the integration of hiv and aids response into the health system
(2)
THE INTEGRATION
OF HIV AND AIDS
RESPONSE
INTO THE HEALTH SYSTEM :
Landscaping from nine provinces in
Indonesia
(3)
TheIntegrationofHIVandAIDSResponseintotheHealthSystem:Landscappingfrom nineprovincesinIndonesia
ǣIgnatiusPraptoraharjo;IkoSafika;M.Suharni;IgnatiusHersumpana;ChrysantLilyK; ItaPerwira;SatitiRetnoP;SwastiSempulur;EvianaHapsariDewi
Ƭǣ
UniversityTeams:
ǣǡǡǤǢǤ ǣǤǡǢǤǡ ǣǡǡǢǡ
ǣǤǡǤǢǤǤǡ ǣǡǡǢǡǡ ǣǡǡ
ǣ
TheIntegrationofHIVandAIDSResponseintotheHealthSystem:Landscappingfrom nineprovincesinIndonesiaȀǢǢǤǢ ǢǢǢǢǢ Ȁǣ ȋȌ ǡ ǤȋȌ
ͳʹͷ Ǣͻʹ
ǡʹͲͳ ǣͻͺǦͲʹǦͲͺͷǦʹǦͺ
ͳǤʹǤ͵ǤͶǤ ͷǤ
I.TheIntegrationofHIVandAIDSResponseintotheHealthSystem:Landscappingfrom nineprovincesinIndonesia
ȋ Ȍ ȋȌǡ ǡǤ Ǥ
Ǥ
ǡ ǡ ǡ ǡ ǡ Ǥ
ȋȌǡ ǡǤ
ǣ
Ǥ ʹͲͳǤTheIntegration ofHIVandAIDS Responseinto theHealthSystem: LandscappingfromnineprovincesinIndonesia.ǣ
̹ʹͲͳ
ȋȌǡ ǡ
(4)
3
Foreword
Ǧ
DFAT
ǦȋȌ ̵ǡ ǡ Ǧ Ǥ
ǡ ǡ̵ Ǥ
ǡ ǡ Ȁ ǡ ȋ ǡ ǡ ǡ ǡ ǡ ǡ ǡȌǤ
̵ ǡ Ǥ ǡ Ǥ ǡ ǡ Ȁ ǡ Ȁ Ǥ
Ǧ Ǥ Ȁ ȀǤ
(5)
4
Foreword
–
Indonesian
Ministry
of
Health
ǡ ̶ ̶ǡ Ǥ ǡ ǡ ǡ ǡ ǡ Ǥ
ǣȋͳȌ ǡȋʹȌ ǡ Ǧ Ǥ ͺ ͳͳ Ȁ Ǥ ǡǦ ȋ Ȍǡ ǡ ǡǡ Ǧ Ǥ
ǡ ǡ Ǥ ǡ ǡǡ Ǥ
ǡ ȋȌ ǡ ǡǡ ǡ Ǥ
(6)
5
Table
of
Contents
ForewordǦDFAT...3
Foreword–IndonesianMinistryofHealth...4
TableofContents...5
ListofTables...8
ListofDiagrams...8
ListofFigures...8
ListofAcronyms...9
ExecutiveSummary...12
I. Introduction...14
Ǥ...14
Ǥ...15
Ǥ ...17
Ǥ ...17
Ǥ ...17
Ǥ ...18
Ǥ ...19
Ǥ ...19
Ǥ ...20
Ǥ ... ....20
Ǥ... ....20
Ǥ...21
Ǥ ... ..21
Ǥ ...23
II. Context...24
Ǥ ...24
Ǥ ...24
Ǥ...25
Ǥ ... ...25
Ǥ ...26
Ǥ ...27
C.LocalResponsetoHIVandAIDS...28
(7)
6
A.Introduction... ...31
RolesandInteractionsofStakeholdersinHIVandAIDSResponse...31
ǡ Ȁ Ǥ ǡ ȋȌͳͲ Ǥǡ ǡ ͳͲ Ǥǡ Ȁ ǤȀ ͻ Ǥ ͺǡͷǤǡǡǡ Ȁǣ...31
ͳǤ...33
a.HighInterestsandHighPower...33
b.HighInterestandLowPower...35
c.HighPowerandLowInterest...39
d.LowPowerandLowInterest...41
ʹǤ ...43
IV.PatternsofIntegration...46
Ǥ ... ...46
Ǥ ...46
ͳȌ...46
ʹȌ ... ...49
͵Ȍ ...52
ͶȌ ...57
ͷȌ ...59
Ȍ ...61
Ȍ ...63
Ǥ ...68
Ǥ...70
1....71
2....71
3. ...72
Ǥ ...72
Ǥ ...73
Ǥ ...75
V. ConclusionsandRecommendations...78
(8)
7
Ǥ ...80 Bibliography...82 Appendix1.ResearchInstrument:PrimaryDataCollection...85 Appendix2.SubǦsystem,Dimensions,andQuestionsthatLeadtoMeasurementof Integration...89
(9)
8
List
of
Tables
ͳǤ ...22
ʹǤ ...33
͵Ǥ Ȁ ...37
ͶǤǦ ...42
ͷǤ ...54
Ǥ ...63
Ǥ ...68
ͺǤ...70
ͻǤ ...72
List
of
Diagrams
Figure1.HIVPrevalenceper100.000peopleinthestudylocations...27
ʹǤ ...28
͵Ǥ ...30
ͶǤ ...32
ͷǤ ...50
Ǥ ǣ...76
Ǥ...77
List
of
Figures
ͳǤ ...18
ʹǤ...32
(10)
9
List
of
Acronyms
Ȁ AnggaranPendapatandanBelanjaNasional/Daerahȋ Ȁ Ȍ
Badan Perencanaan Pembangunan Daerah ȋ Ȍ
BadanPerencanaanPembangunaKotaȋ Ȍ BadanKepegawaianDaerahȋ Ȍ
ǡ DinasKesehatanȋ Ȍ
DinasPendidikandanOlahRagaȋ Ȍ DinasTenagaKerjadanTransportasiȋ
Ȍ
DinasSosialȋ Ȍ
DinasSosialdanTenagaKerjaȋ Ȍ DaerahKhususIbukotaȋ Ȍ
Ȁ DiskusiKelompokTerarahȀ
DewanPerwakilanRakyatDaerahȋ Ȍ FasilitasPelayananKesehatanȋ Ȍ
FakultasKedokteranȋ Ȍ
InfeksiMenularSeksualȋ Ȍ InfeksiOportunistikȋ Ȍ
JaminanKesehatanNasionalȋ Ȍ JaminanKesehatanMasyarakatȋ Ȍ JaminanKesehatanDaerahȋ Ȍ
KelompokDukunganSebayaȋȌ KementerianKesehatanȋȌ KesehatanIbudanAnakȋȌ
Komunikasi, Informasi, dan Edukasi ȋ ǡ Ȍ
KomunikasidanInformatikaȋ Ȍ ȀȀ KomisiPenanggulanganAIDSNasional/Provinsi/Kota/Kabupaten ȋȀ ȀȀ Ȍ
Ȁ KonselingdanTesSukarelaȀ LayananJarumdanAlatSuntikSterilȋ Ȍ
LayananKomprehensifBerkesinambungan ȋ Ȁ Ȍ
ʹ LembagaPengkajianDanPemberdayaanEkonomiMasyarakat ȋ Ȍ
LelakiSeksdenganLelakiȋȌ
LembagaSwadayaMasyarakatȋǦǦȌ Ƭ Ƭ
(11)
10
MitraPembangunanInternasionalȋȌ MusyawaranPerencanaanPembangunanȋȌ Narkoba,PsikotropikadanZatAdiktif ȋ ǡ ǡ Ȍ
OrangDenganHIVdanAIDSȋȌ OrganisasiMasyarakatSipilȋ Ȍ OrganisasiBerbasisSosialȋ Ȍ
OrganisasiBerbasisMasyarakatȋȌ OrganisasiKemasyarakatanȋȌ
OtonomiKhususȋ Ȍ
PendapatanAsliDaerahȋ Ǧ Ȍ
Ȁ Perawatan,DukungandanPerawatanȀǡ PemerintahDaerahȋ Ȍ
PenggunaNapzaSuntikȋ Ȍ PeraturanGubernurȋ̵Ȍ PeraturanDaerahȋ Ȍ
PeraturanKementrianDalamNegeriȋ̵Ȍ PeraturanWalikotaȋ̵Ȍ
Ǧ
PusatKesehatanMasyarakatȋȌ
PusatKebijakandanManajemenKesehatanȋ
Ȍ
PusatKesehatanReproduksiȋ Ȍ
PencegahanHIVMelaluiTransmisiSeksualȋ
Ȍ
KelompokStudiKhususȋ Ȍ KelompokKerjaȋȌ
KepolisianResorKotaBesarȋ Ȍ PosPelayananKhususȋ Ȍ
Ȁ PusatPenelitianHIVdanAIDSȀ
Pencegahan Penularan dari Ibu ke Anak ȋ Ȍ
Program Terapi Rumatan Metadon ȋ Ȍ
PusatKesehatanMasyarakatȋ Ȍ RencanaStrategisȋ Ȍ
Ƭ Ƭ
ResikoTinggiȋȌ RumahTahananȋȌ
RumahSakitȋȌ
RumahSakitUmumDaerahȋ Ȍ
RencanaPembangunanJangkaMenengahȋǦȌ RencanaPembangunanJangkaMenengahDaerahȋ Ǧ
Ȍ
SurveiCepatPerilakuȋȌ SumberDayaManusiaȋ Ȍ SuratKeputusanȋ Ȁ Ȍ
SistemKesehatanNasionalȋȌ
SatuanKerjaPemerintahDaerahȋ Ȍ SistemInformasiHIV/AIDSȋȀȌ
(12)
11
SistemInformasiPerkumpulanKeluargaBerencanaIndonesia ȋ Ȍ
Ȁ SistemInformasiKesehatanNasional/DaerahȋȀ
Ȍ
StrategiRencanaAksiNasionalȋ Ȍ
ȀIBBS SurveilansTerpaduBiologisdanPerilaku/
ǦǦ
ȀMMT TerapiRumatanMetadon/ TugasPokokdanFungsiȋ Ȍ
WawancaraMendalamȋǦȌ WargaPeduliAIDSȋ Ȍ WanitaPekerjaSeksȋ Ȍ
WanitaPekerjaSeksLangsungȋ Ȍ WanitaPekerjaSeksTidakLangsungȋ Ȍ
Ȁ
̵
UndangUndangȋȌ
(13)
12
Executive
Summary
Ǥ ǡ Ǥ
Ǥ Ǥ ǣͳȌ ǢʹȌ ͷǦͳͲǤ ͳͳ Ȁ Ǥ etalǤǯǡȋʹͲͳͲȌǤ
Ǥǡ Ǥ ǡ ǡ Ǥ Ǥ Ǥǡ Ǥ
Ǥ continuumofcare ǡ ǡ ȋȌ Ǥ Ǥ ǡ Ǥ ǡ ǡ ǡ Ǥ
Ǥ Ǥ ǡ Ǥ ǡ ǯ Ǥ ǡ ǯ Ǥ ǡ Ǥ
Ǥ ǡ ǡ
(14)
13
ǡǡ Ǥ ǡ ǡ ǡ ǡ Ǥ ǡ ǡ ǡ ǡ Ǥ
ǡ ǡ ǡ ǡ Ǥ Ǥ Ǥ
ǡ ǡ ǣ ͳȌ ȋǤǤ ǡ Ȁǡ Ǧ Ȍ Ǣ ʹȌ Ǣ ͵Ȍ ȋ Ȍǡ ǡǡ ǢͶȌ ǢͷȌ Ǧ Ǣ Ȍ ǢȌ Ǥ
ǡ Ǥ ǡ Ǥ Ǥ
(15)
TheIntegrationofHIV/AIDSResponseintotheHealthSystem:PKMKFKUGMͲDFAT 14
I.
Introduction
A. HIV
and
AIDS
Response
in
Indonesia
ȋͳͻͺȌǡ Ǥ ǦͳͻͻͲǤ ǡ Ǥ Ǧ ȋǡ ʹͲͳͶȌǤ
Ǥ͵ͳͻͻͶ ǡǤǤ ȋKomisiPenanggulanganAIDSNasional Ǧ ȌǤ Ǥ ǡ ȋStrategiRencanaAksi NasionalǦȌǡ ͳͻͻͷʹͲͲͲǤ ǡ Ǥ ǡ ǡ ǡ ȋǣ Ȍǡ Ͳ Ǥ ʹͲ ȋǡ ʹͲͳͶȌǤ Ǥ
ʹͲͲͲ Ǥ Ǥǡ Ǥ ǡ ȋ Ȍ ʹͲͲ͵ ȋ ͳȌǤ ͳͻ ʹͲͲͷ ʹͲͳͲ ȋ ͶȌǤ ǡ ǡ ͳͲȋǡʹͲͳͳȌǤ
ǡ ǡ ǡ ǡ ǡ ͺͲΨ Ǥ ǡ ǡ ȋȌǡ ǡ ǡ ȋǡ ʹͲͳͳȌǤ ǡ ǡ ǡ Ǥ ͲǤͷΨ ʹͲͳͷȋʹͲͳͳȌǤ ǡǡʹͲͳͲǦʹͲͳͷ ͳ͵ Ȁ ͵͵ Ǥ ͺͲΨ Ǥ
(16)
TheIntegrationofHIV/AIDSResponseintotheHealthSystem:PKMKFKUGMͲDFAT 15
ǡ ȋƬȌǡ ǡ Ǥ
ʹͲͳʹ ǡǡ Ǥ ȋǡʹͲͳʹȌǤ ȀȋȌǤ Ǥ ȋȌ Ǧ Ǥ Ǥ ǡ Ǥ Ǧ Ǧ Ǥ
B. The
Health
System
and
HIV
and
AIDS
Response
Ǥ ǡ ͶͲΨ ȋǡ ʹͲͳ͵ȌǤ ȋ Ǥǡ ʹͲͳͲǢ Ǣ Ǥǡ ʹͲͳ͵Ǣ Ǥǡ ʹͲͳͲǢ Ǥǡ ʹͲͲͺǢ Ǥǡ ʹͲͳʹǢ ǤǡʹͲͳͲȌǤǡ ȋǡʹͲͲͲȌǤ
ǣȋͳȌǡǤǤ ǢȋʹȌ Ǣȋ͵Ȍ Ǣ ȋͶȌ ǡ ǢȋͷȌ Ǥ
Ǥ ȋetal., ʹͲͳͲǢ etalǤǡ ʹͲͳͲǢǡʹͲͳʹȌǤ Ǥ Ǥ Ǥ
(17)
TheIntegrationofHIV/AIDSResponseintotheHealthSystem:PKMKFKUGMͲDFAT 16
ȋȌ Ǥ ǡƬǡǡǡ ȋetalǤǡʹͲͳͲǢetalǤǡʹͲͳͲȌǤ ͳͻͺ ʹͲͳ͵ ȋǡ ʹͲͳͷȌ ǣȋͳȌ ǢȋʹȌ ǡ ǡ ǡ ǡ Ǣ ȋ͵Ȍ Ǣ ǡ ǡǢȋͶȌ Ǥ
Ǥ ȋ Ȍǡ ȋǡʹͲͳͳǡetal.ǡʹͲͳͲȌǤ DzdzDz Ǥ Ǥ ǡ ǡ ȋ ǡʹͲͳʹȌǤ
ǡ Ǥ Ǥǡ ȋ ǡ ʹͲͳʹ etalǤǡ ʹͲͳͲȌǤ Ǥ ǡ Ǥ ǡ ǡ ȋ ǡ ʹͲͳͳǢ etal., ʹͲͳͲȌǤ ǡ Ǥ
ǣȋͳȌ ȋʹȌ Ǣ ǡ Ȁ ǡ Ǧ Ǥ
ǡ ǡ ȋ Ȍǡ ǡ Ǥ
(18)
TheIntegrationofHIV/AIDSResponseintotheHealthSystem:PKMKFKUGMͲDFAT 17
Ǥ
C. Research
Questions
and
Objectives
a. ResearchQuestions
ǫ
ǣ
ͳǤ ǡ ǫ
ʹǤ ǡ Ȁ ǡ ǫ
͵Ǥ ǫ
ͶǤ ǡ ǡ ȋe.g.ǡȀ Ȍ ǫ
ͷǤ ǡ Ǧ ǫ Ǥ
ǫ ̵ ̵ ǫ
Ǥ ǡ ǡ ȋJaminanKesehatanNasionalǦȌǫ ͺǤ
ǫ
ͻǤ ǡ ǫ
b.ResearchObjectives
ͷǦͳͲ Ǥ ǡ ǣ
ͳǤ ǡ Ǣ
ʹǤ ǡ ǡ Ǣ
͵Ǥ Ǣ ͶǤ ǡ ǡ
ȋe.gǤ ǡ Ȁ Ȍ Ǣ
ͷǤ ǡ Ǧ Ǣ Ǥ
̵ ̵ Ǣ
(19)
TheIntegrationofHIV/AIDSResponseintotheHealthSystem:PKMKFKUGMͲDFAT 18
Ǥ ǡ ǡ Ǣ
ͺǤ Ǣ ͻǤ
ǡ Ǥ
D. Conceptual
Model
Ǥ etal., ȋʹͲͳͲȌ ȋʹͲͳͲȌ ȋ ͳȌǤ
Figure1.ConceptualFramework
etal., ȋʹͲͳͲȌǡ Ǥ Ǥ ȋ Ȍ ǡ Ǥ ǡ ȋǡ ʹͲͲȌǤ ǡ Ǣ Ǣ Ǣ Ǣ Ǣ ǡ ȋ ǤʹʹͲͳʹȌǤ
HealthIssues Law
Politics Economics
Strategi c Info
Communi ty Provisionof
Drugs and Human
Resour Management
and Financing
HealthSystem
Strategi c Info
Communi ty Provisionof
Drugs and Human
Resour Management
and
Financing
HIV&AIDSServiceDelivery Prevention CST and Impact Mitigation
HIV&AIDSProgression
s
(20)
TheIntegrationofHIV/AIDSResponseintotheHealthSystem:PKMKFKUGMͲDFAT 19
ǣ ȋͳȌ ǡ ǡ Ǣ ȋʹȌ Ǣ ȋ͵Ȍ Ǣ ȋͶȌ ǡ ǡ Ǥ ǡ ǡ ǡ ǡ ǡ ǡ Ǥ
ǡ ȋǡ ǡ ȌǤ ǣȋͳȌ ȋ ȌǢȋʹȌ ȋ ȌǢȋ͵Ȍ Ǧ Ǥ
E. Research
Methods
ʹͲͳ͵ ʹͲͳǤ ǡǡǡǡ Ǥ ǡ Ȁ Ǥ
Ǥ Ǥ
a. ResearchDesignandProcedure
Ǥ ȋʹͲͲ͵Ȍǡ ǣ
ͳǤ Thefirstphase: maindata(primary)additionaldata(secondary)Ǥ Ǧ Ǥ
ʹǤ Thesecondphase: ȋ ͳȌǡ ǤǤǣ ȋȌ Ǣ ȋȌ Ǣ ȋ Ȍ Ǣ ȋȌ Ǥ ǦǤ
͵Ǥ Thethirdphaseǣ Ǥ
ͶǤ Thefourthphaseǣ ȋet alǤǡʹͲͳͲǢetalǤǡʹͲͳͲȌǤ
(1)
TheIntegrationofHIV/AIDSResponseintotheHealthSystem:PKMKFKUGMͲDFAT 88
Ȍ ǫ
Ȍ ǯ ǫ ǣ
Ȍ ̵ ǫ
Ȍ ǫ
Ȍ ȋǤǤ ȌǤ
Ȍ Ǧ ǫ
Ȍ ǡ ǫ
Ȍ ǫ ǫ
Ȍ ǡ ǫ Ȍ
ǡ ǫ
Ȍ ǫ ǫ
(2)
TheIntegrationofHIV/AIDSResponseintotheHealthSystem:PKMKFKUGMͲDFAT 89
Appendix
2.
SubǦsystem,
Dimensions,
and
Questions
that
Lead
to
Measurement
of
Integration
SubǦsystem Dimension KeyWords LeadingQuestions
1. Management and Regulations
1.Regulations x
x x x x x (Perda HIV, Strategic Plan/SRAD, Local Health System, Regent Regulation,etc.)ǫ
Reference:
Ͳ Ǥʹǡ͵ǡͶ ǦǤ
2. Policy
Formulation x ȋ Ȍ
x
ȋǡ ǡ Ȍ ǫ Æ similar to other health efforts – Family Health, Environment, Infectious Disease Eradication,etc.
Reference:
Ͳ Ǥͷ ǦǤ
3.Accountability
and
Responsiveness
x Ǥ Ǧ ǫ(Ædoesthemanagementof theHIVandAIDSprogramusegood principlesofpublicservice)
Reference:
Ͳ Ǥ ǦǤ
Ͳ Ǥ ͻ Ƭ ͳͲ Ǧ
2. Financing 4.Managementof
FundingSources x
x
x ǫ Reference:
Ͳ Ǥ ͳ Ƭ ͵ ǦǤ
5. Budgeting,
Proportions, distribution and expenditure?
x
x ǫ(in theformofbudgetsinSKPDorSocial Assistance)
(3)
TheIntegrationofHIV/AIDSResponseintotheHealthSystem:PKMKFKUGMͲDFAT 90
x
x ǡ ǡ
Reference:
Ͳ Ǥ ͳ Ƭ ʹ ǦǤ
6.Mechanismof
servicefinancing x
ǫ
Reference:
Ͳ ǤͶƬͷ ǦǤ
3. Service
delivery 7.servicesAvailabilityof x
x ǡ ǡ
x
ǫ
Reference:
Ͳ Ǥͳǡʹǡ͵ Ǥ
8. Coordination
andreferral x
x
Ǥ
Reference:
Ͳ Ǥ ͳ ǦǤ
Ͳ Ǥͳǡʹǡ͵ Ǧ Ǥ
9.Servicequality
assurance x
x
ǫ(implementationofservice SOP,compliancetoimplementation guidelines, accreditation, client satisfactionsurvey,etc.)
Reference:
Ͳ Ǥ ͳͲ Ƭ ͳͳ ǦǤ
4. Human
Resources 10.managementPolicy and system
x
x
ǫ (competence, capacity development, placement/transfers, working relationswithnonǦgovernment) Reference:
Ͳ Ǥ ͳǡ ͵ǡ ͷ ǦǤ
(4)
TheIntegrationofHIV/AIDSResponseintotheHealthSystem:PKMKFKUGMͲDFAT 91
11.Financing x
Ǧ ȋȌǫ Reference:
Ͳ Ǧǣ Ǥ
12.Competence x
x ǫ Reference:
Ǥ ͳ ǦǤ
5. Provision of
Drugs and Medical Equipment 1. Regulations onprovision, storage, diagnostics, andtherapy.
x ǡ ǡ ǡǡ ǡ ǫ (reagent, ARV, condoms, syringes,CD4andVLmachines) Reference:
Ǥ ͳǡ ͷǡ ͺǡ ǦǤ
2. Resources x
ǡ ǡ ǫ
Reference:
Ǥ ʹǡ Ͷǡ ǦǤ
6. Information
system 3.Synchronization of information systems
x
x
x
x
ǫ (surveillance,survey,monitoringand evaluationbasedoninput,process, output)
Reference:
Ǥ ͳǡ ʹǡ ͷ ǦǤ
4. Dissemination
anduse x
x ǫ Reference:
Ǥ ͵ Ͷ Ǥ
7. Community Empowermen t
5. Community
participation x ȋǤǤ
(5)
TheIntegrationofHIV/AIDSResponseintotheHealthSystem:PKMKFKUGMͲDFAT 92
Ȍ
x
x ȋǤǤ Ȍ
ǫ
Reference:
Ǥͳǡʹǡ͵ǡͻ ǦǤ
6. Access and
use of
services
x
x
ǡ ǡ ǫ
Reference:
Ǥͺǡͳʹǡͳ͵ǡ ǦǤ
(6)