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The Importance of Integrated Development with a Health Perspective

The Alma Ata declaration of 1978 stated that health services are the key to achieving the minimum health standards needed to guarantee productivity of life, both socially and economically (Leary, 1997). The degree to which individuals and groups are able to obtain health services from an existing system is connected with the characteristics of society, and also connected with the health care system itself. Goldard and Smith (2001) stated that we can only consider a society to have achieved access to health services if quality health services are available at an accessible cost, where there is also adequate information.

Intervention in various health issues and access to health services can also not be separated from a variety of factors outside the health sector. Braveman (1993) stated that to achieve the highest degree of health, all forms of inequity of access to health services and inequities in the various determinants of health must be reduced. Braveman (1993), Kaplan (1996), Wilkinson (1996), Kawachi and Kennedy (1997) as well as Lynch and Kaplan (1997) have consistently stated that absolute and relative inequity have a negative impact on the health status of a society. Society is a social system where contact between susceptible individuals and biological/infectious agents occur, and where different social behaviour occurs at each social stratum. The social context produces different opportunities for individuals and households to react to diseases or wounds, and these incidences also give rise to different consequences.

Although non health related policy does not seem to be directly connected with health, in fact non health policy can reduce inequity of access which will in turn reduce inequalities in health status. Factors such as education, income, environmental conditions, housing, nutrition, and social and gender equality influence the level of exposure to biological agents/infections. In the end, this will also result in differing degrees of access and health status.

About CHPSC

The Center for Health Policy and Social Change (CHPSC) foundation is a non-government organization whose work is based on the principles of Pancasila (The Five Basic Principles of the Republic of Indonesia) and is not affiliated with any particular religious or political group.

The CHPSC foundation was established on the 15th of May 2002 in the presence of notary Dewi Karomah, with the aim of helping to improve the level of community health in Indonesia. (Act No: 01/15-05-02). The founders of the CHPSC foundation are doctors and behavioural experts who see the importance of making change in various sectors in Indonesia, particularly the health system. The founders of CHPSC are Dr. Susilowati M.Kes., a doctor involved in the field of community health, Prof. Johana E. Prawitasari, Ph.D, a professor in psychology, and Dr. Iwan Ariawan, M.Sc. a doctor involved in the field of statistics and information systems.

The CHPSC foundation is a non-government organization which was only established in 2002, however activities related to the vision and mission of the founders have been in progress for 5 years prior to this. Previously all the activities, which were particularly concentrated on research and the development of the health system, were done under the auspices of a state university. In order to develop the vision and mission of the founders in a more extensive and dynamic way by using a community perspective, the CHPSC foundation was established as a non-government organization. Currently all the activities of CHPSC are completely community endeavours, and organizationally have no connection with any governmental body.



Vision and Mission

The vision of CHPSC is to become a professional and trusted partner in achieving ‘Health for All’, by giving an opportunity for wider involvement to women and minority groups.

The mission of CHPSC is 1)To develop models and concepts of development particularly in the health sector which are based on information and other objective evidence; 2) To endeavour to support all practitioners of development, particularly those in the health sector, in helping to realize the goals of national development; 3) To foster a working network at the micro, macro and global scale and utilising this network to develop and promote concepts/models of development that encourage efforts at achieving prosperity for all; 4) To provide consulting services and technical assistance based on the spirit of professionalism and the search for a best practice solution.



The Activities of CHPSC

In Indonesia women shoulder the heaviest burden in terms of health problems due to their reproductive function. Women run the risk of complications with pregnancy and childbirth, and bear the burden of contraceptive use and complications of infections of the reproductive organs. The maternal mortality rate, one indicator of gender equality in Indonesia, is still high and is only decreasing gradually. On the issue of women’s health, the professionals at CHPSC have national and international cross-sectoral networks which include the police, judges, and prosecutors. The aim is to make law enforcement officials more sensitive in handling cases of violence against women. Capacity building of this system was done by working together will other parties to compile modules on gender sensitivity for The Police. The findings of research and national and international cooperation have been published so that they can become learning material for a wider range of interested parties. Cultural aspects in society help to perpetuate public and domestic violence against women. As such we need the society to become actively involved to realize the importance of change toward gender equality in the field of health care. The CHPSC foundation, which is supported by a multidisciplinary team, conducted capacity building of the health system to improve the access of women in chosen locations to quality, integrated reproductive health services. Training was provided to improve the capacity of health workers. Furthermore, women will be involved and empowered in an integrated program of community mobilization. This effort will be conducted by graduates from various fields including behavioural experts, sociologists and architects. In the field of reproductive health, the CHPSC foundation has also conducted a survey of infertility and observational research about the implementation of policy for the control of sexually transmitted diseases (STDs). We have also conducted an in-depth review of the role and the potential of the private sector in the provision of midwifery services. A survey on the prevalence of iron deficiency anaemia in children under 5 and pregnant women completed the picture of health status in vulnerable groups in this society.

The exchange rate of the rupiah against the US dollar which fell drastically in August 1997 signalled the beginning of an economic crisis in Indonesia, which was then followed by the implementation of a policy of decentralization in 2001. At the same time, the number of cases of malaria rose dramatically in several areas in Indonesia. The CHPSC foundation has conducted extensive research on the effect of the national crisis as well as the potential implications of the decentralization policy on access to health services, especially malaria treatment. It was proven that social, economic, behavioural and even political factors can influence the incidence of malaria and access to health services.

The continuing multidimensional crisis which has been accompanied by horizontal conflict and natural disasters in various regions has led to the existence of groups of refugees within their own country. In East Java, and particularly on the island of Madura, the CHPSC foundation has researched the impact of the crisis on the control of tuberculosis amongst refugees. Expanding the context of observation, the CHPSC foundation researched factors contributing to the resilience of the refugees, the health system and the social system. The CHPSC foundation has tried to see the emergence of tuberculosis and its persistence amongst refugees as part of the stress and social crises they have experienced, and not merely as a medical problem. The access of patients to medicine and health services is determined by social, economic and behavioural determinants. The CHPSC foundation has given a picture of the role of the private sector in the control of tuberculosis as something important which should be factored in and enhanced by the government in the development of its program.

To strengthen the health system, the CHPSC foundation has developed management information systems and various health programs, a training needs analysis for the Department of Health, development of human resources in the health sector, development of the concept of accountability and complaint resolution in health services as well as supervision and evaluation of several programs from the government and the private sector.



Networks

Organisations that have worked together with the professionals at the CHPSC foundation include: The Department of Health of the Republic of Indonesia, United States AID, The World Health Organization, Asian Development Bank, The World Bank, The British Council, The Ford Foundation, United States Naval Medical Research Unit – 2 (Namru-2), several state universities and the various regional governments. The CHPSC foundation is also involved in international training and research forums like the UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Disease.