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

2.7 Component 3: Policy support to the Ministry of Health

Overarching objective: To develop, disseminate and implement an evidence-based MoH national policy framework relevant to HIV-related care, support and treatment.

Outcome: Evidence based policies approved and disseminated

Why are we doing this?

The current process for MoH HIV CST policy review and development is slow, cumbersome and not always evidence based. To address this situation, REACH will provide technical assistance to the MoH’s AIDS Sub Directorate to support an evidence based process for policy review and development, linked to training and dissemination. More effective, evidence based policies will facilitate the roll-out of the MoH’s HIV CST program in the Papuan provinces and nationally.

How will we do it?

REACH will support the establishment of a small Policy Secretariat within the AIDS Sub Directorate to assist policy review and development by expert panels. The Policy Secretariat will be accountable to the Sub Directorate. Staffing will be one policy analyst and one program officer.

The policy analyst will:

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  Review literature and international policies and guidance for policy implications in Indonesia.
  
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  Review operational research and monitoring data from REACH’s work in the Papuan provinces for policy and programmatic implications.
  
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  Develop evidence based white papers setting out how key findings from the literature, international policies and guidance and operational research can be applied to policies and guidelines in Indonesia. These papers will form the basis of discussion and review by expert panels.
  
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  Provide technical support to working groups in drafting policies and guidelines.
  
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  Identify the programmatic and cost implications of policy options (in broad terms).
  
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  Promote dissemination.
  

The program officer will:

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  Provide secretariat functions to expert panels convened by the Sub Directorate.
  
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  Review existing MoH HIV CST training materials to ensure consistency with policy and update training materials as new policies are developed.
  
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  Develop links with universities and organisations conducting health worker professional development to promote incorporation of MoH policies into training curricula.
  
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  Establish a system for dissemination of policies and guidelines through both MoH systems and through professional associations.
  

Priorities for policy review and development will be set by the Sub Directorate in consultation with stakeholders and be reflected in an annual results-based work plan developed by the Policy Secretariat and approved by the Sub Directorate. The Secretariat will work with the Sub Directorate to develop and publish a protocol for transparent decision-making about policy development that is evidence led and gives equal weight to all informed opinions. Final approval for policy will remain with the Sub Directorate, on the advice of expert panels.

Currently, policy is developed by a panel of experts which has 25 members. A more streamlined approach will be taken by forming time limited smaller expert panels to develop policy in particular areas. Membership of these expert panels will be drawn from a list of experts who are willing to contribute to policy development. This flexible approach will ensure that appropriate expertise is drawn on, relevant to the policy under development. As needed, membership of the expert panels will include a broader range of expertise.

CHAI will continue to work with ASHM in supporting the Sub Directorate’s policy work. Lessons drawn from ASHM’s support for policy development in Australia will be applied as appropriate.

National policies and guidelines will form the basis for technical assistance by CHAI and CoE staff in the Papuan provinces in training and mentoring.

The Policy Secretariat provides a vehicle for increased dialogue between AusAID and the MoH on policy and programming issues relating to the health sector’s response to HIV. In the medium term, the National AIDS Commission and MoH may agree to a transfer of the coordinating and programming responsibilities for all aspects of the health sector response to the MoH, including health sector prevention activities. Should this occur the Policy Secretariat could broaden its focus beyond HIV CST.

Funding for Secretariat salaries and some operating costs will be provided by AusAID through REACH. Due to the civil service staffing freeze it will be necessary for CHAI to employ the Secretariat staff who will be seconded to the Sub Directorate. Staff selection will be a joint decision of the Sub Directorate and CHAI. The Sub Directorate will be responsible for payment of expert panel meeting expenses.

Will it work?

The AIDS Sub Directorate supports the establishment of the Policy Secretariat. The Secretariat will be physically located in the Sub Directorate to promote ownership and integration of its work with the Sub Directorate’s other functions.

It will be important that the Secretariat ensures the continuing involvement of a broad range of national and international partners in policy development to promote ownership, validation and consensus. WHO’s Indonesia office has indicated strong support for establishment of the Policy Secretariat. Stakeholder management will be a priority of the Secretariat. In the past, where there have been different opinions on policy directions, some of which have not been evidence based, the expert panel has had difficulty in coming to decisions by consensus. The strong focus on the weight of evidence should help in the forging of consensus.

How will we know?

The key indicators for success will be:

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  Recruitment of Policy Secretariat staff with the requisite skill sets and development of effective systems for policy review and development.
  
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  The number of existing policies reviewed for consistency with evidence.
  
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  The number of new policies developed.
  
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  Incorporation of policies into MoH CST training and training by professional bodies.
  
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  Establishment of an effective dissemination system.
  
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  Implementation of national policies in the Papuan provinces. (This can be monitored by CHAI. Measurement of implementation on a national basis will not be possible.)
  

Will the benefits last?

CHAI will work with the Sub Directorate on a plan for a full transition of the Policy Secretariat into the Sub Directorate by mid-2016. This will include the Sub Directorate taking on full budgetary support for the work of the Secretariat.

Programmatic needs for policy support post 2016

Should AusAID support a continuation of HIV programming by CHAI post-June 2016, this could include a continuation of higher level technical inputs by CHAI into policy development.