unfpa seminar material 2008 - … · web viewhence, each karang werda serves 1,561 the elderly in...

AGING IN CITY OF SURABAYA, BURDEN OR OPPORTUNITY

Sri Setijani, MDDivision of Community Health, Department of Health City of Surabaya

Kuntoro, MD, MPH, DrPHDepartment of Biostatistics and Population Study Airlangga University School of

Public HealthSunarjo, MD, MS., MSc, PhD

Department of Public Health and Preventive Medicine Airlangga University School of Medicine

Abstract

This study is designed to learn about the elderly, their problems, the alternative

strategy chosen to overcome the problems. Based on balance of burden and

opportunity, and conditions of man, money, material and method, four types strategy

is proposed.

The appropriate strategy selected will affect the achievement of elderly welfare. The

strategy selected should be communicated to all components concerning the elderly,

the elderly themselves, families where they live, community where they interact,

private sectors, and Government of City of Surabaya.

Keywords Elderly Burden Opportunity

Setijani, Kuntoro, Sunarjo, UNFPA Seminar, Kobe, Japan 26 Oct – 3 Nov 2008 1

I INTRODUCTION

Surabaya is the second largest city in Indonesia. The process of regional

development in City of Surabaya is running so fast. The results of

physical structure and infrastructure development as well as the results

of health development affect various aspects of human life. The success

of health development is characterized by the increased health facilities

that are easy to be accessed, the increased good health behavior in which

people are willing to be healthy, and the decreased infant mortality, and

the increased life expectancy.

In City Government of Surabaya, the institutions that concern with the

elderly particularly in health, social, and empowerment aspects are

respectively Department of Health, Department of Social, and Board of

Community Empowerment. The available facilities for the elderly are 53

Public Health Centers (PHC), 67 Sub Health Centers(SHC), 241 Elderly

Integrated Services Posts or Posyandu Lansias, 163 Elderly Posts or

Karang Werdas and seven Elderly Nursing Homes.

There is a community organization called Abiyoso Gerontology

Foundation in the level of province and in the level of district/city. A

name of Abiyoso is adapted from an Ancient Epic of Mahabharata.

Abiyoso is grandfather of five knights called ”Pandawa Lima”. He

takes care his grandson after their father died. There is a good

relationship between elderly represented by Abiyoso and the youth

represented by five knights. Abiyoso teaches wisdom, patriotism,

honesty, team work to his grandsons. Grandsons respect to their

grandfather. This foundation imitates this scenario for implementing the

program for the elderly. This foundation has important role in issueing

Elderly Regional Regulation No 5/2007.

To enhance services for the elderly, East Java Province Regional

Government has issued the Elderly Regional Regulation No 5/2007. The

regulation gives guidelines for regional governmental institutions,

private sectors, and community in promoting the elderly welfare through


seven activities. These are first, religion and mental-spiritual services;

second, health services; third, job opportunity services; fourth, educatian

and training services; fifth, public infrastructure and facility services;

sixth, social support, and seventh, social protection.

The following figures shows trend of life expectancy and the number of

elderly as the consequence of the success of health development.

Figure 1 Life Expectancy in City of Surabaya, 1990 – 2007(Source : Central Board of Statistics, 2004)

Figure 2 The Number of the Elderly in City of Surabaya, 1990 – 2004

(Source : Central Board of Statistics, 2004)

Both figure 1 and 2 show the increased trend of life expectancy and the

number of the elderly respectively.


According to data from Department of Population and Civil Registry

City of Surabaya in 2005 the number of people was 2,448,550 in which

238,712 of them or 8.7 % were elderly. In March 2008, the number of

people are 2,839,192 in which 254,420 of them or 8.96 % are elderly.

During the last three years the number of elderly increases 0.26 %

(Department of Health City of Surabaya, 2008)

The scope of health services concerning the elderly welfare is addressed

to enhance the quality of life of elderly in order that they can be self-

supportive, productive, effective in their family and community lives.

Health services to be provided include :

- Health enlightment for elderly

- Building fitness through elderly gymnastic

- Early detection of health state and routinely medical check-up

- Curing diseases and their referal

- Developing ”Posyandu Lansia” and Elderly Decent PHC or ”

Puskesmas Santun Lansia”, and Out-patient and In-patient clinic for

elderly in hospital

- Facilitating and Guiding elderly in enhancing participation and

community empowerment (elderly group)

- Providing special rest room for elderly in hospital and PHCs

- Networking cooperation among related inter-sectors.

II ELDERLY IS BURDEN FOR REGIONAL DEVELOPMENT

The elderly welfare is a state of social life experienced by the elderly

that includes safety feeling, ethics, phyisical and spiritual peace that

enable the elderly meet their physical, spiritual, social requirements well

in the frame of keeping human rights (Regional Regulation No.5/2007

Chapter 1 Section 1). This condition should be achieved by the elderly

programs that will be implemented by City Government of Surabaya, its

community and its private sectors. Hence, a good program that is

designed should operationalize the state of the elderly welfare. It gives

the consequences of man, money, material, and method.


The man means people who are involved to implement the elderly

program, health personnel in Posyandu Lansia who serve the elderly in

health aspects, PHC that builds and supervise Posyandu Lansia that is

running the elderly program, Section of Family Health and Division of

Community Health who build and supervisi the performance of PHC

personnel who build and supervise the performance of Posyandu Lansia.

The money means expenditure budget should be provided by City

Government in order to run the elderly program. This budget in City

level is often critical and debatable among institution within City

Government and among members of Regional Parliament. Within City

Government at least there are three institutions that is responsible to the

elderly problem. These are Department of Health, Department of Social,

and Board of Community Empowerment. There are several Departments

that support the elderly life concerning public facilities. These are

Department of Sanitation and Garden that provides convenient

recreation garden for the elderly; Department of Transportation that

provides convenient and special seats in public transportation for the

normal and handicapped elderly; Department of Public Work that

provides convenient and saved road for the elderly who access the road;

Task Force Unit of Governmental Police that control and monitor how

far regional regulation No 5/2007 has been implemented by the

institution mentioned above and other institutions related to public

facilities for the elderly.

There are other agencies outside of the stucture of City Government such

as Regional Police of Surabaya and its subordinates in the levels of sub

region such as Sub Region Police of Northern, Eastern, Southern,

Western, and Central Surabaya; Sectoral or Subdistrict Police. The

police institution vertically is under National Police. This institution keep

the community safety and order including for the elderly. All institutions

need expenditure budget for activities and facilities concerning the

elderly activities.


The material means any facility such as equipment, device, structure,

infrastructure, hardware as well as software used for supporting the

elderly program activities. To provide and maintain a material, an

expenditure budget is needed. Man, money, and material are strongly

related each other when the expenditure budget is proposed. In a limited

budget provided by City Government, how can be managed in balance

among man, money, and material to realize the elderly program

effectively and efficiently.

The method means a specific procedure for running the elderly program.

A system approach can be used for supporting the achievement of the

elderly program compared to hierarchical approach by topdown

command. In City of Surabaya the latter still prevails. It is rare a good

idea in a bottom level can be discussed in a top level. It is rare a person in

a bottom level understands and commits with the mission and vision of

the institution particularly concerning the elderly welfare.

According to Regional Regulation No.5/2007 Chapter 4 Section 8, the

enhancement of the elderly welfare includes religion, mental, spiritual

services, health services, job opportunity services, education and training

services, services to access public facilities, law support services, social

support, and social protection. Moreover, providing a public facility that

is accessable for the elderly is mandatory according to Section 30

versions 1 to 5. Furthermore, anyone or institution that violates this

regulation is subject to be penalized 6 months in prison or fine of 50

millions rupiahs as stated in Chapter 7 Section 41.

According to Regional Regulation No.5/2007 Chapter 1 Section 1 there

are three types of the elderly, the potential elderly, the non-potential

elderly, and the neglected elderly. The first one is an elderly who is

capable to work and/or activity that can produce goods and/or services,

The second one is an elderly who has not capability to earn money for

his/her daily life so that his/her daily life depends on support from other

person. The third one is an elderly who is due to any cause, he/she can

not fulfill his/her main requirements spiritually, physically, and socially.


The number of the elderly tends to increase (See Figure 2). During the

last three years the number of the elderly increases 0.26%. Until March

2008 the number of the elderly is 254,420. There are 241 Posyandu

Lansias. Hence, in average each Posyandu Lansia serves 1,056 the

elderly in health aspects. There are 163 Karang Werdas. Hence, each

Karang Werda serves 1,561 the elderly in various aspects other than

health aspects. In Posyandu Lansia, the elderly receive health promotion

and prevention through enlightment, leaflets, and other information

media. That means a number of man and materials is needed. If

morbidity rate among the elderly is 10 % per year, there are 25,442

elderly who are sick with various types of diseases and various degree

of severity. They need curative services through 53 PHCs, 67 Sub HCs,

two general hospitals, each belongs to City of Surabaya and East Java

Province. This curative services can be extended to

geriatric/gerontologic services.

Among 254,420 elderly there are numbers of them who are classified as

the potential, non-potential, and neglected elderly. Those who are well

educated, former senior officials both in governmental or private

institutions, healthy, social-economically well established are classified

to be the potential elderly. Probably the percentage is not more than 10

%. Most elderly are classified as the non-potential and neglected

elderly. Assuming the non-potential elderly is 80% and the neglected

elderly is 10 %. Hence, it is expected that the number of the non-potential

elderly would roughly be 203,536 and the number of the neglected

elderly would roughly be 25,442. The neglected elderly should be

placed in the elderly nursing homes. There are 7 elderly nursng homes

in City of Surabaya that have been identified. Each will accommodate

3,635 neglected elderly. It is impossible to be accomodated. If each

elderly nursing home can accommodate 100 elderly, 255 elderly nursing

homes are needed, that means City of Surabaya should build additional

248 elderly nursing homes. If the cost is US$ 50,000 for building and

equipments of each nursing homes. The cost could be US$ 12,4 millions.

If the expenditure budget only provides two nursing homes/years, within


124 years the requirements will be fulfilled. All neglected elderly are

placed in the elderly nursing homes (Regional Regulation No.5.2007

Chapter 4 Section 38 Versions 1, 2, and 3 ).

About 203,536 non-potential elderly should be protected from any

hazard that resuls in physical, mental, and social disturbances and threats

that may affect disability to do social roles. The protection is done

through social facilitation at their homes or the Consultation Institutes of

the Elderly Wefare organized by government and private agencies. It can

be calculated how many personnel to be recruited, how many institutes

to be constructed. How many non-potential elderly who live in the

family who are poor, the number is not available. Assuming 15% of the

non-potential elderly live in their poor families, then the number is

30,530. They need cash support. If cash support is US$ 10

/elderly/month (it is equivalent to Rp 100,000 for direct cash support for

poor family through national program). The expenditure budget needed

is US$ 305,300 /month or around 3.7 millions US$. It can be imagined

how can an elderly expenses the daily life in a poor family only with

US$ 10 /months or US$ 0.33/day. This number less than US$ 1 for the

poor based on MDGs criteria.

It is assumed that about 85% of the non-potential elderly live in the

families whose social-economic status are moderate to good. Probably

most of them live happily with their sons/daughters/grandchildren. Some

of them feel unhappy because their sons in law/daughters in

law/grandchildren do not appreciate them. If the elderly consider these

are kinds of disturbances or threats according to Regional Regulation

mentioned above. There will be a conflict within family in which law

enforcement will operates. This is a kind of silly problem that should not

happen in the Indonesian family.

Probably among the non-potential elderly need activities outside their

families. In this case a Karang Werda is a good solution. There are 163

Karang Werda in City of Surabaya. Assuming 50 % of the non-potential

elderly participate in Karang Werda, there could be 101,768 elderly are


accomodated in these places. Hence, each Karang Werda serves 424

elderly. If each Karang Werda needs US$ 500/year for basic activites,

the expenditure budget would be US$ 81,500.. That means each elderly

receives US$ 1.18/year for his/her activities in Karang Werda. This

activities include religion, mental, spiritual services, job opportunity

services, education and training services, law support services. The

quality and quantity of services are appropriate to the expenditure budget

provided. Given the minimum budget, only one or two activities can be

done. The easy activity is religion enlightment by ulama or Islamic

religion teacher. However, in limited budget condition the achievement

of the elderly welfare is difficult to be realized.

Challence as Burden

The challences faced by family, community, and local goverment

concerning the elderly conditions quite vary, these are

- The aging process that occurs is natural. It has consequences on

physical, mental, and social problems. Depending on the severity of the

problem and number of elderly affected. These give consequences in

budget. It could be burdern for stakeholders.

- Change of socialization because productivity begins to decline,

declining social activities and interaction with environment. Change of

socialization strategy in which the health personnel are not familiary,

they should learn more. It could be a burden for the health personnel.

- Ability and skill decline that result in declining productivity. As

consequence job opportunity is limited. In other hand requirement of

daily life tends to increase. When they earn less than they expense,

there will be family budget deficit. When elderly live with their

families, the problem is to be burden for the family

- Health services need mainly for degenerative diseases requires high

cost

- Change of social values towards individualistic order in the community,

the elderly receive less attention so that they are marginalized in the

community life and to be neglected. The more neglected elderly occur


the more elderly nursing homes to be constructed the more expenditure

budget to be allocated.

III ELDERLY AS OPPORTUNITY IN REGIONAL

DEVELOPMENT

Assuming 25,442 elderly are potential. Can the small number of potential

elderly balance the burden of regional government due to large number

of non-potential elderly and the small number of the neglected elderly.

An idea of silver college is one of the various solutions. The ability of

knowledge, capability of skill, expertise, experience owned by the

potential elderly are the factors that can be considered as the opportunity.

Assuming they are distributed equally in Karang Werdas, there could be

156 potential elderly participate in each Karang Werda. If 10 % of them

have properties in their bank accounts at least US$ 10,000 /individual,

there could be US$ 156,000 funds. Assuming that they want to dedicate

their Bank Interest for Karang Werda because they want to submit

completely to God AlMighty by helping other people and they consider

what they do are saving deposit for the Day After. Let the Bank interest

is 5%/year. There could be US$ 7,800/year/Karang Wreda compared to

US$ 500 allocated by City Government. It implies that community

participation is greater than Governmental participation concerning

budget.

This is an example of Karang Werda “Harapan” located in Subdistrict of

Rungkut, City of Surabaya. The chairman is the retired lecturer of a

State University in Surabaya, he holds master degree. The secretary is the

retired senior officer in Provincial Government, he hold undergraduate

degree. They are classified as potential elderly. This Karang Werda has

written vision, mission, statutes, and clear program. Its vision has five

core values such as self-support, welfare, productive, dignity, and

wisdom. The program is derived from mission in order to achieve

vision. There are weekly, monthly, and yearly activities. Every week they

do elderly gymnastic that makes physical fitness, sing a song that makes


happy, plant traditional herbs that makes healthy. Every month they visit

each other to their homes. It is called “silaturrahmi” . It is believed that

this habit may prolong the age. They join adult education and

enlightment about health in elderly. Karang Werda distribute bulletin

every month during meeting. Every year they do comparative study

tour/recreation, Seminar, Exhibition, Social contribution to poor

community.

This is a kind of best practices in which the elderly can do anything that

is useful for human being. They do not have to depend on family,

community and government. There are 163 Karang Werda in the level of

Kelurahan in City of Surabaya. Although Head of Kelurahan only

recommend one Karang Werda for one Kelurahan, but Karang Werda

“Harapan” is in the level of hamlet or “Rukun Warga = RW “. Hence,

163 Karang Werda can not accommodate 228,978 elderly. When elderly

in the community want to develop Karang Werda in the level of hamlet,

Head of Kelurahan should respond postively. Probably Head of

Kelurahan is reluctant to add more than one Karang Werda, it is a matter

of budgeting. It is believed that there are Karang Werdas like Karang

Werda “Harapan” that do not depend on governmental budget.

IV STRATEGY FOR BALANCINNG BURDEN AND

OPPORTUNITY

The sources of opportunity:

1. Elderly : indicated by more potential elderly with good

educational background, good social-economic status, humble,

patience, strong spirit, patriotism, willing to help other people who

need them.

2. Family : indicated by respect to and support elderly

3. Community : indicated by participation and commitment

4. Private sector : indicated by attention, socially responsible to

elderly

5. City Government : indicated by strong commitment in man,

money, material, method


The sources of burden:

1. Elderly : indicated by more non-potential and neglected elderly

with low educational background, low social-economic status,

arrogant, impatient, weak spirit, ignorant, do not willing to help

other people who need them.

2. Family : indicated by does not respect to and support elderly

3. Community : indicated by no participation and no commitment

4. Private sector : indicated by no attention, socially not responsible

to elderly

5. City Government : indicated by weak commitment in man,

money, material, method

There are four possible combination of opportunity and burden. First,

opportunity is greater than burden; second, opportunity is as great as

burden; third opportunity is smaller than burden, fourth, opportunity is

as small as burden.

1. OPPORTUNITY IS GREATER THAN BURDEN

Component Elderly Family Communit

y

Private

Sector

City

Government

Opportunity > > > > >

Burden < < < < <

Strategy :

Maintaining opportunity by :

1. pioneering potential elderly to be initiator, motivator, creator of

Karang Werda

2. keeping good relationship between elderly and family


3. promoting various types of community-based organization that

have competitive advantage such as Posdaya or Family

Empowerment Post

4. endorsing private sectors to support Karang Werda in finance and

job opportunity

5. keeping the strong commitment of City Government on man,

money, material, and method

2 OPPORTUNITY IS AS GREAT AS BURDEN


y

Private

Sector

City

Government

Opportunity > > > > >

Burden > > > > >

Strategy :

Maintaining opportunity and reducing burden:

1 by empowering non-potential elderly through education and

training and guiding

2. by strengthening elderly –family relationship

3. by enhancing community understanding about elderly problem

4. by enhancing private sector commitment to elderly

5. by providing man, money, material, method by City Government

3. OPPORTUNITY IS LESS THAN BURDEN



y

Private

Sector

City

Government

Opportunity < < < < <

Burden > > > > >

Strategy :

Enhancing opportunity and reducing burden

1. by involving potential elderly in strategic position and

empowering non-potential elderly through education and training

2 by strengthening elderly-family relationship and reducing

irrespective attitude among members of family to elderly

3 by enhancing community commitment and reducing

miunderstanding and unawareness about elderly

4 by enhancing private sector commitment and reducing

misunderstanding and unawareness about elderly

5 by enhancing City Government commitment on elderly and

reducing ineffective and inefficient bureaucratic system related to

man, money, material, and method.

4. LESS OPPORTUNITY AND LESS BURDEN


y

Private

Sector

City

Government

Opportunity < < < < <

Burden < < < < <

Strategy :

Enhancing opportunity ;

1 by mobilizing, motivating and activating potential elderly to solve

the problem

2 by enhancing family understanding about elderly problem

3 by enhancing community understanding about elderly problem


4 by enhancing private sector commitment in supporting ederly

program

5 by enhancing commitment of City Government to increase man,

money, ,material and method.

V CLOSING REMARKS

The success of health development in City of Surabaya characterized by

the increase of life expectancy and the number of elderly. Depending on

the conditions of elderly, families where elderly live, community where

elderly live, private sectors, and City Government of Surabaya the

increase number of elderly could become burden or opportunity of

regional development.

There are four scenarios related to burden and opportunity balancinng.

These are burden less than opportunity, burden as great as opportunity,

burden more than opportunity, and burden as small as opportunity. They

give the difference of strategy to solve the problem of elderly. A good

strategy is inspired by shared vision and considers man, money,

material, and method owned by City Government of Surabaya. The

increased number of elderly is demographic reality. Elderly is the part of

history of mankind in the past, today and in the future. Elderly is source

of wisdom and spirit of patriotism for the youths to solve the problem in

local, regional, and national level.

Acknowledgement

Government of City of Surabaya and Airlangga University appreciate highly to

AUICK that invites the authors to attend AUICK Second 2008 Workshop; UNFPA

that gives opportunity to the authors to present the ideas and experience of solving

the problem of elderly; Prof Haryono Suyono, MA, PhD, Director of Damandiri

Foundation who proposes and gives opportunity to the authors to act in international

forum. His thoughts inspire the authors to do the best for the elderly. Part of his daily

life is dedicated to establish City of Surabaya to be better in the future.


Reference :

Department of Social East Java Province. 2008. Elderly National Commision.

Surabaya. Dinsos Jatim

Department of Social East Java Province. 2008. The Regional Regulation No.5/2007.

Surabaya. Dinsos Jatim

Suyono, H. 2006. Elderly care in Surabaya – A Case Study of Best Practices In Care

for Old Elderly. Jakarta. Dana Sejahtera Mandiri Foundation.

Suyono, H. 2005. Population, Health, Education Dynamics in the City of Surabaya,

Indonesia: Towards MDGs 2015.Jakarta. Dana Sejahtera Mandiri Foundation.


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