REFORM : Oxford dictionary 1987

 A. Membuat atau menjadi lebih baik

dengan membuang atau membetulkan
yang salah
 B. Perubahan yang dibuat untuk
menghilangkan hal hal yang salah

REFORMASI : Proses reform, perubahan untuk

menuju keadaan yang lebih baik secara incremental,
mix scanning atau fundamental (radikal)
 Health Sector Reform
 A new and greater role for the private sector
in the provision of health care
 Increased people’s self-reliance
(Kemandirian)
 Managed market competition
 Government as provider of last resort
 HEALTH SECTOR REFORM
( Definisi)
As a process that seeks major changes at the national
polices, programs and practices through changes in
health sector priority, laws, regulations, organizational
structure and financing arrangements. The central goals
are most often to improve access, equity, efficiency
and/or sustainability
TUJUAN REFORMASI SEKTOR KESEHATAN

PERUBAHAN
To improve health
PEMBANGUNAN service system through :
KESEHATAN •ACCESS
•EQUITY
•QUALITY
•EFFICIENCY
•SUSTAINABILITY
INDONESIA SEHAT
(4 PILAR)
 PROFESIONALISME
 DESENTRALISASI
 BPJS
 PARADIGMA SEHAT
KESEHATAN (OBYEK MATERIAL)

. KEDOKTERAN

. KESEHATAN MASYARAKAT

 . KEPERAWATAN
 Mengapa MINDSET
Sangat Penting?

• Kita hidup di dunia yang tidak berpeta.

• Kemampuan untuk up-dating peta
mental sangat menentukan efektivitas
perjalanan organisasi.
• Mindset dapat dan perlu di-up-date
setiap lingkungan yang kita hadapi
berubah.
Arti Penting MINDSET
terhadap PERILAKU

Perilaku Tampak Luar

Sikap Tampak
Dalam
MINDSET

Paradigma
 MINDSET
Sikap Mental Mapan (Fixed
Mental Attitude) yang dibentuk
melalui Pendidikan, Pengalaman,
dan Prasangka
Merupakan PETA MENTAL yang dipakai
oleh orang sebagai dasar bersikap atau
bertindak.
 PENTINGNYA PARADIGMA
Frank Outlaw

 Watch your thoughts; they become

words.
 Watch your words; they become
actions.
Watch your actions; they become
habits.
 Watch your habits; they become
character.
Watch your character; it becomes
destiny.
 Paradigma
Adalah Cara (kacamata)
yang digunakan oleh
seseorang dalam
memandang sesuatu.
Tindakan seseorang sangat
ditentukan oleh Cara
Pandang orang tersebut
terhadap sesuatu.
 Keyakinan Dasar
Adalah Kepercayaan yang
dilekatkan oleh seseorang
terhadap sesuatu
Orang melakukan tindakan
berdasarkan pada apa yang
diyakininya benar
We do what we believe
 Nilai Dasar
Adalah Sikap, Sifat, dan Karakter yang dijunjung tinggi
oleh seseorang.

Nilai-nilai yang dijunjung tinggi oleh seseorang menjadi

pembatas di dalam ia memutuskan tindakan-tindakan
yang akan dilakukan

Nilai Dasar:
(1) kejujuran,
(2) kerendahan hati, dan
(3) kerja keras
Keyakinan dasar:
(1) kita hrs mengetahui fakta,
(2) alasan dan belajar,
(3) selalu ada cara yang lebih baik,
(4) kita harus selalu berusaha untuk
sempurna
 PARADIGMA TENTANG
RESPON TERHADAP PERILAKU SALAH
• PARADIGMA LAMA
•Tidak dapat menerima kesalahan.
•Kesalahan sebagai kegagalan pribadi, dan mereka
memberikan respon terhadap kesalahan dengan
hukuman untuk menanamkan ketakukan dalam diri
mereka yang bersalah.
•Konsekuensi: mereka yang bersalah akan merasa
takut dan akan berusaha untuk menutupi kesalahan
mereka di masa yang akan datang.
 PARADIGMA BARU
• Kesalahan merupakan hal yang tidak diinginkan;
• Kesalahan sebagai suatu kesempatan untuk dipelajari.
• Kesalahan tidak dapat dihindari, penting bagaimana
meniadakan kesalahan terulang
 PERSPEKTIF
PARADIGMA TENTANG
PENGAMBILAN KEPUTUSAN
PARADIGMA LAMA
• Manajer membuat keputusan yang
secara politik mudah atau memenuhi
tujuan jangka pendek pribadi.

• PARADIGMA BARU
•Manajer membuat keputusan yang berfungsi
untuk memenuhi tujuan strategik jangka
panjang.
 Perilaku
1)Individu
2)Team work Praktek
2)Multidiscipline IKM
3)Komprehensif

Keyakinan : Upaya Cost effective

1) Promotive, Protective, Preventive,
3)Pro-active, 5) Health maintenance
model 6) Kajian Individu, kelompok dan Mindset
masyarakat Paradigma
Nilai : 1) Konsep Winslow, 2) Sehat WHO, 3) IKM
BLUM, 4) Eco-system 5) 5 Tingkat pencegahan
Paradigma Ilmu Kesehatan Masyarakat :
1) Balance:Biopsiko-sosio-budaya 2) Paradigma sehat

Gb Public Health Paradigm and mindset

 PARADIGM
Stephen R. Covey, (1997) : "The word paradigm comes from the
Greek. It was originally a scientific term, and is more commonly
used to day to mean a model, theory, concept, perception,
assumption or frame of reference

In the more general sense. its the way we see the world
not in term of visual sense of sight, but in term of perceiving,
understanding and interpreting"

Health is not everything,

but without health
everything is nothing

MEN SANA IN CORPORE

SANO
 MINDSET PERUBAHAN

 Problemsolving mindset.
 Opportunity mindset.
 STRATEGI BERUBAH
• 1. Tingkatan Komitmen Perubahan
• 2. Gaya Manajemen Perubahan
•

STRATEGI PERUBAHAN EFEKTIF:

EVOLUSIONER BUT
REVOLUSIONER
 TINGKATAN KOMITMEN
PERUBAHAN
ADA 4 TINGKATAN KOMITMEN PERUBANAH
 Incremental Change
 Step-Shift Change (MIX SCANNING)
 Radical Change and
 Fundamental Change
 INCREMENTAL CHANGE
• Low-risk adjustment.
• Safety play with small reward.
• But remember: “Continuous
improvement is exactly the right
idea if you are the world leader in
everything you do. It is a terrible
idea if you are lagging in the world
leadership benchmark.” (Paul
O’Neil, Chairman of Alcoa)
 STEP-SHIFT CHANGE
• Making significant process changes
but not changing the basic direction
of the business and how it generates
value.
• Typically focuses on applying
worknetting to a portfolio of
priority processes.
 RADICAL CHANGE
• Making aggressive actions to leave
the existing business entity and its
basic assumption intact.
• The identity of the organization is
not in question, but the way it
carries out business may be
significantly altered.
• Typically focuses on applying
importing and franchising.
 FUNDAMENTAL CHANGE
• Committed to create what will in
effect be a new organization.
• Processes, structure, markets,
strategy, and even identity are up for
review.
• The risk and potential rewards of
fundamental change are high.
• Typically focuses on applying new
vision and structure.
 GAYA MANAJEMEN
PERUBAHAN
ADA 6 TIPE:
 Transformational leadership
 Delegated mandate
 Reactive urgency
 Individual initiative
 Sustained improvement
 Opportunism
 TRANSFORMATIONAL
LEADERSHIP
• The personal credibility, commitment,
and energy of the CEO drive change.
• Almost always uses education to
mobilize the organization and provide a
shared language of change.
• Educational programs are not designed
to build skills (which usually the goals of
training), but to get everyone on the
same wave-length and unify efforts.
DEFINISI SEHAT DAN KESEHATAN MASYARAKAT

(1) Tujuan akhir dari Ilmu Kesehatan Masyarakat adalah

tercapainya kesehatan optimal bagi seluruh penduduk
yang oleh WHO dan dalam UU Kes. No.23, 1992
dinyatakan sebagai berikut:
"Sehat adalah keadaan sejahtera dari badan, jiwa, dan
sosial yang memungkinkan setiap orang hidup produktif
secara sosial dan ekonomis"

(2) Sir Donald Acheson (1988) memberikan batasan

kesehatan masyarakat sebagai berikut : " Kesehatan
Masyarakat adalah ilmu dan seni mencegah penyakit,
memperpanjang usia dan meningkat kan derajat kesehatan
melalui upaya masyarakat yang terorganisir"
 (3) Winslow 1920. Kesehatan Masyarakat adalah ilmu (science)
dan seni (art)
a. mencegah penyakit (preventing disease)
b. memperpanjang usia (prolonging life)
c. meningkatan kesehatan fisik dan mental serta efisiensi,
melalui upaya masyarakat yang terorganisir guna :
 menyehatkan lingkungan
 pemberantasan penyakit infeksi
 pendidikan individu tentang hygiene perorangan
 pengorganisasian pelayanan medis dan perawatan
guna ditegakkannya diagnosis dini dan pencegahan
penyakit serta
 pengembangan sistem sosial yang menjamin bahwa
setiap individu dalam masyarakat akan mendapatkan
standar hidup yang layak untuk mempertahankan
kesehatannya
The Broad Determinant of Health

Social &
Economic
Environment

Health Physical
Services Environment
Health
Status

Health Biological
Behavior Influence
& Skills
 ISU PELAYANAN KESEHATAN

 UNIT SOSIAL  UNIT EKONOMI

 PELAYANAN  KESEHATAN
KESEHATAN DASAR SEKUNDER/TERTIER

 FOKUS KEBUTUHAN  WILAYAH CAKUPAN

INSTITUSIONAL

 SENTRALISASI  DESENTRALISASI

 PROTEKSIONISME  LIBERALISASI

 PARADIGMA SAKIT  PARADIGMA SEHAT

1. Health Inequilities are preventable and unfair differences
in health status between groups, populations or individuals
RAINBOW MODEL : Social determinants of Health
 Health
Q.o.L
Bio-Psiko-Sosio ekonomi Happiness

Activities  Procedures  Tasks

A A
s Po s
s Li s
e cy u
s De r
s ve a
m lop n
e me c
n nt e
t

Public Health Science, Substances

ROLE: Values, Beliefs, Asumptions
PARADIGM OF PUBLIC HEALTH
 HEALTH
PENYIMPANGAN:
BIO-PSIKO-SOSIO-EKONOMI-BUDAYA  HAPPINESS

BALANCE:
BIO-PSIKO-SOSIO-EKONOMI-BUDAYA  HAPPINESS

QUALITY of LIFE
(Q.o.L)
 Holistic Approach
HEALTH
PARADIGM Best
(85% Pop) Practice
HEALTH & PARADIGM
PROBLEM IN HEALTH

SICK
PARADIGM
Health
(15% Pop) Status,
Quality
of Life

PARADIGM VALUES BEHAVIOR

 SERVICE
PROGRAM
SERVICE
1.1
FUNCTION1 STRATEGI
SERVICE
1 PROGRAM
1.2 SERVICE
F
U SERVICE
N PROGRAM
C 2.1 TASKS
ROLE T
STRATEGI
2 SERVICE
I PROGRAM
FUNCTION2 O 2.2 SERVICE
N
PROGRAM SERVICE
3.1 SERVICE
FUNCTION3 STRATEGI
3
PRORAM SERVICE
3.2
SERVICE

FUNCTION  STRATEGI  PROGRAM  SERVICE

 TASKS
PROCEDURE
TASKS
1.1
FUNCTION1 ACTIVITY
TASKS
1 PROCEDURE
1.2 TASKS
F
U TASKS
N PROCEDURE
C 2.1 TASKS
ROLE T
ACTIVITY
2 TASKS
I PROCDURE
FUNCTION2 O 2.2 TASKS
N
PROCEDURE TASKS
3.1 TASKS
FUNCTION3 ACTIVITY
3
PROCEDURE TASKS
3.2
TASKS

FUNCTION  ACTIVITY  PROCEDURE  TASK

Public Health is continous process that is supported
by management & developed by research (USA)
SOCIAL ROLE is A SET of connected BEHAVIOURS, RIGHT
and OBLIGATION, BELIEF AND NORM as conceptualised
by people in A SOCIAL SITUATION. is an expected or free
or continuously changing behaviour and may have a
given individual SOCIAL STATUS or SOCIAL POSITION

“Role" as the set of expectations, like.

“DOCTOR”, “MOTHER”,” CHILD”,” NURSE”. “EPIDEMIOLOGIST”

"sick role“......, a person is exempted from their

usual roles, but is expected to conform to transitory
behavioural standards, such as following doctors'
orders and trying to recover. Talcott Parsons in 1940
 Top 10 Most Common Health Issues

1. Physical Activity and Nutrition

2. Overweight and Obesity
3. Tobacco
4. Substance Abuse
5. HIV/AIDS
6. Mental Health
7. Injury and Violence
8. Environmental Quality
9. Immunization
10. Access to Health Care
 Public Health , WHO
refers to all organized measures (whether public or private)
to prevent disease, promote health, and prolong life
among the population as a whole.

Public Health Campaigns:

• Vaccination and control of infectious diseases
• Motor-vehicle safety
• Safer workplaces
• Safer and healthier foods
• Safe drinking water
• Healthier mothers and babies and access to family
planning
• Decline in deaths from coronary heart disease and stroke
• Recognition of tobacco use as a health hazard.
Its activities aim to provide conditions in which people can
be healthy and focus on entire populations, not on
individual patients or diseases. Thus, public health is
concerned with the total system and not only the eradication
of a particular disease
The three main public health functions are:
•The assessment and monitoring of the health of communities
and populations at risk to identify health problems and
priorities.
•The formulation of public policies designed to solve identified
local and national health problems and priorities.
•To assure that all populations have access to appropriate and
cost-effective care, including health promotion and disease
prevention services.
ROLE ATRIBUT :
"appropriate" and others "inappropriate".

For example DOCTOR ROLE: An appropriate doctor

1. Dresses fairly conservatively,
2. Asks a series of personal questions about one's
health,
3. Touches one in ways that would normally be
forbidden,
4. Writes prescriptions, and
5. Shows more concern for the personal wellbeing of
his

SOCIAL NORM HEORY states that much of people's

behaviour is influenced by their perception of how
other members of their SOCIAL GROUP behave
 GOVERNMENT ROLE

MOH, POLICY MAKER 1. TUJUAN & PRIORITAS H.CARE

access, focus on the supply of
Health services, Health Status
2. REGULATOR. controlling quantity
and Equity distribution, cost-
Efficiency and quality of Hcare
3. INFORMATION SOURCE
4. STEERING THN ROWING

Public Health Profesional ADVOCATE and EQUITY

 10 Essential Public Health Services
1. Core Function 1: Assessment
Assessment, monitoring and surveillance of local
health probelm, needs and of resources for
dealing with them
1. Monitor health status to identify, understand community
health problems/issues facing the community.
2. Diagnose and investigate health problems and health
hazards in the community protect people from them.

CF. 2: POLICY DEVELOPMENT

Policy development and leadership that foster local
involvement and a sense of ownership, that emphasizes
local needs and tht advocate equitable distribution of
Public resources and complementary private activities
compensureate with com. need
3. Inform, educate, and empower people about health
issues. Give the people teh information to make choice
4. Mobilize community partnerships (engage the community)
to identify and solve health problems
5. Develop policies and plans that support individual and
community health efforts.
CF. 3: ASSURANCE
6. Link people to needed personal health services and
assure the provision of health care when otherwise
unavailable.
7. Assure a competent public health and personal healthcare
workforce.
8. Evaluate effectiveness, accessibility, and quality of personal
and population-based health services.
Core Function 4. System Mangement
9. Contribute and apply the evidence base of public
health

CF.5:RESEARCH
10.Research for new insights and innovative
solutions to health problems.
Best Practice:TEN ESSENTIAL ENVIRONMENTAL
HEALTH SERVICE & CORE OF PH (ENV. HEALTH)
Assessment
• Monitor environmental and health status to identify and solve
community environmental health problems
• Diagnose and investigate environmental health problems and
health hazards in the community
Policy Development
• Inform, educate, and empower people about environmental
health issues
• Mobilize community partnerships and actions to identify and
solve environmental health problems
• Develop policies and plans that support individual and
community environmental health efforts
Assurance
• Enforce laws and regulations that protect
environmental health and ensure safety
• Link people to needed environmental health services and
assure the provision of environmental health services
when otherwise unavailable
• Assure a competent environmental health workforce
• Evaluate effectiveness, accessibility, and quality of
personal and population-based environmental health
services
• Research for new insights and innovative solutions to
environmental health problems
HEALTH PROMOTION :
FUN CTION, ACTIVITIES,
TASKS
1. THALASEMIA. No: 1, 2, 3, 5
2. DIABETES MELLITUS. No: 6, 7, 8, 9, 14
3. KEMATIAN IBU No: 10, 4, 11, 12, 13

ROLE
1. PUBLIC HEALTH
2. MEDICAL
3. NURSING, MIDWIDE
Public Health is continous process that is
supported by management & developed by
research
WHO IT IS? WHO IS SHE ?

DIAN SUMMER IS NURSE ... FITNESS

CHALLENCE IN NEW YORK
 Health Promotion
Health Protection
Disease Prevention

Specialized Wellness/ Health

Maintenance
Institution
Self-care &
Care Mutual Aid

Facilities Based Community

Care Based Care

The Continuum of Health Services

ALLOCATION OF FINANCIAL RESOURCES

Source of funding  the public &private

sectors
Funding for specific (core) health services
Shifting resources to health promotion &
disease prevention
Funding allocated on the basis of need
 Terima Kasih

 Semoga Anda Puas

 Santen Toya Kelapa Cekap Semanten
Atur Kula