| 4. In which ways is the initiative creative and innovative?
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The initiative to improve the quality of one stop service for socially stigmatized groups was carried out according to the following strategies:
a. Problems Identification
• Most injected-drug users converted to oral-based drugs resulting in the decreased number of HIV/AIDS transmission through unsterilized syringes;
• Due to the high rate of HIV/AIDS transmission through sexual activities in 2011, it was crucial to apply visible solution to mitigate the rate of HIV/AIDS transmission through Sexually-Transmitted Infections (STI);
• The HIV/AIDS high risk people and the patients of STI were reluctant to having a medical examinations due to the identity secrecy issues, the high cost, and the lengthy procedures);
• Patients with HIV/AIDS were reluctant to being referred to the new hospital due to psychological reasons including social stigmatization and discrimination. Other reasons were about the cost, the distance, and the lengthy procedure.
The problems sparked the idea of HIV/AIDS cases detection by conducting the screening at Methadone Clinic, STI Clinic and by providing such simple, prompt, and free service for people living with HIV/AIDS.
b. Coordination
Handling groups of people who require a high privacy needs to involve the people winning the trust of the group. After having a warm welcome from the Local Office of Public Health, the coordination continued to strive the support (in the forms of human resources, infrastructure and facilities, and fund) from NGOs, private parties, and social foundations.
c. Resources Preparation
Once there was an agreement between the government and the private parties, preparation activities we then conducted, taking forms of human resources provision and training, facilities and infrastructures building, and diagnosis and treatments. Some of the facilities, such as computers, laboratory facilities including CD4 testing tool, and office furniture (including drugs closet) were financed by foundations. Human resources provision (one doctor, one analyst, and three counsellors) was handled by the Bali Peduli Foundation.
d. Cooperation Agreement
The contract was between the Gianyar Regent and Bali Peduli Foundation. With the completion of all resources and infrastructures, as well as the facilities, the one-stop-service clinic for socially stigmatized and discriminated group was officially opened for public in July 2013.
e. Service Socialization
As a new public service, the institution needs to widely disseminate the information about its existence. Socialization activities were done in several ways:
• Publishing brochures about HIV/AIDS, Methadone and IMS, direct meetings with the citizens, youth group, the members of Family Welfare Education Program;
• Providing online information on website of www.balipeduli.org giving information about Anggrek Clinic – Public Health Center of Ubud II.
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| 5. Who implemented the initiative and what is the size of the population affected by this initiative?
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The parties associated with this service are:
Methadone and VCT Clinic
a. Provincial and Local Office of Public Health as service regulators;
b. HCPI as funders;
c. Provincial and Local AIDS Commission as partners and funders;
d. Local and National Narcotics Agency as partners and funders;
e. Sanglah Public Hospital as the custodian of Methadone clinic;
f. Dua Hati Foundation as partner and field outreach
STI and Counselling and Support Treatment (CST) Clinic
a. Provincial and Local Office of Public Health as service regulators;
b. Provincial and Local AIDS Commission as partners and funders;
c. Sanjiwani Public Hospital of Gianyar Regency as the custodian of CST Clinic;
d. Bali Peduli Foundation as partners and funders;
e. Rotary Club Foundation as partners and funders
Government authorities and village Leaders, as well as community leaders.
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| 6. How was the strategy implemented and what resources were mobilized?
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The initial phase of the establishment of the Methadone clinic in 2008 was fully funded by HCPI covering the clinic infrastructure, personnel training and clinic’s operational activities. In 2009 and 2010, the clinic’s operational activities were funded by Local HIV/AIDS Countermeasure Commission (ACC/KPA), Local Narcotics Agency, and Local Budget of Gianyar Regency. In 2011 and 2012, the clinic’s operational activities were funded by Provincial and Local Budget. In 2013, methadone clinic’s maintenance and VCT operational activities were funded by ACC/KPA and Local Budget while the STI Clinic and CST Clinic were funded by the Bali Peduli Foundation, Rotary Club Foundation, and local budget.
Other support in the form of liquid methadone drug was handled by Sanglah Public Hospital. The drugs and medication for STI and ARV were supported by central government authorities via Local Office of Public Health and Sanjiwani Public Hospital of Gianyar Regency.
The personnel involved in the service are:
a. 7 civil servants and 2 private employees (two doctors, one pharmacist assistant, two nurses, one laboratory attendant, and two security guards) on methadone and VCT clinics. All the power received special training before serving.
b. 2 government doctors and nurses and 5 private employees (one doctor, one analyst, one administration officer, and two counsellors) for STI and CST clinics.
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| 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
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Concrete outputs of the service are:
a. VCT Clinic Services
The increase number of visits to VCT Clinic from the average of 0.5 people monthly in 2009 to 79 people monthly in 2014. There has been an increase in the number of people having a thorough HIV/AIDS examination from 0.2 people monthly in 2009 to 3.5 people monthly in 2014.
b. STI Clinic Services
Average visit in 2013 was as many as 40.5 people monthly. The number increased to 107.3 people monthly in 2014.
c. HIV / AIDS Treatment (CST)
Since its opening, the clinic has been handling 64 patients (one under-aged was referred to custodian hospital, one people was referred to 2nd Degree Treatment, three people died, and four people were dropped out from the treatment). The dropped-out patient were then encouraged to continue their medication.
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| 8. What were the most successful outputs and why was the initiative effective?
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Monitoring and evaluation were conducted comprehensively and sequentially by Bali Peduli Foundation and Public Health Center of Ubud II. The three-monthly evaluation is also conducted involving components of the service (Technical Taskforce Unit of Public Health Center of Ubud II, Local Office of Public Health of Gianyar Regency, Local and Provincial ACC, Bali Peduli Foundation, and Dua Hati Foundation), assessing the results, the constraints, as well as the solution.
Annual evaluation is done by involving all components of the service (Technical Taskforce Unit of Public Health Center of Ubud II, Local Office of Public Health of Gianyar Regency, Local and Provincial ACC, National Narcotics Agency, Chief of District Police, Heads of Districts, Village Leaders, Indigenous Leaders, Bali Peduli Foundation, and Dua Hati Foundation), assessing the same matters along with the recommended inputs for future references. The annual meeting is also a means of introduction and program information dissemination to new leaders inside the government authorities, particularly the Districts Office and District Police Department with frequent replacement of the leaderships.
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| 9. What were the main obstacles encountered and how were they overcome?
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1. Funding
The allocation of funds from the government is still limited in the field of promotion and prevention have not touched the curative phase. No insurance companies are willing to take the disease as their point of protection. Proposal were submitted to government institutions and agencies and the response were quite positive, particularly from Local and National Narcotics Agency. The biggest funding is from Bali Peduli Foundation supported by the Rotary Club.
2. Manpower/Human Resources
The innovation needs qualified, trained, and experienced personnel. Some of the human resources are coming from government institutions while others are from private institutions and the two foundation supporting the innovation.
3. The Legal Matters
To legalize the service, some legal documents have been signed and documented:
The cooperation agreement between the Gianyar Regent and Bali Peduli Foundation;
The cooperation agreement between Technical Taskforce Unit of Public Health Center of Ubud II and HIV/AIDS Countermeasure Commission (ACC/KPA);
The cooperation agreement between Technical Taskforce Unit of Public Health Center of Ubud II and HCPI;
The Inauguration of the clinics
4. Public Participation
Inviting government agencies, private and public figures at the time of service opening and inauguration;
Conducting a direct meeting with community, social groups, or at- risk social groups through discussions and seminars;
Spreading certain brochures to government institutions, private parties, and high-risk social group;
Disseminating the information through the online media on www.balipeduli.org.
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