Best Practice

Surabaya Case

Dr. Haryono Suyono
Member of AUICK International Advisory Committee
Former Coordinating Minister for Social Welfare and Poverty Alleviation, Indonesia

Back Ground

Surabaya is Indonesia's second-largest city and has a population of 2.7 million. It is a port city and the capital of East Java province. It is also a strategically important city given its location as a regional hub. The mayor is elected by the people, while the heads of the city's 31 districts are appointed. Its districts are further divided into 153 villages, 1,350 community organizations and 8,762 neighborhood organizations.

Dr. Haryono pointed out that in addition to the official population of 2.7 million, there are an estimated 300,000 to 500,000 migrant workers who are not counted nor eligible for health care and other services. He stressed that these migrant workers are human resources that should be developed and tapped, and it is important that these migrant workers be treated as city residents and supported accordingly.

Poverty

Dr. Haryono stated frankly that we cannot talk about health in Surabaya without discussing poverty. It is estimated that 15 to 25% of families in the city live below the poverty line. As an example of poverty conditions, he raised the issue of shanty towns or slums located in the city's outskirts, where homes constructed from scrap materials are often shared by families having alternating patterns of sleep and work.

A prime factor behind the poverty is lack of "legal" or "legitimate" jobs. In fact, he said there are higher numbers of people working illegitimately than legitimately. Due to the scarcity of legitimate jobs, people are willing to work for low paying illegitimate jobs, which provide no insurance and no health care. This situation applies especially to the 300,000-500,000 migrant workers.

Many children and youths have to work or try to find work due to familial needs. Moreover, among the impoverished are increasing numbers of unmarried young women.

Health Services

Public health services are provided through hospitals, district clinics and outreach "health clubs" called posyandu. A number of shortcomings in the provision of health services. For instance, although one clinic is allotted per district, the system neglects to take into account actual population numbers and population increases. Furthermore, as he mentioned earlier, non-residents are not eligible for health care. He stressed the need for clinics to encourage themselves to provide "people-centered" services, or in other words services for all people in need. He also drew attention to the relatively high child mortality rate, and suggested that efforts on immunization should be doubled or tripled to address the problem.

Family planning is an ongoing endeavor. On a positive note, contraceptive prevalence is high due to past activities, and special professional services for pregnant women are available in all government clinics. He also cited the posyandu, or health and family planning clubs, which encourage health awareness and safe practices at the community level. Local women's organizations are also working to increase community participation in health.

As regards HIV/AIDS, the total number of confirmed cases has risen from 57 in 2002 to 167 in 2004, a 300% increase in just a few years. However, that the official figures do not tell the real story, as people are reluctant or unable to report they have been infected or unwilling to be tested. Illustrating the lack of official statistical understanding of the problem, he also noted that a large portion of efforts for prevention and support are not documented, as they are done by NGOs and other non-official means.

Dr. Haryono explained that a focus is being placed on educating young people, especially women, on health issues such as HIV/AIDS and family planning. Hospitals are providing HIV/AIDS testing and steps are being taken to get people out into the community, while midwives and other professionals are being encouraged to talk about family planning and be involved with local residents.

Questions and Answers

Q: Is there a relation between HIV/AIDS and migrant workers?

A: Yes there is a relation because the migrant workers are a very vulnerable segment of society. The link is clear; the link is poverty. Some of these people must turn to prostitution as a means to make a living. Intravenous drug users are another highly susceptible group. Poverty and HIV/AIDS are inseparable issues.

Q: How can you overcome conservative elements to promote reproductive health in schools?

A: No single solution is available. Trial and error and continuous actions are required. But one must be careful of making serious mistakes, as they can easily reverse the progress of previous accomplishments.

• If there is opposition to the concept of reproductive health education then perhaps try to make the educational content less direct or obvious. Focus on promoting the goals of the program instead of the program content. Show appreciation for results, such as through newspaper articles or other means.
• Commitment is required in face of opposition, especially in the case of politics. The vision for a policy or program should be one of shared responsibility, one that encourages the participation of all individuals and segments of society.