Rapidly Expanding Access to Care for hiv in Tanah Papua (reach) 2012 2016



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Rapidly Expanding Access to Care for HIV in Tanah Papua (REACH) 2012 – 2016

Proposal to AusAID by the Clinton Health Access Initiative for a funding grant under the Australia Indonesia Partnership for HIV

8 May 2012


Acknowledgements

Design team


This funding proposal was developed by a design team with the following members:

David Lowe, Team Leader (Independent consultant)

Budi Arto, Deputy Country Director – Programs, CHAI Indonesia

Prescott Chow, Country Director, CHAI Indonesia

Astrid Kartika, Senior Program Manager, Health Unit, AusAID Indonesia

Penny Miller, STI Specialist (Independent consultant)

Elizabeth Pisani, Operational Research and Monitoring and Evaluation Specialist (CHAI engaged consultant)

Hariadi Wisnu Wardana, Indonesian Ministry of Health representative

Steve Wignall, Senior Advisor, CHAI Indonesia

AusAID


In development of this funding proposal the design team consulted extensively with the following AusAID staff:

Helen McFarlane, Counsellor, Health and Disaster Response, AusAID Indonesia

Gerard Cheong, First Secretary, HIV and Communicable Diseases, Health Unit, AusAID Indonesia

Lea Suganda, Program Manager, HIV and Communicable Diseases, Health Unit, AusAID Indonesia

Prerana Mehta, Risk and Fraud Manager, AusAID Indonesia

Rebecca McLaren, Design Manager, AusAID Indonesia

Robyn Biti, HIV Adviser, Health and HIV Thematic Group, AusAID Canberra

Logistical support


The design team would like to express their thanks to the following AusAID and CHAI staff who provided substantial logistical support:

Maulina Febriyati, AusAID Indonesia

Lucyan Umboh, CHAI Indonesia

Rilia Maristela, CHAI Indonesia

Johanis Reawaruw, CHAI Indonesia

Reyki Gantare, CHAI Indonesia

Titik Bachtiar, CHAI Indonesia

Rina Helen Mandibondibo, CHAI Indonesia


Translators


The design team was supported by two excellent translators:

Carmelita Cajumban

Dewi Arilaha

AusAID Health Resource Facility


CHAI would like to thank the AusAID Health Resource Facility (HRF) for its input to the design of this funding proposal. The services of the Team Leader were contracted through the HRF. The HRF also had input to the development of the methodology and work plan for the design and reviewed and provided feedback on the draft proposal.

Contents


Acknowledgements 2

Figures, tables and boxes 4

Acronyms 5

Executive summary 7

1. Situation analysis and strategic context 11

1.1 Indonesian health sector overview and decentralisation 11



1.1.1 Indonesian health sector overview 11

1.1.2 Decentralisation and health care 11

1.2 Papua and West Papua overview 12

1.3 HIV in Indonesia and the response 13

1.3.1 National overview of epidemiology and the national response 13

1.3.2 Papua and West Papua 14

1.4 Programmatic needs 16



1.4.1 HIV care, support and treatment in Papua and West Papua 16

1.4.2 Supply chain management for HIV-related commodities 22

1.4.3 HIV care, support and treatment policy support to the Ministry of Health 24

1.4.4 Lessons learnt from other programs 25

1.5 Synergies and linkages with AusAID and other donor programs 25



1.5.1 Facilitation of decentralisation 25

1.5.2 Health system strengthening and governance 26

1.5.3 Demand creation for HIV testing and treatment, and prevention 26

1.5.4 Technical assistance for health programs 27

1.5.5 Supply chain management 27

1.5.6 Policy support to the Ministry of Health 27

1.5.7 Operational research 27

1.6 Rationale for AusAID’s involvement 28



2. Program description 31

2.1 Overview 31

2.2 Goal and objectives 32

2.3 Program logic 33

2.4 Guiding principles 37

2.5 Component 1: Care, support and treatment in Tanah Papua 37



Sub-Component 1.1: Antiretroviral therapy 37

Sub-Component 1.2: Tuberculosis 40

Sub-Component 1.3: Sexually transmitted infections 42

 Steen R, Chersich M, de Vlas SJ. Periodic presumptive treatment of curable sexually transmitted infections among sex workers: recent experience with implementation. Curr Opin Infect Dis. 2012 Feb;25(1):100-6. 44



Sub-Component 1.4: Laboratories 45

Sub-Component 1.5: Infrastructure 46

Sub-Component 1.6: Support for effective decentralised systems 48

Sub-Component 1.7: Medical waste management 50

Community empowerment 51

Programmatic needs for Papua and West Papua post 2016 51

2.6 Component 2: Supply chain management 53



Sub-Component 2.1: Provincial level 53

Sub-Component 2.2: National level 53

Sub-Component 2.3: One Gate 55

Programmatic needs for supply chain management post 2016 56

2.7 Component 3: Policy support to the Ministry of Health 56



Programmatic needs for policy support post 2016 58

2.8 Component 4: Operational research 59

2.9 Programming areas from the AIPH IPR not addressed 62

2.10 Form of aid proposed 62



3. Implementation arrangements 64

3.1 Implementation plan 64

3.2 Budget 64

3.3 Governance, coordination, management and structure 65



3.3.1 Governance 65

3.3.2 Roles and responsibilities and reporting and communication channels of key parties 66

3.3.3 Mechanisms for coordination with other programs 66

3.3.4 Annual planning 67

3.3.5 CHAI’s management, technical, finance and administrative capacity 67

3.4 Monitoring and evaluation 68



3.4.1 The monitoring framework 68

3.4.2 Data feedback and use mechanisms 69

3.4.3 Baseline data 69

3.4.4 Longer term evaluation: a recommendation to AusAID 70

3.5 Critical issues and risk management strategies 70

3.6 Sustainability 71

Annex 1: Overview of the epidemiology of HIV in Indonesia 74

Annex 2: Ministry of Health model of decentralised HIV CST 79

Annex 3: Key achievements in CHAI Phase II 80

Annex 4: Lessons learned from CHAI Papua New Guinea 82

Annex 5: Programmatic structure of REACH 85

Annex 6: CoE and puskesmas site selection criteria 87

Annex 7: Sexually transmitted infections programming 90

 Steen R, Chersich M, de Vlas SJ. Periodic presumptive treatment of curable sexually transmitted infections among sex workers: recent experience with implementation. Curr Opin Infect Dis. 2012 Feb;25(1):100-6. 97



Annex 8: Community empowerment proposal 101

Annex 9: Implementation plan 105

Annex 10: Budget 121

Annex 11: Roles and responsibilities and key relationship flowchart 130

Annex 12: Program management 135

Annex 13: REACH monitoring structure and resourcing 143

Annex 14: Issues management register 146

Annex 15: Compliance with AusAID policies 156

Annex 16: Key CHAI position descriptions 158

Annex 17: Options for funding of the Centres of Excellence 171

Annex 18: Bibliography 173



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