human rights and social welfare
Studi Kasus :
HAK ATAS JAMINAN SOSIAL
DAN HAK ATAS KESEHATAN
Heru Susetyo, SH. LL.M. M.Si.
case
• Sejak Januari hingga Maret 2008
sebanyak 5 orang di Rote Ndao,
NTT meninggal dunia karena
busung lapar. Sumber-sumber
kehidupan masyarakat setempat
tidak lagi berproduksi, dan daya beli
masyarakat tidak ada sama sekali.
• Kelimanya meninggal di Rumah
Sakit Umum Daerah Rote Ndao.
Belum termasuk yang meninggal di
Puskesmas atau keluarga.Pasien
gizi buruk yang sedang dirawat di
rumah sakit setempat sebanyak
delapan orang. Sementara itu
selama 2007 sebanyak 17 anak
Balita meninggal dunia
SITUASI KESEHATAN
INDONESIA
• Jumlah Puskesmas (2005) 7669 unit
• Rasio : 3.46 – 3.56 per 100.000 penduduk
• (setiap 100.000 penduduk dilayani oleh 4
unit Puskesmas)
• Jumlah Rumah Sakit (Umum dan Khusus)
pada tahun 2005 : 1268 unit
• Pada tahun 2000 – 2005 rasi tempat tidur
RS per 100.000 penduduk relatif berkisar
antara 61 – 62 per 100.000 penduduk
SITUASI KESEHATAN
INDONESIA (2)
• Jumlah penduduk Indonesia tahun 2010
diperkirakan 236 juta jiwa
• Untuk mencapai Indonesia Sehat 2010
diperkirakan kebutuhan tenaga kesehatan
sebanyak 1.000.338 jiwa
SDM Kesehatan
• Provinsi dengan Jumlah SDM Kesehatan
terendah tahun 2005 :
• Gorontalo (258 orang)
• Maluku Utara (351 orang)
• Bangka Belitung (521 orang)
• Berdasarkan profesinya jumlah tenaga
kesehatan yang bekerja di RS per 2005 adalah
159.999 dengan komposisi perawat 105.563
jiwa dan dokter 25.941 jiwa
Pembiayaan Kesehatan oleh
Pemerintah
Alokasi Anggaran tahun 2005 (rutin,
pembangunan) Depkes Rp 10.67 trilyun
dan realisasinya sebesr Rp 6.52 trilyun
Pembiayaan Kesehatan oleh
Masyarakat
• Persentase Kepersertaan Jaminan
Pemeliharaan Kesehatan tahun 2005
•
•
•
•
•
•
Kartu Sehat
Askes
Jamsostek
Dana sehat
JPKM
Lain-lain
27.7 %
6.7 %
2.08%
1.92%
0.95%
2.51%
Penyebab kematian
di middle income countries
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Stroke and other cerebrovascular disease
Coronary heart disease
Chronic obstructive pulmonary disease
Lower respiratory infectrion
HIV/ AIDS
Perinatal conditions
Stomach cancer
Trachea, bronchus, lung, cancers
Road traffic accidents
Hypertensive heart disease
Low income countries
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Coronary heart disease
Lower respiratory infections
HIV/ AIDS
Perinatal conditions
Stroke and other cerebrovascular diseases
Diarrhoeal diseases
Malaria
TBC
Chronic obstructive pulmonary disease
Road traffic accidents
Article 22 UDHR
• Article 22
Everyone, as a member of society, has the right
to social security and is entitled to realization,
through national effort and international cooperation and in accordance with the
organization and resources of each State, of the
economic, social and cultural rights
indispensable for his dignity and the free
development of his personality.
Perbandingan Pembiayaan Kesehatan di ASEAN
(2003)
no
Negara
Persentase Keseluruhan pengeluaran
di bidang kesehatan dibandingkan PDB
1
Cambodia
10.9%
2
Vietnam
5.4%
3
Singapore
4.5%
4
Malaysia
3.8%
5
Brunei Darussalam
3.5%
6
Thailand
3.3%
7
Filipina
3.2%
8
Laos
3.2%
9
Indonesia
3.1%
10
Myanmar
2.8%
Article 25 UDHR
Article 25
1. Everyone has the right to a standard of living adequate
for the health and well-being of himself and of his
family, including food, clothing, housing and medical
care and necessary social services, and the right to
security in the event of unemployment, sickness,
disability, widowhood, old age or other lack of livelihood
in circumstances beyond his control.
2. Motherhood and childhood are entitled to special care
and assistance. All children, whether born in or out of
wedlock, shall enjoy the same social protection.
Article 9 ICESCR
(ratified by UU No. 11/ 2005)
Article 9
• The States Parties to the present
Covenant recognize the right of everyone
to social security, including social
insurance.
AArticle 9 ICESCR
(ratified by UU No. 11/ 2005)
Article 12
1. The States Parties to the present Covenant recognize the right of
everyone to the enjoyment of the highest attainable standard of
physical and mental health.
2. The steps to be taken by the States Parties to the present Covenant
to achieve the full realization of this right shall include those
necessary for:
(a) The provision for the reduction of the stillbirth-rate and of infant
mortality and for the healthy development of the child;
(b) The improvement of all aspects of environmental and industrial
hygiene;
(c) The prevention, treatment and control of epidemic, endemic,
occupational and other diseases;
(d) The creation of conditions which would assure to all medical service
and medical attention in the event of sickness.
UU No. 39 tahun 1999
• Pasal 41
(1) Setiap warga negara berhak atas jaminan social yang
dibutuhkan untuk hidup layak serta untuk perkembangan pribadinya
secara utuh.
(2) Setiap penyandang cacat, orang yang berusia lanjut, wanita
hamil, dan anak-anak, berhak memperoleh kemudahan dan
perlakuan khusus.
Pasal 42
Setiap warga negara yang berusia lanjut, cacat fisik dan atau cacat
mental berhak memperoleh perawatan, pendidikan, pelatihan, dan
bantuan khusus atas biaya negara, untuk menjamin kehidupan yang
layak sesuai dengan martabat kemanusiaannya, meningkatkan rasa
percaya diri, dan kemampuan berpartisipasi dalam kehidupan
bermasyarakat, berbangsa, dan bernegara.
TIGA GENERASI
HAK ASASI MANUSIA
GENERASI
PERTAMA
GENERASI
KEDUA
GENERASI
KETIGA
JENIS
HAK
Hak-Hak Sipil dan Politik
Hak-hak Ekonomi, Hak-Hak Kolektif
Sosial, dan
Budaya
ASAL
IDEOLO
GI
Liberalisme
Sosialisme,
Demokrasi Sosial
Ekonomi, Studi
Pembangunan
MACAM
HAK
Hak untuk memilih,
kebebasan mimbar, peradilan
yang adil, bebas dari
penganiayaan, perlindungan
hukum, bebas dari
diskriminasi
Hak atas
pendidikan,
perumahan,
kesehatan,
employment,
pendapatan yang
berimbang,
jaminan sosial,dll
Hak atas
pembangunan
ekonomi dan
kemakmuran,
keuntungan dari
pertumbuhan
ekonomi, harmoni
sosial, lingkungan
yang sehat, udara
TIGA GENERASI
HAK ASASI MANUSIA (2)
GENERASI
PERTAMA
GENERASI
KEDUA
GENERASI
KETIGA
BADAN YANG
MENANGANI
Klinik hukum,
amnesty intl,
human rights
watch, refugee
work
Negara
kesejahteraan,
sektor ketiga,
private market
welfare
Agen2
pembangunan
ekonomi, proyek2
komunitas,
Greenpeace
PROFESI YANG
DOMINAN
Hukum
Pekerjaan sosial
Community
development
PEKERJAAN
SOSIAL
Advokasi,
penanganan
pengungsi,
penanganan
pencari suaka,
reformasi lembaga
pemasyarakatan
Pelayanan
langsung,
manajemen negara
kesejahteraan,
pengembangan
kebijakan dan
pengkajian advokasi
Community
development, social,
economic, political,
cultural,
environmental,
personal/spiritual
Kewajiban Negara terhadap HAM
•
Amnesty International (2007) mentioned that the
State’s obligations are derived from four key principles :
(1) Equality and non-discrimination, which require the
State to take measures to prevent discrimination
including taking affirmative measures;
(2) Indivisibility and interdependence of rights;
(3) Accountability;
(4) Participation, which requires that policies must be
devised, implemented and monitored in a manner that
allows for popular participation.
Kewajiban Negara terhadap HAM
(2)
• Obligation to Respect; In the context of delivering
essential services, the duty to respect means that the
State is responsible for ensuring the enjoyment of
human rights relevant to the concerned service.
• Obligation to Protect; The State has an obligation to
protect citizens from human rights violations. The duty to
protect requires that vulnerable groups be given special
protection.
• Obligations to Fulfill and to Promote; The State’s duty
to fulfill includes the duty to promote, essential to
ensuring effective public participation and access to
information. The obligation to fulfill requires the adoption
of positive measures that enable and assist individuals
and communities to enjoy their rights. Additionally, there
is an obligation to provide the right when individuals or
groups are unable to realize the right by their own means.
Paradigma Kesejahteraan Sosial
• Titmuss suggested three models of social policy
for the provision of social welfare :
• The residual welfare model asserts that social
welfare institutions come into play only
temporarily when the institutions of family and
the private market fail.
• The industrial achievement-performance model
says that social needs should be met on the
basis of merit, work, and productivity.
• The institutional redistributive model calls for
universal services to be provided outside the
market and on the basis of need. (Iatridis, 1994).
Paradigma Kesejahteraan Sosial
(2)
• Residual paradigm views that the state responsible only in the last
resort of social welfare system or so called `minimalist` system. This
system applies only when other systems (market, family system, etc)
have failed in meeting individual needs.
• Institutional paradigm or Institutional welfare model is developed
by consensual values between state and the people. Conformity is met
by social integration process not only rely on individual choices.
• Developmental paradigm, on the other hand, is a social welfare
system based largely on social justice or democratic socialist
perspective which strongly emphasizes social justice and equality. The
role of the state, in this paradigm, is very strong and proactive, and
therefore lies as antitheses of residual paradigm which tends to be
reactive (Adi, 2006).
Social Security/ Jaminan Sosial
• Danny Pieters (2006) defines social security as :
the compilation of benefits in cash and in kind, including
services, granted to some persons. The arrangement as
granting protection against the insecurity resulting from
the risks related to the ascent of the industrial society
and its development or, in short, against social risk.
• Sinfield (2006) defines social security as a situation of
complete protection against the loss of resources while
Berghman (2006) perceives it as a situation of complete
protection against human damage.
Hak Atas Jaminan Sosial
• The right to social security is recognized, since
the end of the Second World War, as a basic
human right. Nobody doubts its fundamental
importance. Social security is one of the greatest
achievements of modern society, even if it is
certainly not fully available to every human being
on this planet. For those who have access to it,
social security means freedom.
• (Langendonck & Put).
Hak Jaminan Sosial seperti apa?
•
1.
2.
3.
4.
What should social security offer? Most people will
agree on the following:
it has to provide an income to those who are deprived of
it; it has to guarantee a replacement income to those
who are temporarily out of employment;
it has to provide suitable employment or a replacement
income for those who have permanently lost their
employment;
it has to offer possibilities of social integration to those
who are handicapped; and
it should provide the necessary care for those who
cannot lead an independent life. These must be the
benefits to be provided by social security in present-day
society. (Langendonck & Put).
•
•
Social security has to :
offer every person sufficient resources for a living
according to human dignity, including health care;
• offer workers (employed and self-employed)
replacement incomes at the end of their working life, or
when their earnings are interrupted because of
sickness, accident, maternity, invalidity or
unemployment;
• contribute to social integration of all residents and to
integration of all potential workers into the labor market
(Langendonck & Put).
• Social security systems in many developed countries consist of a
combination of two major programs: social insurance and social
assistance. Characteristics of social insurance programs are they
are financed by contributions, they generate "earned" benefits for
workers and their families, and they provide for various
contingencies that interrupt or stop earnings (such as illness, old
age, maternity and unemployment). On the other hand,
characteristics of social assistance programs are they are noncontributory and met from general revenues; they are designed to
supplement the incomes of particularly vulnerable groups (elderly
and disabled). In some countries they provide a "safety net" for
those who are not able to access social insurance benefits. The
benefits and eligibility conditions vary from country to country. The
benefits may be either in cash or in-kind in the form of food aid. The
schemes include "income replacement schemes" or "cost
compensation schemes" that provide complete or partial compensation for family care, health care, funeral costs, etc (University
of Minnesota Training Module, 2008).