Delivering Expanded Resources for AIDS Programming Project (DERAP) – USAID

CIRCLE Indonesia Team

1. Deddy Heriyanto, Team Leader
2. Galuh Andhani Ratih, Finance Officer
3. Reina A, Admin Officer
4. Panca Saktiyani, Gender Based Violence Specialist -DKI
5. Suhendro Sugiharto, Technical Integrity Adviser – DKI
6. Novitasari, Technical Integrity Consultant – DKI
7. Lucky Sanjaya, Technical Integrity Consultant – DKI
8. Edi Sugiarto, Community Empowerment & Advocacy Specialist – DKI
9. Tengku Rodhan, Technical Integrity Consultant – Papua
10. Lucia Ernie, Gender Based Violence Specialist – Papua
11. Aries Setiawan, Community Empowerment & Advocacy Specialist – Papua

Background
Indonesia is a country with a concentrated HIV epidemic, meaning that in one or more key populations the HIV prevalence rate has been greater than 5%. The key populations in question are intravenous drug users, transvestites, female sex workers and their customers, as well as men who have sex with men (MSM).

The HIV / AIDS prevention program in Indonesia was started in 1987 and ramped up from 1999 to the present with the help of USAID, AUSAID and the Global Fund. The Government’s effort in AIDS prevention was:

1. Establishing a National AIDS Commission (AID) in 1994 to coordinate HIV / AIDS prevention efforts involving inter-ministries not only the Ministry of Health.
2. In 2013 the Ministry of Health launched the Strategic Use of Antiretroviral (SUFA) program in several districts/cities. The aim of the SUFA is “Achieving the national target of clinical care and antiretroviral treatment for PLWHA, increasing the participation and adherence to antiretroviral treatment in order to have an impact on the reduction of HIV transmission”.
3. The implementation of the SUFA is incorporated with the LKB (Sustainable Comprehensive Services) program which launched in 2012. LKB is a promotive, preventive, curative and rehabilitative effort as an integrated and sustainable service and provides support for managerial, medical, psychological and social aspects for PLWHA and the community. LKB involves the community, private sector, cadres, NGOs, assisted groups, PLWHA, families, Family Welfare Development, traditional leaders, religious leaders and community leaders, as well as organizations/groups in the community. LKB and SUFA aims to:
   • reduce the number of new cases of HIV,
   • reduce mortality,
   • reduce stigma and discrimination to improve the quality of life of PLWHA

The DERAP Project is supported by USAID to expand government services in HIV/AIDS prevention. DERAP supports the implementation of LKB/SUFA at the district/city level through cooperation with CSOs and the network of health care providers (Public Health Center, clinic, Regional Public Hospital). The project supports a program of outreach and mentoring which aim to

1. Increase the scope of voluntary HIV testing services;
2. Promote healthy living behaviors through consistent use of HIV prevention tools (condoms and lubricants, and/or syringes);
3. Accessing the services of STI examination and treatment regularly; Access antiretroviral treatment early;
4. improve medication adherence,
5. accessing viral load testing, and
6. Examination and treatment of opportunistic infections

The activities of CIRCLE Indonesia team
CIRCLE Indonesia’s partnership with the DERAP Project was to provide technical assistance to CSOs, government (especially Local government health work unit, Public Health Center, Regional Public Hospital) and private (clinic) at district and provincial level to achieve 4 outcomes. DERAP project is implemented in 5 cities in DKI Jakarta and 3 districts/cities in Papua (Wamena, Jayapura and Timika) from 1 July 2015 to 9 May 2016.

CIRCLE Indonesia worked with 13 CSOs which located in DKI Jakarta and Papua, as stated below:

8 (eight) CSOs in DKI Jakarta:

• Yayasan Rempah
• Yayasan Anak dan Perempuan
• Yayasan Bandung Wangi
• Yayasan Srikandi Sejati
• Yayasan Karisma
• Yayasan Kusuma Buwana
• Angsa Merah
• Yayasan Inter Medika

5 (five) CSOs in Papua:

•  Perkumpulan Keluarga Berencana Indonesia (PKBI) Kota Jayapura
• Institut Pengembangan dan Pemberdayaan Masyarakat (ICDP) Kota Jayapura Mimika
• Yayasan Caritas Timika Papua
• Yayasan Tali Kasih Wamena
• Klinik Kalvari Wamena

4 outcomes of DERAP Project

•  Outcome 1: Strengthened province and district partner coordination and district partners’ preparation to implement SUFA;
• Outcome 2: Enhanced district government capacities and resources to improve and expand service delivery to support the achievement of PEPFAR’s ultimate goal of three 90s;
• Outcome 3: Strengthened district CSOs-Public Heath Centre/hospital and private clinic pairs in HIV prevention, care and support, and ARV treatment;
• Outcome 4: Increased community participation from within key populations to create a favorable environment for support HIV prevention to care spectrums.

CIRCLE Indonesia mentors (who are experienced consultants on the issue of HIV / AIDS and gender experts) have adopted the following strategy:

1. Establish a strategic partnership with the Health Office, as the primary responsibility of the SUFA, as well as a supervisor and coach of health services.
2. Coordinate with Provincial and District AIDS Commissions in the implementation of HIV prevention at their respective levels.
3. Strengthen the Local government health work unit (provincial and municipalities in DKI) in the planning of HIV prevention programs through advocacy / strengthening of district budget planning, initial hearings, leveling the perceptions of DERAP project activity plan to support the implementation of Fast track Jakarta City Ending AIDS Epidemic 2020 AIDS Commission of DKI Jakarta Province, Coordination Meeting of Welfare Bureau – AIDS Commissions – local government health work unit, Workshop, Publishing and Socialization the North Jakarta Mayor Instruction, Submitting the results of the workshop and the recommendation to AIDS Commissions
4. Improving cross-sector networks for GBV (Gender Based Violence) handling in HIV issues
5. Implement direct reinforcement to health services, to improve the quality of planning, the quality of Community Health Empowerment services in terms of HIV testing, counseling and HIV treatment through mini workshop activities at Public Health Center.
6. Strengthening CSO and Public Health Center partnerships in order to have a closer and more effective engagement partnership.
7. Strengthen CSOs organizational capacity, by increasing CSO capacity in terms of organizational governance such as data analysis, planning management, human resource management, and negotiation.
8. Strengthening CSOs in terms of technical capacity of services, including strengthening SOP outreach and assistance, capacity building in community organizing, CSO assistance in field activities, educating key populations, and enhancing key community participation to encourage policies and environments conducive to HIV prevention as well as care and treatment. The activities undertaken to support this strategy were to explore the performance of the organization by using QAQI tools
9. Closer the access of MARPs for the National Health Insurance (JKN) membership. Through the BPJS Workshop which encouraging BPJS to clarify the position of HIV funding in JKN, look for alternative funding opportunities for HIV treatment, such as local health insurance (Jakarta healthy, Jamkesda, Jamkespa). The follow up of the workshop: encourage AIDS Commission to register BPJS or to access other available financing alternatives, socialization of JKN – BPJS, and Identity for MARPs

Until the end of the project, the CIRCLE Indonesia team conducted activities such as training, workshop, assessment, technical guidance of Community Health Empowerment, as well as one on one mentoring. The total participants who involved in the activities with CIRCLE Indonesia are 1789 from CSOs (722 males, 982 females and 85 transgender), 776 from Public Health Center (211 males, 559 females and 6 transgender) and 465 (200 male and 265 female) from other stakeholders (hospital, Health Office, Provincial/District AIDS Commission, etc).

Even though the DERAP project has ended on 9 May 2016, however with the cooperation of the Ministry and Health Office and related CSOs, it is expected that HIV/AIDS prevention activities at the community level will continue