Indonesian Physicians Competency in Global Era

Prof.Dr.dr.H. Rusdi Lamsudin SpS(K), M.Med.Sc

Dekan Fakultas Kedokteran UII

Prof.Dr.dr. H. Rusdi Lamsudin, M.Med.Sc Spesialis Saraf (Consultant)

Medical Doctor, Faculty of Medicine, UGM, 1971 Neurologist, Unair-UGM, 1978 Master of Medical Sciences, New Castle Univ, Australia, 1986 Head of Executive Board Muhammadiyah Hospital, Yogyakarta, 1993-1999 Vice Dean, Faculty of Medicine Muhammadiyah Yogyaakarta University, 1993-1999 PhD, UGM, 1996 Short-course, Unit Stroke & Neuro-Intensive, Insburck, Austria,15 July-15 October, 1997 Head of Stroke Unit, Sardjito Hospital, Yogyakarta, 2001-2005 Head of Neurology Department Faculty of Medicine, UGM, 2001-2005 Dean of Faculty Medicine, Indonesia Islamic University, Yogyakarta, 20012006, 2006-2010

GLOBALIZATION

We are a part of a Global Village having Dual Citizenship Disease knows no boundaries Communications revolution Terrorism and local conflicts Distinction between domestic and international problems is losing its usefulness.

GLOBALIZATION

We are a part of a Global Village having Dual Citizenship Disease knows no boundaries Communications revolution Terrorism and local conflicts Distinction between domestic and international problems is losing its usefulness.

Globalization involves multi-dimensional integration of world economics, politics, culture, health and human affairs, facilitated by a scientific revolution in information and biotechnology.

Globalization is a process of broad social transformation that make national borders more permeable.
Trade is the leader and most powerful force of our time.

NEW GLOBAL ECONOMIC ORDER (1945)

International Monetary Fund (IMF) World Bank General Agreement on Traffic and Trades (GATT) World Trade Organization (1995)

Trade-related aspect of International Property Rights (TRIPS) General Agreement on Trade in Services (GATS)

GLOBAL TRADE
1970 25% Global Output 2002 50% Global Output 2020 67% Global Output

Speed of globalization is exceptional

Good economic policies Structured reforms

Most Governments are ill equipped to manage problems that transcend their borders Global bodies are too weak to provide monitoring of commerce, environment, social development, health, and education

GLOBALIZATION: OPPORTUNITIES

A RISING TIDE WILL LIFT ALL BOATS

Reduction in poverty Exchange of ideas Infusion of scientific knowledge Improvement in health status Social development

GLOBALIZATION: RISKS

A FAST RISING TIDE WILL LIFT BIG YACHTS BUT WILL CAPSIZE SMALL BOATS

Spread of disease Hazardous material Disparities Negative behavior change Corruption

CURRENT STATUS
1 Billion People in the Developed World United States, Europe, Japan
Increase in disposable income Enhanced social injustice Improved standard of living

CURRENT STATUS
3 Billion People in Developing Countries are integrated into the global economy, i.e. China, India, Thailand, Taiwan
Stable governments (good economic policy) Human capital Infrastructure Visionary leadership

CURRENT STATUS
2 Billion People in poor countries have been left behind

Political instability (poor economic policies) Poor or no infrastructure Lack of human capital No natural resources

Their participation in world trade is less than it was 20 years ago, with income falling and poverty increasing.

FIVE GAINS IN GLOBAL HEALTH

Reduction in vaccine preventable diseases Reduction in childhood morbidity and mortality leading to increased life expectancy Tremendous advances in biomedical research; new drugs, new vaccines, genetics Reduction in fertility rates Public private partnerships adding additional resources to solve public health problems

FIVE MISSED OPPORTUNITIES

Dealing effectively with HIV/AIDS epidemic Imbalance in resource allocations between prevention and medical care Environmental degradation Donor-driven need of quick and time limited results, did not allow for development of integrated health infrastructure Missed gender recognition

MISSED GENDER RECOGNITION

Failure to recognize gender dimensions of health Maternal morbidity still very high Failure to have family planning services available to all women Gender based violence remains unaddressed Exploitation of women

SYSTEM IS RUN BY COMPETITION FOR PROFITS

Creates conditions in which powerful control Uneven enforcement of economic order Short term focus on return (profits) No transparency Create competition vs. collaboration

20% of worlds population receives more than 80% of the worlds income

Disparities

WEAKENING THE NATIONAL GOVERNMENTS

Power shift to multi-national corporations, influence of money in the political process Weakening of occupational and environmental standards Less investment in health and social sectors Privatization of health and social sectors

Russia, China, Pakistan

Weakening of safety net institutions Increase of corruption

SOCIAL CHANGE IN SOCIETY

Rapid change creates uncertainty, which leads to polarization of a society

a)

Unable to keep pace with change leads to:

Smoking Drug/alcohol abuse Child abuse Violent crime STD/HIV Unhealthy diets

SOCIAL CHANGE IN SOCIETY

b)

Unable to keep pace with changes, individuals react and become fundamentalists, and struggle to overthrow the government system

India Pakistan Egypt

c)

Russia China United States

Most people try to keep pace with change

Stress in individual and society More material things but no happiness

HUMAN VALUES OF SOCIAL JUSTICE, EQUITY, COMPASSION ARE REPLACED BY A SINGLE FOCUS ON PROFITS

Investment in community slows down Institutions such as schools look to outside help Further power shifts to wealthy people and now the anti human rights activists have legitimacy

ENVIRONMENTAL DEGRADATION
Rapid exploitation of natural resources = rapid profits = rapid environmental degradation Global warming CO2 accumulation Ozone depletion

Many gains of the past may even be lost

SUSTAINABLE DEVELOPMENT BECAME AN EMPTY DREAM

Development that meets the needs of the present without compromising the ability of the future generation to meet future needs.
Human beings are the center of concern for sustainable development. They are entitled to healthy and productive life in harmony with nature.

Absolute Poverty is Still the Major Risk Factor of Poor Health

The path leading from poverty to poor health goes through inadequate nutrition, inadequate housing, lack of education and lack of access to health services. Need for action We need sustainable development in globalizing the economy We need monitoring of unhealthy policies

Change in global economic policies

Advocacy for healthy economic policies to narrow the gap between the need and the services available Effective dissemination of global health knowledge

WFPHA Global Health Council

Necessary to move beyond health for all to consider all of the other dimensions Global good one world, one people New research in social sciences

Global Era

6 millions physicians worldwide serving over 6 billion inhabitants Over 1800 medical schools throughout the world Health services and medical practice are undergoing profound changes forced by economic difficulties in financing healthcare systems

Global Era

Increasing cost of health interventions are related costcontainment policies could threaten physicians humanism and value Rapid advances are occurring in biomedical sciences, information technology and biotechnology New ethical, social and legal challenges for profession of medicine and call for preservation of a balance between science and the art of medicine

Global Era

Medical Standards

Medical standards in use: the worlds overview

USA

The National Board of Medical Examiners (NBME) (1915) The Federation of State Medical Boards (1993)

Europe

Maastricht Agreement (1993)

Australia

The Accreditation Committee of the Australian Medical Council (1985, 1991)

Medical standards in use: the worlds overview

Latin America Asia The World Federation for Medical Education (WFME) (1999)

Medical standards in use: the worlds overview

The Institute for International Medical Education (1999) WHO

Five Stars Doctor National Competencies of Primary Care Physicians (2005)

Indonesia

Global Standard on Basic Medical Education (WFME, 2003)

9 Area 36 Sub-areas (Criterias) STANDARD

Basic -- must Quality development--should

Institute for International Medical Education (seven broad educational outcome-competence domains)

Professional Values, Attitudes, Behaviour, and Ethics Scientific Foundation of Medicine Clinical Skills Communication Skills Population Health and Health Systems Management of Information Critical thinking and research

The Five Stars Doctor (WHO)

Communicator Care provider Care manager Decision maker Community leader

National Competencies of Primary Care Physicians (2005)

Effective communication Performing basic clinical skills Application of Principle from Biomedical, Clinical and Behavioral Sciences and Epidemiology in the Practice of Family Medicine Management of health problems in the individual, family and community Accessing, critical appraising and managing information Self awareness. Self-care and personal development Professional, moral and ethics contexts of practice