Dr. Sri Setiyani , with interpreting assistance of Dr. Kuntoro of Airlangga University School of Public Health, presented the challenges facing Surabaya to provide welfare to its aged, and her plan to raise awareness for community participation.

1. The City

Surabaya is the second largest city in Indonesia. In 2005 its population was 2,448,550, of which 238,712 people (8.7%) were elderly. In March 2008, the population had increased to 2,839,192, with an aged population of 254,120 (9.0%). Rapid development and increased and easily accessible health facilities in the region have decreased infant mortality and increased life expectancy. 

Surabaya health service provision for the aged includes health awareness promotion; fitness building; medical check-ups and referral; the developing of public health centers and hospital clinics for the elderly; facilitation and guidance of participation and community empowerment (elderly groups); provision of special elderly rest rooms in health care facilities; and networking cooperation among related inter-sectors. 

There are 241 ’Elderly Integrated Service Posts’ (Posyandu Lansias) which provide health promotion and prevention through awareness raising, leaflets, and other information media. There are also 163 ’Elderly Posts’ (Karang Werdas), organizing religious, mental and spiritual activities, as well as job opportunities, education, training and legal support. Regional regulation requires the enhancement of elderly welfare to incorporate these services, as well as social support and protection. Moreover, providing public facilities that are accessible to the elderly is mandatory. 

Elderly citizens at one of Surabaya’s shelters

The aged are categorized into three types - the potential elderly, the non-potential elderly and the neglected elderly. The potential elderly are healthy and able to work or provide a service to society. The non-potential elderly are dependent on financial and non-financial support, and should be protected through social facilitation at their homes or elderly welfare consultation institutes, arranged by government and private agencies. ‘Elderly Posts’ facilitate their active participation through study tours, recreation, seminars, exhibitions, and social contributions (depending on their economic conditions). This relieves dependence on family, community and government. The neglected elderly are those whose basic needs are not met, and they should be placed in elderly nursing homes. The potential aged can balance the burden of the non-potential elderly and the neglected elderly through projects such as the ‘silver college’ learning institute for the aged. 

Challenges Surabaya faces concerning the aged are their declining social activity, interaction, abilities and skills. Their employment opportunities are limited at very time that their daily life needs and health care costs for degenerative disorders increase. Changes towards individualistic social values in the community mean that the elderly are often marginalized from community life. 

These challenges need to be overcome through more cooperation and participation of social organizations, NGOs and the community; more understanding of elderly issues and services by health workers; and promotion to families of the importance of elderly group activities. Strategies need to be formulated with shared vision, utilizing the appropriate manpower, money, materials and methods.

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1. The Proposed Action Plan

As national development has resulted in increased life expectancy, there is a higher demand for health care provision to the elderly populaiton of Surabaya City. Primary Health Care Centers are the first line in community health care provision, and so their services need to be expanded to meet this demand. 

With out-patient clinics, the centers are funded by a community health insurance system. With the Department of Health Promotion and Education of Airlangga University School of Public Health, Dr. Sri Setiyani’s plan will initiate an information network on elderly health issues, to provide local citizens with information, incresing public awareness through radio, TV and leaflets on issues affecting the elderly. Awareness will be raised on local ‘Family and Community Emporwerment Posts’ (Posdaysas) and ‘Elderly Posts’ (Karang Werdas). Ten Posdayas will be used as a pilot scheme for the project, which will be promoted to a further 43 Primary Health Centers in Surabaya for future replication beyond the pilot area. Technical support for the project will also come from Airlangga University School of Medicine and Dr. Soetomo Hospital.

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Surabaya Action Plan Time Frame (1): November 2008 – November 2009

Surabaya Action Plan Time Frame (2): December 2009 – December 2010

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