Yogyakarta City Government

A. Problem Analysis

 1. What was the problem before the implementation of the initiative?
The total population of senior citizens (over the age of 45) in Yogyakarta City is 125,880 residents (30.95% of all-age total population). It has been common fact that degenerative diseases (heart disease, hypertension, kidney, blood vessel blockage, stroke, diabetes) start attacking people in their pre-elderly age. Such diseases even have been the top cause of death for roughly 19.3% of total population of the city. The condition was mainly initiated by the lack of information, as well as the lack of promotional and preventive activities from the authorities and communities, about the worrying diseases. The minimum access to Internists, as the most appropriate health personnel who are experts in disseminating related information about the diseases, is the main reason why the above condition existed in a huge portion. Public Health Center only provides the primary health services, in accordance to the regulations enclosed in the National Health Insurance System, generating the common fact that people are not going to be able to be referred to upper-scale health service to have comprehensive examination on the degenerative diseases unless they are previously diagnosed with the symptoms. To summarize, the problems before the implementation of the innovation were: 1. The absence of special access for the senior citizens to consult the affordable medical specialists due to the hospital-centered post of the specialists; 2. The absence of health promotion and consultation centers to provide promotional and preventive degenerative diseases service; 3. The tiered-lengthy-procedures of getting specialists consultation service for senior citizens.

B. Strategic Approach

 2. What was the solution?
Health Center for Senior Citizens (RUSELA) initiative was first proposed by the Local Office of Public Health of Yogyakarta City in collaboration with the Local Commission of Senior Citizen, and the Office of Local Buildings and Assets (DBGAD). The program is not a curative treatment but is more likely the preventive efforts to reduce the increase of degenerative diseases cases. In the short term, it was expected that senior citizens would be able to get free consultation with specialists about the degenerative diseases.

 3. How did the initiative solve the problem and improve people’s lives?
a. RUSELA innovation is unique since it is the pioneer of providing specialists (internists) to public (senior citizens) through direct consultation approach, considering the fact that no Public Health Center has ever provided such specialists service. b. RUSELA cuts down the lengthy procedure of getting specialists (internists) service from the common 2 days of waiting to only few minutes. Senior citizens only need to come to RUSELA, register themselves, and meet the specialists. c. RUSELA uses the religious, cultural, humanitarian, bio-psycho-social, and spiritual approach to deal with the senior citizens that obliges the health center to task the specialists who are also in the possession of those counselling-approach abilities. d. RUSELA provides creative, interesting, innovative, memorable, and applicable materials in every consultation session.

C. Execution and Implementation

 4. In which ways is the initiative creative and innovative?
a. Analysis of the problem The main problem was the absence of the access for senior citizens to medical specialists to gain more information about degenerative diseases. b. Concept Creation RUSELA will be the one-stop promotional and preventive health center for senior citizens who are in need of the access to the specialists. c. Academic Study The results of problem analysis and concept creation were then discussed in a Focused Group Discussion consisting of academia and academic-related elements. d. Bureaucratic Study The goal was to get the full support from government authorities and non-governmental organizations. e. Advocacy The advocacy activities, to get official approval from local authorities, was conducted by holding official meetings with the followings: • The City Mayor • The Local House of Representatives • Dr. Sardjito Public Hospital of Yogyakarta f. Establishment Preparation The process of the physical building establishment was done by coordinating with the officials from DBGAD. g. Facilities and Infrastructure Setting The process was fully supported by the Local Office of Public Health of Yogyakarta City. h. Manpower Provision The human resources for the initiative are the qualified and well-trained health personnel, supported by the Local Office of Public Health of Yogyakarta City. i. Regulatory Issues The local regulations were then issued to back-up the legal entity of the program realization. j. Cooperation Agreement Documentation The agreement was signed on the cooperation of civil servants delegated to the programs and the utilized access of training for the health personnel. k. Health Personnel Training The goal was to prepare all the health personnel to fully comprehend the pre-condition and the preferred approaches to deal with senior citizens. The process is supported by the Dr. Sardjito Public Hospital of Yogyakarta City from Internist Division, particularly from Geriatric Sub-Division. l. Socialization. The goal was to improve the knowledge and the awareness of community about the program’s existence and beneficial advantages.

 5. Who implemented the initiative and what is the size of the population affected by this initiative?
a. Academic Elements • Faculty of Medicine of Gadjah Mada University; • Faculty of Engineering, particularly The Architectural Engineering Major, of Gadjah Mada University b. Governmental Elements • Local Office of Social Affairs, Employment, and Transmigration; • Office of Local Building and Assets • Office of Local Tax and Financial Management • Local Planning and Development Agency • Local Employment Agency • Office of Community and Women Empowerment • Office of Local Revenue and Cooperation • Division of Legal and Organization Adminstration c. Non-Governmental Organization Elements • Members Family welfare Education Program (PKK) • Local Commission of Senior Citizens d. Public Elements This element is represented by the Local House of Representatives and Community Leaders
 6. How was the strategy implemented and what resources were mobilized?
The resources include; a. Human Resources in the planning/development process, including Bachelors of Law, Bachelors of Architecture, Specialists (Internists), Bachelors of Public Health, Bachelors of Government Science, Geriatric Sub-Specialists; b. Human resources in service delivery process, including Geriatric Sub-Specialists, Nurses, Nutritionists, Instructors of Elderly Exercise, Administration Officers; c. Technical Resources, including the physical building of 200 m2 width and other supporting facilities; d. Financial Resources, including all funding from Local Budget of Yogyakarta City through DBGAD, Local Office of Public Health, and Public Health Center of Umbulharjo I. RUSELA initiative’s mobilization is done through: a. Budget Mobilization b. Manpower Mobilization. c. Supporting Facilities Mobilization

 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
a. The availability of special access for the elderly to consult affordable specialists; b. The availability of consultation centers and promotional health efforts center for senior citizens in Yogyakarta City; c. The straightforward and prompt access to specialists for senior citizens. RUSELA cuts down the lengthy procedure of getting specialists (internists) service from the common 2 days of waiting to only few minutes. Senior citizens only need to come to RUSELA, register themselves, and meet the specialists.

 8. What were the most successful outputs and why was the initiative effective?
Monitoring activities are done by conducting the followings: a. Holding regular coordination meetings on the RUSELA operational activities; b. Technical Mentoring to RUSELA c. Complaint Center (UPIK) Opening through the official number of 08122780001; d. Community Satisfaction Survey Implementation in 2014; The result shows that more than 97% respondents are satisfied with the program. e. USELA Progress Monitoring It is expected that by the end of 2015, RUSELA will escalate the excellence rate to B-grade and continues to strive for A-grade in 2017. Evaluation activities are done by conducting the followings: a. Short-Term Evaluation in every 2 years 1. Number of Visits Escalation 2. Partnership Collaboration Evaluation b. Mid-Term Evaluation in every 5 years 1. Community Survey on healthy life-style of the senior citizens 2. The Laboratory Attendance for Health Checking Activities by the Senior Citizen c. Long-Term Evaluation in every 8 Years 1. The decrease in the number of degenerative diseases cases among senior citizens 2. The decrease in the rate of death caused by degenerative diseases, particularly among senior citizens.

 9. What were the main obstacles encountered and how were they overcome?
a. Constraints in making the initiative. 1. The lack of understanding in determining the program of health promotional and preventive services for the senior citizens; the problem was solved by applying the solutions of: • Describing the health paradigm; • Explaining the health issues in Yogyakarta City; • Explaining the main purpose of the initiative that is to enable the senior citizens to remain healthy and productive. 2. The limited numbers of health personnel in Yogyakarta; the problem was solved by applying the solutions of hiring technical manpower (contract-based) b. Constraints in the implementation of RUSELA: 1. Most people are not aware of the existence of RUSELA; the problem was solved by applying the solutions of optimizing RUSELA’s existence at village level; 2. The number of visitors is less than the quota; the problem was solved by applying the solutions of opening the limited phone registration.

D. Impact and Sustainability

 10. What were the key benefits resulting from this initiative?
a. Impact on Elderly 1. Special privilege for senior citizens to have their exclusive consultation with the specialist without having to mingle with other patients; 2. Special assurance of certainty to be able to consult with specialists 3. Sense of Comfort Pre-elderly and elderly citizens can consult with convenient, easy, the process is not lengthy, extensive consultation time, handled by qualified and well-trained specialists. b. Impact on access to services More people are gaining access to specialists which was previously exclusive and not so affordable. c. Impact on quality of service. 1. The realization of promotional and preventive health efforts program into a legal entity of RUSELA; 2. The increase of numbers of visits to RUSELA from 2013 until 2014. d. Impact on health development program 1. The improvement of the supporting program for senior citizens at Public Health Center 2. The increase of the awareness of the importance of pre-elderly and elderly degenerative disease prevention e. Social and Economic Impact 1. The improvement of productive activities of Local Commission of Senior Citizen of Yogyakarta City 2. The productivity improvement of the pre-elderly people in the community

 11. Did the initiative improve integrity and/or accountability in public service? (If applicable)
With the issuance of Regulation of Mayor of Yogyakarta City No. 61 Year 2013 on the RUSELA of Yogyakarta City, there are some points to be considered: 1. The warranty of the program’s sustainability in the future; 2. The assurance of the funding for the initiative in the future; 3. The initiative is a great starting point for Local Office of Public Health to support and implement the value of "good governance" This RUSELA future development includes the completion of the supporting facilities, including: 1. Sport Facilities, tailored to the age of the patients and types of degenerative disease; 2. Canteen, providing healthy menu to support the degenerative diseases preventive efforts; 3. Library; 4. Traditional Herbal Garden Due to the very young age of the institution, the replication process has been a priority for the institution. However, should there be any other organizations or institutions willing to replicate the initiative, RUSELA are absolutely opened for any visits or comparative studies in the future.

 12. Were special measures put in place to ensure that the initiative benefits women and girls and improves the situation of the poorest and most vulnerable? (If applicable)
Some of the lessons learned from the initiative implementation are: a. Cross-program, cross-sector, and community-driven cooperation The clear vision, brief mission, proper strategies and goals, the development process of RUSELA receives many great supports from all parties; b. Systemized-Work Scheme The culture of working systematically and continuous communication and the promotion of the interests of the community are the keys to success in RUSELA; c. Socialization. RUSELA still needs to improve and multiply its efforts to promote the institution in order to be well-recognized in the future. Recommendations for National Health Development: It is time for all elements in Indonesia to prioritize the development of health paradigm in the form of health development frameworks to build the strong foundation for all citizen of the country. Proper national policies on this issue ought to be followed by the appropriate allocation of resources, personnel, facilities and optimal system. Recommendations for Home Healthy Elderly a. The need for larger scale of building facilities in the future; b. The need for the acupressure service at RUSELA; c. The need for modest laboratory facility to accommodate the initial screening phase; d. The need for the conducting of fitness test to optimize the service delivery at RUSELA.

Contact Information

Institution Name:   Yogyakarta City Government
Institution Type:   Government Agency  
Contact Person:   Fita Yulia
Title:   Mrs  
Telephone/ Fax:   +62274 5151869
Institution's / Project's Website:  
Address:   Kenari Street No 56 Timoho Komplek Balai Kota Yogyakarta
Postal Code:  
City:   Yogyakarta
State/Province:   DIY

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