“Service
Development Under
ASEAN Economic
Community”
Health and Education
Fasli Jalal
Chairperson of
BKKBN
INDONESIA among ASEAN COUNTRIES
Basic Demographic Indication
Demographic transition is taking place at among the fastest rates compared with other
regions of the world, whether in terms of fertility reductions, population ageing, and rural-tourban migration. Rapid epidemiological transition is also occurring, with the disease burden
shifting from infectious to chronic diseases.
Availability of Health Workers in South East Asia
Kanchanachitra C, Lindelow M, Johnston T, Hanvoravongchai P, Lorenzo FM, Huong NL, Wilopo SA,
Rosa JF. Human resources for health in southeast Asia: shortages, distributional challenges, and
international trade in health services. Lancet; 2011
Production of Health Workers in South East Asia
Kanchanachitra C, Lindelow M, Johnston T, Hanvoravongchai P, Lorenzo FM, Huong NL,
Wilopo SA, Rosa JF. Human resources for health in southeast Asia: shortages,
distributional challenges, and international trade in health services. Lancet; 2011
Trade in Health Services
Kanchanachitra C, Lindelow M, Johnston T, Hanvoravongchai P, Lorenzo FM, Huong NL,
Wilopo SA, Rosa JF. Human resources for health in southeast Asia: shortages,
distributional challenges, and international trade in health services. Lancet; 2011
Migration of ASEAN Health Workers
Kanchanachitra C, Lindelow M, Johnston T, Hanvoravongchai P, Lorenzo FM, Huong NL,
Wilopo SA, Rosa JF. Human resources for health in southeast Asia: shortages,
distributional challenges, and international trade in health services. Lancet; 2011
Kebutuhan, Perkiraan Lulusan
dan Kekurangan/Kelebihan Tenaga Kesehatan Tahun 2014
Tahun 2014
No
Jenis Tenaga
1
Dokter Spesialis
2
Dokter Umum
3
Dokter Gigi
4
Kebutuhan
2014
Ketersediaan 2013
Lulusan
Atrisi (2,5%/
tahun)
Kekurangan
/ Kelebihan
29.452
20.602
366
515
8.999
117.808
85.405
6.939
2.135
27.599
26.998
28.772
1.675
719
(2.730)
Perawat
387.785
427.243
28.835
10.681
(57.612)
5
Bidan
184.075
217.016
18.545
5.425
(46.061)
6
Perawat Gigi
39.269
37.897
1.085
947
1.235
7
Apoteker
29.452
31.076
3.946
777
(4.793)
8
Asisten Apoteker
58.904
53.293
4.864
1.332
2.080
9
SKM
29.452
35.424
6.174
886
(11.260)
10
Sanitarian
36.815
26.631
1.685
666
9.165
11
Gizi
58.904
44.364
1.812
1.109
13.837
12
Keterapian Fisik
14.726
10.816
730
270
3.450
13
Keteknisan Medis
22.089
25.036
4.107
626
(6.428)
Challenges :
Human Resources of Health in Indonesia
Global vs Local
Demand
Disparity of
Institution Quality
Causing the Variability
of Competencies & the
needs of Health
Facilities
Urban vs Rural
Demand
Advance vs
Common Disease
Demographic challenges
Geographic challenges
Incongruity of regulations for health education
Incompatibility of Role & Functions of MoH & MoE
10
Healthcare in AEC 2015
Lim J. Healthcare & AEC 2015: framework for considering benefits and costs. Available
at www.insightshealthassociates.com. Downloaded March 2014
Trade in Health Care Services
• Two types of health care services:
1. Medical professional services
2. Health services by hospitals or other facilities (e.g.
laboratory, ambulance)
• Four modes of service trade:
Hanvoravongchai P. ASEAN Community 2015: what is it all about. Department of Preventive
& Social Medicine, Faculty of Medicine Chulalongkorn University.
Mutual Recognition Arrangement
•
Allows health professional (doctors, dentists, nurses) certified
in one ASEAN country to be recognized in other countries
within certain conditions, such as:
•
•
•
•
•
Registration and certification by the regulatory authority of the
country of origin
Active practice experience
Compliant with Continuing Professional Development
Free of professional ethical violation or any legal proceeding
Compliant with other assessment or requirement by host country
Hanvoravongchai P. ASEAN Community 2015: what is it all about. Department of
Preventive & Social Medicine, Faculty of Medicine Chulalongkorn University.
• Goals of Mutual Recognition Agreements:
• Encourage Foreign Direct Investment (FDI)
• Meet short-term skill shortages
• Facilitate upgrading of local population
• Meet international commitments under GATS/FTA
• Challenge: policies and regulatory frameworks
affecting mobility of skilled labor flow
Lim J. Healthcare & AEC 2015: framework for considering benefits and costs. Available at
www.insightshealthassociates.com. Downloaded March 2014
Strategic Steps :
Continous Quality Improvement
Quality of System
Health Education System
Accreditation System
Quality of Schools
Certification System
Quality of
Graduates
Continuous Professional Development
QUALITY CASCADE
Quality of
Practice
The Best Health
Outcomes
3 Paradigms of Reform
Re-engineering Quality Culture
•Standards of Education
•Standards of Competencies
•Academic paper of
Education System
for each profession
Partnership among
professions :
education to services
Quality
Assurance
System
Interprofessional
Collaboration
• Accreditation System
• Competency Examination
System
• Indonesian Qualification
Framework
PublicPrivate
Partnership
Partnership between
government,
professionals
community &
independent agencies
agent for maintaining sustainability
Independent agency
for accreditation & competency examination
REGULATORY REFORM IN HEALTH HIGHER EDUCATION
Education Sector
< Year 2010
PRE PROJECT
Act No.20/2003 :
National Education
System
Year 2010 - 2014
PROJECT IMPLEMENTATION
Ministrial Decree :
National HE Standards
Act No.12/2012 :
Higher Education
Ministrial Decree :
Quality Assurance System
Act No.20/2005 :
Teacher & Lecturer
Ministrial Decree :
Accreditation system
Government Decree
No.19/2005 :
National Education
Standard
Ministrial Decree :
Competence Certificate
UU No.20/2013 :
Medical Education
DGHE Decree :
Student Quota
> Year 2014
POST PROJECT
Govern. Decree :
Primary Healthcare &
Internship Arrangement
Govern. Decree :
Clinical Lecturer
Ministerial Decree :
Medical Student
Selection
Ministerial Decree :
Medical Faculty
Governance
Health Sector
Harmonization of higher education & health regulation
Act No.29/2004 :
Medical Practices
Joint Decree (MoEC-MoH):
Competency Examination
Act No.36/2009 :
Health
Joint Decree (MoEC-MoH):
Transfer of academic coaching for the
instititutions under MoH to MoEC
Act No.44/2009 :
Hospital
Joint Decree (MoEC-MoH):
Teaching Hospital for Public Universities
Govern. Decree :
Teaching Hospital
Health Worforce Act
Nursing Act
Road Map from Quality Education into Services :
Lessons Learned from Medicine
Stakeholder Roles & Authorities & Legal Aspects
Academic
diploma
&
Professional
diploma
Medical Faculty
Professional
Certificate
&
Competency
Certificate
Letter of
Registration
(STR)
• Higher Education Decree
• Medical Education Decree
Medical Practice
Decree
Professional Organization
Indonesian Medical
Council
Independent Agency of Accreditation &
Competency Examination
Letter of
License
(SIP)
Government
Regulations on Foreign Ownership in
the Healthcare Sector of each ASEAN
Country
• Indonesia
Foreign equity share limit in hospital services,
clinics of specialist doctors, clinic laboratories
and medical check-up clinics is 67%.
SIGNIFICANT IMPORTANCE
• The 12th ASEAN Summit in January 2007- Cebu
Declaration on the Acceleration of the
Establishment of an ASEAN Community by 2015.
• This process is set up to achieve the noble target
in enduring solidarity and unity among the
nations and peoples of ASEAN.
• “Education is the pre-eminent source of
economic development in the 21st century,
creating more and higher quality jobs and
bolstering economic growth”.
(20th APEC Economic Leaders’ Declaration: Annex D Promoting CrossBorder Education Cooperation)
I. ROAD MAP for the DEVELOPMENT of ASEAN
QUALIFICATION REFERENCE FRAMEWORK
•
•
•
•
•
Adoption of the Cha-Am Hua Hin Declaration-2009
DEVELOP national skills framework as an incremental
approach towards an ASEAN skills recognition
framework;
PROMOTE greater mobility of students;
SUPPORT greater mobility of skilled workers;
DEVELOP an ASEAN competency-based occupational
standard aimed at supporting the development of
ASEAN human resources that are regionally and
globally competitive;
ENCOURAGE the development of a common standard
of competencies for vocational and secondary
education as a base for promoting mutual
recognition.
ASEAN QUALIFICATIONS REFERENCE FRAMEWORK
OBJECTIVES:
development of infrastructure in the form of Regional
common reference frameworks that enable:
1. deepen integration and harmonization by strengthening
mutual trust and cooperation among ASEAN nations
2. create a common identity;
3. support and inform reform in individual countries,
providing guidance and promoting good international
policy and practice in HRD;
4. Facilitate transparency and commonality of multiple
complex systems; mobility of workers and students;
5. support economic imperatives such as removal of
barriers to trade by promoting labour market mobility
with fair recognition of competencies and reduction of
barriers to the mutual recognition of the skills and
qualifications.
Bateman&Cole-2013; David Lythe-2013
The creation of the
free flow of skilled
labour through
‘harmonisation and
standardisation
Formation of MRAs
The 12th ASEAN Summit in
January 2007- Cebu Declaration
on the Acceleration of the
Establishment of an ASEAN
Community by 2015
2005
2015
2007
1995
The ASEAN
Framework
Arrangement
on Services
(AFAS) of
1995
Establishment of
AQRF Board
Sectoral
implementation
the ANNZFTA
Qualifications
Reference Framework
Forum held in late
April 2011
2011 20122013
Oct 12- concept paper
of AQRF
March 2013 draft
outlines of AQRF
2014
2018
Referencing
Processes is
concluded
S-3
S-2
S-1
D-4
9
+
8
D-3
D-2
7
D-1
Yr-12
6
Yr-11
5
4
3
2
1
II. Strategic Alliances among ASEAN Universities
• Specific Educational Program(s) based on Strategic
Alliances is required to be operated under national
and international laws.
• Strategic Alliances should be engaged based on these
five principles:
1.
2.
3.
4.
5.
Prioritizing the national development
Equal and mutual respect
Highest value addition to a Quality improvement
Sustainable
Diversity
Types of Specific Educational Program(s)
based on Strategic Alliances
Degree awarding programs:
1. Joint Degree (Program Gelar Bersama)
2. Double degrees (Program Gelar Ganda)
2 types of Double Degree programs
A. Acceleration or fast track
B. Regular
Operating Modes
• Credit Transfer (Program Pemindahan Kredit) &
Credit Earnings (Program Perolehan Kredit);
• Twinning (Program Kembaran)
• Joint Supervision (Program Pembimbingan Bersama
dalam Penelitian);
• Student and/or Staff Exchanges (Program Pertukaran
Mahasiswa dan/atau Dosen)
MINISTRY OF EDUCATION AND CULTURE’S
COMMITMENT FOR AFAS 8

Universities throughout the world, including those in
South-East Asia, will no longer be the sole producer
and disseminator of knowledge amid the emergence
of multiple competitors such as corporate
universities,
research
institutes,
industrial
laboratories, think tanks and various kinds of
consultancies.

Greater cross-border provision through transnational
education expansion and the concentration of
research expertise and funding will ensure that this
area will continue to be of interest and concern to
higher education providers and policy makers.

South-East
Asian
higher
education
institutions face multiple challenges. How
well
they
redefine
and
reinvent
themselves to suit the changing societal
needs in the era of globalization is critical
for their development and future.

There is a need for greater cooperation
and collective effort in tackling the
challenges of making higher education
more relevant and competitive within the
global knowledge economy.

Universities also have a role to play in
promoting inclusive multiculturalism and
universal values. This has become even
more significant given the greater
polarization of communities and religions
around the region and the world.

Student and academic mobility and
exchange can serve to share a greater sense
of
cross-cultural
understanding
and
tolerance among ASEAN member countries
and communities.
Thank You
Together We Can
HPEQ DIKTI