from research to action a story of change
FROM RESEARCH TO ACTION
A Story OF CHANGE
CENTER FOR HEALTH POLICY AND MANAGEMENT
FACULTY OF MEDICINE UNIVERSITAS GADJAH MADA
2016
1
From Research to Movement for Change: A Story of Change
By:
Mukhotib; Ignatius Praptoraharjo; Eviana Hapsari Dewi; Swasti Sempulur; M.
Suharni; Ignatius Hersumpana; Ita Perwira; Satiti Retno Pudjiastuti
National Library: Catalog under Issuance
From Research to Movement for Change: A Story of Change/Mukhotib;
Ignatius Praptoraharjo; Eviana Hapsari Dewi; Swasti Sempulur; M. Suharni;
Ignatius Hersumpana; Ita Perwira; Satiti Retno Pudjiastuti
Yogyakarta: Center for Health Policy and Management (CHPM) Faculty of
Medicine Universitas Gadjah Mada
66 pages/16.5 x 23 cm
First edition, August 2016
ISBN:
1. Research 2. HIV-AIDS 3. Health System 4. Movement 5. Story of Change
I. From Research to Movement for Change: A Story of Change
Cover design by: Flyingpants.Lab
Written with the support of the Australian government through a grant from
the Department of Foreign Afairs and Trade (DFAT) to the Center for Policy and
Health Management (CHPM), Faculty of Medicine, Universitas Gadjah Mada. This
publication does not represent the views of either the Government of Australia
or the Government of Indonesia.
All rights reserved.
Any part of the report may be used, reprinted, reproduced, quoted, or cited
in any manner through proper citation and for the purpose of community
education, not for commercial interests.
For more information please contact the Center for Policy and Health
Management (CHPM), Faculty of Medicine, Universitas Gadjah Mada.
Suggested citation:
CHPM. 2016. From Research to Movement for Change: A Story of Change.
Yogyakarta: CHPM GMU
Copyright © 2016 by
Center for Policy and Health Management (CHPM), Faculty of Medicine,
Universitas Gadjah Mada
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FOREWORD
Research on HIV and AIDS policy in Indonesia remains insuiciently explored by university
researchers. As of current, research has largely been focused on its medical, behavioural,
and social aspects. A series of collaborative research was undertaken by nine Indonesian
universities on “The Integration of HIV and AIDS Response into the National Health System”
and it was an efort in illing the research gap on HIV and AIDS policy. This study was carried
out in eight provinces which included the Province of North Sumatera, Special Capital
Region (SCR) of Jakarta, East Java, Bali, East Nusa Tenggara, South Sulawesi, West Papua, and
Papua. The nine universities responsible for their respective provinces are the University of
Sumatera Utara (USU), Atma Jaya Catholic University Jakarta and the HIV and AIDS Special
Discussion Group of Cipto Mangunkusumo Hospital University of Indonesia, Airlangga
University, Udayana University, Nusa Cendana University, Hasanuddin University, Papua
State University, and Cenderawasih University. Universitas Gadjah Mada as a coordinator
for this collaborative research series.
The aim of the research is to formulate a map of HIV and AIDS policies and its implementation
at the national, provincial and district/city level. The policy mapping includes policies on
promotion and prevention aspect, care, support and treatment (CST) aspect, and impact
mitigation of the HIV and AIDS epidemic for people living with HIV and AIDS (PWLHA),
their family, and the community. The development and implementation of the HIV and
AIDS policy should be observed within the existing health system in Indonesia in order to
understand the extent of its integration into the health system. Integration is a strategically
issue in HIV and AIDS response due to the fact that HIV and AIDS policies have always
been developed vertically initiated by donor. In the context of the need for the expansion,
efectiveness and continuity of future HIV and AIDS program, it is importance to consider
its integration into the health system as donor support will ultimately expire along with the
increasingly improving Indonesian economic conditions.
This research series also to enhancing researchers’ capacity who have been participating in
the study for nearly 3 years to induce change at the individual, societal, institutional, and
public policy level. The capacity building program was achieved through various means in
the form of training, online and face-to-face integrated learning, knowledge development,
and various network meetings at national and local level. The focus of the capacity building
is mainly aimed at enhancing understanding and skills in conducting policy research
and translating research results into policies as well as in creating networks for policy
development at local and national level.
3
In order to document the experiences gained during this collaborative research, particularly
in regard to capacity building, various stories of change directly experienced by researchers of
the respective universities have been compiled into a book. The researcher’s experiences are
illustrated in this book, from the completion of their understanding on policy research, the
opportunity to introduce aspects of health policy in their lectures, and even the opportunity
for researchers to interact with stakeholders of HIV and AIDS programs which consequently
enables them to carry out policy advocacy.
With the publication of the book on stories of change, we are very hopeful that the
collaborative research model undertaken by the nine universities could become an model for
other universities in Indonesia, as the research could still be further executed in more varied,
more extensive and more comprehensive locations. The capacity of researchers at the local
level could also be improved more through prevailing inter-university networks regarding
particular policy issues in order to encourage more contextual research. Due to its contextual
aspect, the knowledge produced through this research series can subsequently be followedup by policy makers to create programs that could appropriately and eiciently address
issues in the society.
To conclude, the capacity building process which has been carried out and the information it
has produced are beneicial to anyone who aspires for change in health services particularly
in the interest of the planning and implementation of the HIV and AIDS programs. We
would like to convey our gratitude to the Center for Health Policy and Management (CHPM),
Faculty of Medicine, Universitas Gadjah Mada as the coordinator of this research series, who
has involved and enhanced our capacity in policy research. We would also like to express
our appreciation to the Department of Foreign Afairs and Trade (DFAT), the National AIDS
Commission (KPAN) and the Regional AIDS Commission (KPAD) as the research site, for
without their valued assistance none of this would have been possible.
Jayapura, August 2016
Melkior Tappy, SKM, M.Kes
Faculty of Public Health, Cenderawasih University - Papua
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ACKNOWLEDGEMENTS
Our appreciation goes to the researchers of the eight (8) participating universities of the policy research program, whose contributions through their stories of change have made possible the
writing and publication of this Lessons Learned. Our appreciation
also goes to all organizations and individuals engaged in the HIV
and AIDS response, including the respective communities for their
contributions to the development of knowledge hub program and
other associated activities.
In addition, we also express our appreciation to the local AIDS
comission and health oices at the provincial/district/city levels
where the research program activities were done. Their support
throughout the course has allowed this research program to be
implemented as planned.
Our gratitude goes to the Ministry of Health (Kemkes RI) and the
National AIDS Commission (KPAN), and particularly to dr. Astrid
Kartika, MPP (DFAT); Irawati Atmosukarto, MPP (member of the
Research Consultative Group); dr. Trijoko Yudopuspito, M.Sc.PH
(Sub-Directorate for AIDS of the Indonesian Ministry of Health),
and Ir. Halik Sidik (KPAN) for their overviews in support to the implementation of this program.
Acknowledgements are extended to the Department of Foreign
Afairs and Trade (DFAT) Team, for the ongoing support throughout
the process of writing and publishing this book. Nevertheless, all
notions and conclusions presented in this document do not necessarily relect the views of DFAT.
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08
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TABLE OF
CONTENTS
31
33
Table of Contents
List of Figures
Section I: PROGRAM NARRATIVE, A CONTEXT
14
17
18
B. Program Goals
C. Activity Outputs
Section II: THE MSC, A PARTICIPATORY APPROACH
IN M&E
The MSC as a Complement to other M&E Methods
The Ethical Conduct of the MSC Application
The Stages of the MSC Implementation
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27
27
28
28
28
30
A. Deining the Domains of Change
B. Data Collection
1. Narrative Stories
2. Focus Group Discussion (FGD)
3. Interviews
4. Website User Survey
C. Analysis: Selection of Stories
Section III: MEASURING CHANGE, LEARNING FROM
THE FIELD
The Translation of HIV and AIDS Program Policy
and Development at the National and Sub-National Health Systems
34
34
33
37
38
40
40
42
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A. Background
A. Domain of Individual Change
1. The Concept of HIV and AIDS Response
2. Understanding the Policy Analysis
3. Capacity Building
4. Implementation Plan
B. Domain of Community Change
C. Domain of Institutional Change
D. Domain of Policy Change
44
Development of National and Provincial Level Intermediary
Facilities and Knowledge Management Advocacy
46
47
67
68
73
85
86
1. Website Users Survey
B. Blended Learning
C. Cultural Discussion
Section IV: THE COLLEGIAL VIEWS
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79
80
81
83
83
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A. The Three Noble Goals
B. Research Result, What’s Next?
C. Integration, Bottom-Up Experimentation
D. Culture, the Missing Aspect of Policy Research
E. The Role of Researcher in a 'question mark'
F. The Low Regional Budget
G. How much of the results of research have been used?
H. Future Challenges of Policy Research
I. Notes for the Centre of Policy Study
Section V: CONCLUSIONS AND RECOMMENDATIONS
Conclusions
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A. Use of Website: www.kebijakanaidsindonesia.net
A. Translation of AIDS Policy and Program Development within the
National and Sub-National Health Systems
1. Domain of Individual Change
2. Domain of Community Change
3. Domain of Institutional Change
4. Domain of Policy Change
B. Development of National and Provincial Level Intermediary
Facilities and Knowledge Management Advocacy
1. Use of Website: www.kebijakanaidsindonesia.net
2. Blended Learning
3. Cultural Discussion
Recommendations
7
LIST OF
FIGURES
8
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56
57
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Figure 1. Respondents’ Origin
Figure 2. Respondents’ Age
Figure 3. Respondents’ Gender
Figure 4. Respondents Sexual’s Orientation
Figure 5. Respondents’ Highest Level of Education
Figure 6. Respondents’ Occupation
Figure 7. Respondents’ Employment Sector
Figure 8. Respondents’ Sources of Information about
the Website
Figure 9. Length of Respondents’ Knowledge about
the Existence of the Website
Figure 10. Frequently Visited Menu
Figure 11. Type of Information Needs related to the
Promotion of HIV and AIDS Prevention
Figure 12. Type of Information Needs related to Care
and Support
Figure 13. Type of Information Needs related to HIV
and AIDS Response Impact Mitigation
Figure 14. Type of Information Needs related to Governance Aspects of HIV and AIDS Response
Figure 15. Interest to Share Knowledge and Experience through the Website
Figure 16. Form of Knowledge and Experience
Sharing
Figure 17. Assessment on the Website Display
Figure 18. Easy Switch between Web Pages with the
Available Navigation Bar
ACRONYMS
AIDS
Acquired Immune Deiciency Syndrome
APBD
Anggaran Pendapatan dan Belanja Daerah (Regional Government Budget)
BAPPEKOT
ment Agency)
Badan Perencanaan dan Pembangunan Kota (City Planning and Develop-
CSO
Civil Society Organization
DFAT
Department of Foreign Afairs and Trade
DIKTI
Pendidikan Tinggi (Higher Education)
FGD
Focus Group Discussion
FK
Fakultas Kedokteran (Faculty of Medicine)
FKM
Fakultas Kesehatan Masyarakat (Faculty of Public Health)
HIV
Human Immunodeiciency Virus
KPA
Komisi Penanggulangan AIDS (AIDS Commission)
KPAD
Komisi Penanggulangan AIDS Daerah (Local AIDS Commission)
KPAN
Komisi Penanggulangan AIDS Nasional (National AIDS Commission)
LGBT
Lesbian, Gay, Biseksual dan Transgender
LKB
Layanan Komprehensif Berkelanjutan (Comprehensive and Continuity of
HIV & AIDS and STIs Service)
LSL
Laki-laki Seks dengan Laki-laki (Men who have Sex with Men)
LSM
Lembaga Swadaya Masyarakat (Civil Society Organization)
M&E
Monitoring and Evaluation
MSC
The Most Signiicant Change
NGO
Non Government Organization
Pemilukada
Pemilihan Umum Kepala Daerah (Local Leader Election)
PKMK
Management)
Pusat Kebijakan dan Manajemen Kesehatan (Centre for Health Policy and
PLWHA
People Living with HIV & AIDS
Posyandu
Pos Pelayanan Terpadu (Integrated Service Point)
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Puskesmas
Pusat Kesehatan Masyarakat (Public Health Center)
SKPD
Satuan Kerja Pemerintah Daerah (Local Government Work Unit)
STI
Sexually Transmitted Infections
UGM
Universitas Gadjah Mada (University of Gadjah Mada)
UPT
Unit Layanan Terpadu (Integrated Service Unit)
WPA
Warga Peduli AIDS (Citizens Care for AIDS)
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PREFACE
The series of studies conducted by the Center for Health Policy and Management, Faculty of
Medicine, Universitas Gadjah Mada, with funding support from the Australian Government's
Department of Foreign Afairs and Trade (DFAT) on the integration of HIV and AIDS response
policies and programs into the health system, had been designed not merely as a research but
had also been directed to promote changes, both at an individual level (changes in knowledge,
attitudes and behaviors of the individuals involved in the research) as well as at a structural
level (policy on HIV and AIDS response at the local and national levels). These changes refer to
the actualization of potentials of various parties involved in the study who were encouraged
to substantiate the policy and program practices. The relection upon these potentials were
initiated through a variety of research and capacity building activities designed in the forms
of training, online and oline integrated learning, provision of knowledge resources, cultural
discussion, national meetings, and publications of research reports, policy briefs and policy
papers. In turn, the actualization was also initiated through such forums. For approximately
three years, these eforts have been carried out in nine cities (Yogyakarta, Jakarta, Surabaya,
Denpasar, Kupang, Manokwari, Jayapura, Makassar and Medan), each of which was initiated
and driven by various activists in HIV and AIDS response including researchers from each of
the local universities.
A study to relect various parties involved in the research project was undertaken to capture
the actualization of these potentials, using The Most Signiicant Change (MSC) approach.
Changes seen in this study were not in the sense of objective changes but rather in the
form of subjective interpretation of the authors and narrators of stories of change about the
beneiciaries themselves, their communities and institutions, as well as the interpretation of
changes at the policy level as an impact of the program implementation. Thus, the changes
presented are subjective reality of their chosen potential actuality. Narratives on the changes
were freely interpreted by the narrators and authors of this study, within the following
four domains of change being the focus of the stories of change: (1) individual change; (2)
community change; (3) institutional change; and (4) public policy change.
This relective study showed that generally, the process of research and capacity development
has been able to promote changes across researchers and wider communities who have
been exposed to the implementation of various program activities under development.
The narrators of the stories of change claimed that the research and capacity development
11
process conducted within this study has been able to bring together the actors in HIV and AIDS
response, including the policy makers. Furthermore, it also provides sources of inspiration for
the HIV and AIDS response actors in developing their program strategies.
If viewed from the actualization of various parties’ potentials, the research process has
demonstrated its usefulness in eforts to promote the integration of HIV and AIDS response into
the national health system. It was also depicted that these series of events have contributed
to the increasing capacity and skills of the beneiciary researchers in Indonesia. Such increase
in capacity evolved within the research process and across other activities carried out within
the framework of establishment of the knowledge hub platform. In the institutional domain,
the study also described that the process has inspired research institutions to conduct policy
analysis and encourage students to undertake policy analysis in support to their thesis writing.
In the praxis domain, the study assessed that the process has only been able to advocate
policy changes in HIV and AIDS response at the local level, particularly in budgetary policy.
While at the macro level, the contribution of process and result of the short-term study in
eforts to promote the integration of HIV and AIDS response into the national health system
is yet to be seen.
Nevertheless, there are a number of challenges in promoting changes at various levels.
Firstly, though it has become an inspiration for policy studies at the beginning, there have
been researchers who do not fully understand HIV and AIDS policies. By this, further capacity
building needs to be continuously carried out. Secondly, the tendency to think critically
and analytically seemed to have not been strongly built within the HIV and AIDS activists,
thus created challenges for others to advocate policy changes, especially those in favor of
marginalized groups. The third challenge is that accountability, transparency and efective
team are required for the expected changes to transpire. Or in other words, social ingenuity
and technical ingenuity are prerequisites for the network to be able to inluence the target
policies.
The lesson learned from the process of this research is that to actualize potentials, even those
could be clearly mapped, is not easy. In practical policies and programs, the interactions
between various parties with political economy motives seemed to be more dominant as a
determinant of the actualization of potentials related to equitable justice for disadvantaged
groups in society, particularly in the HIV and AIDS response. Changes at the levels of individual
and community otherwise tend to be more easily controlled and have more predictable
outcomes. Narratively, this book intends to illustrate the dynamics of the research process in
relation to the integration of HIV and AIDS policies and programs into the health system, to
initiate and promote various levels of shifts from changes at individual level to those leading
to a social movement that encourages changes in HIV and AIDS policies.
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section I
PROGRAM NARRATIVE,
A CONTEXT
13
A. background
14
There still seems to be a gap between supply and demand
for the provision of services to the key populations and
people living with HIV and AIDS (PLWHA) to date. Results of
the research of the National AIDS Commission (NAC) on AIDS
and its program evaluation conducted in 2011 indicated that
programs that were responsive to HIV and AIDS response
policies in Indonesia have not been evenly distributed. In
addition, the programs have also neither been aligned with
nor integrated into the health system in Indonesia.
This situation has become a major challenge in managing
more efective and eicient HIV and AIDS programs. The
increase in reported cases in 341 districts and cities across
33 provinces of Indonesia, and the Indonesian government's
eforts – whether or not supported by donor agencies –
illustrated that provision of better prevention, treatment,
care and support programs, and programs working on
minimizing the number of HIV and AIDS still need to be
revisited.
During the period of August 2013 to June 2016, the AustraliaIndonesia cooperation program for HIV through the Center
for Health Policy and Management (CHPM), Faculty of
Medicine, Universitas Gadjah Mada conducted a research
with the support of DFAT. The goal of this research was to map
the existing HIV and AIDS programs and implementation of
HIV and AIDS policies within the framework of health system
in Indonesia.
15
In the context of decentralization in Indonesia, it is clear to what extent the health system
is able to adapt and absorb the increase of demand for response to HIV and AIDS cases,
especially at the district level. Through the viewpoint of health system in Indonesia, this
research focuses on the main issue, the integration of HIV and AIDS response into the national
health system.
The research uses historical approaches in the study of documents related to HIV and AIDS
response policies and programs, mixed-methods research, and case studies to collect
information related to the integration of HIV and AIDS response policies and programs into
the national health system. The indings of this research are used to make recommendations
to stakeholders of HIV and AIDS response, such as central government, local government,
community sector, and civil society in the efort of integrating HIV and AIDS response
programs into the national health system. The results can furthermore be applied in the
development of HIV and AIDS response programs in Indonesia.
The research activities were divided into three categories. Firstly, the mapping of integration
of HIV and AIDS policies, which is currently used as an approach in the HIV and AIDS response
in Indonesia and the what extent the health system in Indonesia has adopted the response
16
to HIV and AIDS epidemic.
Secondly, the exploration of optimal choices of HIV and AIDS response models that will
be able to expand and increase the interventions against the complexity of HIV and AIDS
response into the highly decentralized health system framework in Indonesia, without ruling
out the needs for other basic health services.
Thirdly, the strengthening of knowledge management network with the 9 selected
universities in 8 provinces of Indonesia. The CHPM conducted this research in collaboration
with the Research Centre for HIV Atma Jaya Catholic University in Jakarta and eight other
local universities, namely (1) Cenderawasih University in Jayapura, Papua; (2) University of
Papua in Manokwari, West Papua; (3) Nusa Cendana University in Kupang, East Nusa Tenggara
(NTT); (4) Udayana University in Denpasar, Bali; (5) Hasanuddin University in Makassar, South
Sulawesi; (6) Airlangga University in Surabaya, East Java; (7) University of Indonesia in Jakarta;
and (8) University of North Sumatra in Medan, North Sumatra.
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b. PROGRAM GOALS
The strengthening of health system as a response to HIV and AIDS intends to
achieve the following four targeted outcomes: (1) the informed policy makers;
(2) the use of facts of policy development; (3) the implementation of policies
and programs within the national health system; and (4) the improvement and
renewal of production, dissemination and use of knowledge.
c. ACTIVITY OUTPUTS
The outputs of this research can be described below:
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1.
The map of the Government of Indonesia’s policies related to the
prevention, care, support and treatment of HIV and AIDS and the
mitigation impact within the health system afecting policies of other
sectors at the national and sub-national levels.
2.
The collection and analysis of a wide range of examples of policy
practices within the health system at the national and sub-national
levels using the advantage and disadvantage analysis as well as the
opportunities and risks of each case study.
3.
The policy model to strengthen the existing policies on health system
in an efort to improve the efectiveness of HIV and AIDS response
programs.
4.
The network of national AIDS policies consisting of researchers,
policy makers and stakeholders, that contribute to the formation of
knowledge management center for better advocacy of HIV and AIDS
policy development and implementation.
AECTION Ii
THE MSC, A PARTICIPATORY
APPROACH IN M&E
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The Most Signiicant Change (MSC)1, is a participatory Monitoring and Evaluation (M&E) tool
based on stakeholders’ stories of change. The beneiciaries would independently write their
stories of change considered most signiicant to themselves, the people in their surroundings,
the institutions they work, and the policy level as a result of the program implementation.
As a report of a journalist, everyone may have a diferent story, though it has to follow the
same process, to face the same empirical facts, to be involved in the same incident. As in
the writing process of the stories, every journalist is inluenced by his/her own perspectives,
viewpoints, knowledge and experience.
Simple stories based on the experience of beneiciaries’ involvement in the program were
analyzed to see the changes that were transpired and considered most signiicant. The process
of analysis is a major process and a critical point in viewing the diversity of values contained
in every changes. The main conviction is that any sentence expressed by the author is a set of
values relecting the author’s awareness and attitude.
The principles of participatory and appreciation to everyone's perspective in assessing
changes within social life as the substance of the MSC has become basis of a major traction of
the method being chosen for the writing of the lessons learned of the Research Program “HIV
and AIDS Policy within the National Health System Framework”.
1 The Most Signiicant Changes (MSC) was introduced by Rick Davies, 1996 on his research about
the learning organisation in a non-governmental organisation in Bangladesh (The Most Signiicant
Technique: A Guide to Its Use, Version 1, Rick Davies and Jess Dart, Care International et al, 2005).
The MSC as a Complement to
other M&E Methods
The MSC as an evaluation tool is not in substitution of other evaluation models. In contrast to
qualitative approach, which is generally centered on "what we want to know and things that
are to be known", the MSC aims at seeing the achievements that have not been previously
formulated, and even the stakeholders may be unaware of changes that evolved within
themselves, their communities, their work places, and the policy domain.
By this, the MSC does not intend to see the achievements based on measurable and
predeined indicators as stated in the logical framework of a program (input-output-outcome,
and impact).
21
Deining the unthinkable changes has actually made the MSC an important tool to complement
the qualitative and quantitative evaluation methods carried out simultaneously to note the
achievements of the program implementation. At least, the writing process was based on the
stories of beneiciaries that were freely disclosed and without restrictions. The writing was
based on what have been perceived by beneiciaries during their involvement in the program
implementation.
"
Nevertheless, it was precisely the freedom of such
highly subjective disclosure that has become
methodological limitation of the MSC’s. There have
been various biases arising in the whole process
of writing and analysis, given the beneiciaries’
subjective world as the main basis.
Firstly, the bias in the writing of stories of change. These biases were embodied in the shape of
tendency of people to tell the positive sides of changes and the bias of popular views that at a
certain point may very likely drown the "unpopular stories" in the lives of marginalized groups.
In anticipation of the bias, ever since its inception, the writing guidelines has clearly
communicated that changes over the program implementation may not always be interpreted
as positive changes, but very likely, also as negative ones.
Secondly, the bias in the selection of narrators. This bias occurred due to a tendency to choose
good storytellers who are capable of writing narratives. This is a subjectivity bias of the panel
selecting the stories.
Nevertheless, there was no such bias in this writing process. The selection of stories was not
done through an elimination of narrators, where the selection of certain narrators would
eliminate the others. The process instead gathered all statements of authors considered
presenting both positive and negative changes, even those to be written as they were in the
form of direct quotations.
Despite the anticipation, taking into account the potential biases, it was not recommended to
use the MSC as a sole M&E method and it shall rather be complemented by other methods,
such as quantitative surveys, group discussions, and literature studies.
Through the MSC eforts of quantiication, the accumulation of stories of change can take
place. These eforts can be done by counting how many times the changes was stated by the
narrators. When there are 100 authors, and 75 authors state the same changes, it means 75%
of the authors consider the same changes occurred as an impact of the program.
However in this context, the efort of quantiication was not administered, the content of
stories of change varies, and diferent types of statement were used. Thus, quantiication was
22
impossible to be done. In addition, it was also impossible to be done due to the number of
authors as many as 22.
THE ETHICAL CONDUCT OF
THE MSC APPLICATION
The evaluation process in the course of the MSC was conducted within the scope of the
principles of respect for the right to privacy under the following conditions:
1.
The lesson learned documents will only contain stories of change written by the
beneiciaries.
2.
The name of beneiciaries would not be included in the lesson learned documents,
in exception of the beneiciaries who expressed their no objection for their names,
positions and institutions to be disclosed, by completing the informed consent forms
attached to the circulated writing guidelines.
3.
Only the name and institution of the beneiciaries who had illed the informed consent
forms that will further be included in the process of analysis of the stories of change
along with the program implementers.
4.
The name and contact of the beneiciaries related to the stories of change will not be
handed over to the program managers, but will only be used by the consultant for a
more in-depth analysis and/or conirmation of their stories of change, when necessary.
23
THE STAGES OF THE MSC IMPLEMENTATION
a. DEFINING THE DOMAINS OF CHANGE
In this document, four domains of change have been selected and will be referenced with the
stories of change and statements presented in the Focus Group Discussions (FGDs). The result
of interviews of selected resource persons are presented in the section on collegial views as a
relection of the policy research program.
A domain of change is not a deinition leading to the indicators of outcome achievements.
Indicator is a formula that requires everyone to have the same understanding as its
formulation; this does not allow any diferences in interpretation. Typically, the indicator must
meet the following criteria: speciic, achievable, relevant, and time-limited.
The domain of change in this document is more accurately referred as a subjective
interpretation of the authors and narrators of the stories of change about themselves, their
communities and institutions, as well as the interpretation of changes occurred at the policy
level, as an impact of the program implementation. In other words, the domain of change is a
subjective reality of what experienced diferently when they saw the objective reality of each
of their chosen categories.
Every person, every narrator, and every author of the narratives of change has freedom in
interpreting changes, even if the change occurred only once in a single domain of change. In
this document, four domains of change have been selected as focus of the stories of change.
First, the domain of individual change. This domain will indicate the changes occurred in every
person involved in the program implementation, which might be a change of perspective,
knowledge, and skills capacity, and change of attitude towards objective reality upon
completion of the whole program, such as: research, capacity building, blended learning,
cultural discussions, and access to the website of Indonesia AIDS Policy managed by the
CHPM.
These changes may occur in the domain of knowledge (e.g., the importance of policy analysis
to inluence better policy-making), the domain of attitude (e.g., the response and mitigation
of HIV and AIDS impacts in Indonesia and other social issues, will be more efective when they
are contextualized in the appropriate policy in correspond to the needs and interests of the
community rather than being merely viewed as a matter of person by person’s behavioral
issue), and the domain of action (e.g., motivation to undertake a policy analysis in other ields).
24
Second, the domain of community change. This domain will indicate what changes
occurred within the people in the surrounding of the beneiciaries based on subjective
assessment of the author of the stories of change. These changes could take place in
the domain of perspective, knowledge and skill, and community behavior, as a result of
intensive communication with the beneiciaries and their involvement in various activities
developed in the program. These changes may occur in the domain of knowledge (e.g.,
change of knowledge in policy analysis), the domain of attitude (e.g., they showed
a diference in seeing the root of HIV and AIDS issues), and the domain of action (e.g.,
students showed interest in doing policy analysis).
Third, the domain of institutional change. This domain will show the institutional response
of institutions or organizations where the beneiciaries work. These changes could take
place in the domain of change as a form of support to program activities, the availability
of running the same program, and allowing the emergence of policies at the institution
level that provides development opportunities in the future program. As well as their
emerging interests in developing policy-oriented programs, there may also be intentions
to do policy analysis and plan for policy advocacy.
Fourth, the domain of public policy change. This domain will show how the program
beneiciaries see the program impact on the expected policies as a result of the program
achievement will change during the course of program implementation. As the subjective
point of view, the assessment of this policy change will certainly vary as those of diferent
statements made on the occurred changes.
For example, during the course of engagement in the research program, meetings with
policy makers at a certain level (district/city/provincial/national) and discussions on the
results of research have been completed, and through this interaction policy makers may
want to make changes to the HIV and AIDS policy.
25
26
B. DATA COLLECTION
The collection of stories of change was administered in three methods: narrative stories, focus
group discussions, and in-depth interviews. In this document, the methods are presented
in diferent parts. In addition to the collection of the MSC stories, data collection was
administered through some website surveys.
1. NARRATIVE STORIES
A total of 22 researchers from nine Indonesian universities and some researchers of HIV
and AIDS policy team - CHPM wrote the narrative-form stories of change. The researchers
wrote theirs rather independently. Prior to the writing of the stories of change, each of
the researchers must read the writing guide and ill in the informed consent form, in
relation to their statement of no objection for the author's identity to be disclosed in the
lessons learned document.
The data collection was administered during February 2016. The writing guide and
informed consent form were emailed to the beneiciary researchers. Subsequently, they
would email back their stories of change. The process of technical explanation of the
MSC writing guide was completed on February 23rd, 2016 at Novotel Hotel, Solo.
There were 22 researchers who submitted their stories of change and most of them
opted for their anonymity in the lessons learned documents. Those who were reluctant
to be identiied did not state in writing. They rather not return their completed informed
consent forms. During the researchers meeting in Solo, they were asked once again
about their informed consent forms, but until the writing of this document they have
not returned the forms to the team. By this situation, it was concluded that those who
did not return the forms were grouped as researchers objecting any disclosure of their
identities.
The Guiding Questions for the Writing of the Stories of Change
The collection of narratives was done by rewriting researchers’ experience in the stories
of change. The guiding questions were provided below:
1.
Please tell me in 2 or 3 sentences, your exposure to the research or capacity
building programs implemented by HIV and AIDS policy team - CHPM.
2.
Please tell me in 2 or 3 sentences, how did you irst get involved in the program
and how is your recent involvement? (It is worth mentioning the type of
programs, such as research, blended learning courses, cultural discussions,
etc.).
3.
Please list both of good and bad changes due to the exposure to the research
27
and capacity building programs implemented by HIV and AIDS policy
team - CHPM.
4.
From the above mentioned changes, which are the most important ones?
They can be either positive or negative change.
5.
Please describe those changes in the form of a story [for example, initial
period (how was it previously), mid period (what caused the changes) and
inal period (what is it like now)].
6.
Please name the reasons you chose these changes in particular. For
example, whether these changes are signiicant for you or for others.
There were no speciic rules on how the narrators are supposed to present their
stories of change. However it is advisable to use the form of essay or narrative style,
and not in the form of popular-scientiic articles.
2. Focus Group Discussion (FGD)
An FGD was delivered to get the stories of change from program beneiciaries in
addition to the research, such as cultural discussion, dissemination of research
results, and other speciic activities such as the World AIDS Day.
The FGD was conducted on March 8th, 2016 attended by 18 participants. The
participants came from diferent backgrounds, communities, CSOs, academia,
media, and agencies/government institutions (local government oices and
commissions). In the FGD process, the participants were also requested to ill out
the informed consent forms and all participants expressed their no objection for
their identities to be disclosed in the document.
In getting the stories of change, the FGD was moderated by a facilitator whose
role was to facilitate the process of discussion and sharpen each of the stories of
change told by the participants.
3. INTERVIEWS
The purpose of the interviews is to gather the views of the parties who are
considered having a high level of understanding of the progress of the program.
The interviews were conducted openly to provide lexibility for the resource
persons to express their views in relation to the program implementation. Four
resource persons were selected to interview: (1) dr. Astrid Kartika, MPP, DFAT; (2)
Irawati Atmosukarto, MPP, a member of the Consultative Group (CG) of AIDS Policy
Research Program, and was a staf of the NAC; (3) dr. Trijoko Yudopuspito, M.Sc.PH,
28
Sub-Directorate for AIDS of the Indonesian Ministry of Health, and (4) Ir. Halik Sidik, a
staf of the NAC. The interviews were conducted on March 16th and on 17th, 2016.
4. Website USER SURVEY
The Indonesian AIDS Policy website (www.kebijakanaidsindonesia.net) has been
developed since early 2013, as a knowledge forum presenting a variety of information
about HIV and AIDS response, particularly those that are policy-related. The information
on the website are presented in the form of research reports, policy studies, policy
articles and other information in the form of correspondence, Community of Practice, as
well as Blended Learning. The contributions of articles and resources of information to
date come from the Indonesia AIDS Policy researchers’ team, local researchers from the
9 selected universities, NGOs and the Yogyakarta Provincial AIDS Commission.
The method of extracting information used an online system displaying a survey sheet
in the form of pop-up windows on the website during the data collection period from
29
February to March 2016. In addition to using a banner for the survey announcement,
the website manager sent out a notiication that also serves as a request for the
website visitors to participate as a survey respondent through cultural discussions and
researchers mailing lists.
The website manager performed the processing of analysis against survey results, and
presented them in an info graphics form. Based on this survey, the development and
improvement of the website will be undertaken.
c. ANALYSIS: SELECTION OF STORIES
The stories of change analyses were undertaken on each of all stories of change written by
the beneiciaries. By this, selection of the stories of change was not done to select which
stories to be analyzed, but to quote statements assessed as indicating changes within the
speciied four domains of change.
The grouping of statements of change was done by the author of this lessons learned
document, after all stories of change were received from the researchers at the end of
February 2016. The statements were grouped under four speciied domains changes.
Quotations of statements were discussed with HIV and AIDS policy team - CHPM on March
8th, 2016, using the assessment statement of: (1) whether the statement is a story of the
process of the beneiciary’s engagement in the program; and (2) whether the statement
expresses any changes. Statements that were assessed as only presenting the process will
be excluded from the list, and those assessed statements would be the ones to be included
in the subsequent writing process. The process of testing whether a statement includes the
value of change was by asking the question, 'If ....., then ......'
In the selection and analysis of the statements of change, almost all beneiciaries did neither
show nor stated their changes altogether in the four domains of change.
While the analysis of the results of website user survey was presented as quantitative data.
The goal is to see the use of website as one of the means providing network of knowledge
and information as part of an advocacy efort of the integration of HIV and AIDS response into
the national health system.
30
SECTION Iii
MEASURING CHANGE,
LEARNING FROM THE FIELD
31
The HIV and AIDS response policy program analysis includes the following three main activities; (1) the elaboration of policies and development of HIV and AIDS programs in the health
system at the national and local levels; (2) the development of policies and service models of
HIV and AIDS; and (3) the development of facility and advocacy hub for knowledge management at the national and provincial levels.
This lessons learned document contains two main activities of this program, (1) the elaboration of policies and the development of HIV and AIDS programs in the health system at the
national and sub national levels; and (2) the development of facility and advocacy hub for
knowledge management at the national and provincial levels, as the modeling activities were
still undergoing at the time of drafting of the document.
32
THE TRANSLATION OF HIV AND AIDS PROGRAM
POLICY AND DEVELOPMENT AT THE NATIONAL AND
SUB-NATIONAL HEALTH SYSTEMS
Based on the stories of change, the policy analysis program appeared to be able to determine
the emerging changes in four domains, namely individual, community, institution and policy.
First, at the individual domain, there have been changes on perspective on HIV and AIDS
that is now seen not only as a medical problem but also as systemic problem rooted in the
political, social, and cultural systems. This situation encouraged a shift of paradigm in HIV and
AIDS response, which is no longer suicient to be done only through behavioral change but
rather requires criticism of the policies related to HIV and AIDS response.
The policy change thus became the main entrance to HIV and AIDS response program. The
policy analysis became the most important part in eforts to encourage policy changes
through the integration into national health system.
The policy analysis program has increased the knowledge and skills of researchers on policy
research, national health systems, and HIV and AIDS response programs. The policy analysis
program has also inspired the enhancement of research plans, development of lecture
materials, and their publication in the university journal.
Second, changes in the community domain. The topic of policy analysis became a discussion
material amongst university professors who are interested in conducting analysis of policies
and health systems. In the meantime, some of the students continued to have further
discussions and conduct policy analysis, and it even changed the attitudes of students in
responding to HIV and AIDS issues.
Third, changes in the institutional domain, there were support, interest and desire to undertake
policy analysis. Not only they would enhance policy research but also allow permissions for
their students to conduct policy analysis in completion of their thesis for graduate school.
Fourth, in terms of policy change, the policy analysis program has demonstrated the existence
of a policy change at the local level. However, the development at the national level seemed
to be limited still to the discourse of the importance of results of policy analysis in policy
change and program development.
33
a. DOMAIN OF INDIVIDUAL CHANGE
1. THE CONCEPT OF HIV AND AIDS RESPONSE
The implementation of policy program analysis has been able to shift the beneiciaries’
views about HIV and AIDS in Indonesia. In the very basic context, HIV and AIDS are no
longer seen as merely medical problem, as many people would understand, and these
include activists in HIV and AIDS response and government. Moreover, HIV and AIDS is
seen as an issue directly related to cultural, social, and political systems.
At the technical level, HIV and AIDS response is no longer seen as limited to prevention,
treatment and management of people living with HIV and AIDS but more in a macro
context that is rooted in the political, cultural, social systems, and that it is carried out
comprehensively. This includes the review of government's policies on HIV and AIDS
response program.
An example of change at the technical level can be seen in the experience of Swasti
Sempulur, a researcher of the CHPM. She has been involved in various HIV and AIDS
response programs in Indonesia since 1998. However, the activities under development
have been more in the programmatic and pragmatic areas; promoting non-risk sexual
behavior, raising awareness on HIV testing, and accessing health services, as they have
been considered most serious issues at the community level.
Previously, she had never thought about the importance of policy research as part of
advocacy on HIV and AIDS and even more about thinking of the idea of integration of HIV
and AIDS response into the system of national health policy.
"
When the CHPM developed the policy research program,
she considered it as another way of doing advocacy and it
became a new experience for her. “Like it or not, I changed
my mindset, from programmatic and pragmatic to strategic
thinking, and looking at issues in a macro context, " said
Swasti.
Amelya, B. Sir, a Lecturer at Public Health Faculty Undana University, Kupang, said that she
had previously viewed AIDS issues limitedly to the prevention, treatment, and response
for people living with HIV and AIDS. Having been involved in this policy research program,
according to her, HIV and AIDS response has to be undertaken comprehensively, not only
34
on the downstream but it has to also shift the issues on the upstream. One of the
eforts is through making policy changes in relation to HIV and AIDS research and
delivering advocacy to policy makers.
In the meantime, Hersumpana, a researcher of the CHPM had seen HIV and AIDS
as a solely medical issue. After conducting the policy research, he saw that HIV and
AIDS as an actually complex issue. It is not only a medical problem but moreover
has a broad dimension, concerning cultural, social and political systems. "Everything
is intertwined," he said.
2. UNDERSTANDING THE POLICY ANALYSIS
Policy analysis has similarities with and diferences from research in general. The
similarities are in regards to the collection of reading materials and references,
interviews of informants, and review of the results of interview transcripts. While
the diference lies on the process of analysis and report writing, particularly,
the utilization of policy review instruments, formulation of association and
incorporation of indings against policy facts, interpretation of structured data, and
research interests.
The beneiciaries recognized the importance of policy analysis for public policy
change. Policy analysis is able to identify policy implementation an
A Story OF CHANGE
CENTER FOR HEALTH POLICY AND MANAGEMENT
FACULTY OF MEDICINE UNIVERSITAS GADJAH MADA
2016
1
From Research to Movement for Change: A Story of Change
By:
Mukhotib; Ignatius Praptoraharjo; Eviana Hapsari Dewi; Swasti Sempulur; M.
Suharni; Ignatius Hersumpana; Ita Perwira; Satiti Retno Pudjiastuti
National Library: Catalog under Issuance
From Research to Movement for Change: A Story of Change/Mukhotib;
Ignatius Praptoraharjo; Eviana Hapsari Dewi; Swasti Sempulur; M. Suharni;
Ignatius Hersumpana; Ita Perwira; Satiti Retno Pudjiastuti
Yogyakarta: Center for Health Policy and Management (CHPM) Faculty of
Medicine Universitas Gadjah Mada
66 pages/16.5 x 23 cm
First edition, August 2016
ISBN:
1. Research 2. HIV-AIDS 3. Health System 4. Movement 5. Story of Change
I. From Research to Movement for Change: A Story of Change
Cover design by: Flyingpants.Lab
Written with the support of the Australian government through a grant from
the Department of Foreign Afairs and Trade (DFAT) to the Center for Policy and
Health Management (CHPM), Faculty of Medicine, Universitas Gadjah Mada. This
publication does not represent the views of either the Government of Australia
or the Government of Indonesia.
All rights reserved.
Any part of the report may be used, reprinted, reproduced, quoted, or cited
in any manner through proper citation and for the purpose of community
education, not for commercial interests.
For more information please contact the Center for Policy and Health
Management (CHPM), Faculty of Medicine, Universitas Gadjah Mada.
Suggested citation:
CHPM. 2016. From Research to Movement for Change: A Story of Change.
Yogyakarta: CHPM GMU
Copyright © 2016 by
Center for Policy and Health Management (CHPM), Faculty of Medicine,
Universitas Gadjah Mada
2
FOREWORD
Research on HIV and AIDS policy in Indonesia remains insuiciently explored by university
researchers. As of current, research has largely been focused on its medical, behavioural,
and social aspects. A series of collaborative research was undertaken by nine Indonesian
universities on “The Integration of HIV and AIDS Response into the National Health System”
and it was an efort in illing the research gap on HIV and AIDS policy. This study was carried
out in eight provinces which included the Province of North Sumatera, Special Capital
Region (SCR) of Jakarta, East Java, Bali, East Nusa Tenggara, South Sulawesi, West Papua, and
Papua. The nine universities responsible for their respective provinces are the University of
Sumatera Utara (USU), Atma Jaya Catholic University Jakarta and the HIV and AIDS Special
Discussion Group of Cipto Mangunkusumo Hospital University of Indonesia, Airlangga
University, Udayana University, Nusa Cendana University, Hasanuddin University, Papua
State University, and Cenderawasih University. Universitas Gadjah Mada as a coordinator
for this collaborative research series.
The aim of the research is to formulate a map of HIV and AIDS policies and its implementation
at the national, provincial and district/city level. The policy mapping includes policies on
promotion and prevention aspect, care, support and treatment (CST) aspect, and impact
mitigation of the HIV and AIDS epidemic for people living with HIV and AIDS (PWLHA),
their family, and the community. The development and implementation of the HIV and
AIDS policy should be observed within the existing health system in Indonesia in order to
understand the extent of its integration into the health system. Integration is a strategically
issue in HIV and AIDS response due to the fact that HIV and AIDS policies have always
been developed vertically initiated by donor. In the context of the need for the expansion,
efectiveness and continuity of future HIV and AIDS program, it is importance to consider
its integration into the health system as donor support will ultimately expire along with the
increasingly improving Indonesian economic conditions.
This research series also to enhancing researchers’ capacity who have been participating in
the study for nearly 3 years to induce change at the individual, societal, institutional, and
public policy level. The capacity building program was achieved through various means in
the form of training, online and face-to-face integrated learning, knowledge development,
and various network meetings at national and local level. The focus of the capacity building
is mainly aimed at enhancing understanding and skills in conducting policy research
and translating research results into policies as well as in creating networks for policy
development at local and national level.
3
In order to document the experiences gained during this collaborative research, particularly
in regard to capacity building, various stories of change directly experienced by researchers of
the respective universities have been compiled into a book. The researcher’s experiences are
illustrated in this book, from the completion of their understanding on policy research, the
opportunity to introduce aspects of health policy in their lectures, and even the opportunity
for researchers to interact with stakeholders of HIV and AIDS programs which consequently
enables them to carry out policy advocacy.
With the publication of the book on stories of change, we are very hopeful that the
collaborative research model undertaken by the nine universities could become an model for
other universities in Indonesia, as the research could still be further executed in more varied,
more extensive and more comprehensive locations. The capacity of researchers at the local
level could also be improved more through prevailing inter-university networks regarding
particular policy issues in order to encourage more contextual research. Due to its contextual
aspect, the knowledge produced through this research series can subsequently be followedup by policy makers to create programs that could appropriately and eiciently address
issues in the society.
To conclude, the capacity building process which has been carried out and the information it
has produced are beneicial to anyone who aspires for change in health services particularly
in the interest of the planning and implementation of the HIV and AIDS programs. We
would like to convey our gratitude to the Center for Health Policy and Management (CHPM),
Faculty of Medicine, Universitas Gadjah Mada as the coordinator of this research series, who
has involved and enhanced our capacity in policy research. We would also like to express
our appreciation to the Department of Foreign Afairs and Trade (DFAT), the National AIDS
Commission (KPAN) and the Regional AIDS Commission (KPAD) as the research site, for
without their valued assistance none of this would have been possible.
Jayapura, August 2016
Melkior Tappy, SKM, M.Kes
Faculty of Public Health, Cenderawasih University - Papua
4
ACKNOWLEDGEMENTS
Our appreciation goes to the researchers of the eight (8) participating universities of the policy research program, whose contributions through their stories of change have made possible the
writing and publication of this Lessons Learned. Our appreciation
also goes to all organizations and individuals engaged in the HIV
and AIDS response, including the respective communities for their
contributions to the development of knowledge hub program and
other associated activities.
In addition, we also express our appreciation to the local AIDS
comission and health oices at the provincial/district/city levels
where the research program activities were done. Their support
throughout the course has allowed this research program to be
implemented as planned.
Our gratitude goes to the Ministry of Health (Kemkes RI) and the
National AIDS Commission (KPAN), and particularly to dr. Astrid
Kartika, MPP (DFAT); Irawati Atmosukarto, MPP (member of the
Research Consultative Group); dr. Trijoko Yudopuspito, M.Sc.PH
(Sub-Directorate for AIDS of the Indonesian Ministry of Health),
and Ir. Halik Sidik (KPAN) for their overviews in support to the implementation of this program.
Acknowledgements are extended to the Department of Foreign
Afairs and Trade (DFAT) Team, for the ongoing support throughout
the process of writing and publishing this book. Nevertheless, all
notions and conclusions presented in this document do not necessarily relect the views of DFAT.
5
06
08
13
19
21
23
24
TABLE OF
CONTENTS
31
33
Table of Contents
List of Figures
Section I: PROGRAM NARRATIVE, A CONTEXT
14
17
18
B. Program Goals
C. Activity Outputs
Section II: THE MSC, A PARTICIPATORY APPROACH
IN M&E
The MSC as a Complement to other M&E Methods
The Ethical Conduct of the MSC Application
The Stages of the MSC Implementation
24
27
27
28
28
28
30
A. Deining the Domains of Change
B. Data Collection
1. Narrative Stories
2. Focus Group Discussion (FGD)
3. Interviews
4. Website User Survey
C. Analysis: Selection of Stories
Section III: MEASURING CHANGE, LEARNING FROM
THE FIELD
The Translation of HIV and AIDS Program Policy
and Development at the National and Sub-National Health Systems
34
34
33
37
38
40
40
42
6
A. Background
A. Domain of Individual Change
1. The Concept of HIV and AIDS Response
2. Understanding the Policy Analysis
3. Capacity Building
4. Implementation Plan
B. Domain of Community Change
C. Domain of Institutional Change
D. Domain of Policy Change
44
Development of National and Provincial Level Intermediary
Facilities and Knowledge Management Advocacy
46
47
67
68
73
85
86
1. Website Users Survey
B. Blended Learning
C. Cultural Discussion
Section IV: THE COLLEGIAL VIEWS
75
76
78
79
80
81
83
83
84
A. The Three Noble Goals
B. Research Result, What’s Next?
C. Integration, Bottom-Up Experimentation
D. Culture, the Missing Aspect of Policy Research
E. The Role of Researcher in a 'question mark'
F. The Low Regional Budget
G. How much of the results of research have been used?
H. Future Challenges of Policy Research
I. Notes for the Centre of Policy Study
Section V: CONCLUSIONS AND RECOMMENDATIONS
Conclusions
87
87
88
88
88
89
89
91
91
92
A. Use of Website: www.kebijakanaidsindonesia.net
A. Translation of AIDS Policy and Program Development within the
National and Sub-National Health Systems
1. Domain of Individual Change
2. Domain of Community Change
3. Domain of Institutional Change
4. Domain of Policy Change
B. Development of National and Provincial Level Intermediary
Facilities and Knowledge Management Advocacy
1. Use of Website: www.kebijakanaidsindonesia.net
2. Blended Learning
3. Cultural Discussion
Recommendations
7
LIST OF
FIGURES
8
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
Figure 1. Respondents’ Origin
Figure 2. Respondents’ Age
Figure 3. Respondents’ Gender
Figure 4. Respondents Sexual’s Orientation
Figure 5. Respondents’ Highest Level of Education
Figure 6. Respondents’ Occupation
Figure 7. Respondents’ Employment Sector
Figure 8. Respondents’ Sources of Information about
the Website
Figure 9. Length of Respondents’ Knowledge about
the Existence of the Website
Figure 10. Frequently Visited Menu
Figure 11. Type of Information Needs related to the
Promotion of HIV and AIDS Prevention
Figure 12. Type of Information Needs related to Care
and Support
Figure 13. Type of Information Needs related to HIV
and AIDS Response Impact Mitigation
Figure 14. Type of Information Needs related to Governance Aspects of HIV and AIDS Response
Figure 15. Interest to Share Knowledge and Experience through the Website
Figure 16. Form of Knowledge and Experience
Sharing
Figure 17. Assessment on the Website Display
Figure 18. Easy Switch between Web Pages with the
Available Navigation Bar
ACRONYMS
AIDS
Acquired Immune Deiciency Syndrome
APBD
Anggaran Pendapatan dan Belanja Daerah (Regional Government Budget)
BAPPEKOT
ment Agency)
Badan Perencanaan dan Pembangunan Kota (City Planning and Develop-
CSO
Civil Society Organization
DFAT
Department of Foreign Afairs and Trade
DIKTI
Pendidikan Tinggi (Higher Education)
FGD
Focus Group Discussion
FK
Fakultas Kedokteran (Faculty of Medicine)
FKM
Fakultas Kesehatan Masyarakat (Faculty of Public Health)
HIV
Human Immunodeiciency Virus
KPA
Komisi Penanggulangan AIDS (AIDS Commission)
KPAD
Komisi Penanggulangan AIDS Daerah (Local AIDS Commission)
KPAN
Komisi Penanggulangan AIDS Nasional (National AIDS Commission)
LGBT
Lesbian, Gay, Biseksual dan Transgender
LKB
Layanan Komprehensif Berkelanjutan (Comprehensive and Continuity of
HIV & AIDS and STIs Service)
LSL
Laki-laki Seks dengan Laki-laki (Men who have Sex with Men)
LSM
Lembaga Swadaya Masyarakat (Civil Society Organization)
M&E
Monitoring and Evaluation
MSC
The Most Signiicant Change
NGO
Non Government Organization
Pemilukada
Pemilihan Umum Kepala Daerah (Local Leader Election)
PKMK
Management)
Pusat Kebijakan dan Manajemen Kesehatan (Centre for Health Policy and
PLWHA
People Living with HIV & AIDS
Posyandu
Pos Pelayanan Terpadu (Integrated Service Point)
9
Puskesmas
Pusat Kesehatan Masyarakat (Public Health Center)
SKPD
Satuan Kerja Pemerintah Daerah (Local Government Work Unit)
STI
Sexually Transmitted Infections
UGM
Universitas Gadjah Mada (University of Gadjah Mada)
UPT
Unit Layanan Terpadu (Integrated Service Unit)
WPA
Warga Peduli AIDS (Citizens Care for AIDS)
10
PREFACE
The series of studies conducted by the Center for Health Policy and Management, Faculty of
Medicine, Universitas Gadjah Mada, with funding support from the Australian Government's
Department of Foreign Afairs and Trade (DFAT) on the integration of HIV and AIDS response
policies and programs into the health system, had been designed not merely as a research but
had also been directed to promote changes, both at an individual level (changes in knowledge,
attitudes and behaviors of the individuals involved in the research) as well as at a structural
level (policy on HIV and AIDS response at the local and national levels). These changes refer to
the actualization of potentials of various parties involved in the study who were encouraged
to substantiate the policy and program practices. The relection upon these potentials were
initiated through a variety of research and capacity building activities designed in the forms
of training, online and oline integrated learning, provision of knowledge resources, cultural
discussion, national meetings, and publications of research reports, policy briefs and policy
papers. In turn, the actualization was also initiated through such forums. For approximately
three years, these eforts have been carried out in nine cities (Yogyakarta, Jakarta, Surabaya,
Denpasar, Kupang, Manokwari, Jayapura, Makassar and Medan), each of which was initiated
and driven by various activists in HIV and AIDS response including researchers from each of
the local universities.
A study to relect various parties involved in the research project was undertaken to capture
the actualization of these potentials, using The Most Signiicant Change (MSC) approach.
Changes seen in this study were not in the sense of objective changes but rather in the
form of subjective interpretation of the authors and narrators of stories of change about the
beneiciaries themselves, their communities and institutions, as well as the interpretation of
changes at the policy level as an impact of the program implementation. Thus, the changes
presented are subjective reality of their chosen potential actuality. Narratives on the changes
were freely interpreted by the narrators and authors of this study, within the following
four domains of change being the focus of the stories of change: (1) individual change; (2)
community change; (3) institutional change; and (4) public policy change.
This relective study showed that generally, the process of research and capacity development
has been able to promote changes across researchers and wider communities who have
been exposed to the implementation of various program activities under development.
The narrators of the stories of change claimed that the research and capacity development
11
process conducted within this study has been able to bring together the actors in HIV and AIDS
response, including the policy makers. Furthermore, it also provides sources of inspiration for
the HIV and AIDS response actors in developing their program strategies.
If viewed from the actualization of various parties’ potentials, the research process has
demonstrated its usefulness in eforts to promote the integration of HIV and AIDS response into
the national health system. It was also depicted that these series of events have contributed
to the increasing capacity and skills of the beneiciary researchers in Indonesia. Such increase
in capacity evolved within the research process and across other activities carried out within
the framework of establishment of the knowledge hub platform. In the institutional domain,
the study also described that the process has inspired research institutions to conduct policy
analysis and encourage students to undertake policy analysis in support to their thesis writing.
In the praxis domain, the study assessed that the process has only been able to advocate
policy changes in HIV and AIDS response at the local level, particularly in budgetary policy.
While at the macro level, the contribution of process and result of the short-term study in
eforts to promote the integration of HIV and AIDS response into the national health system
is yet to be seen.
Nevertheless, there are a number of challenges in promoting changes at various levels.
Firstly, though it has become an inspiration for policy studies at the beginning, there have
been researchers who do not fully understand HIV and AIDS policies. By this, further capacity
building needs to be continuously carried out. Secondly, the tendency to think critically
and analytically seemed to have not been strongly built within the HIV and AIDS activists,
thus created challenges for others to advocate policy changes, especially those in favor of
marginalized groups. The third challenge is that accountability, transparency and efective
team are required for the expected changes to transpire. Or in other words, social ingenuity
and technical ingenuity are prerequisites for the network to be able to inluence the target
policies.
The lesson learned from the process of this research is that to actualize potentials, even those
could be clearly mapped, is not easy. In practical policies and programs, the interactions
between various parties with political economy motives seemed to be more dominant as a
determinant of the actualization of potentials related to equitable justice for disadvantaged
groups in society, particularly in the HIV and AIDS response. Changes at the levels of individual
and community otherwise tend to be more easily controlled and have more predictable
outcomes. Narratively, this book intends to illustrate the dynamics of the research process in
relation to the integration of HIV and AIDS policies and programs into the health system, to
initiate and promote various levels of shifts from changes at individual level to those leading
to a social movement that encourages changes in HIV and AIDS policies.
12
section I
PROGRAM NARRATIVE,
A CONTEXT
13
A. background
14
There still seems to be a gap between supply and demand
for the provision of services to the key populations and
people living with HIV and AIDS (PLWHA) to date. Results of
the research of the National AIDS Commission (NAC) on AIDS
and its program evaluation conducted in 2011 indicated that
programs that were responsive to HIV and AIDS response
policies in Indonesia have not been evenly distributed. In
addition, the programs have also neither been aligned with
nor integrated into the health system in Indonesia.
This situation has become a major challenge in managing
more efective and eicient HIV and AIDS programs. The
increase in reported cases in 341 districts and cities across
33 provinces of Indonesia, and the Indonesian government's
eforts – whether or not supported by donor agencies –
illustrated that provision of better prevention, treatment,
care and support programs, and programs working on
minimizing the number of HIV and AIDS still need to be
revisited.
During the period of August 2013 to June 2016, the AustraliaIndonesia cooperation program for HIV through the Center
for Health Policy and Management (CHPM), Faculty of
Medicine, Universitas Gadjah Mada conducted a research
with the support of DFAT. The goal of this research was to map
the existing HIV and AIDS programs and implementation of
HIV and AIDS policies within the framework of health system
in Indonesia.
15
In the context of decentralization in Indonesia, it is clear to what extent the health system
is able to adapt and absorb the increase of demand for response to HIV and AIDS cases,
especially at the district level. Through the viewpoint of health system in Indonesia, this
research focuses on the main issue, the integration of HIV and AIDS response into the national
health system.
The research uses historical approaches in the study of documents related to HIV and AIDS
response policies and programs, mixed-methods research, and case studies to collect
information related to the integration of HIV and AIDS response policies and programs into
the national health system. The indings of this research are used to make recommendations
to stakeholders of HIV and AIDS response, such as central government, local government,
community sector, and civil society in the efort of integrating HIV and AIDS response
programs into the national health system. The results can furthermore be applied in the
development of HIV and AIDS response programs in Indonesia.
The research activities were divided into three categories. Firstly, the mapping of integration
of HIV and AIDS policies, which is currently used as an approach in the HIV and AIDS response
in Indonesia and the what extent the health system in Indonesia has adopted the response
16
to HIV and AIDS epidemic.
Secondly, the exploration of optimal choices of HIV and AIDS response models that will
be able to expand and increase the interventions against the complexity of HIV and AIDS
response into the highly decentralized health system framework in Indonesia, without ruling
out the needs for other basic health services.
Thirdly, the strengthening of knowledge management network with the 9 selected
universities in 8 provinces of Indonesia. The CHPM conducted this research in collaboration
with the Research Centre for HIV Atma Jaya Catholic University in Jakarta and eight other
local universities, namely (1) Cenderawasih University in Jayapura, Papua; (2) University of
Papua in Manokwari, West Papua; (3) Nusa Cendana University in Kupang, East Nusa Tenggara
(NTT); (4) Udayana University in Denpasar, Bali; (5) Hasanuddin University in Makassar, South
Sulawesi; (6) Airlangga University in Surabaya, East Java; (7) University of Indonesia in Jakarta;
and (8) University of North Sumatra in Medan, North Sumatra.
17
b. PROGRAM GOALS
The strengthening of health system as a response to HIV and AIDS intends to
achieve the following four targeted outcomes: (1) the informed policy makers;
(2) the use of facts of policy development; (3) the implementation of policies
and programs within the national health system; and (4) the improvement and
renewal of production, dissemination and use of knowledge.
c. ACTIVITY OUTPUTS
The outputs of this research can be described below:
18
1.
The map of the Government of Indonesia’s policies related to the
prevention, care, support and treatment of HIV and AIDS and the
mitigation impact within the health system afecting policies of other
sectors at the national and sub-national levels.
2.
The collection and analysis of a wide range of examples of policy
practices within the health system at the national and sub-national
levels using the advantage and disadvantage analysis as well as the
opportunities and risks of each case study.
3.
The policy model to strengthen the existing policies on health system
in an efort to improve the efectiveness of HIV and AIDS response
programs.
4.
The network of national AIDS policies consisting of researchers,
policy makers and stakeholders, that contribute to the formation of
knowledge management center for better advocacy of HIV and AIDS
policy development and implementation.
AECTION Ii
THE MSC, A PARTICIPATORY
APPROACH IN M&E
19
20
The Most Signiicant Change (MSC)1, is a participatory Monitoring and Evaluation (M&E) tool
based on stakeholders’ stories of change. The beneiciaries would independently write their
stories of change considered most signiicant to themselves, the people in their surroundings,
the institutions they work, and the policy level as a result of the program implementation.
As a report of a journalist, everyone may have a diferent story, though it has to follow the
same process, to face the same empirical facts, to be involved in the same incident. As in
the writing process of the stories, every journalist is inluenced by his/her own perspectives,
viewpoints, knowledge and experience.
Simple stories based on the experience of beneiciaries’ involvement in the program were
analyzed to see the changes that were transpired and considered most signiicant. The process
of analysis is a major process and a critical point in viewing the diversity of values contained
in every changes. The main conviction is that any sentence expressed by the author is a set of
values relecting the author’s awareness and attitude.
The principles of participatory and appreciation to everyone's perspective in assessing
changes within social life as the substance of the MSC has become basis of a major traction of
the method being chosen for the writing of the lessons learned of the Research Program “HIV
and AIDS Policy within the National Health System Framework”.
1 The Most Signiicant Changes (MSC) was introduced by Rick Davies, 1996 on his research about
the learning organisation in a non-governmental organisation in Bangladesh (The Most Signiicant
Technique: A Guide to Its Use, Version 1, Rick Davies and Jess Dart, Care International et al, 2005).
The MSC as a Complement to
other M&E Methods
The MSC as an evaluation tool is not in substitution of other evaluation models. In contrast to
qualitative approach, which is generally centered on "what we want to know and things that
are to be known", the MSC aims at seeing the achievements that have not been previously
formulated, and even the stakeholders may be unaware of changes that evolved within
themselves, their communities, their work places, and the policy domain.
By this, the MSC does not intend to see the achievements based on measurable and
predeined indicators as stated in the logical framework of a program (input-output-outcome,
and impact).
21
Deining the unthinkable changes has actually made the MSC an important tool to complement
the qualitative and quantitative evaluation methods carried out simultaneously to note the
achievements of the program implementation. At least, the writing process was based on the
stories of beneiciaries that were freely disclosed and without restrictions. The writing was
based on what have been perceived by beneiciaries during their involvement in the program
implementation.
"
Nevertheless, it was precisely the freedom of such
highly subjective disclosure that has become
methodological limitation of the MSC’s. There have
been various biases arising in the whole process
of writing and analysis, given the beneiciaries’
subjective world as the main basis.
Firstly, the bias in the writing of stories of change. These biases were embodied in the shape of
tendency of people to tell the positive sides of changes and the bias of popular views that at a
certain point may very likely drown the "unpopular stories" in the lives of marginalized groups.
In anticipation of the bias, ever since its inception, the writing guidelines has clearly
communicated that changes over the program implementation may not always be interpreted
as positive changes, but very likely, also as negative ones.
Secondly, the bias in the selection of narrators. This bias occurred due to a tendency to choose
good storytellers who are capable of writing narratives. This is a subjectivity bias of the panel
selecting the stories.
Nevertheless, there was no such bias in this writing process. The selection of stories was not
done through an elimination of narrators, where the selection of certain narrators would
eliminate the others. The process instead gathered all statements of authors considered
presenting both positive and negative changes, even those to be written as they were in the
form of direct quotations.
Despite the anticipation, taking into account the potential biases, it was not recommended to
use the MSC as a sole M&E method and it shall rather be complemented by other methods,
such as quantitative surveys, group discussions, and literature studies.
Through the MSC eforts of quantiication, the accumulation of stories of change can take
place. These eforts can be done by counting how many times the changes was stated by the
narrators. When there are 100 authors, and 75 authors state the same changes, it means 75%
of the authors consider the same changes occurred as an impact of the program.
However in this context, the efort of quantiication was not administered, the content of
stories of change varies, and diferent types of statement were used. Thus, quantiication was
22
impossible to be done. In addition, it was also impossible to be done due to the number of
authors as many as 22.
THE ETHICAL CONDUCT OF
THE MSC APPLICATION
The evaluation process in the course of the MSC was conducted within the scope of the
principles of respect for the right to privacy under the following conditions:
1.
The lesson learned documents will only contain stories of change written by the
beneiciaries.
2.
The name of beneiciaries would not be included in the lesson learned documents,
in exception of the beneiciaries who expressed their no objection for their names,
positions and institutions to be disclosed, by completing the informed consent forms
attached to the circulated writing guidelines.
3.
Only the name and institution of the beneiciaries who had illed the informed consent
forms that will further be included in the process of analysis of the stories of change
along with the program implementers.
4.
The name and contact of the beneiciaries related to the stories of change will not be
handed over to the program managers, but will only be used by the consultant for a
more in-depth analysis and/or conirmation of their stories of change, when necessary.
23
THE STAGES OF THE MSC IMPLEMENTATION
a. DEFINING THE DOMAINS OF CHANGE
In this document, four domains of change have been selected and will be referenced with the
stories of change and statements presented in the Focus Group Discussions (FGDs). The result
of interviews of selected resource persons are presented in the section on collegial views as a
relection of the policy research program.
A domain of change is not a deinition leading to the indicators of outcome achievements.
Indicator is a formula that requires everyone to have the same understanding as its
formulation; this does not allow any diferences in interpretation. Typically, the indicator must
meet the following criteria: speciic, achievable, relevant, and time-limited.
The domain of change in this document is more accurately referred as a subjective
interpretation of the authors and narrators of the stories of change about themselves, their
communities and institutions, as well as the interpretation of changes occurred at the policy
level, as an impact of the program implementation. In other words, the domain of change is a
subjective reality of what experienced diferently when they saw the objective reality of each
of their chosen categories.
Every person, every narrator, and every author of the narratives of change has freedom in
interpreting changes, even if the change occurred only once in a single domain of change. In
this document, four domains of change have been selected as focus of the stories of change.
First, the domain of individual change. This domain will indicate the changes occurred in every
person involved in the program implementation, which might be a change of perspective,
knowledge, and skills capacity, and change of attitude towards objective reality upon
completion of the whole program, such as: research, capacity building, blended learning,
cultural discussions, and access to the website of Indonesia AIDS Policy managed by the
CHPM.
These changes may occur in the domain of knowledge (e.g., the importance of policy analysis
to inluence better policy-making), the domain of attitude (e.g., the response and mitigation
of HIV and AIDS impacts in Indonesia and other social issues, will be more efective when they
are contextualized in the appropriate policy in correspond to the needs and interests of the
community rather than being merely viewed as a matter of person by person’s behavioral
issue), and the domain of action (e.g., motivation to undertake a policy analysis in other ields).
24
Second, the domain of community change. This domain will indicate what changes
occurred within the people in the surrounding of the beneiciaries based on subjective
assessment of the author of the stories of change. These changes could take place in
the domain of perspective, knowledge and skill, and community behavior, as a result of
intensive communication with the beneiciaries and their involvement in various activities
developed in the program. These changes may occur in the domain of knowledge (e.g.,
change of knowledge in policy analysis), the domain of attitude (e.g., they showed
a diference in seeing the root of HIV and AIDS issues), and the domain of action (e.g.,
students showed interest in doing policy analysis).
Third, the domain of institutional change. This domain will show the institutional response
of institutions or organizations where the beneiciaries work. These changes could take
place in the domain of change as a form of support to program activities, the availability
of running the same program, and allowing the emergence of policies at the institution
level that provides development opportunities in the future program. As well as their
emerging interests in developing policy-oriented programs, there may also be intentions
to do policy analysis and plan for policy advocacy.
Fourth, the domain of public policy change. This domain will show how the program
beneiciaries see the program impact on the expected policies as a result of the program
achievement will change during the course of program implementation. As the subjective
point of view, the assessment of this policy change will certainly vary as those of diferent
statements made on the occurred changes.
For example, during the course of engagement in the research program, meetings with
policy makers at a certain level (district/city/provincial/national) and discussions on the
results of research have been completed, and through this interaction policy makers may
want to make changes to the HIV and AIDS policy.
25
26
B. DATA COLLECTION
The collection of stories of change was administered in three methods: narrative stories, focus
group discussions, and in-depth interviews. In this document, the methods are presented
in diferent parts. In addition to the collection of the MSC stories, data collection was
administered through some website surveys.
1. NARRATIVE STORIES
A total of 22 researchers from nine Indonesian universities and some researchers of HIV
and AIDS policy team - CHPM wrote the narrative-form stories of change. The researchers
wrote theirs rather independently. Prior to the writing of the stories of change, each of
the researchers must read the writing guide and ill in the informed consent form, in
relation to their statement of no objection for the author's identity to be disclosed in the
lessons learned document.
The data collection was administered during February 2016. The writing guide and
informed consent form were emailed to the beneiciary researchers. Subsequently, they
would email back their stories of change. The process of technical explanation of the
MSC writing guide was completed on February 23rd, 2016 at Novotel Hotel, Solo.
There were 22 researchers who submitted their stories of change and most of them
opted for their anonymity in the lessons learned documents. Those who were reluctant
to be identiied did not state in writing. They rather not return their completed informed
consent forms. During the researchers meeting in Solo, they were asked once again
about their informed consent forms, but until the writing of this document they have
not returned the forms to the team. By this situation, it was concluded that those who
did not return the forms were grouped as researchers objecting any disclosure of their
identities.
The Guiding Questions for the Writing of the Stories of Change
The collection of narratives was done by rewriting researchers’ experience in the stories
of change. The guiding questions were provided below:
1.
Please tell me in 2 or 3 sentences, your exposure to the research or capacity
building programs implemented by HIV and AIDS policy team - CHPM.
2.
Please tell me in 2 or 3 sentences, how did you irst get involved in the program
and how is your recent involvement? (It is worth mentioning the type of
programs, such as research, blended learning courses, cultural discussions,
etc.).
3.
Please list both of good and bad changes due to the exposure to the research
27
and capacity building programs implemented by HIV and AIDS policy
team - CHPM.
4.
From the above mentioned changes, which are the most important ones?
They can be either positive or negative change.
5.
Please describe those changes in the form of a story [for example, initial
period (how was it previously), mid period (what caused the changes) and
inal period (what is it like now)].
6.
Please name the reasons you chose these changes in particular. For
example, whether these changes are signiicant for you or for others.
There were no speciic rules on how the narrators are supposed to present their
stories of change. However it is advisable to use the form of essay or narrative style,
and not in the form of popular-scientiic articles.
2. Focus Group Discussion (FGD)
An FGD was delivered to get the stories of change from program beneiciaries in
addition to the research, such as cultural discussion, dissemination of research
results, and other speciic activities such as the World AIDS Day.
The FGD was conducted on March 8th, 2016 attended by 18 participants. The
participants came from diferent backgrounds, communities, CSOs, academia,
media, and agencies/government institutions (local government oices and
commissions). In the FGD process, the participants were also requested to ill out
the informed consent forms and all participants expressed their no objection for
their identities to be disclosed in the document.
In getting the stories of change, the FGD was moderated by a facilitator whose
role was to facilitate the process of discussion and sharpen each of the stories of
change told by the participants.
3. INTERVIEWS
The purpose of the interviews is to gather the views of the parties who are
considered having a high level of understanding of the progress of the program.
The interviews were conducted openly to provide lexibility for the resource
persons to express their views in relation to the program implementation. Four
resource persons were selected to interview: (1) dr. Astrid Kartika, MPP, DFAT; (2)
Irawati Atmosukarto, MPP, a member of the Consultative Group (CG) of AIDS Policy
Research Program, and was a staf of the NAC; (3) dr. Trijoko Yudopuspito, M.Sc.PH,
28
Sub-Directorate for AIDS of the Indonesian Ministry of Health, and (4) Ir. Halik Sidik, a
staf of the NAC. The interviews were conducted on March 16th and on 17th, 2016.
4. Website USER SURVEY
The Indonesian AIDS Policy website (www.kebijakanaidsindonesia.net) has been
developed since early 2013, as a knowledge forum presenting a variety of information
about HIV and AIDS response, particularly those that are policy-related. The information
on the website are presented in the form of research reports, policy studies, policy
articles and other information in the form of correspondence, Community of Practice, as
well as Blended Learning. The contributions of articles and resources of information to
date come from the Indonesia AIDS Policy researchers’ team, local researchers from the
9 selected universities, NGOs and the Yogyakarta Provincial AIDS Commission.
The method of extracting information used an online system displaying a survey sheet
in the form of pop-up windows on the website during the data collection period from
29
February to March 2016. In addition to using a banner for the survey announcement,
the website manager sent out a notiication that also serves as a request for the
website visitors to participate as a survey respondent through cultural discussions and
researchers mailing lists.
The website manager performed the processing of analysis against survey results, and
presented them in an info graphics form. Based on this survey, the development and
improvement of the website will be undertaken.
c. ANALYSIS: SELECTION OF STORIES
The stories of change analyses were undertaken on each of all stories of change written by
the beneiciaries. By this, selection of the stories of change was not done to select which
stories to be analyzed, but to quote statements assessed as indicating changes within the
speciied four domains of change.
The grouping of statements of change was done by the author of this lessons learned
document, after all stories of change were received from the researchers at the end of
February 2016. The statements were grouped under four speciied domains changes.
Quotations of statements were discussed with HIV and AIDS policy team - CHPM on March
8th, 2016, using the assessment statement of: (1) whether the statement is a story of the
process of the beneiciary’s engagement in the program; and (2) whether the statement
expresses any changes. Statements that were assessed as only presenting the process will
be excluded from the list, and those assessed statements would be the ones to be included
in the subsequent writing process. The process of testing whether a statement includes the
value of change was by asking the question, 'If ....., then ......'
In the selection and analysis of the statements of change, almost all beneiciaries did neither
show nor stated their changes altogether in the four domains of change.
While the analysis of the results of website user survey was presented as quantitative data.
The goal is to see the use of website as one of the means providing network of knowledge
and information as part of an advocacy efort of the integration of HIV and AIDS response into
the national health system.
30
SECTION Iii
MEASURING CHANGE,
LEARNING FROM THE FIELD
31
The HIV and AIDS response policy program analysis includes the following three main activities; (1) the elaboration of policies and development of HIV and AIDS programs in the health
system at the national and local levels; (2) the development of policies and service models of
HIV and AIDS; and (3) the development of facility and advocacy hub for knowledge management at the national and provincial levels.
This lessons learned document contains two main activities of this program, (1) the elaboration of policies and the development of HIV and AIDS programs in the health system at the
national and sub national levels; and (2) the development of facility and advocacy hub for
knowledge management at the national and provincial levels, as the modeling activities were
still undergoing at the time of drafting of the document.
32
THE TRANSLATION OF HIV AND AIDS PROGRAM
POLICY AND DEVELOPMENT AT THE NATIONAL AND
SUB-NATIONAL HEALTH SYSTEMS
Based on the stories of change, the policy analysis program appeared to be able to determine
the emerging changes in four domains, namely individual, community, institution and policy.
First, at the individual domain, there have been changes on perspective on HIV and AIDS
that is now seen not only as a medical problem but also as systemic problem rooted in the
political, social, and cultural systems. This situation encouraged a shift of paradigm in HIV and
AIDS response, which is no longer suicient to be done only through behavioral change but
rather requires criticism of the policies related to HIV and AIDS response.
The policy change thus became the main entrance to HIV and AIDS response program. The
policy analysis became the most important part in eforts to encourage policy changes
through the integration into national health system.
The policy analysis program has increased the knowledge and skills of researchers on policy
research, national health systems, and HIV and AIDS response programs. The policy analysis
program has also inspired the enhancement of research plans, development of lecture
materials, and their publication in the university journal.
Second, changes in the community domain. The topic of policy analysis became a discussion
material amongst university professors who are interested in conducting analysis of policies
and health systems. In the meantime, some of the students continued to have further
discussions and conduct policy analysis, and it even changed the attitudes of students in
responding to HIV and AIDS issues.
Third, changes in the institutional domain, there were support, interest and desire to undertake
policy analysis. Not only they would enhance policy research but also allow permissions for
their students to conduct policy analysis in completion of their thesis for graduate school.
Fourth, in terms of policy change, the policy analysis program has demonstrated the existence
of a policy change at the local level. However, the development at the national level seemed
to be limited still to the discourse of the importance of results of policy analysis in policy
change and program development.
33
a. DOMAIN OF INDIVIDUAL CHANGE
1. THE CONCEPT OF HIV AND AIDS RESPONSE
The implementation of policy program analysis has been able to shift the beneiciaries’
views about HIV and AIDS in Indonesia. In the very basic context, HIV and AIDS are no
longer seen as merely medical problem, as many people would understand, and these
include activists in HIV and AIDS response and government. Moreover, HIV and AIDS is
seen as an issue directly related to cultural, social, and political systems.
At the technical level, HIV and AIDS response is no longer seen as limited to prevention,
treatment and management of people living with HIV and AIDS but more in a macro
context that is rooted in the political, cultural, social systems, and that it is carried out
comprehensively. This includes the review of government's policies on HIV and AIDS
response program.
An example of change at the technical level can be seen in the experience of Swasti
Sempulur, a researcher of the CHPM. She has been involved in various HIV and AIDS
response programs in Indonesia since 1998. However, the activities under development
have been more in the programmatic and pragmatic areas; promoting non-risk sexual
behavior, raising awareness on HIV testing, and accessing health services, as they have
been considered most serious issues at the community level.
Previously, she had never thought about the importance of policy research as part of
advocacy on HIV and AIDS and even more about thinking of the idea of integration of HIV
and AIDS response into the system of national health policy.
"
When the CHPM developed the policy research program,
she considered it as another way of doing advocacy and it
became a new experience for her. “Like it or not, I changed
my mindset, from programmatic and pragmatic to strategic
thinking, and looking at issues in a macro context, " said
Swasti.
Amelya, B. Sir, a Lecturer at Public Health Faculty Undana University, Kupang, said that she
had previously viewed AIDS issues limitedly to the prevention, treatment, and response
for people living with HIV and AIDS. Having been involved in this policy research program,
according to her, HIV and AIDS response has to be undertaken comprehensively, not only
34
on the downstream but it has to also shift the issues on the upstream. One of the
eforts is through making policy changes in relation to HIV and AIDS research and
delivering advocacy to policy makers.
In the meantime, Hersumpana, a researcher of the CHPM had seen HIV and AIDS
as a solely medical issue. After conducting the policy research, he saw that HIV and
AIDS as an actually complex issue. It is not only a medical problem but moreover
has a broad dimension, concerning cultural, social and political systems. "Everything
is intertwined," he said.
2. UNDERSTANDING THE POLICY ANALYSIS
Policy analysis has similarities with and diferences from research in general. The
similarities are in regards to the collection of reading materials and references,
interviews of informants, and review of the results of interview transcripts. While
the diference lies on the process of analysis and report writing, particularly,
the utilization of policy review instruments, formulation of association and
incorporation of indings against policy facts, interpretation of structured data, and
research interests.
The beneiciaries recognized the importance of policy analysis for public policy
change. Policy analysis is able to identify policy implementation an