DECENTRALIZATION BRINGS LOCAL SOLUTIONS TO HEALTH SERVICES

UNCLAS SECTION 01 OF 02 SURABAYA 000073 SENSITIVE SIPDIS DEPT FOR EAP/MTS, EAP/RSP E.O. 12958: N/A TAGS: EAID SENV SOCI ID SUBJECT: DECENTRALIZATION BRINGS LOCAL SOLUTIONS TO HEALTH SERVICES IN SURABAYA SURABAYA 00000073 001.2 OF 002 This message is sensitive but unclassified. Please protect accordingly. ¶1. (SBU) Summary: The GOI's decentralization program has created significant leeway for local governments to prioritize community services and spending. Surabaya, Indonesia's second largest city, has focused its attention on improving health services and allocated significant budget resources to restructure its community health centers (Puskemas) to provide cheap, high quality, and improved health services. Eight Surabaya Puskesmas achieved certification by the International Standards Organization (ISO) in 2008 for their quality management and high level of service and eleven more are expected in reach this standard in 2009. Surabaya also revised procedures to allow more poor families to qualify for the People's Health Insurance (Jamkesmas) Program. In 2009, Surabaya's success was recognized by the Jawa Pos Group's Institute of Pro Otonomi (JPIP),which rewards achievements of local governments in improving public services. End Summary. Targeted "Puskesmas" -------------- ¶2. (SBU) Community health centers (Puskesmas) have long been the foundation of community-level health care programs. Each Puskesmas serves an estimated 30-150,000 residents of a district, but has traditionally been hampered by substandard facilities, poor quality service, and inexperienced doctors. In an effort to improve health services in the city, Surabaya's government restructured local Puskesmas to better serve their communities and attract higher quality medical providers. As a result, Surabaya's Puskesmas are now considered valuable places to obtain cheap yet high quality health services. The Jawa Pos media group's Pro Otonomi Institute (JPIP) recognized Surabaya's success with an award for local health services. In 2008, 8 of Surabaya's Puskesmas achieved international certification (ISO 9001:2000 standards),with 11 more projected to reach the same standard in 2009. ¶3. (SBU) Surabaya simplified registration procedures and patients are now treated by medical specialists instead of only by general practitioners. Registration now takes only 15 minutes; laboratory results are now available in only 20 minutes. Previously patients had to wait for two hours to register and laboratory results were only available the following day. While the care and services have improved, the cost to the patient remains less than USD 1.00. An official from the Surabaya Health Department, Esty Martiana Rachmie, told ConGen Surabaya that the number of visitors to Puskemas has doubled since the program began. She added that Puskesmas is no longer a medical provider of last resort for the poor; middle income patients have begun using Puskesmas's service. ¶4. (SBU) Each Puskesmas has its own specialization based on local conditions. For example, the Puskesmas in Surabaya's prostitution district offers a Sex-Transmitted Disease (STD) clinic that sees approximately 600 - 800 patients every month. This program was initiated by and continues to receive technical assistance from USAID-funded partner Family Health International. With the increase in patients, this Puskemas identified 68 people living with HIV/AIDS through the Voluntary Counseling and Testing (VCT) Program in 2008. In 2007, the number was 29; in 2006, only 14. The Puskesmas in Sidosermo succeeded in reducing the number of malnutrition cases from 30 to 21 in six months through its Children's Nutrient Clinic. The Puskesmas in Balongsari became the first Puskesmas in Indonesia to offer a palliative clinic and palliative home care for cancer sufferers. Some Puskesmas in Surabaya have finger print facilities where people can use their thumbprint to access their medical records. Attracting Quality Medical Personnel -------------- - ¶5. (SBU) A lack of medical personnel is a problem facing almost all Indonesian communities. The central government retains responsibility for filling quotas and recruiting medical personnel. While other regencies/cities have not allocated significant budget for health sector, the Surabaya government allocated USD 1.3 million from its 2009 local budget just to hire additional medical specialists and other medical personnel for Puskesmas. Surabaya cooperated with the medical faculty of Airlangga University and province's Dr. Sutomo hospital to hire contract medical specialists and recruit an estimated 800 medical personnel. According to Esty Martiana Rachmie, Surabaya SURABAYA 00000073 002.2 OF 002 still needs an additional 700 medical personnel for 2009. Health Insurance -------------- ¶6. (SBU) The central government provides free health service for poor people through the People's Health Insurance (Jamkesmas) Program. Unfortunately, many people categorized as poor are not listed in Jakesmas' quota due to incomplete population databases. The Surabaya administrator revised local procedures to allow poor people not included in the official Jamkesmas program to receive free health services. The administrator allocated funding from the local budget and signed agreements with nine private hospitals to treat these patients. Patients can present a letter issued by a local official confirming that they are poor and a reference letter from their local Puskesmas to the private hospital to receive free service. MCCLELLAND