISASI GLOBALISASI VIRTUALISASI KOMPETENSI MIRACLE JAMINAN KESEHATAN KOMPETENSI MIRACLE YANKESMAS BERMUTU HARMONISASI GLOBALISASI VIRTUALISASI PARADIGMA SEHAT

SOFTSKILLS – SOFTSKILS – SOFTSKILLS(1) 1. Bekerja dengan hati. If you can’t be passionate about the work itself, be passionate about the reason you do it. 2. Ajak keluarga dalam keputusan2 kerja. Be passionate in your choice to do right by your family while also taking steps to find a role you do love. 3. Carilah teman dengan enersi positif optimistik. Surround yourself with positive people and you’ll have a positive outcome.

SOFTSKILLS – SOFTSKILS – SOFTSKILLS(2) 4. Berikan waktu yg luas utk talenta yg dimiliki. If you spend most of your time using your talents and doing things you are good at, you’re more likely to be happy. 5. Bisa frustasi urusi kekuarangan diri. Waspada. If you spend most of your time struggling to improve your weaknesses, you’re likely to be frustrated. 6. Berlatihlah utk penyempurnaan. Yang sabar dalam hal baru. Practice is the only true way to master a new skill. Be patient with yourself while you learn something new.

SOFTSKILLS – SOFTSKILS – SOFTSKILLS(3) 7. Bosan karena tak mau hal baru. The only way to stay fresh is to keep learning new things. 8. Hal baru pasti lewati kesalahan2. Ikuti tahapannya. To learn new things means being a beginner, and that means making having a ‘beginner mind’ and making mistakes. 9. Nikmati setiap kesalahan dg ihlas. The more comfortable you grow with making beginner mistakes, the easier it is to learn new things.

SOFTSKILLS – SOFTSKILS – SOFTSKILLS(4) 10. Jadilah pembaharu didepan. If you think something needs changing, be the one to lead the change.  11. Mulai yg sederhana. Start small and build from there. 12. Petik tujuan yg terjangkau dulu kmd yg sukar. Do the obvious stuff first, then progress to the harder stuff. (Otherwise known as going for the low-hanging fruit.)

SOFTSKILLS – SOFTSKILS – SOFTSKILLS(5) 13. Faham disemua aspek dlm organisasi tmsk hal teknis smp kepemimpinan. Always try to get better at your craft from the technical aspects to your leadership skills. 14. Memutuskan adalah har tersukar. Biasakanlah. The hardest lesson to learn is when to keep going and when to quit. No one can teach you that. At some point, you have to choose.

SOFTSKILLS – SOFTSKILS – SOFTSKILLS(6) 15. Gila kali ya berharap lebih dg cara sama. The definition of crazy is to do the same thing the same way and expect a different result. If the result isn’t good, change something and then try again. 16. Bekerjasamalah. Begitulah Allah menciptakan. No one succeeds alone.  17. Tanya kalau ga ngerti dan bersyukur abiss telah dibantu. Ask for help. Be specific when asking. Be graceful and grateful when help comes.

SOFTSKILLS – SOFTSKILS – SOFTSKILLS(7) 18. Setiap kita punya pandangan. Hargailah. People experience the world differently. Don’t fight that. Use it. 19. Manfaatkan kelebihan org lain. Keberagaman itu PENTING. Embrace diversity. The best way to compensate for your own weaknesses is to pick teammates who have different strengths. 20. Hargai orang lain dg cara terbaikmu. You don’t have to like someone to treat that person with respect and courtesy.

SOFTSKILLS – SOFTSKILS – SOFTSKILLS(8) 21. Jangan memaksa kehendakmu. Don’t “should” all over someone, and don’t let someone else “should” all over you. 22. Diatas gunung ada gunung lain. No matter what you do or how much you achieve, there are always people who have more.  23. Lihat kebawah utk bersyukur. There will always people who have less, too.

SOFTSKILLS – SOFTSKILS – SOFTSKILLS(9) 24. Sumberdaya itu milikNya ingat itu. You will never have all the resources (time, money, people, etc.) that you want for your project or company. 25. UjianNya dalam susah justru rahmat utk kreatif. A lack of resources isn’t an excuse. It’s a blessing in disguise. You’ll have to get creative. 26. Belajar cara baru utk pekerjaan yang sama itu kreatifitas namanya. Creativity and innovation are skills that can be learned and practiced by doing your usual things in a new way.

SOFTSKILLS – SOFTSKILS – SOFTSKILLS(10) 27. Belajar absorbsi apa saja di awal dan tapis banyak hal bila sudah pengalaman. In the early stages of a company, career, or project, you’ll have to say “yes” to a lot of things. In the later stages, you’ll have to say “no.” 28. Kritik miring itu perlu. Ariflah Negative feedback is necessary. Don’t automatically reject it. Examine it for the nuggets of truth, and then disregard the rest. 29. Pujian hhm.. waspada aja deh. Ditto for positive feedback.

SOFTSKILLS – SOFTSKILS – SOFTSKILLS(11) 30. Opini barangkali ada mutiara didalamnya. Don’t automatically accept it (or reject it). Examine it for the nuggets of truth. 31. Memberi kritisi itu ke obyek bukan ke subyek. When delivering criticism, talk about the work, not the person.  32. Mimpilah setingginya. Think big. Dream big. (The alternative is to think small, dream small.)

SOFTSKILLS – SOFTSKILS – SOFTSKILLS(12) 33. Mimpi itu artinya pelan2 dicapai. Treat your dream as an ultimate road map. 34. Mimpi gede itu banyak protes. Sabar dan putuskan If you think big, you will hear “no” more than you hear “yes.” They don’t get to decide. You do. 35. Dibalik sukses ada peluang emas. Siapkan diri. As you achieve successful outcomes, you will be pressured to do more and do it faster.

SOFTSKILLS – SOFTSKILS – SOFTSKILLS(13) 36. Ini rahasia sukses: diskusi dg siapa saja. Communicate your plans with other people and keep communicating those plans in every way possible. 37. Jejaring itu PENTING. Grow your network. Make an effort to meet new people and to keep in contact with those you know. 38. Apapun pekerjaannya itu karena SDM. Hargai mereka. It’s always about the people and the lives you will improve.

SOFTSKILLS – SOFTSKILS – SOFTSKILLS(14) 39. Dibalik sukses itu kegagalan. No matter how successful you get, you can still fail and fail big. 40. Gagal itu bukan hal buruk. Failure isn’t a bad thing. It’s part of the process.  41. Lakukan perhitungan setiap risiko. Take risks. Not wild risks. Calculated ones. 42. Kegagalan itu terencana. The best way to always win the big game is to have alternate plans for losing various battles.

SOFTSKILLS – SOFTSKILS – SOFTSKILLS(15) 43. Hidup itu penuh risiko. Kuatkan hati. No one can tell you when to do anything. If you feel strongly enough, Bismillah. 44. Hargai siapa saja walau saat menolak. Learn how to respectfully, but firmly, say “no.” 45. Sanggupi segala hal. NTT, Nanti Tuhan Tolong. Say “yes” as much as you can.  46. Sanggupi tapi jelas batasannya. In order to say “yes” often, attach boundaries or a scope of work around your “yes.”

SOFTSKILLS – SOFTSKILS – SOFTSKILLS(16) 47. Bahagia itu bukan karena sukses tp syukuri keberadaan, apapun. Happiness is the art of being satisfied with what you already have. 48. Teman kerja pasti ada yg bikin BeTe. Sabar hargai dan tetap fokus. Working with difficult personalities will be a part of every job. Be respectful, do your job well, and cheerfully don’t let the difficult person derail your project.

SOFTSKILLS – SOFTSKILS – SOFTSKILLS(17) 49. Fokus pada tujuan. Focus on what you want, not on what you don’t want. 50. Mau mengubah dunia? Jaga amanah dg mulai diri sendiri berubah. If you truly want to change the world, you’ve got to earn a position of influence or power and use that influence to change your part of the world. Do it openly and as a role model and you will empower others to change, too

JATI DIRI “MIRACLE” M I R A C L E MENGELOLA KEBIJAKAN DAN PROGRAM KESEHATAN I INOVASI SEBAGAI KUNCI DAN PARADIGMA SEHAT R REAL TIME DATA UNTUK MEMBANGUN KEPUTUSAN2 BANGKES A APPRENTICING, MENJADI PEMBELAJAR UTK YANG TERBAIK C COMMUNITARIAN, MEMAHAMI DAN MELAYANI SELURUH KEBUTUHAN PEMANGKU KEPENTINGAN L LEADING, MEMIMPIN MENUJU BUDAYA KELUARGA SEHAT MELALUI JEJARING KERJA EFEKTIF E EDUKASI SEMUA UNTUK KELUARGA MAMPU MANDIRI We call it “PH workers are a MIRACLE for all”

MIRACLE Health in All Policies . Dibutuhkan kepemimpinan kesmas untuk capai pekerjaan keprofesian yang bermutu MIRACLE REVOLUSI MENTAL menggerakkan SEMUA UNSUR untuk menyehatkan bangsa Health in All Policies . Gerakan Masyarakat Untuk Hidup Sehat Asses Develop Manage Professionalism

KKNI Kesmas Untuk Profesi MIRACLE Renc CPD-PostGradEd STR-IAKMI Bekerja di bidang Kesmas SKP sebagai pengalaman ContProfDevt sepanjang karir Karir Profesi 6-Ahli KM Pratama MIRACLE identity 7-AKM Muda 8-AKM Madya 9-AKM Utama Jenjang KKNI

Curabitur elit sanitati iurum humanorum* *Elit tenaga kesehatan masyarakat yang mampu menjamin hak kesehatan setiap individu Curabitur elit sanitati iurum humanorum*