VZCZCXRO9133
RR RUEHCHI RUEHCN RUEHDT RUEHHM
DE RUEHJS #0073/01 2230112
ZNR UUUUU ZZH
R 110112Z AUG 09
FM AMCONSUL SURABAYA
TO RUEHC/SECSTATE WASHDC 0442
RUEHJA/AMEMBASSY JAKARTA 0431
INFO RUEHZS/ASSOCIATION OF SOUTHEAST ASIAN NATIONS
RHHMUNA/HQ USPACOM HONOLULU HI
RUEHWL/AMEMBASSY WELLINGTON 0168
RUEHBY/AMEMBASSY CANBERRA 0203
RUEHJS/AMCONSUL SURABAYA 0453

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