| 4. In which ways is the initiative creative and innovative?
Maternal care initiative for pregnant women- HIV sufferer in Kardinah Hospital is unique and different program with many other hospitals. Maternal care for pregnant women-HIV sufferer are handling earlier, comprehensive, sustainable to strengthen mental and spiritual in personal treatment.
Initiation of this actions have been started before the pregnancy process, especially for the bride and groom, conducted a Voluntary HIV testing and Provider Initiative for women and men and his/her partners, and also providing the education about HIV / AIDS.
The assistance efforts / case managers, both individual and Peer Support Group undertaken to strengthen patient’s mental and spiritual, and also the supervision of Medication.
VCT and CST teams Kardinah Hospital monitor the general health of patients through periodic pregnancy controls, advise the nutrients supply, including delivery planning process and identify the condition of the baby and its postpartum.
Strengthening the society through community forum to accept the conditions of HIV-AIDS sufferers in their neighborhood, psychosocial support to patients and families in order to survive naturally. This is a special concern of Kardinah Hospital direct handling for HIV – AIDS sufferer that is still frightening and have a negative stigma and social discrimination in the family and the surrounding community
| 5. Who implemented the initiative and what is the size of the population affected by this initiative?
In accordance to implement the initiative, an action plan has developed to support the successful handling of HIV-positive pregnant women by a series of main activities as follows:
1. The establishment of Polyclinic VCT in Kardinah Hospital that can provide integrated services (counseling to mentoring) in handling the HIV-Sufferer
2. Mobile screening and screening of HIV cases through the implementation of a series of tests VCT for the HIV potential high risk community (Worker Night / PSK, Homosexual/Gay, Transgender and people who are living in the prostitution area)
3. Screening and filtering of HIV through methods PITC (Provider Initiative Test and Counseling) to each patient who potentially HIV transmission, such as in case of surgery in Kardinah Hospital
4. Optimally the STI (Sexually Transmitted Infections) clinic satellites in each Primary health center (Puskesmas=Pusat Kesehatan Masyarakat) to prevent cases of transmission through sexual transmission
5. Establishment of community support groups, namely Aids Concerned Citizens Forum (WPA) in all 27 villages, establishment of Continuous Comprehensive Services (LKB=Layanan Komprehensif Berkesinambungan) in every area of the primary health center (Puskesmas), strengthening the networking with NGOs and women religious group - Fatayat NU (Nahdatul Ulama)
6. Cooperation with the PMI (Indonesian Red Cross) to follow up on reactive donor blood through the mechanism of Informed Consent
7. Health education and conselling to the public about HIV / AIDS through a pregnant women class, IHC/ Integrated Health Care in Community, socialization of school children, workers and the environment
8. Treatment of patients through the establishment of clinics CST (Care Support and Treatment) in Kardinah Hospital
9. Management of Integrated Ante Natal Care (ANC) for pregnant women, Delivery and Post Natal Care (PNC) for HIV-sufferer - pregnant women
10. Monitoring and health care for mothers and babies after treatment from the hospital
| 6. How was the strategy implemented and what resources were mobilized?
Program initiatives maternal HIV services in Kardinah Hospital is part of the referral health services in Kardinah Hospital supported with funds derived from:
Tegal local budget of Rp.100,000,000 in 2013 and Rp.150,000,000 in 2014; Medical devices sourced from National & Provincial Budget (DAK, TK APBD I (Bangub).
Human resources involved in maternal care for pregnant women with HIV / AIDS are:
• Health Cadre
• Reach Fatayat NU
• Companion KDS (Peer Support Groups)
• Commissioner KPA (AIDS Commission)
• Social Fund PKPU (Pos Keadilan Peduli Umat) to PMT for patients
• Kardinah Hospital team consists of:
- Councelor And Doctor VCT (Voluntary Counselling and Test)
- Health analyst
- Medical Records
- CST doctor (Care Support and Treatment)
- HIV Program Manager HIV
All resources play their roles according their function, ranging from the education and outreach initiator in the community, outreach the potentially infected with the HIV virus especially from the women group of childbearing age, including pregnant women, carry out a blood test on the client, accompany if detected positive HIV, manage pregnant women before until after birth, babies born to handle and ensure to get appropriate follow-up of post-natal examination.
| 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
1. Kardinah Hospital both team leaders and health care team as the key stakeholders of maternal care for pregnant women with HIV / AIDS,
2. Community Group / Forum: Health care, Pregnant Class, and Sub District Kelurahan Siaga), be an important contributor in implementating of these services.
3. a) Active involvement of Peer Support Groups (KDS), namely 'Bahari Plus': in assisting clients,
b) NGO Fatayat NU I: doing outreach,
c) Citizens Concerned Aids (WPA) for each village: eliciting community participation tackling the spread of HIV / AIDS,
d) Association of Transvestites Tegal (IPWT): reaching the transgender and special community,
4. AIDS Commission (KPA) Tegal: coordinating the relevant stakeholders in HIV / AIDS,
5. Tegal District Health Office and Bappeda (regional planning agency) Tegal: in collaboration and funding programs,
6. The Indonesian Red Cross (PMI): in a screening and outreach.
| 8. What were the most successful outputs and why was the initiative effective?
The output of the initiative program management services for maternal HIV sufferer are as follows:
1. The establishment of Polyclinic VCT and CST in Kardinah Hospital supported by Medical Physician Specialists and Midwifery, Pediatrician, Specialist, Doctors Nursing and Medical Support staff who are trained and willing to treat patients of HIV / AIDS sufferer
2. Management of Ante Natal Care (ANC) integrated to detect women of childbearing age as soon as possible of their HIV status, Delivery and Post Natal Care (PNC) by Tim HIV in Kardinah Hospital to deal with HIV-positive pregnant women and infants
3. The establishment of Citizens AIDS Care (WPA) in villages in Tegal as a community forum to disseminate the information and to participate in the handling of preventing transmission of the HIV virus in the community
4. Establishment of Sustainability Comprehensive Services (LKB) in all primary health care (Puskesmas) in Tegal to assist HIV-positive clients while in the community and make sure to get psychosocial support
| 9. What were the main obstacles encountered and how were they overcome?
The main problems encountered and solutions to overcome these problems during the implementation of the program initiatives maternal care of pregnant women with HIV positive indication is as follows:
1. The increasing number of cases of HIV-positive findings on housewives, it needs the additional reagent for HIV testing to test of all groups in society, not only in high-risk groups. Today there is an increasing number of reagent through local budget funds and Global Fund.
2. There is still a stigma that the health workers who are unwilling to serve patients with HIV-positive, and then Kardinah Hospital increase the workshops and meetings on the medical officer / paramedic and related units to discuss about HIV AIDS and conducted the staff capacity building in the prevention of transmission of infection.
3. Pregnant women with HIV usually still willing to have their maternity with the midwife near her domicile , so that created networks between hospitals with health centers and midwives Kardinah Independent Practice, in order to facilitate the patient while handling needs.
4. The high stigma and discrimination against HIV-positive patients, so hospitals Kardinah together Tegal City Health Department multiply step socialization and counseling to the public health and family about HIV AIDS.