City Report and Action Plan

Surabaya

Dr. Esty Martiana Rachmie
Head, Coordinating Board of Municipal Family Planning
Surabaya City Government
Indonesia

CITY REPORT

Surabaya is the second-largest city in Indonesia and has a population of around 2.6 million. It is also the country's oldest city, a major port city and the capital of East Java province.

The mayor of Surabaya is elected by the people to serve a five-year term. Below the mayor and deputy major are the city's 23 departments (including health), six agencies, four offices and 31 districts, which are further divided into 163 villages. The local authority consists of an executive and legislative board. The legislative board members are directly elected to serve five-year terms and are responsible for legislation, budgeting and monitoring of services and programs. The mayor has the authority to set policy on internal government systems, but for public policy, approval of the legislative board is required.

Reproductive Health

In 2004, Surabaya's budget for public health services was divided into 46% for health promotion, 19% for preventive health and hygiene, and 35% for community health. The Department of Health is currently aiming to (1) improve quality, availability and reach of health services, (2) improve individual, family, community and environmental health and (3) encourage community independency on health. Strategies involve making improvements in the following areas: (1) human resources in health management, (2) health planning, (3) quality of health services, (4) efforts for preventive health and disease control, (5) efforts for family health services and (6) city hygiene and sanitation.

Relating to reproductive health, the city has the following programs and services available: (1) Services and counseling for mother/child health (2) Reproductive health and family planning services, (3) immunization (4) information, education and communication activities and (5) controlling SDIs including HIV/AIDS.

Challenges facing the above programs include inadequate budgets, shortage of qualified people to execute the programs and inadequate knowledge of reproductive health. Relating specifically to immunization, the program has low coverage of young women and pregnant women. IEC activities, on the other hand, are hampered by a lack of coordination among institutions involved.

HIV/AIDS

The incidence of HIV/AIDS in Surabaya has been increasing annually, going from just one case in 1997 to over 300 cases in 2004. The program to combat the disease is being implemented jointly by the health department, hospitals, community health centers and NGOs. The program is aimed at the general population with specific emphasis on targeting adolescents and high-risk groups such as sex workers, drug users and the poor. In addition to decreasing the rate of HIV/AIDS infection, the program aims to increase knowledge of HIV/AIDS in the community and raise awareness of preventive measures. The budget for HIV/AIDS has been increasing yearly, with a substantial increase occurring in 2005, particularly for testing and supporting people living with HIV/AIDS. At present there is generally low knowledge of HIV/AIDS at the community level, and people suffering from HIV/AIDS are stigmatized and discriminated against.

Current Status of Adolescents

The number of youths 15 to 19 years old is 269,284, about 10 percent of the population. The number of youths 20 to 24 years old is 336,362, about 12.5 percent of the population.

A survey showed that two percent of females and seven percent of males in senior high school, had premarital sex. Among all adolescents, 15 percent had premarital sex. The age of first sexual encounter was as low as 14 among males.

Adolescents and HIV/AIDS:
2000 - 16 HIV cases, 9 AIDS cases.
2001 - 46 HIV, 15 AIDS.
2002 - 41 HIV, 44 AIDS.
2003 - 99 HIV, 49 AIDS.
2004 - 217 HIV, 106 AIDS.

Existing services for adolescent reproductive health and HIV/AIDS are very limited. Online counseling is not available. Adolescents do not come to the health centers for counseling about reproduction. Condom use among the high-risk population is very low.

ACTION PLAN

Objectives

We need a priority program on adolescent reproductive health, to improve young people's knowledge about reproductive health issues and HIV/AIDS.

Target group

Public health center workers, junior high school teachers, senior high school teachers and students, young people out of school.

Program - Timeline

1. Public health centers
   One doctor and two nurse/midwives for each center. Each center to have room for adolescent reproductive health services. (Jan-Mar 2006, 15 centers; Apr-Jun 2006, 30 centers; Jul-Sept 2006, 45 centers; Oct.-Dec. 2006, 51 centers)
2. Junior high schools
   One teacher at each school to receive training. (Jan-Mar 2006, 15 schools; Apr-Jun 2006, 30 schools; Jul-Sept 2006, 45 schools; Oct.-Dec. 2006, 57 schools)
3. Senior high schools
   One teacher at each school to receive training. Five students from each school to form peer group counseling team. (Jan-Mar 2006, 12 schools; Apr-Jun 2006, 24 schools; Jul-Sept 2006, 36 schools; Oct.-Dec. 2006, 42 schools)
4. Out-of-school youths
   Form two peer counseling groups in each subdistrict. (Jan-Mar 2006, 10 subdistricts; Apr-Jun 2006, 20 subdistricts; Jul-Sept 2006, 31 subdistricts)

Action steps - Timeline

1. Meet with mayor to request support for program. Jul 05.
2. Coordinate with related departments (health, education, city management, communication and information). Aug-Sept 05.
3. Contact schools and/or NGOs to look for trainer. Oct.-Nov. 05.
4. Develop training material. (Nov.-Dec. 05).

Budget

Funding to be established by budget committee. Use local government budget for program start-up.