Transcript GOVERNMENT’S ROLE IN THE PREVENTION OF CARDIO VASCULAR DISEASES Oleh : DR. dr.

GOVERNMENT’S ROLE
IN THE PREVENTION OF
CARDIO VASCULAR DISEASES
Oleh : DR. dr. I r e n e, MKM
OUTLINE
1. Introduction
2. NCDs Starategy and Diseases
Control Program
3. CVDs Control Program
4. Regulation
5. Implementation
1
INTRODUCTION
Provincial Health Office West Sumatra
Introduction : What Are NCD’s
Slow
progressing
and of long
duration
Related to
lifestyle
WHAT ARE
NCDs
Result from
behavioral
risk factors
Largely
Preventable
Introduction : Mayor NCD’s
Stroke
Heart
Diseases
Cardio
Vascular
Disease
Diabetes
Cancer
MAYOR
NCDs
COPD
Chronic
Respiratory
Diseases
Asthma
Introduction : Behavioral Risk Factor
BEHAVIORAL
RISK FACTOR
Introduction : Behavioral Risk Factor
Tobacco
Use
Physical
Inactivity
BEHAVIORAL
RISK FACTOR
Unhealthy
Diet
Harmfull
use of
alcohol
Introduction : Reduction of Risk Factor
NCD’s
Tobacco
Use
Unhealthy
Diet
Physical
Inactivity
Harmfull
Use Of
Alcohol
CardioVascular




Diabetes




Cancer




Chronic
Respiratory

Introduction : NCD’s
NCD’s
Raised blood pressure
Overweigh/obesity
Raised blood glucosed
Raised lipids
Tobacco use
Unhealthy diet
Physical Inactivity
Harmfull use of alcohol
Population ageing
Globalization
Urbanization
Socizl Determinan Of Health
Metabolic/phy
siological risk
factor
Behavioral
risk factor
Underlying
Drivers
Introduction: Magnitude of NCD’s (Cause of Death)
SEARO
World
Deaths Due
to injury,
5.1, 8.98%
Cedera, 1.6,
11.03%
Penyakit
Tidak
Menular,
7.9, 54.48%
Deaths Due
to NCD's,
36.1,
63.56%
Penyakit
Menular,
kelainan
maternal &
perinatal,
Defisiensi
Nutrisi, 5.0,
34.48%
Deaths Due
to CD, MN
Condition,
Nutritional
Deficiency,
15.6,
27.46%
Source:
WHO Global Status Report on NCDs 2010
Source:
WHO global Health observatory 2011
(in miillion)
Introduction: Magnitude of NCD’s
(Death Due To NCD’s in The World)
Other, 16%
Cardiovascul
ar Disease,
48%
Chronic
Respiratory
Dieases, 12%
Cancer, 21%
Diabetes, 3%
Introduction : Magnitude of NCD’s
(Cause of Death in Indonesia)
70
59.5
60
59.5
49.9
50
44.2
41.7
40
31.2
30
28.1
28.1
20
10.1
10
6
6.5
6
0
Maternal &
Perinatal Condition
CD's
HHS 1995
NCD's
HHS 2001
BHS 2007
Injury
Most Disease Outpatient and Inpatient,
Jamkesmas 2012
No
Disease's
1 Haemodialisa
Advanced Outpatient
Number of
Total Cost
Visit
291,017 191,813,784,964
Advanced Inpatient
Number of
Total Cost
Visit
Total Cost
8,267
35,679,741,155
227,493,526,119
16,281,797,495
59,992,976,932
2 Thalasemia
13,513
43,711,179,437
7,941
3 TBC
99,736
17,597,259,255
30,996
4 Cancer
33,324
9,462,376,093
5 Heart Disease
15,336
3,264,033,343
88,905,376,945 106,502,636,200
25,236 135,226,855,147
4,980
19,731,040,425
144,689,231,240
22,995,073,768
Source: P2JK Kemenkes RI, 2012
2007
2013
Ac
cid
en
ts
ce
r
DM
hm
a
or
/C
an
As
t
1.4
4.3
2.1
1.1
4.5
3.5
0.83
12.1
20
Tr
af
fic
on
10
St
ro
ke
te
n
31.7
25.9
24.7
30.3
25.8
30
Ar
th
rii
ts
pe
r
40
Tu
m
Hi
60
50
47.7
Introduction : Magnitude of NCD’s
(Prevalence of NCD’s in Indonesia)
0
Sawahlunto
Tanah Datar
Payakumbuh
Solok Selatan
Dharmasraya
Pdg Pariaman
Pdg Panjang
Agam
Pasaman
Kota Solok
Nasional
Pessel
Sumbar
Solok
Bukittinggi
Pas.Barat
Pariaman
50 Kta
Kota Padang
Sijunjung
Mentawai
43.2
Hipertension
40.8
39.2
37.6
36.9
35.7
34.6
33.2
32.4
31.8
31.7
31.6
31.2
30.6
29.2
28.8
28.7
27.6
26
24.5
11.1
0
5
10
15
20
25
30
35
40
45
50
Riskesdas, 2007
Solok Selatan
Pdg Pariaman
Sawahlunto
Pariaman
Pasaman
50 Kta
Pessel
Pdg Panjang
Dharmasraya
Sumbar
Pas.Barat
Solok
Sijunjung
Nasional
Payakumbuh
Tanah Datar
Agam
Kota Solok
Kota Padang
Bukittinggi
Mentawai
2.6
2.1
1.9
1.7
1.5
1.5
Stroke
1.4
1.3
1.2
1.1
1
1
0.9
0.8
0.8
0.8
0.7
0.6
0.4
0.3
0.3
0
0.5
1
1.5
2
2.5
3
Riskesdas, 2007
Pessel
Agam
Pdg Pariaman
Pariaman
50 Kta
Solok Selatan
Sawahlunto
Pasaman
Sumbar
Tanah Datar
Sijunjung
Nasional
Bukittinggi
Pas.Barat
Dharmasraya
Pdg Panjang
Kota Solok
Solok
Mentawai
Payakumbuh
Kota Padang
Hearth Diseases
25
23.1
17
13.4
13
12.7
12.3
11.6
11.3
11.2
9.8
7.2
7.2
7
7
6.9
6.2
5.1
3.9
2.9
2.5
0
5
10
15
20
25
30
Riskesdas, 2007
Diabetes Mellitus
Sawahlunto
Pdg Pariaman
Pariaman
50 Kta
Pessel
Payakumbuh
Bukittinggi
Pdg Panjang
Solok Selatan
Sumbar
Solok
Nasional
Dharmasraya
Agam
Pasaman
Kota Solok
Kota Padang
Sijunjung
Tanah Datar
Pas.Barat
Mentawai
2.1
2
1.9
1.9
1.9
1.8
1.8
1.5
1.4
1.2
1.2
1.1
1.1
1
0.9
0.8
0.7
0.7
0.6
0.5
0
0
0.5
1
1.5
2
2.5
Riskesdas, 2007
50 Kta
Sawahlunto
Agam
Pariaman
Sijunjung
Pessel
Nasional
Pdg Pariaman
Sumbar
Solok
Kota Padang
Pasaman
Dharmasraya
Bukittinggi
Solok Selatan
Kota Solok
Mentawai
Payakumbuh
Pdg Panjang
Pas.Barat
Tanah Datar
15.7
12.3
11.6
10.7
9.3
Injury
8.2
7.5
7.5
7.2
6.6
6.4
6
4.9
4.4
4.1
4
3.2
3.1
3
3
2.7
0
2
4
6
8
10
12
14
16
18
Riskesdas, 2007
Sijunjung
Tanah Datar
50 Kta
Solok
Pasaman
Kota Padang
Mentawai
Agam
Pas.Barat
Dharmasraya
Sumbar
Kota Solok
Pessel
Pdg Panjang
Solok Selatan
Sawahlunto
Nasional
Bukittinggi
Pdg Pariaman
Pariaman
Payakumbuh
31.2
% Somkers
29.4
29
29
28.9
28
28
27.9
27.2
26.3
25.7
25.6
25.6
25.3
23.9
23.8
23.7
23.5
22.2
21.2
18.1
0
5
10
15
20
25
30
35
Riskesdas, 2007
2
NCDs STRATEGY AND
DISEASES CONTROL
PROGRAM
Provincial Health Office West Sumatra
Serangan
Jantung
Kanker
Diet
Diabetes
Penyakit Paru
Kronik
Kurang
aktifitas fisik
Gangguan Janin
Impotensi
Stroke
Alkohol
Cidera
PTM and Risk Factor
Meroko
k
Objectives NCD’s Program
Advocacy and cpollaboration to raise the priority of NCDs
Employ leadership, governance, multisectoral action and
partnership to acceleate responses to NCDs
Create health promoting environments to reduce exposure to
modifiable risk factor
Strengthenand reorient health systems to address prevention
and control of NCDs
Promote and strngthen capacity for knowledge management and
quality research
Monitor trends and determinants and evaluate progress in prevention
and control
Key Strategies and Priority Action For
Prevention and Control NCD’s
Mapping the
NCD Epidemic
Reducing
exposure to
risk factor
Strengthening
health care
system to
treat NCDs
Surveillance
Prevention
Management
NCDs Control Framework
Health
Promotion
Enabling
Environments
enrichment
CERDIK
LIFESTYLE
BIOLOGY
- Smoking
- Diet
- Physical
activity
- Stress
- Hypertension
- Hiperkolestrol
- Obesity
-Hyperglycemia
PTM &
Cedera
PATUH
POS
BINDU
Increased
community
capacity
PANDU
Early
Detection and
Follow-up
Increased
Knowledge /
Skills Health
Staf
KuratifRehabilitatif
Improvement of
HealthFacilities,
Drugs, Medical
Equipment, etc.
Monitoring Evaluation
Surveillance
Health Promotion
Policy Advocacy NCDs
Strengthening
Community
Action
Support
Networking – Partnership of NCDs
Surveillance and Registry
- Geographic
- Workplace
Environment
ENVIRONMENT
Residential
- School
Promotif
“Health in
All Policy”
Coordination and synchronization
SOCIAL
STRUCTURE
- Social Status
- Age
- Gender
Information
Health Services
Approach of NCDs
HEALTHY
POPULATION
POPULATION
WITH RISK
Health Promotion
Integrated Control
of Risk Factors








Enabling Environments
KTR, Sports Facilities etc.
Healthy Lifestyle:
Not Smoking
Enough Physical Activity
Healthy diet
Behavior CERDIK
Early detection and
Follow Up /Counseling FR
 Referral
Adequate Case Management
of Risk Factors:
 hypertension
 dyslipidemia
 hyperglycemia
 smoke
 obesity
 Pre-cancerous lesions
PATUH
PANDU PTM
 Referral
POSBINDU PTM
COMMUNITY
NCDs SERVICE IN THE
BASIC HEALTH
FACILITIES
Surveillance FR-NCDs in Community
-SP2TP
POPULATION WITH NCDs
NCDs and Complications Control
NCDs Case Management




Emergencies
Outpatient hospitalization
Medical action
Management
PATUH
PANDU PTM
 Referral
HOSPITAL
Complications Prevention
and Rehabilitation:
 Medical Rehabilitation,
 Palliative cancer
 Home Care, Stroke
survivor and
neurorestorasi
 Monitoring and Control
FR
 DM Foot Care
 Calorie Healthy Balanced
Diet
 Gymnastics PTM
PANDU PTM
 Referral

BASIC HEALTH FACILITIES
 PTM-POSBINDU
 COMMUNITY
Survey / Registry NCDs –
SIRS
3
CVDs CONTROL
PROGRAM
Provincial Health Office West Sumatra
CVD Control Program
CVD Control
Program
Health
Promotion
Surveilans
Risk Factor
Smoking
Physical
Activity
Balanced
Nutrition
Diseases
Death
Healthy Life
Behavior
Periodic
checks FR
Population
Screening
Health Facilities
Management
Health
Centre
Early
detection
Reduce the
risk factors
Hospital
Early
detection
Prevention
and
promotion
Health Care
Rehabilitatio
n
CVDs Situation
Conditions NCDs Society (CVD)
 Social Economy (farmers, traders,
fishermen, workers, GAMBLER,
ect)
 Health Seeking Behavioral
 Paradigm
 DEMOGRAPHICS
REGULATION
Community Needs to NCDs
 Disease patterns / TREND
 Stay of Length Inpatient/ not
continuous
 Stay of Length per person per year
 Visits Rate per person per year
CVDs
Risk Factors:
- Diet: gorengan
- Lifestyle:
smoking, no
phisical activity
MASTER
PLAN
MODE OF ACTION
(NILAI AMBANG BATAS
KHUSUS UNTUK MANUSIA)
 Technical and
Projections
Planning
 Organization and
Management
Planning
 Financial and
Projections
Planning
 Community Base
Planning
Program of CVD’s
Integrated With Various Roles In Community, NGOs,
community, ect.
Use Media, local and national
Formulate good ways to give information to
community
Funding from APBD
Make routine time frame and target with capacity
building
Start of community leader
Find national/local “key person” for NCDs
National Program of CVD’s (PERKI)
Community Health Center
1. Healthy CV for community and In and Out Patient
2. Early detection of various CVDs:
a. Risk factors: hypertension, smoking, obesity / BB, DM, etc.
b. Congenital heart disease easily Physical examination: PDA,
VSD, ASD, TOF and other cyanotic infection.
c. Rheumatic Fever and Heart Valve Disease
d. Angina pectoris
e. Heart attack
f. Heart Failure
3. BCLS (Basic Cardiac Life Support),
4. ACLS (Advanced Cardiac Life Support).
National Program of CVD’s (PERKI)
Hospital Class C
1.
2.
3.
4.
Health Promotion for patient, family dan visitor (PKMRS)
Early detection of various CVDs:
a. Risk factors
b. Congenital heart disease easily Physical examination:
PDA, VSD, ASD, TOF and other cyanotic infection.
c. Rheumatic Fever and Heart Valve Disease
Advance Life Support and and advance cardiac support
Hipertension therapy, Mild heart failure, Rhematoid Fever,
cyanotic without complication and advance therapy without
complication for secondary prevention
National Program of CVD’s (PERKI)
Partnership, Private Sector and Community
a.
b.
c.
NGOs ex Yayasan Jantung Indonesia, etc
Profession Organization, ex PERKI, Perhimpunan Bedah
Thorak, Ikatan Ners kardiovaskuler Indonesia, Persatuan Ahli
Gizi
Other NGOs and Private, profit or non profit
ROLE:
a. Preventive and Promotive
b. Health services including Emergency
c. Information services
d. Capacity Building
e. Funding
f. BLN
Scheme: Comprehensive Public Health
Strategies In Heart Disease And Stroke Control
VISI
Environmen
tal
Conditions
Supporting
the Health
and Social
Healthy
Lifestyle
Pattern
Decreased
Risk of
Disease of
the
population
Reduced
incidence of
sudden
death cases
Reduced
incidence of
Disability
Good
Quality of
Life Until
Death
INTERVENTION APPROACH
Policy Change
and
Environmental
Behavior
Change
Detection
and Control
of risk
factors
Management
of Acute and
Emergency
Case
Management
Rehabilita
tion and
Konis Case
End of
Treatment
CONTROL
CURRENT REALITY
Environmen
tal and
Social
Conditions
That Do Not
Support
Unhealthy
Lifestyle
Patterns
Increased
Risk
Factors
Incidence of
Sudden
Death
Becomes
First Case
Recurrence
Risk /
Disabilities
Complicatio
ns Attack
Cardiovasc
ular Disease
fatal /
decompens
ation
3
REGULATION
Provincial Health Office West Sumatra
Permenkes No.28 Tahun 2013
Permenkes No.28
Tahun 2013:
Inclusion of Health
Information and
Health Warnings
On Tobacco
Product Packaging
Application of PHW
begins June 24,
2014
Permenkes No. 30 Tahun 2013
Pencantuman Informasi Kandungan Gula, Garam dan Lemak
pada Pangan Olahan dan Pangan Siap Saji
 Strengthening Food labeling
(Requiring Inclusion of the
information content of total
sugar, total sodium and total
fat)
 Health message about the
maximum limit consumption of
sugar, salt and fat per person
per day
Pesan kesehatan :
“Konsumsi Gula lebih dari 50 gr, Natrium lebih
dari 2000 mg, atau Lemak total lebih dari 67 gr
per orang per hari berisiko hipertensi, stroke,
diabetes dan serangan jantung”
By looking at the
public health message
is able to limit the
consumption of sugar,
salt and fat consumed
to avoid NCDs
PERDA PROV SUMBAR
NO 8 TH 2012 TTG KTR
 Perda Provinsi
 Perda Kota Padang
Panjang, Bukittinggi,
Payakumbuh
 Perbub, Perwako
dan Surat Edaran
4
IMPLEMENTATION
Provincial Health Office West Sumatra
CERDIK dan PATUH
Periksa Kesehatan secara
rutin
Atasi Penyakit dengan
pengobatan yang tepat
Tetap diet sehat dan gizi
seimbang
Upayakan beraktivitas
fisik dengan aman
Hindari rokok, alkohol dan zat
karsinogenik lainnya
POSBINDU PTM ACTIVITY
Monitoring :
Obesitas
Hipertensi
Hiperglikemi
Hiperkolesterol
Pem.Klinis Payudara
Faktor lain
Aktifitas bersama :
KIE
Aktifitas Fisik
Sarasehan
Konseling :
Diet,
Stop merokok
Stress
Self Care
41
DISTRIBUTE OF POSBINDU PTM WEST SUMATRA
NO
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
KAB/KOTA
KAB. AGAM
KAB. DHARMASRAYA
KAB. 50 KOTA
KAB. PADANG PARIAMAN
KAB. PASAMAN
KAB. PASAMAN BARAT
KAB. PESISIR SELATAN
KAB. SIJUNJUNG
KAB. SOLOK
KAB. SOLOK SELATAN
KAB. TANAH DATAR
KAB. KEP. MENTAWAI
KOTA BUKITTINGGI
KOTA PADANG
KOTA PADANG PANJANG
KOTA PARIAMAN
KOTA PAYAKUMBUH
KOTA SAWAHLUNTO
KOTA SOLOK
JUMLAH
Jumlah
Jumlah
Puskesmas
Nagari
Pelayanan PTM
22
82
12
52
22
79
24
60
16
32
17
19
18
182
12
80
18
74
8
39
23
75
10
7
22
4
7
8
6
4
260
774
Jumlah
Desa/Kelura
han
Jumlah
Posbindu
6
2
27
13
10
4
22
179
11
2
5
1
14
5
22
2
77
19
16
1
43
24
104
16
71
76
37
13
385
437
%
7.32%
3.85%
34.18%
21.67%
31.25%
21.05%
12.09%
220.99%
14.86%
5.13%
6.67%
2.33%
58.33%
4.81%
137.50%
2.82%
101.32%
51.35%
123.08%
37.30%
CERDIK dan PATUH
di ‘HEALTHY LIFESTYLE CLINIC’
Healthy Lifestyle Clinic
Early Detection of Cancer
BREAST CANCER
CERVICAL CANCER
SADARI
&
CBE (Clinical Breast
Examination)
Metode IVA (Inspeksi Visual
Asam Asetat)
SVA (Single Visite Approach)
IVA + Treat (krioterapi)
DOWN STAGING
Ca Mamae
DILAKSANAKAN
SECARA
KOMPREHENSIF
PREVENTION OF
Ca CERVIX
Integrated With STI, Family Planning and PKK
NCDs Quick response
Quick response is the first aid to the patient quickly and accurately
before the patient / victim was taken to a health care facility / referral
(Health Care Level 1, 2 and 3)
NCDs condition with quick response
• Loss of consciousness (hyperglycemia, hypoglycemia, etc.)
• Chest pain (myocardial infarc, etc.)
• Breathless (asthma exacerbation, exacerbation of COPD,
pneumothorax, etc.)
• Hemorrhage (injury, fracture, etc.)
• Paralysis (stroke, etc.)
• Nausea and vomiting (Hypertension emergency, due to chemo
radiotherapy and radiotherapy, etc.)
• Seizures (stroke, etc.)
• Great pain (cancer, etc.)
• Bluish
FAKTOR
RISIKO
A
N
A
M
N
E
S
I
S
ROKOK
OBESITAS,
pola makan,
-Berapa lama
sebagai perokok
-Usia
mulai
merokok
-Banyak
batang
rokok
yang
dikonsumsi/ hari
-Jenis rokok
-Apakah terpapar
rokok/
perokok
pasif
-Derajat obesitas
-Lama menderita
obesitas
-Riwayat obesitas
di keluarga
-Pola
makan
(konsumsi garam,
gula, lemak, buahsayuran)
-Aktivitas
fisik
terkait pekerjaan
-Olahraga
HIPERKOLESTE
ROL
-Kadar
kolesterol
-Konsumsi
makanan
berlemak
HIPERTENSI
-Derajat hipertensi
-Lama
menderita
hipertensi
-Riwayat hipertensi
dalam keluarga
-Konsumsi garam
sehari-hari
-Riwayat hipertensi
dalam kehamilan
STRESS
-Stressor
lingkungan
-Stressor
fisiologik
-Stressor
pikiran
ALKOHOL
-Berapa lama
sebagai
peminum
alkohol
-Usia
mulai
minum alkohol
-Banyak alkohol
yang
dikonsumsi/
hari
-Kadar alkohol
KONSELING SESUAI FAKTOR RISIKO
FAKTOR
RESIKO
DENGAN
GEJALA
DIAGNOSA
KERJA
-Batuk kronis
berdahak
-Sesak nafas
-Peningkatan
produksi sputum
-Perubahan warna
dahak
-Batuk
dengan
demam
-Sering makan
-Sering merasa
haus
-Sering BAK
-sesak
PPOK, ASMA, TB,
Kanker Paru,
Pneumonia
DM- Hipertensi
-Nyeri dada
-kesemutan
-sakit
kepala
hebat
-Rasa berdebardebar
Penyakit Jantung
Infark Miokard
-sesak
-udem
kedua
tungkai
-sakit
kepala
hebat atau tidak
biasa
-sakit
pada
belakang kepala
Infark Miokard
Strok
-Denyut jantung
bertambah cepat
-Banyak keringat
-Pernafasan
terganggu
-Otot
terasa
tegang
-Sulit tidur
-Gangguan
lambung
-Perubahan nafsu
makan
-Sulit
berkonsentrasi
-Sering BAK
Infark Miokard
Strok
-Gangguan
lambung
-Berkeringat
berlebihan
- Berdebardebar
Infark Miokard
Penyakit Jantung
NCDs Networking
SUB NETWORKING
1. Surveilans
2. Masalah
merokok
3. Gizi
4. Aktivitas
fisik
5. Manajemen
pelayanan
kasus
Other Programe
Sector
NGO’s
Profession
Function:
Reviewer
Advokator
Think Thank
Inisiator
Fasilitator
Coordinator
Trainer
University: Medical
Faculty, Public Health
Fac
Private Sector (CSR,
PSR)
Mass Media
NCDs Guidelines
Conclusion
 Improved impact of NCDs as a
major challenge for health
programs
 NSDs Control need strong
support, for budgeting, resource
capacity, infrastructure and
community development.
 Cooperation other sectors and
programs is needed for NCDs
Networking
“VISION WITHOUT
ACTION IS JUST A
DREAM”
“ACTION WITHOUT VISION IS
JUST ACTIVITIES”
“ACTION WITH VISION CAN
CHANGE THE WORLD”