Dr. Muhlas Udin
Chief, Mother and Child Welfare
Surabaya Municipality, Indonesia

Surabaya is the second biggest city in Indonesia after Jakarta and it plays an important role in the regional and national development. People who need special attention in Surabaya city are the urban poor who usually located in marginal area or illegally occupied land without basic infrastructure. These people subject to environmental and health risk deriving from crowding, lack of clean water and sanitary facilities, low level of nutrition, pollution, new communicable disease and accident. Poor urban population estimated at 16.73% of total population who live in 163 villages of Surabaya city. Various programs have been undertaken to combat nnvertv anrl their effect nn health.

1. Health Status

Table 1: Coverage of Mother and Child Health

Indicator	1993	1994	1995	1996	1997
Antenatal Care	74.21	70.11	75.25	79.65	80.84
Deliveries performed by A. Health Personal B. Traditional Birth Attendant	65.98 9.13	68.28 9.09	71.16 6.56	77.22 5.57	80.38 3.96
Postnatal Care	80.42	85.73	87.54	90.58	95.17
Neonatal Care	-	16.55	22.04	50.58	80.17
Lactation mother examination	80.53	95.12	98.10	103.26	108.97
Crude Birth Rate	1.94	1.51	1.60	1.35	1.14
Crude Death Rate					2.09
IMR	0.20	0.22	0.19	0.17	0.18
MMR (per 10,000 live birth)	0.66	1.24	1.43	3.08	2.26

2. Health System

Referring to National Health Development Policy, Surabaya Health Care Delivering System has been developed through Primary Health Care approach which is recognized as a practical approach to the effective provision of essential health services that are community based, assessable, acceptable and sustainable at the cost which the community and the government can effort. It includes the full participation and active involvement of the community towards the development of a self-reliance people, capable of achieving an acceptable level of health and well-being. It recognized the inter relationship between health and overall socio-economic development. The municipal government strategies are as follow:

1. Increasing opportunity for community participation in local planning within the context of regional and national objective
2. Developing interdisciplinary, inter-sectoral linkages with other government and private agencies. Hence programs of health sector must be closely linked with those of other socio-economic sectors at all levels.
3. Emphasis on partnership so that those in the health system and the community view each other as partners rather than merely providers and receivers of health care respectively. The Indonesian health system is organized at various levels. At the level of the district or municipality, a district or municipal health office is established by the Ministry of Health and a district or municipal health service is operated by local government.

The main functions of the district/municipal health service are to care for patients and examine specimens in the laboratory. Many of the patients will have been referred from the sub district level. In
addition, the district/municipal health service carries out public health activities such as disease control, health education and the training of health personal.
The district/municipal health office is mainly an administrative and supervisory body. It ensures that medical intervention reach the people who can benefit from them, especially high risk groups and organizes public works aimed at improving environment hygiene and safety. Its responsibilities include village community health development, the management of drugs, manpower, public information, planning and general administrative work. At the village level, community health development is an integral part of overall village development under the umbrella of the Village Community Resilience Institute, which is the forum of all development activities requiring inter-sectors cooperation.
At least one health center and 3-5 sub centers can be found in every sub district. Their wok involves case finding treatment, immunization, environmental interventions, and the teaching of healthy life styles.
The activities of health centers are not only complete in themselves but also integrated with the village community and linked with all other kinds of health activities carried out in the community under the coordination of the Village Community Resilience Institute.

3. Population and Family Planning

Population control program started in 1957 by medical and social community called PKBI, 01 Indonesian Family Planning Society. On January 1970, National Family Planning Coordination Board was established to 1) decrease population growth and 2) achieve prosperous.

The following programs have been implemented to achieve the above objectives:

a. Family Welfare Reproduction Movement

b. Family Welfare Economic Movement

c. Family Welfare Defense Movement

a. Family WelfareReproduction Movement

The activities include:

1. Postpone marriage age by married law (20 years for women and 25 years for men)

2. Achieve use of contraceptive method

   - reward for ten years current user (free school charge for his children)

   - free of charge for poor people

   - continues medical follow up to current user

   - allowance to failed(pregnant) and complicated acceptor

   - slogan "two children enough. Daughter and boy are the same"

   - family planning insurance

b. Family Welfare Economic Movement

People are divided by the level of prosperous:

Level 1: Pre Prosperous

Level 2: Prosperous 1

Level 3: Prosperous II

Level 4: Prosperous III

Level 5: Prosperous III plus

Table 2: Coverage of Family Planning

Indicator	1993	1994	1995	19961	1996
Eligible Couple	325,217	372,239	396,147	400,884	404,160
Acceptor Family Planning: Current User	80.24	78.68	82.12	86.93	89.24
Tubectomy	6.42	6.78	7.34	9.81	11.01
Vasectomy	0.17	0.32	0.12	0.07	0.08
IUD	18.67	21.03	24.23	28.31	31.09
Implant	21.75	23.85	25.52	27.71	34.12
Injection	21.85	19.21	20.11	22.21	18.12
Pill	29.90	27.79	21.68	10.97	4.18
Condom	1.24	1.02	1.10	0.92	1.40
Drop Out Acceptor	1.30	1.20	1.40	101	1.21
Side Effect	1.88	1.29	1.31	1.35	0.05
Failure	0.07	0.04	0.05	0.06	0.05

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