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

Annex 12: Program management

A12.1 Staffing

Care, support and treatment program component

Twenty-eight full-time staff in Papua and West Papua provinces will implement REACH’s CST activities. The two Regional Program Managers, one in each province, will oversee the scale up of technical assistance. These managers will direct the programming and coordinate with the Program Managers in SCM, Policy, Operational Research and Monitoring, as well as with the Finance and Operation Managers. Two Deputy Regional Managers, one in each province, will support their work and directly manage the provincial CST Program Managers. The four site-based teams (in Jayapura, Jayawijaya, Nabire, and Sorong) will consist of Program Managers, Program and Technical Officers, Communications Officers, and other support staff. Each team will be responsible for providing technical assistance to CoE hospitals to integrate quality HIV-related services. In addition, 11 staff from Operational Research and Monitoring, SCM, Policy, Finance, and Administration will also support the CST efforts and will be embedded within the teams in the Papuan provinces. Finally, the Clinical Mentoring Team will consist of a rotating roster of Senior Clinical Mentors (up to three positions) with combined experiences in STI, TB-HIV, MCH, and laboratory management to supplement the CST component with on-the-job training, mentoring, and technical assistance. (The clinical mentors will support the work of the CoE. However, the bulk of clinical mentoring for hospitals and puskesmas will be provided by CoE staff.) Government Relations Officers in Papua and West Papua will work at the provincial level to coordinate with government offices, bilateral and multilateral donors, and facilitate the transition planning process for provincial assumption of CoE budgets and staffing in year 4.

Supply chain management program component

SCM will be staffed by one manager to oversee national and provincial SCM activities. One Jakarta-based supply chain analyst will work on decentralization to other provinces and support national-level forecasting, recording and reporting and data collection activities in conjunction with Global Fund-supported seconded staff. Two analysts will be based in the Papuan provinces to focus on site and provincial level supply chain issues.

Policy support to the Ministry of Health program component

Policy will be staffed by one manager to oversee the national policy development activities and support policy dissemination at the provincial level. The Policy Manager will work with the AusAID funded Policy Secretariat staff in the AIDS Sub Directorate to ensure the development and implementation of an evidence-based policy process.

Operations research and monitoring program component

One manager and several technical analyst positions will staff operational research and monitoring. A qualified monitoring and evaluation specialist will be hired as an advisor to design the monitoring framework and to periodically oversee monitoring and implementation over the life of the program. The Operational Research and Monitoring Manager will provide leadership and technical oversight across monitoring programs and operational research efforts. A Senior Data Analyst, along with Data Analysts and Data Mentors, will work with CoE data staff to monitor the program’s progress towards intended outcome. The Senior Data Analyst will work closely with Regional Program Managers to assess and realign activities to reach these objectives. A Monitoring Specialist will work at national levels to ensure reporting happens upwards to GoI, AusAID, and other donors. Data Analysts in the field will work with other program staff to report key findings to health facilities and other stakeholders. Finally, the Operational Research and Monitoring team has other analysts that will support all teams in applied analytics activities.

Finance & administration team

The Operations Managers, Finance Managers, Human Resource Administrator, Office Managers, and other support staff will ensure sound finance and administration policies are followed.

Management

A management team will support these program teams. The Country Director will provide overall oversight and management for REACH and ensuring coordination with government and partner organizations. Two Deputy Country Directors will be part of the senior management team. The Deputy Country Director for Programs will provide programmatic and clinical oversight. The Deputy Country Director for Finance and Operations will provide oversight to all human resource, administrative, and finance functions. Senior management will liaise with AusAID and be the main points of contact for reporting and compliance with AusAID policies.

Figure 8 (see below) shows the CHAI Indonesia organisational chart, detailing all CHAI staff positions for implementation of REACH. Figure 9 (see below) shows the staffing for the CoE. Note that the staffing for the CoE varies by sites and this is not reflected in Figure 9. The actual staffing for each CoE site is as follows:

• 
  Jayapura: 12 positions (3 doctors, 3 nurses and midwives, 2 laboratory technicians, 2 data clerks, 1 communications officer, and 1 administration assistant)
  
• 
  Pegunungan Bintang: 4 positions (4 doctors)
  
• 
  Jayawijaya: 11 positions (2 doctors, 3 nurses and midwives, 2 laboratory technicians, 2 data clerks, 1 communications officer, and 1 administration assistant)
  
• 
  Mulia: five positions (5 doctors)
  
• 
  Enarotali: six positions (1 doctor, 1 nurse or midwife, 1 laboratory technician, 1 data clerk, 1 communications officer, and 1 administration assistant)
  
• 
  Nabire: 12 positions (3 doctors, 3 nurses and midwives, 2 laboratory technicians, 2 data clerks, 1 communications officer, and 1 administration assistant)
  
• 
  Sorong: 10 positions (2 doctors, 2 nurses and midwives, 2 laboratory technicians, 2 data clerks, 1 communications officer, and 1 administration assistant)
  
• 
  Manokwari: eight positions (2 doctors, 1 nurse and midwife, 1 lab technician, 2 data clerks, 1 communications officer, and 1 administration assistant)
  
• 
  Fak-Fak: eight positions (2 doctors, 1 nurse and midwife, 1 laboratory technician, 2 data clerks, 1 communications officer, and 1 administration assistant)
  

CHAI’s South East Asia Regional Team

CHAI’s South East Asia Regional Team will support the in country team’s efforts through regular on- and off-site assistance. The Regional Director for South East Asia and the Deputy Regional Director will provide overall management and program guidance to the Country Director. The Deputy Regional Director will also ensure fiscal and administrative procedures follow CHAI headquarters’ policies. The Director of Rural Program will assist the teams in program development and implementation, focusing on sustainable rural health service delivery models. The Operations Research and Monitoring Manager will support the development of appropriate systems and tools for that program component.

CHAI’s Papua New Guinea program

CHAI’s PNG team will also provide support and assistance to REACH. While there are differences between the PNG and Indonesian programs, both programs are assisting governments to increase access to HIV-related services and to scale up these interventions to the rural poor. CHAI PNG has been established since 2006 and has extensive experiences with similar communities and environments that can inform the work in the Papuan provinces. Their expertise includes health systems strengthening through HIV service delivery; decentralising care services with centralized coordination; laboratory strengthening; and appropriate technologies for health (see Annex 4 for a list of lessons learned by CHAI PNG and their potential application to REACH).

CHAI global teams

CHAI Indonesia will also work with CHAI’s global teams to implement the REACH program. This may include the Health Systems Strengthening Team to identify new solutions to address bottlenecks in the public finance system; the Clinical Services Team to provide clinical updates and assist in training and mentoring; the Drug Access Team to accelerate access to new drug products; and the Laboratory Support Team to strengthen in-country systems and introduce new diagnostic technologies. CHAI Indonesia will continue to report to CHAI’s Headquarters office on all its operational functions, including budgeting, finance, reporting, human resources, and safety and security.

A10.2 Procurement arrangements

CHAI manages its expenditures through a decentralized control system with oversight from its Boston Headquarters office.

CHAI uses the following principles in making spending commitments:

Meet Patient Needs: Above all, the procurement of products or services should be conducted in the best interests of the patients and other individuals affected by HIV that CHAI is seeking to serve. This includes ensuring that the products or services provided are of high quality, are rapidly and effectively delivered, and suited to the specific needs or challenges identified.

Achieve Best Value for Money: In order to maximize the impact of the funds available, products or services should be purchased from sources that offer the best combination of quality and price.

Balance the need for efficiency with the requirement for strong financial oversight: Given the complexity of CHAI’s work, the dynamic and complex nature of the health landscape in the Papuan provinces and elsewhere in Indonesia, and the core belief that every day that CHAI wastes, people die, it is important that country teams have the flexibility to make commitments to ensure the effective flow of work while observing all CHAI and AusAID financial management policies and guidelines.

CHAI Indonesia procurement procedures

All purchase requisitions require the approval of the Program Manager or budget holder and for items greater than IDR 10,000,000 the Country Director or Deputy Country Director. Any purchase exceeding IDR 20,000,000 requires two written quotations. A Procurement Committee consisting of the Operations Manager, Finance Manager and the person making the request must review the quotations. A recommendation is made which takes into account price and quality. A bid analysis form is completed documenting the reasons for the purchase decision and is signed by each person on the committee. The Country Director or Deputy Country Director must then approve the recommendation before purchase can proceed.

If a purchase exceeds IDR 20,000,000 but only one supplier is able to provide a quote on a product or service, a sole source justification must be provided.

All purchases greater than IDR 50,000,000 require a formal tender where advertisements are placed in the local newspaper with more stringent purchasing guidelines (for example, formation of a bid committee, preparation of a request for quotation, etcetera). A formal tender process for lesser purchases is encouraged if cost savings can be expected.

Figure 8: CHAI Indonesia organisational chart for REACH by location of staff

Figure 9: Staffing of Centres of Excellence by province