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


Training, mentoring, and technical assistance



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Training, mentoring, and technical assistance


  • Conduct extensive Train the Trainer courses on HIV, CST, TB-HIV, and STIs for CHAI and CoE staff in the first six months; train and establish 21 district training teams in the first 24 months.

  • Mentor and conduct training on HIV, TB-HIV, and STIs for eight hospitals and up to 35 puskesmas in year one.

  • Train up to seven hospitals as ARV referral hospitals and up to 35 puskesmas as ARV satellite sites in year one.

  • Conduct training for up to ten hospitals on TB Hospital DOTS Linkage and TB-HIV, and develop TB-HIV recording and reporting systems in eight hospitals and ten puskesmas in year one.

  • Train up to five puskesmas as STI referral clinics for high prevalence populations in year one (in Jayapura, Sorong, Manokwari, and Wamena, brothel and street-based sex workers will be referred into services; in Fak Fak, MSM will be prioritised for these services).

  • Strengthen eight hospital laboratories to function as district referral laboratories in year one; train nine puskesmas labs to have functioning STI labs in this same period.

A9.2 Component 2: Supply chain management for HIV-related commodities

Start-up activities in the Papuan provinces include assessment of the current supply chains for TB and STI commodities and identification of potential bottlenecks and mitigation strategies.


Transition


  • Develop a transition schedule with key milestones, in collaboration with AIDS Sub Directorate, the Global Fund, and AusAID in year one.

  • Draft best practice tools and curriculum in year two.

Training, mentoring, and technical assistance


  • Conduct assessment, plan, and implement coordination and harmonization activities for TB and STI supply chain systems with PHOs in the Papuan provinces in year one.

  • Train up to ten treatment sites in the Papuan provinces in recording, reporting, and inventory management in year one; conduct ongoing mentoring with five sites in the Papuan provinces on onsite management.

  • Decentralise ARV management to West Papua as well as two other provinces in year one.

  • Nationally, increase timely and accurate reporting up to 75 per cent in year one.

  • Nationally, introduce, disseminate and promote the reporting system for HIV rapid tests.

  • Develop the road map for the One Gate policy in year one; pilot One Gate activities in the Papuan provinces in year two.

A9.3 Component 3: Policy

Start-up activities include recruiting staff and establishing the Policy Secretariat at AIDS Sub Directorate, forming the expert panel, and developing and disseminating the SOP for evidence-based policy development. CHAI will work with the Secretariat to start implementation of this process with at least one cycle of evidence-based review by the end of year one.



  • Establish Secretariat in the first six months, including development of procedures.

  • Initiate preparation work to develop panel skills (for example, circulate journal articles, studies, and local data analysis).

  • Support the Secretariat to conduct one major policy review in the first year, and two in each subsequent years.

  • Support the rollout and promotion of revised guidelines and policies, especially to partners in the Papuan provinces.

  • Establish with the Secretariat in year one an ‘alert and response’ system that can identify policy issues that fall out of the scheduled policy review cycle and can be addressed through a timely, yet systematic approach.

A9.4 Component 4: Operational research and monitoring

The key priority in the first quarter of year one will be to develop the Monitoring Framework, recruit and orient the team, and collect baseline data. In the second quarter, priority will be given to development of the operational research agenda. The program will implement quarterly data collection and analysis activities as well as develop and institutionalise regular discussion for implementation adjustments and feedback mechanisms with key stakeholders.



  • Establish monitoring team; develop tools and train team on their usage

  • Collect baseline data in the first quarter of year one

  • Work with CoE as they roll out to implement strong data collection, embedded within their activities

  • Conduct regular, systematic monitoring activities (collect data, analyse, review with program teams and stakeholders)

  • Work with programs and other stakeholders to develop indicative research agenda in the first six months

  • Begin at least one operational research project in year one

Table 20: REACH Implementation Plan, years 1 – 2

Note: indicators are used whenever possible; process measures are used in some cases. Actual targets and indicators will be determined in the first quarter in collaboration with the AIDS Sub Directorate, PHOs, and AusAID.



Project Ref.

Key Activities

Key Indicators

Y1

Jul - Dec 2012

Y1

Jan - Jun 2013

Y2

Jul - Dec 2013

Y2

Jan - Jun 2014

Component 1

Care, Support & Treatment 

Component 1 objective

To increase the number of Government of Indonesia (GOI) supported health facilities that are well staffed and equipped and providing quality HIV-clinical services in Tanah Papua

Output 1.1

Antiretroviral Therapy: To increase access to antiretroviral therapy (ART) at puskesmas and hospitals in Tanah Papua, and adherence to ART among patients treated.

1.1.1

BASELINE DATA: Collect baseline data from hospitals and puskesmas

Baseline data collected

11 Hospitals + 25 puskesmas

5 Hospitals + 20 puskesmas

21 puskesmas

16 puskesmas

1.1.2

TRAIN THE TRAINER CST: TOT CST, IMAI training for CHAI, hospitals, puskesmas and CoE team

# of people trained or # of teams

170 people

32 people

21 districts training teams

(5 people for each district)



# of districts (kab/kota) with trainer team in place

21

21

1.1.3

IN-HOUSE TRAINING: CST in-house training for 20 hospital staff

# of hospitals trained

4

4

4

4

1.1.4

MENTORING: Mentoring and in-house training to puskesmas by CoE, CHAI, hospital and DHO

# of puskesmas that have become satellite for ARV implementation

15

20

21

16

1.1.5

ARV REFERRAL HOSPITALS: Help increase number of ARV referral hospitals

# of ARV referral hospitals

3

4

 TBA

 TBA

1.1.6

SATELLITE PUSKESMAS: Help increase number of satellite puskesmas for ARV treatment

# of puskesmas that have become satellite for ARV initiation or follow up

15

20

21

16

Output 1.2 

Tuberculosis: To improve the quality of TB diagnosis and treatment in Tanah Papua

1.2.1

BASELINE DATA: Collect baseline data from hospitals and puskesmas

Baseline data collected

11 Hospital

5 Hospital

21 puskesmas

16 puskesmas

1.2.2

TRAIN THE TRAINER TB: TOT for TB and TB/HIV for CHAI, CoE, hospitals team, puskesmas and DHO

# of people trained or # of teams

97 people

21 district teams

 -

-

# of districts (kab/kota) with TB and TB/HIV trainer team in place.

21

1.2.3

IN-HOUSE TRAINING: TB and TB/HIV in-house training for 20 hospital staff

# of hospitals trained

4

4

4

4

1.2.4

MENTORING: Mentoring and in-house training to puskesmas by CoE, CHAI hospital and DHO

# of PKM trained



20

21

16

1.2.5

HDL AND TB/HIV HOSPITALS: Help increase number of HDL (Hospital DOTS Linkage ) and TB/HIV hospital

# of HDL and TB/HIV hospital

5

5



-

1.2.6

TB DOT, TB/HIV PKM: Help increase number of TB DOT and TB/HIV puskesmas

# of TB DOTS and TB/HIV PKM



10

21

16

1.2.7

TB/HIV TESTING: Implement TB and TB/HIV program in all puskesmas and hospital by offering HIV test to all TB patient and screen TB for all HIV patients and give prompt treatment to people with positive result

# of puskesmas and hospitals implemented TB and TB/HIV program

5 hospitals

5 hospitals/10 puskesmas

25

20

1.2.8

RECORDING/REPORTING: Implement TB and TB/HIV recording and reporting system

# of PKM and Hospital implement National TB and TB/HIV RR system

4

4/10 puskesmas

25

20

Output 1.3

Sexually Transmitted Infections: To reduce sexually transmitted infection (STI) prevalence in high prevalence populations in Tanah Papua

1.3.1

BASELINE DATA: Collect baseline data from hospitals and puskesmas

Baseline data collected

11 Hospital + 5 PKM

5 Hospital + 4 PKM

 -

-

1.3.2

TRAIN THE TRAINER STI: TOT STI for CHAI, CoE, hospitals team, puskesmas and DHO

# of people trained or # of teams

97

21 district teams

-

-

# of districts (kab/kota) with STI trainer team in place.

21

1.3.3

IN-HOUSE TRAINING: STI in-house training for 20 hospital staffs

# of hospital trained on STI

 -

6

6

-

1.3.4

MENTORING: Mentoring and in-house training to puskesmas by CoE, CHAI hospital and DHO

# of PKM/clinic get STI training



10

15

15

1.3.5

STI FOR AT RISK POPULATIONS: Implement TA program for STI for brothel-based sex workers, street-based sex workers or MSM via puskesmas appointed by DHO/PHO

# of STI PKM / clinic

-





-

# of sex workers that receive high quality STI management (including good data management)

1.3.6

STI FOR WIDER COMMUNITY: Implement TA program for wider community by all puskesmas

# of puskesmas implementing program

 -

8

5

5

1.3.7

STI REFERRAL CENTRE: Strengthen puskesmas/CoE capacity to become STI referral centre for FSW

# of STI referral PKM/clinic

 -

5

4

 -

1.3.8

RECORDING/REPORTING: Implement STI recording and reporting system 

# of PKM and Hospital implement STI reporting system

 -

8

5

5



Output 1.4

Laboratories: To strengthen laboratory capacity to provide HIV, TB and STI related diagnostic testing and monitoring

1.4.1

BASELINE DATA: Collect baseline data from hospitals and puskesmas

Baseline data collected

11 hospitals + 25 puskesmas

5 hospitals + 20 puskesmas

21 puskesmas

16 puskesmas

1.4.2

ASSESSMENT: Assessment of lab capacity for HIV, TB, STI in hospitals by BLK

# of hospitals assessed

7

7



-

1.4.3

HOSPITAL LABS: Strengthen hospital lab to be district referral lab by Lab

# Hospitals with strong lab capacity in 9 COE

4

4

4

4

1.4.4

PKM LABS: Set up STI lab in puskesmas referral for STI

# of STI referral puskesmas/clinic

5

4

 -

-

1.4.5

QC PKM: Conduct QC on puskesmas for STI and TB by hospitals

Error rate in all puskesmas implemented TB, STI is matched with national standard of error rate 

implement in 10% of puskesmas

implement in 30% of puskesmas

1.4.6

QC HOSPITALS: Conduct QC for hospitals on STI and TB by BLK

Error rate in hospital is following national error rate 

 -

5 hospitals



4 hospital

1.4.7

EQAS: Conduct QC for CD4, VL, EID, PCR CTNG

 EQAS conducted for these tests

 -

All EQAS completed at CHAI supported sites

 -

All EQAS completed at CHAI supported sites

Output 1.5

Infrastructure: To strengthen health infrastructure at puskesmas level to support provision of primary health services including HIV-related care, support and treatment

1.5.1

ASSESSMENT: Conduct infrastructure assessment

All COE and prioritized puskesmas assessed

9 COE, prioritized puskesmas sites

 -

-

-

1.5.2

PLAN AND IMPLEMENT: Building accommodations, electricity, water supply based on assessment

All COE and prioritized PKM

 -

5 COE, prioritized puskesmas sites

4 COE, prioritized puskesmas sites 

prioritized puskesmas sites 



Output 1.6

Support for Effective Decentralised Systems: To support policies that increase the efficiency, transparency and sustainability of service delivery in a decentralised health system

1.6.1

BASELINE DATA: Collect baseline data

Baseline data collected

2 provinces/7 districts 

6 districts

 -

-

1.6.2

CST PANEL: Create CST Panel in each province

Papua & West Papua Province has CST Panel team



4

4

3

1.6.3

CST WORKING GROUP: Create and Support CST working group in provinces and districts 

# of active CST Working group in each Province & District (kab/kota)

2 provinces

3 districts

3 districts

3 districts

1.6.4

LOCAL POLICY ADVOCACY: Review and provide advocacy on change/adjustment of HIV and HIV-related policy based on data supplied by data management team

Establish HIV and HIV-related policy in each province & district (at PHO, DHO as well as KPAP and KPAK level), such as RENSTRA or other implementing policies (PITC, PMTCT, STI, TB, TB/HIV)



4

4

3

1.6.5

LOCAL POLICY CHANGE: Policy adjustment based on data and recommendation

# of HIV & HIV-related policy (approved by the Local Government and resulted in PERDA HIV with IMS based on panel team recommendation)

2

4

4

3

1.6.6

PROMOTION: Socialization and implementation of the new policy to all districts

# of province and district socialize and implement the new policy

2

4

4

3

1.6.7

ANALYSIS: Analysis of the new implementation policy by the panel team

# of policy analysed by the panel team based on data

 -

-







Output 1.7

Medical Waste Management: To strengthen safe management of infectious medical waste in Tanah Papua

1.7.1

ASSESSMENT: Conduct medical waste management assessment in collaboration with infrastructure assessment (see 1.5)

All COE and prioritized PKM assessed

9 COE, prioritized puskesmas sites

 -

-

-

1.7.2

PLAN AND IMPLEMENT: Develop medical waste plan based on assessment and implement in collaboration with infrastructure assessment (see 1.5)

All COE and prioritized PKM

 -

5 COE, prioritized puskesmas sites

4 COE, prioritized puskesmas sites 

prioritized puskesmas sites 

Component 2

Supply Chain Management For HIV Commodities

 

 

 

 

 

Component 2 objective

To decrease stock outs and increase efficiency of strengthened supply chain management of HIV-related commodities

Output 2.1

Provincial Level: To strengthen supply chain management systems for HIV-related commodities in Tanah Papua

2.1.1

BASELINE DATA: Collect baseline data

Baseline data collected

2 provinces

 -

-

-

2.1.2

PROVINCIAL ASSESSMENT: Logistic need assessment for TB and STI supply chains

The logistic estimation

2 provinces

 -

-

-

2.1.3

COLLABORATE: Work with PHO and DHO to improve coordination

% of hospitals sending accurate and on time HIV reporting

-

 


30%

40%

50%

# of puskesmas and hospitals sending accurate and on time TB/STI reporting

2.1.4

 

 



TRAIN AND MENTOR: Work with sites on quantification, storage, inventory management

% of treatment sites which have never experienced stock outs of STI meds and lab reagents

 

 -

 



30%

40%

50%

% of treatment site which have never experienced stock outs of TB meds and lab reagents

% of treatment site which have never experienced stock outs of HIV meds and lab reagents

Output 2.2

National Level: To strengthen national and decentralised supply chain management systems for HIV-related commodities

2.2.1

Transition Planning

2.2.1.1

DEVELOP SCHEDULE: Create phased transition schedule in collaboration with MoH and GFATM

plan and schedule developed

x

 -

-

-

2.2.1.2

DOCUMENT MODELS: Develop best practice tools and curriculum for SCM absorption into GoI

Drafts of best practice tools and curriculum

 -

-

-

 x

2.2.1.3

GOI ABSORPTION: Ongoing planning and trainings with GoI on the transitions by 2016

 Quarterly meetings to plan transition and develop necessary trainings

 x

 x

 x

x

2.2.2

Decentralisation of ARV and management rapid test storage and distribution

2.2.2.1

DECENTRALISATION ARV: Implement the decentralized ARV system in new 12 Provinces

# of province implement decentralization of ARV

1

2

2

1

2.2.2.2

DECENTRALISATION TESTS: Implement the decentralized rapid test management in new 14 provinces

# of province implement rapid test management

2

2

2

2

2.2.3

Decentralisation in Tanah Papua

2.2.3.1

DECENTRALIZATION TANAH PAPUA: Decentralization of SCM capacity building for HIV-related commodities in Tanah Papua

# of provinces

 -

1 province (West Papua)

-

-

2.2.3.2

PROVINCIAL ASSESSMENT: Logistic need assessment for supply chain

Assessments completed

2 provinces

-

-

-

2.2.3.3

DISTRICT ASSESSMENT: Assessment and Gap Analysis at district level

# of assessment conducted and result available

2

2

3

3

2.2.3.4

CURRICULUM DEVELOPMENT: Adjustment & modification of SOP and develop training curricula.

Training curricula available

 -

Yes

Yes

Yes

SOP available

Yes

 -

-

-

SCM tools and standard forms available

 -

Yes

-

-

2.2.3.5

TRAINING: SOP Training and Go Live Simulation

# of treatment site trained

 -

10

15

15

2.2.3.6

KPI: Set up SCM KPI Measurement

KPI SCM measurement established

 -

Yes

 -

-

2.2.3.7

MENTORING: Supervise and mentoring of SCM implementation

# of treatment sites implement the SOP

 -

5

10

10

% of SCM KPI's being met

 -

TBA

TBA

TBA

2.2.3.8

FORECASTING: Forecasting and quantification for HIV-Related commodities (ARV, Reagents, Rapid Test, CD4, IO dan IMS, TB ) 

# of provinces/districts trained in forecasting

2 provinces

5 district

5 district

5 district

2.2.3.9

REPORTING TRAINING: SCM Reporting System and Training for TB, STI, PMTCT

 # of hospitals and puskesmas trained

-

9 hospitals/10 puskesmas

15 puskesmas

20 puskesmas

2.2.3.10

REPORTING: Timely & accuracy treatment site report for TB, STI, PMTCT

% of site submitting ARV report on time & accurately

 -

TBA

TBA

TBA



2.2.4

National Forecasting

2.2.4.1

FORECASTING: Forecasting and quantification for HIV-Related commodities (ARV, Reagen Rapid Test, CD4, IO dan IMS ) 

Established forecasting and quantification tool at national level for IO, IMS, Rapid Test and ARV

ongoing

ongoing

ongoing

ongoing

2.2.5

National SCM Reporting System and Training

2.2.5.1

 


REPORTS: Timely & accuracy treatment site report for ARV

 


% of site submitting ARV report on time & accurately

0.7

0.75

0.8

0.9

Patient coverage : % of patients who are treated by a site that reported on time and accurate

0.45

0.55

0.6

0.65

2.2.5.2

 


PROMOTION: Introduce and socialize reporting system for HIV rapid test, as well as STI and TB

 


% of site submitting quarterly report on Tool and Material on time & accurately

TBA

TBA

TBA

TBA

# of decentralized provinces following national testing algorithm for reagents, rapid test consumption

TBA

TBA

TBA

TBA

2.2.5.3

 


SATELLITE: To establish satellite system (in order to make access to ARV drug closer to people)

 


Establish SOP for satellite management

 x

-

 -

-

# of satellite for ARV treatment.

 -

TBA

TBA

TBA

2.2.6

National Inventory Order Management System

2.2.6.1

IOMS: To improve and utilize online inventory order management system

% of site using online reporting system

TBA 

TBA

TBA

TBA

2.2.6.2

SYNCHRONIZATION: To synchronize inventory order management system with other reporting system and 3rd party system

Number of decentralized provinces using online order and inventory management system

TBA, but including both provinces in Tanah Papua

TBA

TBA

TBA

2.2.7

ARV Inventory Management




NATIONAL ARV MANAGEMENT: To support AIDS Sub Directorate to manage ARV supply at national warehouse

Value of expired ARV formulations as % of total value of HIV-related commodities in national warehouse

TBA

TBA

TBA

TBA

 

TREATMENT SITE MANAGEMENT: To decrease stock outs at site levels

% of treatment site have experience ARV stock out

 TBA

TBA

TBA

TBA

2.2.8

SCM activities and process quality management

2.2.8.1

KPI REVIEW PROCESS: To support the AIDS Sub Directorate to implement a KPI review process to achieve supply chain targets

% of SCM KPI's being met and monitored by the AIDS Sub Directorate

TBA

TBA

TBA

TBA

2.2.8.2

COMMUNICATION: To reduce SCM communication disruption between national, province and treatment site for all stakeholders

Regular information disseminated re - stock of ARVs (both adult and paeds, IMS reagents and meds, and meds from national, province and district)

 -

nationally distributed

nationally distributed

nationally distributed

% of treatment sites following national HIV/STI guideline

 -

30%

-

40%

Output 2.3

One Gate: To support the medium to long-term shift of incorporating supply chain management of HIV-related commodities within the national one gate policy

2.3.1

PTD: Support policy and standard development of One Gate Policy and initiative People that Deliver (PtD) in national level

Policy and standard documented and socialized

 -

-

Established Policy

-

2.3.2

ONE GATE IN TANAH PAPUA: Piloting One Gate Policy standard in Tanah Papua

Pilot initiated

 -

-

-

Pilot initiated

2.3.3

ONE GATE SOP: Develop and implement SOP for SCM at provincial and district level in Papua

Established SOP standard for storage, order processing and distribution system at Provincial and District level

 -

-

Established

-

% of districts submitting SCM/logistics report on time & accurately

 -

-

-

50%

2.3.4

PHO AND DHO: Develop and implement method for HIV-related commodities management in Papua

% of PHO and DHO have established standardized planning method for HIV-related commodities

 -

-

-

50%

Component 3

Policy

Component 3 objective

To implement an evidence based MoH national policy framework relevant to HIV-related care, support & treatment

Output 3.1

National Level Policy: To strengthen the national policy framework relevant to HIV-related care, support and treatment

3.1.1

SECRETARIAT: Establish Policy Secretariat at AIDS Sub Directorate; hire staff; develop processes

Secretariat established

x

 -

-

-

3.1.2

PRIORITIZE POLICIES: Develop policy priorities with AIDS Sub Directorate

# of prioritized guidelines completed

 x

x

-

-

3.1.3

EVIDENCE BASED PANELS: Conduct review panels through evidence based process

# of review meetings

 -

x



x

3.1.4

DISSEMINATION: Work with Sub Directorate to plan and execute dissemination of approved policies and guidelines

 # of policies disseminated

 -

 1

1

1

3.1.5

CST POLICY ADVOCACY: Provide evidence based advocacy on change or adjustment of the national policy from expert panel from provincial level to national level

# of revision on CST national policy

-

TBA

-

TBA

3.1.6

PROVINCIAL ADVOCACY: Help assure that national policy is able to respond to the provincial policy specific needs and conditions

# of provincial expert team becomes member of the national expert team

 -

TBA

TBA

TBA

Component 4

Operational Research

Component 4 objective

To generate and apply knowledge that contributes to achieving the program goal of increasing access to high quality HIV-related treatment in Tanah Papua

Output 4.1

Embedded Research: To undertake embedded research that generates reliable knowledge with the potential to contributes to program goal

4.1.1

INDICATIVE RESEARCH AGENDA: Develop research agenda with stakeholders

agenda developed

x



-

-

4.1.2

SET UP: Develop and prepare for launch of prioritized research area

 Process and tools developed, staff trained

 x

x

x

-

4.1.3

LAUNCH: Implement research

 Research initiated

 

At least 1 research question

-

At least 1 research question

Output 4.2

Local Engagement: To increase use of operational research data to achieve program goals

4.1.1

DATA SYSTEM: Create data collection system from puskesmas and hospitals

# site with established data collection system

 Each CoE, puskesmas as they become established

 Each CoE, puskesmas as they become established

all 9 CoE, prioritized puskesmas as they become established

 puskesmas as they become established

4.1.2

ANALYSIS: Entry and analyse data at CoE level together with the DHO

 Data collected and analysed, discussed with DHO

ongoing

ongoing

ongoing

ongoing

4.1.3

CoE: Monthly meeting at CoE level

 Meetings conducted, minutes taken

6

6

6

6

4.1.4

PROVINCE: Quarterly provincial level meetings. Deeper data analysis at DHO or PHO level by data analyst and local panel expert

 Meetings conducted, minutes taken

2

2

2

2

 

TANAH PAPUA AND NATIONAL: Semi-annual Tanah Papua meetings; annual national meetings

 Meetings conducted, minutes taken

1

1, 1

1

1, 1

4.1.5

PROGRAM ADJUSTMENTS: Provide recommendation for policy development and program adjustment

 Quarterly adjusted work plans

2

2

2

2



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