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