Asien-Pazifik Woche Seminar (Seminar Asia/Pacifik Week) Berlin, 8-9 September 2011 This forum is the eighth invitation

to the Asia Pacific Weeks in Berlin. There are three international dialogue forums i.e Health, Food and Water. The conference programs, which took place on three days, focused on challenges and joint solution on these global issues. The activity at the firtst day of the conferens ist visitation to some big Hospitals in Berlin. Day two and day three consist of presentations and discussion.

Day Two Health Forum Towards a Green Hospital Donnerstag, 8. 9. 2011 The Forum was being held in three different sessions. The first two sessions before lunch featured the presentations from hospital experts from German and Asian countries. The last session were divided into two different workshop rooms with different theme in relation with Green Hospital concept. The summary of this Health Forum Seminar will be written in six following parts: 1. Partnership between German and Asian country 2. Green Hospital Future Solutions for Existing Hospitals 3. Cost and Benefit of Green Hospital 4. New Dimensions and green Aspects of Hospital Planning 5. The Role of Healthcare IT (e-Health) 6. Healing Architecture In accordance to the shifting philosophy of hospital, from the place to cure the sick to a place to prevent illness, there is also an effort to transform hospitals to be more patient and eco-friendly. Efforts to reduce the ecological footprint of health care summed up as Green Hospitals. The goal of Green Hospital is to create a healing environment for the patients through energy efficiency and saving resources. Green hospital is not always meant by modernizing all aspects in hospital but is rather how the hospital saves more on resources. There are many ways that can be done by the hospitals in order to be a green hospital. Green hospitals usually commit themselves to reduce their energy consumption and increase their efficacy in order to reduce CO2 emission and environment pollution. One redesigns their hospital to be a green building, the other use paperless technology in order to save paper and trees. But the most important is to change the behavior itself. Partnership between German and Asian country German Ministry of Health and Ministry for Economic Cooperation and Development (BMZ) support the program Green Hospital as German commit strongly to preserve the resources and environment. Until now there are about 20 companies are active members of the Partnership (German Healthcare Partnership). This partnership cover the whole range of German expertise in healthcare from defining national and regional health strategies, planning and building top-quality hospitals, providing high-end equipment to offer management support as well as staff training and maintenance. GHP make partnership worldwide with the public and private sectors to provide high quality healthcare solutions. The wide range of services provided by this organizations are including health information service, health strategy service and health financing service. By analyzing and

identifying the need of each particularly receiving country, GHP is able to create specific solutions for each country. Some experts who spoke at the seminar are also members of GHP, for examples from Karl Storz GmbH & Co. KG and Deutsche Gesellschaft fr Internationale Zusammenarbeit (GIZ). Green Hospital Future Solutions for Existing Hospitals PM Wen Jiabao from China visited Germany at 2006, they signed a cooperation contract in the field of medical economy and biotechnology. German Sino Healthcare Group, they call it, still works in close cooperation until 2011 in field of medical technology, hospital management, scientific exchange, etc. There are major challenges to hospital nowadays. Hospital waste and pollution have always been a problem. Have the hospital managed their waste so that it will not pollute the water and air? How much energy consumed by the hospital and how much the CO2 emission per year? When the hospital wants to implement new technology to improve the conditions above, it will always cost more money and technology. The question need to be brought up now is: Can a concept Green Hospital solve at least some of those problems and help to create a sustainable health care structure? For examples, the presenter pointed out at two buildings in China, which have already implemented the green buildings concept. These are Media Tower Beijing and Center of Excellence of Pathology and Pathology Center in Wuxi. Media Tower Beijing has the building technology to reduce and preserve heat through active insulation and natural ventilation. In the other hand, Center of Excellence of Pathology and Pathology Center in Wuxi attempt to be Green Laboratory as part of Green Hospital concept. Green Laboratory improves workflow, turnaround time, and quality, and also decreases waste, consumer goods and energy costs. Thailand is also a good example on how a transformation to be a green hospital costs time and energy. Chief Executive Officer and Chairman Executive Committee of Bangkok Hospital Medical Center (BMC) Thailand hat mentioned in his presentation how to transform 40-years hospital into a new green hospital. They need 5 years continuing process to slowly integrate the green concept into the heart of the employee (from head to heart concept). Basically the concept of green hospital in BMC Thailand is defined with green culture, green behavior and green standard people. To achieve this transformation BMC had done three major steps. First step was to ensure the basic hospital environment in accordance of clinical, Thai hospitality and environment standard. The next step is to get the ISO certification and the most important step is to run a continuous and endless people management until Green People Management is successfully implemented. Green People Management is defined by two large groups of activity, Green Activity and joining the community of Green Activity, like Cans for Prostheses, Recycling Wooden Chopsticks and many more. Green Activity is done by implementing the 4R concept (Recycle, Reuse, Reduce, and Replace) and initiatives in all aspects in hospital, including : a. 4R concept Recycle : water for plants Reuse : furniture, damaged towel, 2nd and 3rd paper Reduce : tap water Replace: Bio-Products

b. Green Initiatives Thai - Preserve the green areas Building garden in living area, receptions, pharmacy, canteen and useless spaces (under the stares) - Improvement energy consumption Natural lighting wards in lobby, exercise room, patients room and ICU Investment in district cooling plants to reduce energy costs Walking campaign (use stairways than elevator and lift) Set hospital solar panel - Improve waste management Garbage selling - Innovation Using transport for human (golf cart) and things (pneumatic tubes and electric scooter) For this effort BMC Thailand is this year become the winner of BEAT 2011 award (Building Energy Awards of Thai). Cost and Benefit of Green Hospital As the Ministry of Health, Berlin Senate Department for Health, the Environment and Consumer Protection Germany is also support the concept of Green Hospital. A partnership agreement was signed between 13 public and private companies, including hospital and nursing homes. They commit themselves to reduce energy and improve energy efficiencies. The purpose of these agreements are specifically to reduce CO2 emission and air pollution, to plan the investment volume and to produce catalog of specific measurement to reduce environment pollution. In order to achieve these goals usually they make a long term contract (minimum 5-15 years), called Energy Performance Contracting. Based on the measurement of CO2 emission, the hospital will get the data on how much the energy costs they have already been saved compared to the volume of eco-technology investment. Meanwhile in China, the transformations process towards Green Hospital has already run for more than 20 years and is still facing problems. There were 17 hospitals being chosen for experimental Green Hospital project. Those hospitals made their own focuses, procedures and implication methods. The concept is to integrate low energy consumption, low emission, zero pollution and standardized management. New Dimensions and green Aspects of Hospital Planning Green Hospital Program of Asklepios Hospital Group is based on three core areas : responsibility for the environment, preventive medicine, and environmentally-friendly use of energy in the construction and renovation of medical clinics in order to support ecological sustainability and qualified responsibility in healthcare sector to protect environment and the patients. There are also 15 other worldwide companies as the partner to this program. By integrating green alliances, green building, green hospital IT, green patient, and green healthcare in Green Hospital Program, the partners group hope they can treat and prevent the diseases while in the same time coping with the global warming issue.

Meanwhile India shares their experience in term of Green Hospital Planning. Building a Green Hospital must be started from the early planning. It is stated in the 20-yearly India Health Care Plan the buildings requirement has to meet the standard otherwise their license will not be approved. One of the Green Concept to be implemented is Micro Zoning, which is to create a zone in hospital for a block of function in order to use the space and energy more efficient. The other principles to design a hospital are incorporate evidence-based design or Healing Architecture and address high level priorities, such as infection control and emergency preparedness, in hospital design and construction.

The Role of Healthcare IT (e-Health) The Charit Uniklinikum as the leading teaching hospital in Berlin has already started their Green IT Project in the middle of 2008. Renewal of the central IT infrastructure is taken into account the environmental guidelines of the Charit. The project consists of three phases approach during the year 2009-2011 for data centers and new PC workstation concept concluded. The Charit had finished the Thermal Assessment at the end of 2010 and improved the efficiency of the cooling technology in the data center by modernizing the air conditioners. Besides that, 200 outdated server and approximately 6.600 from 12.000 PCs (over three years PC-Lifecycle) have been replaced since 2009. As part of the overall project, the entire IT landscape has been trimmed to consistent energy and material efficiency. For the consistent conversion to green IT technologies and and products since middle 2008, the Charit therefore awarded the first project of 2011 with the ecoIT Prize of the German Environmental Aid Association (Deutsche Umwelthilfe). Different challenge will be faced in attempt to introduce Information and Communication Technology as part of Green Hospital Concept in developing countries. In these countries, where people still struggle with money, management and providing health care service, this concept will not be easily accepted, although it is strongly agreed helps the hospital work more efficient. One of the problems faced by a lot of Indonesian health care provider, especially in rural areas, is the long patient waiting time as the use of form paper in every process from patient admission or registration, insurance eligibility, prescription, patient medical record, until radiology and laboratory documentation. Not to mentioned the inefficient work in administration field, such as accounting, billing, summary report, and inventory. Looking at this fact, Paperless Hospital concept may be a better strategy as the beginning step to introduce Green Hospital Concept. And for this reason Deutsche GIZ have cooperated since many years with the Asian and African developing countries to develop a health information system. Healing Architecture Green Hospital concept cannot be separated from the architectural part of the hospital building. Within the last twenty years, a growing scientific evidence showed that the physical environment of hospital have an impact on patients and staffs feeling of wellbeing, stress and general outcome. As what have been presented by the previous expert, light, sound and views to green outdoor areas in hospital give a huge psychological effect to the patients and hospital staffs. That is the reason why the architecture of future hospital needs to take this into account their hospital buildings planning. Future hospital design will combine and integrate the eco-friendly material, design and technology with the humanity aspect in order to provide a healthy conducive work atmosphere for the staff and

in the end a healing environment for patient while at the same time lowering the energy consumption and CO2 emission.

Workshop summary 1. To have the most accurate information before making a plan or an investment can be achieved by doing a simulation. The use of simulation model gives the user security, create transparency and open new possibilities with resulting analytical optimization approaches. Keyword : VAO (visualize analyze optimize) 2. There are common area and high dependency area in hospital in term of their use of energy. In high dependency area like ICU, ER, and operating rooms, zero emission is not possible to be implemented. But in common areas, such as receptionist, lobby, parking, floors, toilet, elevator, administration, caf, etc., zero emission is possible to be implemented through ecotechnology like intelligent AC, sun-shade or light control and optimizing the ventilation.

Day Three Health System Freitag, 9 September 2011 The topics presented on 9th September 2011 in Main Hall (Health themas) devided into three sections: 1. Section 1: under Health System in a state of flux are: a. Challenge of Public Healthcare System in the future b. The Health Care Situation in Vietnam c. The Chinese Healthcare System d. The Indonesian Healthcare System e. The German Public Healthcare System f. Market Entry Asia: an overview about promising markets for German companies 2. Section 2: Change, but how to do it? a. Recent requirements to Hospital Management International Experiences b. One Size does not Fit All Healthcare Services have diverse needs in Asia-Pacific 3. Green Light for Prevention a. National Program for the Promotion of Health and Disease Prevention in Singapore b. Prevention in China c. Workplace Health Promotion d. Prevention First: The Approach of Platform Ernhrung und Bewegung to Avoid Adiposity in Children and Young People Summary from Section 1 (under Health System in a state of flux): - Germany has good health insurance system, which is developed since 19 century. In 2009, 11,6% of its Bruto Produkt Inland was for healthcare sector. The country consist of 16 Lndern (Negara Bagian). Thus, there are three level of regulation in hospital healtcare system, that are Bundes Regierung (Central Government) level who settled the Laws for the country, Landsregierung (regional government) who are settled the regulation for their administrative regions, and the regulation in hospital level. Some of developed countries in Asia (Japan, Korea, Taiwan) develop their health system to be an economic and efficient one. Germany and other European Countries will also get a positive impact when Asian-Pacific countries have good health system. It hopes that people in these developing countries can enjoy good quality and safe healthcare as people in Europa.

Our global problems are weather change, disaster, etc. Developing countries like Vietnam, Indonesia and China are facing similar healthcare problem. Gaps beetween geographycal region and economical status, changing of health cases pattern, limited resources, food poison, etc. Vietnam strategies are improving access to healthcare facilitation by improving number of healtcare resources, improving achievement of some basic health indicators, strengthening preventive medicine, food safety, health promotion, increasing investment and financing mechanism. Indonesian health development reform are revitalizing Primary Health Care and the operational budget, drug supply, distribution of health human resources, developing social insurance including insurance for pregnant woman, decreasing bureaucracy in health sector and to build world class healthcare facilities. China begins its healthcare reform in 2009 with one goal: to establish and to improve esential health system, and to achieve primary healthcare for all. The roadmaps include basic social health insurance, national essential health drug system, improving basic medical service system, equal access to basic public health service, reform in public hospitals as pilot project.

Summary from Section 2 (Change, but how to do it?): - From international cooperatioan experience between Germany and China, the population in China is almost twice of the population of Germany and the capacity of hospital is 6 times as Germany. But number of medical doctor per 100.000 inhabitants in China is three times fiewer, length of stay in hospital is two times longer and life expectation is shorter as in Germany. China is demanding shorter lenght of stay, lower cost and higher quality in hospital service. Starting point to improve health service in China are privatization, open market and potential cooperation, strengthening social insurance and finanzierung system (DRG), improving the service (capacity, structure, supply), integrating China traditional medicine, medical technologie and forschung, information and communication technology, patient safety and risk management, training for health human resources and transfer of knowledge. From Germany Medical Technology perspective, Asia has increasing demand of Healthcare. This is a result of growth population, GDP (Asia will cover 1/3 of total GDP by 2020) and increasing number of aging people. Thats why, medical tehcnology companies must providing integrated healthcare solutions along with clinical pathway in hospitals. Industry has to support change management in healthcare through innovation, and the solutions have to cover broad spectrum of health care. There are three level of healthcare: leading large institution (big cities), medium & large size (urban), and small hospital & health center (rural). This leveling system impacts on the need of healthcare technology. The leading large institutions need cutting-edge technology solutions, the medium & large urgan hospitals need wide range of diagnostic and theraphy solutions, and rural hospitals & healthcare centers need basic health care solution.

Summary from Section 3 (Green Light for Prevention): - Singapores prevention policy is to shift from disease prevention to welness program. Based on The Tipping Point Theory, Singapore believes that Obesity will become the leading disease in the future. To prevent the booming, Singapore government executed public-private strategy by encouraging Private (food industry, restaurnt), People and other department (Public) to campaign and consume healty food (healthy noodle). This became social movement and impacted on the lower risk of obesity.

In China, the objectives of prevention program are to establish and improve a chronic disease prevention and control system, optimize policy support, promote a wide participation of working formation, reduce morbidity and mortality. The Ministerium of Health then promoted healty lifestyle, health knowledge program by engaged mass media, and campaigned self menegement for specific disease. Betrieblicher Gesundheitsfrderung (Health Promotion) in Germany is regulated by Laws; health insurance have to pay the cost for preventive programs (i.e for patient in hospital), there is a chance for employer and employee (beneficiary) to get bonus from this program but only 20% Firms in Germany actively participate in this program. Data from Statistiches Bundesamt (Biro Statistik Germany) shows that working population in Germany, Japan and China have similar trend: percentage of older working people (more than 65 years old) is increases and under 15 years old is decreased. This impcats morbodity amongs employee and the healthcare cost. With this trend, Germany government issued a regulation about safety in workplace, including working hours and holidays, to keep the workers health and prosperous. This will keep the healthcare cost lower compare to cure diseases or accident in unsafe working environment. Prevention programs are implemented also in KITA (Kinder Tagesttte = child daycare) and schools to keep them in their optimal health. These programs are developed on the basis of data, that overweight case increases 50% and adipositas increases 100% amongs children. Plattform Ernhrung und Bewegung e.V (Perkumpulan PEB) is not a short term campaign, but an Europewide network and open for all organizations and groups that want to spread healty lifestyle. PEB supports interdisciplinary exchange, implements pilot projects, develops communication tools, is as center of competence. It has TV program for children and the number of its average viewer is increase.

Written by: Pharmasinta Putri Hapsari, Apt. (Pharmacy Faculty of Airlangga University Indonesia, Berlin School of Economics and Law Germany). Ni Luh Putu Eka Putri Andayani, SKM, MKes (Center for Health Service Management Gadjah Mada University Indonesia, Berlin School of Economics and Law Germany).