Questions/Answers

Makassar City covers175.77 Km2 land area, including 12 islands on Makassar Strait, with about 100 Km2 territorial waters. Based on the Central Agency on Statistic (BPS), the population of the city is 1,659,777 people. The 2014 data showed 58.12% on the Healthy and Clean Behavior indicator, 77.86% healthy houses, and in 2015, 45.04% healthy families. The indicator percentages from data health collection and community development were still low. Through the innovative program of LONGSET (‘Lorong Sehat’ or Healthy Alleys), efforts to achieve the health indicators were initiated by the Health Office through Community Health Centers in Makassar City area. Dissemination, education, advocacy, and community participation (with 70% women) are important activities carried out by people in Makassar, as well as the implementation of social marketing and sustainable integrated quality assessment. With LONGSET program, the target indicators of Healthy and Clean Behavior have achieved 75% of National target, the family-based Health Indonesia program data collection declared by Indonesia Government reached to 50% and the number of healthy houses increased up to 90% in 2019. The program aims to improve the Healthy and Clean Behavior (HCB), increase the number of health houses as well as improve Makassar City’s healthy family indicators especially in the 7,520 alleys that were vulnerable to the health issues.

This initiative is relevant to the second category “Ensuring integrated approaches in the public-sector institutions.” The citizens were involved in the planning phase, through tudang sipulung, the tradition of Makassar citizens to discuss problems such as sanitation, HCB, healthy houses, and baby delivery programs in the alleys. Citizens were also involved in building the constructions in the alleys, such as stop-smoking corner, hand-washing facility and plant-pots. They also participated in the program evaluation process to ensure that LONGSET.

To achieve the sustainable development goals, Makassar City’s Health Office has a Health and Clean Behavior Roadmap, Healthy Houses and Healthy Families to lower the number of patience in 2019 through the 2014-2019 Regional Mid-Term Development Plan of Makassar City. The LONGSET is initiated to fulfill the basic rights of Makassar Citizens and, therefore, the City Government developed partnerships with other stakeholders so they can together achieve the objectives of the program. The implementation of LONGSET is aligned with SDG 11.1 on Sustainable Cities and Settlement. If the citizens actively participate in making the healthy alleys, it means that they become the part of sustainable city. Public participation is a process of giving wider opportunities and authorities to communities to jointly solve various problems. It also plays important role in improving community learning process, leading citizens to become responsible, eliminating the feeling of alienated in some societies, and creating support and acceptance from government.

The strategies for the sustainability of the program are through the establishment of regulations and assignment letters. The letters are issued by the Heads of Sub-districts and Villages given to the active cadres and citizens as well as the women’s communities to ensure that the program is sustainable despite the new mayor. The initiative also carries out participatory community engagement by implementing the distribution of authority, responsibilities and benefits of environmental development. The dissemination involving all stakeholders, especially communities, health cadres, religious and public figures is always conducted through social activities and rewards to LONGSET’s persons in charge as motivation.

The LONGSET initiative aims to provide access to the basic health services through community empowerment in Makassar City. This is as to 80% of Makassar Citizens living in the alleys find it difficult to access data and basic health services. The initiative gives and empowers the community by training them to assist Community Health Centers (Puskesmas) in health services and data collections. The intervention to the alleys is given gradually from 46 alleys in 2016 to 185 in 2019. The initiative has positive impacts on people with illness, pregnant mothers, toddlers, and senior citizens living in the alleys. Their health will be treated by the citizens who already received training and have direct coordination with the community health centers.

Gender is one of the issues in development, especially human resource development.The government has carried out many efforts to improve the quality of women’s life and reduc the gaps between women and men in terms of participation, control, benefits, and resource domination. With 70% of women that participated in the program, their roles have significantly influenced the progress of LONGSET since they have more time to develop, drive and empower communities. Through this program, men or women from all ages, areas, and with disabilities, can be involved in the process so that this program can be beneficial for all.

The LONGSET initiative has positive impacts on the target groups such as people with illness, pregnant mothers, infants, and the elderly. The direct impact received is that their health will be treated by the citizens who already received training and have direct coordination with the community health centers. In addition to that, the implementation of LONGSET program has involved all stakeholders, especially communities, health cadres, religious and public figures. The result of the program is the change in citizens’ health and clean behavior. The data collection on Health and Clean Behavior showed the progress after the intervention, from 58,12% in 2014 to 73.,86% in 2018. The Health Family data collection by National Government also showed the increase from 45,04% in 2015 to 62,11% in 2018, meanwhile the number of health houses increased from 77,86% in 2014 to 91,76% in 2017.

The main step in the LONGSET implementation process is the periodic control, monitoring and evaluation conducted continuously in the tiered system. It is believed that the success of the program is largely determined by how well the implementers in the fields can continuously work, conduct the evaluation, prepare the program improvement, and monitor the program. The monitoring system is very strictly carried out whereby the health workers in the field must continuously provide reports to their head of work unit in the Community Health Centers (Puskesmas) on a daily, monthly and semester basis as well as in the annual evaluation. Those reports will then be submitted to Makassar City’s Health Office which will immediately conduct periodic evaluation to related to the sustainability of the program and, based on those reports, will provide recommendation for the improvement of program implementation. In addition to that, the Health Office and other local government agencies will have field visits and conduct health alley assessment, and in the National Health Day, the most active LONGSET will be announced and rewarded. The health alley initiative evaluation uses the 10 indicators of Health and Clean Behavior and 12 indicators of Healthy Family determined by the Indonesian Ministry of Health. The utilization of community empowerment in each alley is very helpful in collecting basic data on Health and Clean Behavior, Healthy Family, Stickers for toddlers under 2-year-old, Sticker for P4K (for pregnant women), Health House Card, larva-free stickers, infectious-disease-free stickers, clean and green environment, and the behavioral change in family members.

The beginning, citizens only wanted the presence of the government when they faced difficult situations, including when they were sick. Their wishes are the basic needs which are actually easy to be fulfilled by the government. With willingness, sincerity, initiative, creativity and innovation, the government can meet many people’s expectation. Through LONGSET, persuasive approaches are used by health workers and cadres so that citizens are no longer reluctant towards the officers who conduct the basic health data collection to their houses.

This program is implemented through: The formation of Health Alley Cadres (HAC). The HAC working in the alleys to assist the surrounding communities. Education, Socialization and Advocacy. All LONGSET activities are always controlled and thus the management runs very well. Social Marketing. All Community Health Centers (Puskemas), Auxilary Health Centers and HAC made posters for their educational tools. Integrated Quality Assuarance is conducted in integrated and consistent manner through training, field monitoring of program implementation, internal and external crosschecking, refresh training and scoring system utilized for Puskesmas Evaluation.

The LONGSET program was initially implemented in one alley in November 2015 after finding out that the percentages of Health and Clean Behavior, Healthy Houses, and Healthy Families were relatively low in the Community Health Centers’ areas in Makassar City. This program has successfully increased the data coverage during the intervention with the assistance from community and women’s participation. It succeeded in increasing the rates of Health and Clean Behavior at 67.07% in 2016, healthy families at 48% in 2016, and safe houses at 91.45% in 2016.

The program was initially carried out in one Community Health Center’s area as a pilot project. Due to the successfulness of increasing the data coverage, the program was adopted into Makassar City’s LONGSET program covering 185 alleys which continue to increase each year. Some of the achievements of this program include the increase of Health and Clean Behavior rate at 68,16% in 2017, healthy families at 53,11% in 2017 and Healthy Houses at 91,76% in 2017. In 2017, the team from the Ministry of Administrative and Bureaucracy Reform has awarded the LONGSET program as the TOP 99 and TOP 40 Public Services and since then representatives from 27 provincial and district/municipal governments have visited Makassar City. Even some of the local government agencies have applied and replicated the LONGSET program in accordance to their works. This program received recognition and was adopted by other Regencies/Cities as a part of the effective Alley program in improving health data and community empowerment in the region. The LONGSET system developed in the Makassar City is relatively simple and easy to apply in other regions because it does not require special resources.

The initiative has been transferred.

The human resources of LONGSET come from 47 Community Health Centers (Puskesmas). The formation of LONGSET Coordinators was established through the Decree of the Head of the Health Office assigning the Puskesmas as the party in charge and to establish the team. The team coordinates in conducting community empowerment in the alleys and provides reports of activity results to the Health Office. Full support was given by the heads of 14 sub-districts who have added 143 kelurahan (villages) to the program. Currently, the support is increased to 15 sub-districts which have added 153 villages in 2019.

Initially, the LONGSET program used another program’s funding, that is, a socialization program for Healthy and Clean Behavior. Later in 2015, the program was inserted in the Budget Implementation Document of Makassar City’s Health Office for HCB Socialization activities budget of IDR 260,000,200. In 2016, the allocated budget was focused on the LONGSET activities with the increased amount of IDR 400,118,000. In 2017, the budget allocated was IDR 610,517,800 and increased in 2018 by IDR 711,457,000. In 2019, however, the budget was reduced to IDR 437,057,500 because the program was already considered successful.

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Internally, the health workers in the fields must provide reports to their head of work unit in the Community Health Center on a daily, monthly, semester basis and in annual evaluation. The heads of work unit will subsequently submit the printed reports and deliver monthly LONGSET accountability presentation to the Makassar City’s Health Office. Externally, the Health Office and the other Local Government Agencies will have a field visit to assess LONGSET and on the National Health Day, they will announce and award the most active LONGSET.

The healthy alley initiative uses 10 indicators of Health and Clean Behavior and 12 indicators of Healthy Family determined by the Indonesian Ministry of Health. The utilization of community participation in every alley is very helpful in collecting basic data such as the Health and Clean Behavior, Healthy Family, Stickers for toddlers under 2-year-old, Sticker for P4K (for pregnant women), Health House Card, Larva-free stickers, infectious-disease-free stickers, clean and green environment, and the behavioral change in every family members.

The LONGSET program has had very large and significant impacts since it was launched in 2015. The impacts have been received by the people who need health data collection as well as the Makassar City government itself. Many significant changes have occurred in health data collection at the Community Health Centre (Puskesmas) level. Because of the LONGSET program, data collection process is getting better and the environment is getting greener compared to the conditions before the program launched. Citizens’ trust in the dedication of Makassar City government in providing health data collection services and greening the alleys is increasing. This can be observed from the increasing number of people who entrust Puskesmas to conduct basic health data collection for their families.

The LONGSET program is implemented in 47 Community Health Centers (Puskesmas) evenly distributed in Makassar City. In the first year of its implementation in November 2015, LONGSET was carried out in a pilot area directly by the Health Office of Makassar City. It turned out that LONGSET becomes one of the indicators of the Healthy City assessment by the central government. The formation of the LONGSET coordinators was established through a Decree of the Head of Health Office and Puskesmas to assign the local persons in charge to form their teams. In the further development, full support was given by the Mayor of Makassar and the heads of sub-districts from 14 regions plus 143 villages in 2015. Up to now, the support from sub-districts has increased to 15 sub-districts and 153 villages in 2019.

The LONGSET program has been implemented through the collaboration of Private Companies, NGOs, Health Offices, Health Centers and local communities. The private companies through their CSR funding support capacity building for the implementation of the LONGSET program, train health workers, strengthen database systems and certified environmental health workers, as well as conduct field visits. This partnership system has taken place since 2015. To improve program integration, coordination meeting with health center staff was held every month to evaluate programs by involving the Head of the Health Office, and the Public Health Division. To increase community participation, local communities were involved in the decision making process, including for Alley Health Cadres (AHC). Local communities will recommend candidates to be trained as AHC and given training for 2 days by Local NGOs. The AHC is trained on how to collect simple health data, good public communication methods, how to report data and promote education and health to the surrounding communities. After being taken by the Health Office, this program became innovative and solved the problem of data barriers in the community by empowering people in every alley.

Through the Healthy Lorong (LONGSET), a persuasive approach is undertaken by health workers and cadres so that people are no longer reluctant facing the workers visiting their houses for health data collection survey. For this reason, the program must continue to be maintained and there shall be a guarantee for its continuation. This innovative and creative step makes the LONGSET program one of the flagships of the primary health services in Makassar City and Indonesia in the future. This program has shown significant results in improving access to health services for vulnerable communities. It clearly provides a solution for realizing a clean, green and beautiful environment and dealing with health problems in the surrounding areas. We have also developed a number of methods known as low-cost LONGSET system using available local resources. The system can be implemented by Health cadres and other workers to provide fairer services for marginalized communities. In addition, the program has also shown how private companies, NGOs, the Health Services and local communities can overcome health problems.