PANDU PTM

A community intervention model

On prevention and control of NCDs
In indonesia
 INDONESIA
17.504
Islands
1.904.569
square The world ‘s fourth Population
kilometres 34 Province most populous
416 district and density reaches Population
wide country more than 135,2
98 City with 258 million people growth rate is
Decentralization person/square approximately
government kilometres 1,38%
system

Life Years
Expectancy
70,1
9.767 National Health
Public Health Care 341.536 Insurrance
(PHC) Health 1.618 PHC coverage
PHC Ratio per Workers with health 171 Million
30.000 people is including promotors people
1,13 289.465 workers (66,46%) per
Medical December 31
professional 2016

Source : Indonesia Health Profil, MOH 2016

Statistic Bureau 2015
 NCDs CURRENT SITUATION IN INDONESIA

10 CAUSE OF DEATH IN INDONESIA NCDs Prevalence in Indonesia

Cancer(‰) 1.4

Renal Failure (‰) 2

Stroke (‰) 12.1

Coronary Heart Disease(%) 1.5

COPD(%) 3.7

Diabetes Melitus (%) 6.9

Injury(%) 8.2

Hypertension(%) 25.8

0 5 10 15 20 25 30

Source: National Health Survey 2013

 NCDs RISK FACTOR CATASTROPHIC DISEASE BURDEN
IN INDONESIA IN INDONESIA

2014 2015 2016

Mental emotional disorder 6
7.4
6.9
Insufficient Physical Activity 26.1

Eat Salty food 26.2

Smoking 36.3 4.4

Eat Fatty food 40.7

2.7
2.5 2.4
Eat Sweet food 53.1 2.2
1.6 1.5
Eat Flavouring food 77.3 1.1 1.2
0.74
Eat less vegetable and fruits 93.6

0 10 20 30 40 50 60 70 80 90 100 Heart disease Renal failure Cancer Stroke

Source: NHS, 2013 Source: Social Insurance Administration Organization

(BPJS)
 NCDs PREVENTION AND CONTROL POLICY
NATIONAL MID-TERM DEVELOPMENT PLAN
INDICATOR OF NCDs PROGRAM 2015-2019
Presidential decree no. 2, 2015

No Key Performance Indicators

1 Raised blood pressure prevalence

2 Halt Obesity prevalence

3
Smoking prevalence ≤ 18 years old

TARGET AND INDICATOR NATIONAL ACTION PLAN

STRATEGIC PLAN INDICATOR FOR FOR NCDs PREVENTION AND CONTROL 2015-2019
NCDs PREVENTION AND COTROL PROGRAM ( MOH Decree No.5/2017 )
2015-2016
No Indicator
No Indikator
1 Smoking percentation for ≤ 18 years old
1 Morbidity and mortality
2 PHC percentage for implementing PANDU PTM
2 Biologic Risk Factor
3 Village/gampoong percentage with Posbindu PTM 3 Behavioural Risk Factor
(community based intervention)

4 Women age 30-50 years old percentage who had breast 4 Health System Services Response
and cervical cancer screening • PHC percentage for implementing PANDU
PTM
5 District/city with No smoking area policy in minimum 50%
state school
NCDs PREVENTION AND CONTROLING STRATEGY
IN INDONESIA

The prevention and control approach strategy for

NCDs has been done through Healthy Indonesia
program, consists of :

1. Advocacy and partnership inter program and

inter sector
2. Strengthening of health services capacity for
risk factor early detection, diagnosis and
integrated prompt treatment of NCDs cases.
3. Community empowerment with health
promotion, prevention and reducing NCDs
risk factors)
4. Strengtening surveillance, monitoring and
NCDs researches.
 SCOPE OF NCDs INTEGRATED HEALTH SERVICES
(PANDU PTM)
PHC HOSPITAL
CBI

REVERSE REFFERAL

NCDs risk factor Early

NCDs risk factor Early detection, monitoring,
detection, monitoring, counseling and doing
counseling and doing healthy activity
healthy activity
Physical and laboratory
examination, diagnosis and
prompt treatment based on
Reffering NCDs cases to Pandu PTM are being done by
PHC the medical profesional.

Reffer NCDs cases with

complication or target organ
damage to the hospital

Limited rehabilitation and

paliative care for NCDs cases
 INTEGRATED HEALTH SERVICES (PANDU PTM)

• Adapted from WHO-PEN and adjusted to Indonesian Health program

• Strengthening Health system and primary health care services
• It’s a prioritized set of cost effective intervension for an acceptable quality care
that affordable for the local goverment.
• It is a minimum essential intervension in National Health Insurrance.
• Focused on Hypertension and Diabetes management with additional core set of
cancer, thallasemia, glauvoma, hearing disorder and community based
rehabilitation.
• Involving the development of community based intervention (Posbindu PTM) as
apart of referral mechanisme to the primary health care.

Foto
 DIFFERENCE BETWEEN CORE SET OF
WHO-PEN AND PANDU PTM
Core set WHO-PEN PANDU PTM
Primary prevention of heart attacks and √
strokes
Acute myocardial infarction √

Secondary prevention (post myocardial √

infarction)
PAKET TAMBAHAN
Secondary prevention (post stroke) √
PANDU PTM
Secondary prevention (Rheumatic heart -
disease) Glaucoma

Type 1 Diabetes -
Hearing disorders
Type 2 Diabetes √
Community based rehabilitation
Prevention of foot complication through √
exmination and monitoring
Prevention of onset and delay in progression √
of chronic kidney
Prevention of onset and delay of progression √
of diabetic retinopathy
Prevention of onset and progression of -
neuropathy

Bronchial asthma √

Prevent exacerbation of COPD and disease √

progression
Cancer √, Focus on Breast and cerviks cancer
 DEVELOPMENT OF NCDs INTEGRATED HEALTH SERVICES
(PANDU PTM) IN INDONESIA

• TOT
Pandu PTM for
• Develop 21 Province
• Pandu PTM
Guidelines
Pandu PTM training in
18 Province Targetting 50%
• Piloting Assesment of PHC
Pandu PTM 211 District/city,
readiness for implements
in 5 Province 301 PHC, 501
implementing medical workers PANDU PTM
(Sumbar, Sumut, PANDU PTM
Lampung, Bali, in Cimahi and 2018
Aceh)
Palembang City 2017 2019
56 District/City
92 PHC
2016
124 medical 2015 • Pandu PTM
workers 2014 training in
2013 • 3 National
34 Province
34
2012 Assesment of training for District/city,
2011 readiness for
implementing
implementing
WHO-PEN
68 PHC, 180
medical
Piloting PANDU PTM in • TOT workers
Pandu PTM di Katingan and Pandu PTM for • Pandu PTM
Workshop 26 Province Pangkep district 13 Province implementation
WHO-PEN 258 district/city, • Pandu PTM evaluation in 14
Participant: 343 PHC, 561 training for Province
MOH inter- medical workers 4 Province
program, medical 18 District/City
professional 20 PHC, 60
organization, medical
Representative of workers
District health
office
 OBSTACLE
• Limited budgetting/ fund

• Still many local goverment didn’t prioritized NCDs prevention and control
program

• Relatively frequent rotation of trained health workers in the local goverment

CHALLENGES
• Making PANDU PTM as an effort to achieve minimum standard for health
services in local goverment.

• Fulfillment of IT system for strengthening NCDs surveillance system

• Developing PANDU PTM as a part of medical and nursing curriculum .

Alur pandu ptm
COLOPON