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

Annex 5: Programmatic structure of REACH

Figure 3: Programmatic structure of REACH

Annex 6: CoE and puskesmas site selection criteria

A6.1 Centres of Excellence – selection criteria

Selection of the location of CoE was done in collaboration with the PHOs and based on:

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  Geographic location
  
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  Proximity to large population centres
  
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  Logistics and accessibility to surrounding districts with lower levels of HIV, TB and STI care capacity
  
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  Class D, C or B referral hospitals with a laboratory
  
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  Interest on the part of hospital and district to host the CoE
  
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  Currently designated as ART sites (Pegunungan Bintang is an exception)
  
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  PHO support for establishing a team at the site
  

Table 14 lists the sites for the CoE and the broader geographic areas they will service.

Table 14: Centre of Excellence sites and service areas

REACH CoE sites	Service area
Papua Province
Pegunungan Bintang District Hospital	Pegunungan Bintang and adjacent Bovendugal areas
Wamena District Hospital	Jayawijaya, Tolikara, Yahukimo, Membramo Tengah, Yalimo, Lanny Jaya, Nduga
Puncak Jaya District Hospital	Puncak Jaya District and parts of Puncak
Enarotali District Hospital	Paniai, parts of Intan Jaya, Deiyai and Dogiyai
Nabire District Hospital	Nabire District, Nabire City and parts of Deiyai and Intan Jaya
Jayapura District and City	Jayapura City and districts and supports Keerom and Sarmi
West Papua Province
Fak Fak District Hospital	Fak Fak, Kaimana and Bintuni Districts
Sorong District and City	Sorong Kota, Sorong Kabupaten and Sorong Selatan
Manokwari District	Manokwari city and district

The success of CHAI Phase II and the support provided has generated many requests by other districts for CHAI support. The PHOs and Provincial Steering Committees will work with CHAI and AusAID regarding any possible program expansion beyond the current sites. Expansion beyond the current sites will only considered if it is judged to be feasible in the light of experience with the roll-out of REACH and if funds are available.

The CoE in Jayapura and Wamena have already been established under CHAI Phase II. The other seven CoE will be established progressively over an 18 month period. Timing and priorities are as follows:

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  CoE in will be established order: Sorong, Nabire, Enarotali, Mulia, Pegunungan Bintang, Fak-Fak and Manokwari.
  
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  Sorong and Nabire will have CHAI offices established in the first six months of the program. Sorong in West Papua will be prioritised since it is also one of the MoH’s ‘test and treat’ sites. Nabire has a large underserved HIV positive population.
  
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  Other immediate CoE expansion will include Enarotali and Mulia. Enarotali has strong political will to implement and it shares with Nabire a large underserved HIV positive population. While it is the centre of political unease in Papua, Mulia has a highly motivated hospital team and Medecins du Monde staff that are willing to transition to CHAI and continue working there when their program ends in May.
  
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  The other CoE sites in Pegunungan Bintang, Fak-Fak, and Manokwari will be established later, but technical assistance with hospitals and health facilities in those areas will be ongoing.
  

Table 19 in Annex 9 provides a timeline for roll-out of the CoE and REACH supported hospitals and puskesmas.

A6.2 Puskesmas selection criteria

REACH will targeted 120 puskesmas for delivery of comprehensive HIV, TB, STI and PMTCT services. Currently 41 puskesmas are designated ART satellites in Tanah Papua. Those puskesmas falling within the REACH program area will be reviewed for comprehensiveness of services, training, record keeping, reporting and needs for facilities upgrading and staff training.

Prioritization for upgrading additional puskesmas for service delivery and the necessary training and support and facilities improvements will depend on a number of factors:

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  Geographic location and accessibility
  
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  Population need
  
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  Facilities and equipment
  
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  Staffing
  
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  Interest in the program
  
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  Agreement and commitment by PHOs and DHOs.
  

There is insufficient data of a detailed nature on the geographical spread of HIV in Tanah Papua to make HIV or TB prevalence an criteria for puskesmas site selection. However, the 2006 IBBS indicated that there is significantly greater HIV prevalence in the highlands region and this region will be prioritised by REACH.

The results of the Health Facilities Research survey (Riset Fasilitas Kesehatan – RIFASKES) are not available at this the time of writing. Data on facilities and equipment in the original survey will help inform decisions on prioritization. CHAI proposed additional questions on staffing, training and programs such as TB and MCH that was completed for most of the 300 puskesmas in Papua Province. That information will be key in selecting sites that pose minimal challenges to implementation given facilities and adequate staff with minimal training needs. It will also allow for planning for facilities improvements for other high-priority sites that would not be able to provide services until repairs or new installations are made.

Figure 4: Centre of Excellence locations