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

2.9 Programming areas from the AIPH IPR not addressed

The program description outlined above is consistent with the recommendations of the AIPH Independent Progress Review (IPR) and AusAID’s management response with the following exception:

Supply chain issues in correctional facilities

In its management response to the IPR, AusAID tasked HCPI and CHAI to formulate a supply chain management plan with the Ministry of Health and Ministry of Justice and Human Rights to address the ARV, STI and TB supply chain issues for diagnostics and drugs within the correctional health system.

The SCM system in correctional facilities for these diagnostics and drugs is operated through a system which is managed by the Ministry of Justice and Human Rights. Addressing SCM issues in correctional health is therefore not something that can be easily grafted onto CHAI’s existing SCM work with the MoH’s AIDS Sub Directorate. Designing CHAI support for this separate SCM system would have been a substantial task. In discussions between CHAI and AusAID, it was agreed that for the foreseeable future CHAI would be fully committed with the roll-out of REACH and that work on SCM in correctional facilities should be postponed for the time being. Depending on progress with the roll-out of REACH, AusAID and CHAI could make a future assessment on whether it is feasible for CHAI to undertake work on SCM in the correctional health system. This could be examined in the first quarter of 2014.

2.10 Form of aid proposed

Criteria for assessing a suitable form of aid were:

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  Most likely to support achievement of program outcomes and the end of program goal.
  
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  Most likely to support national ownership and leadership.
  
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  Based on international best practice.
  
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  Provides an opportunity for policy dialogue between AusAID and the MoH.
  
• 
  Can start quickly – that is, in July 2012.
  
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  Flexible to allow scale up with possible additional resources in the life of the program.
  
• 
  May involve a future phase of programming beyond the four years.
  
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  Includes robust financial risk management to protect AusAID funds from misuse or leakage.
  

The type of program that best fits these criteria is technical support by CHAI to a government-led program to facilitate implementation of national, provincial and district level activities, accompanied by a sub-grant from CHAI to the PHOs to support salaries for the nine CoE.

REACH is the next stage of the current AusAID funded CHAI Phase II program which is due to end on 30 June 2012. The AIPH IPR recommended a follow-on phase involving a scale up of CHAI’s HIV CST program in the Papuan provinces and a continuation of SCM and policy support activities. AusAID accepted this recommendation.

The three main components of work (Papua, SCM and policy support) are a continuation of existing programming where CHAI has considerable expertise. REACH will build on the achievements of CHAI Phase II. The only new component of work is operational research. CHAI brings to REACH considerable international experience, technical knowledge, programming skills, established relations with the GoI and other partners at the national, provincial and district levels, and knowledge of the operating environment. In particular, CHAI has forged good relations with the Ministry of Health and other key partners at the national level in relation to all three components of work. In Papua, CHAI has developed strong relations with a broad range of partners and is well respected. All these factors provide a solid basis for the third phase of CHAI’s AusAID supported work in Indonesia. It will be important to ensure continuity and a seamless transition between CHAI Phase II and REACH so that momentum is not lost.

Given the challenging operating environment, a flexible approach to program implementation is recommended. In development of this proposal, care has been taken to develop a design that is realistic in terms of scope (that is, the number of CoE and satellite puskesmas). If REACH encounters substantial obstacles the pace of roll-out might need to be slowed down. Alternatively, it may be possible to increase the number of puskesmas if funds are available. Variations such as this can be easily accommodated by modification of CHAI’s contract with AusAID.

CHAI considered two options regarding how AusAID funds could be channelled to support the CoE:

1. 
   CHAI employs all CoE staff and pays for salaries from the AusAID grant for the first three years before the PHOs take over responsibility for CoE funding in year four; or
   
2. 
   CHAI sub-grants the two PHOs for CoE staff salaries for the first three years.
   

If it does not prove possible to enter into a sub-grant agreement with the PHOs prior to commencement of REACH or to establish appropriate financial risk mitigation strategies in a timely manner, a third option would be for CHAI to employ all CoE staff in the first year, with a sub-grant being made to PHOs to cover salaries for years two and three.

CHAI recommends option two or three as this will result in a greater sense of PHO ownership and increase the likelihood of ongoing support for the CoE after AusAID funding ends. These options are explored in more detail in Annex 17.

Substantive consideration was not given to broader budget sector support for HIV CST programming in addition to AusAID support for technical assistance through the CoE. This type of support is not needed as there is adequate funding available at the national level for drugs and reagents and within provincial and district budgets to pay for the scale up of HIV CST in the Papuan provinces. Although there is the issue of ensuring adequate provincial and district level budgetary allocations are made for HIV CST and this has been incorporated into the program design for this proposal. Similarly, the scale-up of CST services in Tanah Papua will put pressure on the supply chain for HIV-related commodities. It will be necessary for CHAI to work closely with the AIDS Sub Directorate and PHOs and DHOs to ensure adequate supplies of commodities, especially test kits and drugs. Accordingly, the focus of REACH will be technical support and some initial program establishment costs (that is, infrastructure and equipment) to build the capacity of services, with service delivery costs being paid by government.

Partnering with another development agency was also considered, however there are currently no other agencies with a track record or expertise in technical support for HIV CST programming in Papua.