Bangil General Hospital of Pasuruan Regency (RSUD Bangil Kabupaten Pasuruan)

A. Problem Analysis

 1. What was the problem before the implementation of the initiative?
1. Pasuruan is one of district in East Java Province, Indonesia. The total area of Pasuruan is 1474.02 km2 with a total population of 1,531,025 inhabitants (Pasuruan Regency,2012) moreover has 24 districts. The administration center located in Bangil Pasuruan, has known as the industrial, agricultural, and tourism destinations. Act No. 36 of 2009 on Health mandates that health development organized based on the principle of humanity, balance, benefits, protection, respect for the rights and obligations, justice, gender and non-discriminatory and religious norms. In accordance with the Sustainable Development Goals (SDGs) third goals are healthy and prosperous life to promote healthy living and support welfare for all ages The development growth of Indonesia accompanied by various social problems wherever one of them is the increased number of cases of HIV/AIDS. Whereas the HIV/AIDS data in Indonesia from 1 April 1987- March 31, 2016 was 269 013 cases. The existence of people living with HIV/AIDS (ODHA) concern in Pasuruan is increasing like an iceberg phenomenon. Pasuruan has only one ARV Referral Hospital by the number of people with HIV/AIDS was 668 cases (AIDS Commission,December 2012), with details recorded 396 AIDS and 103 deaths due to AIDS. The number of HIV/AIDS cases in Pasuruan recorded since 1993-2016 as many as 1126 cases and was ranked third on East Java Province of Indonesia rank. Transmission of HIV/AIDS can occured in susceptible populations, high-risk population, and infected population.High-risk populations are groups of people who because of his behavior at high risk for contracting and transmitting HIV, such as Female Workers Sex (FWS), their clients, men love men (MLM), people who have multiple sexual partners, intravenous Drug Users (IDU) and sexual partners, receiver blood, organ or tissue donor, as well as the baby of pregnant women with HIV. In 2012, Bangil General Hospital establish VCT clinic that strengthenwith the Decree of the Director, August 6th, 2012, No.445/0608/424 079/2012, and the clinic CST with Decree of the Director No.445/0609/424 079/2012, health services related with diseases caused by HIV/AIDS. The clinic serves communityinside and outside Pasuruan region. Voluntary Counselling and Testing Clinic (VCT) is services for patients who want to know, consultation and examination before it is known that was infected or not with HIV, Care Support and Treatment clinic (CST) is a service that cares for supporting and providing ARVs (anti-retroviral). Patients who visited VCT/CST clinics in Bangil General Hospital still low, visits and who seek treatment from 2012 (21:15), in 2013 (48:48), 2014 (139:133), 2015 (167:164) , in 2016 (227:214) this was due to various factors: 1)Knowledge and education of HIV/AIDS is still low 2)Services access that have not been reached by the community because Geographical conditions of Pasuruan are not able to reach the service at the VCT/CST clinic.3)People who infected HIV/AIDS feeling in shame and fear ostracized by the community then it will withdraw and cover status so will not seek treatment.4).There has been no approachment to the key population, importantly for Female Sex Workers (FSW) permitted by pimps to check into VCT/CSTclinic.

B. Strategic Approach

 2. What was the solution?
2. With so many people living with ODHA in Pasuruan, Pasuruan regency administration initiatives help the suffering of ODHA who feel get the stigma and discrimination to be able get the health care. Three initiatives to bring services with ODHA LINK Plus access: • Online Message ODHA will receive information about HIV/AIDS, get treatment, how to take the medicine and the side effects so conveniently for open counseling and finally get a routine treatment. • Delivery Service Delivery service provides patients with Anti Retro Viral Therapy (ART) easily for regularly patients taking medication and avoiding Drop Out. • High Acces Regular and continuous activities such as Counseling, Promotion, Education, Training, Skills, Mobile visit and the Society of Friends of ODHA

 3. How did the initiative solve the problem and improve people’s lives?
3. The health care Access is still difficult for ODHA and yet to create in comfort obtaining service of Bangil General Hospital make an easy access, cheap and affordable for people who want to know the status of their self, also makes it easy for people with HIV positive to get treatment. Everyone could run well and ready to face a variety of problems that will be faced in VCT/CST clinic, then through the Local Government Hospital and the Health Department through Public Health Care sending some medical personnel to attend training related to HIV/AIDS. With the establishment of VCT/CST clinic in Bangil General Hospital and health center which is open every weekday, is expected to be able to attract people with HIV/AIDS are still hidden. People living with HIV/AIDS want to routine treatment, no drug withdrawal and are always consulted about the conditions and the changes that occur both before and after taking antiretroviral drugs. Is not easy to serve patients who related with HIV/AIDS, especially when performing VCT counseling with high-risk patients. Nobody want to check him voluntarily even though he knew that in fact he was among those at high risk .Counsellors in VCT clinic were always patient with the patient and know how to approach, guiding, directing patients who want to check the condition of the disease and are able to use the language well so patients would voluntarily check their own condition, and if the patient can not be treated at the health center then referred Bangil General Hospital that are already available service facilities and inpatient CST. After the patient's test and the results “POSITIVE”with Rapid Test, VCT workers consult to the CST doctor as counselors and nurses assisted giver ARV therapy and concurrent RR (Recoding Reporting) in charge of recording all the data of patients with HIV/AIDS, and assisted by pharmacies. Dispensing ARVs are not only given once cured it becomes easy. But Task Team VCT and CST are not quite up there, they have to fight to HIV/AIDS patients with antiretroviral drugs for the cure would take a lifetime. In terms of what the initiative is a creative and innovative ODHA link Plus include: Online Message is giving out business cards with phone numbers of all VCT/CST and Pharmacy to NGOs, KPA, high-risk groups, Specialist Clinic service, Inpatient Room and all the people who've been visit to VCT/CST clinic. The goal is that society can inquire about HIV/AIDS, a problem Antiretroviral drugs or problems associated with HIV/AIDS itself,. Online sms received daily and directly answered by the officers both in hospitals and in health centers. Message data coming in 2016 as many as 1,943 sms. Online message done every day Delivery Service The purposing is gave the ease patients with ART who live far, busy work, are ill, unable for any reason, and embarrassed to take medication at CST clinic. Delivery services performed by officers hospitals and health centers. Data delivery service in 2016 as many as 472 times Delivery service is conducted every month on schedule patients taking the drug High Acces Education, training, skills, to expand the information about HIV / AIDS in the community are expected to decrease the stigma and empowerment of ODHA in giving skills and expand networks, outreach key populations by conducting VCT mobile. Friends of ODHA society who formed a positive view among ODHA for sharing, sharing life and to find a mate. High activity data Acces has done well in communities, schools and health centers in 2015 (27 times), 2016 (37 times) High acces be made on schedule predefined.

C. Execution and Implementation

 4. In which ways is the initiative creative and innovative?
4. Innovation of the Government of Pasuruan is purely of an initiative that has never been done in other areas by strengthening the commitment of the officers in the field both officers in Bangil General Hospital nor the Environment of Public Health Office level service puskesmas are directly related to people living with HIV, it shows concern and sincerity duty to take risks close to the patient. When the first VCT/CST clinic stands, some patients are always asked repeatedly about his condition, how to take the medicine, the side effects of drugs, and the problems facing patients with their families.With the business card of clinic officers VCT/CST must be ready for Calling and texting by people who needed. The purpose of the provision of this number as a media consulting and counseling regarding: 1).Explanation of how to take the medicine, if not understand when to be briefed on the service; 2).The side effect that occur in each type of ARV.3).The condition and development of the body with reception ARV 4).ARV correct storage method.5).Schedule the next visit. 6).The rest of the drug if any.7) the Society can inquire about HIV/AIDS dan Antiretroviral drugs problem.8) Empowering communities with the coordination of Social Service.

 5. Who implemented the initiative and what is the size of the population affected by this initiative?
Innovation ODHALink PLUS initiated by the Government of Pasuruan in order for the prevention and treatment of HIV/AIDS sufferers is increasing every year. ODHALink PLUS implemented by Bangil General Hospital and Health Service via Satellite-district health centers as networking of Bangil General Hospital and also received support from some of the cross-sector and private parties, namely Community leaders, religious leaders, NGO (NGO, WPA,KPA). In the implementation of this innovation many people who get beneficial including for: a. People with HIV/AIDS (PLWHA) itself, with innovations odhalink they feel comfortable, underserved, more confident because it turns out there are concerned, their privacy is maintained, to take his medication could be monitored. b. ODHA Family; with ODHA family, Odhalink services asissted when taking the drug, more families know and understand how to access information and care for people living with HIV c. Society; with Service Odhalink, society more easily obtain information about what is HIV/AIDS, how it is passed so that people understand, care about, at least in patients with stigma and discrimination of ODHA d. Non Government Organization (NGO) such as the Society of Social Institutions, Citizens Concerned AIDS; Odhalink with the service they are easier to map PLWHA, cooperate in serving the community and people living with HIV with beneficial activities e. Officers odhalink that health workers will gain new knowledge, new information from the community and people living with HIV, inner satisfaction closer and understand the patient's condition. f. Stakeholders, with Odhalink stakeholders understand the condition. situation and information on the development of HIV/AIDS in the Pasuruan Regency, so they can do the planning in the form of policies and funding for service development of HIV/AIDS in Pasuruan.
 6. How was the strategy implemented and what resources were mobilized?
A. Financial Resources In carrying out the activities of PLWHA link would require that the cost of the activities can be run well and smoothly. Below is a supporter of funding, starting from the beginning of clinic VCT/CST stand. 1. Procurement cards are for Bangil General Hospital wears budget costs 2. The cost of each officer Pulse Rp. 50,000/month and budgeted through Bangil General Hospital. 3. To transport a motorcycle delivery service officers wear when return. 4. High acces activities both in hospitals and health centers BANGIL financed through the budget and BLUD. B. Human Resources a. Bangil General Hospital Team of VCT/CST Clinic consists of specialist doctors, general practitioners, paramedics and support personnel as executor VCT/CST Clinic. Support from the Department of Health and KPA (AIDS Commission) as an institution that has always supported and supports a wide range of activities related to HIV/AIDS. NGOs among others from Paramitra, Sadar Hati, Wamapara (transgender community) who helped usher in high-risk patients to want to do the examination VCT, even willing to be the PMO (Supervisory Drink Drugs) and fetch medicine for ART patients who can not take medication. b. Satellite Health Center Health workers trained, certified VCT, PITC, and there are some doctors who already CST The number of doctors in health centers trained VCT SDH there were 20 doctors and officers who have been trained PITC everything in health centers totaled 33 officers. C. Technical Technical resources used are: Mobile and each vehicle executing on VCT/CST Clinic in communicating with the patient as well as the time of the delivery order. High Acces activities using the facilities provided by Bangil General Hospital, KPA and the Health Department. • Online message including the creation of the group Friends of ODHA • Delivery service (closer access ART) to people living with HIV sufferers by officers from Bangil General Hospital. The development by the establishment of four satellite health centers from 33 health centers existing in Pasuruan regency geographically is now reaching all access services, namely in Prigen, Grati, Purwosari and Gempol which will be increased to ART Health Center by Satellite: - Grati Health Center serves the District of Grati, Lumbang, Nguling, Lekok, Ngopak, Rejoso - Purwosari Health Center District Area serves Purwodadi, Purwosari, Sukorejo, Rembang, Wonorejo - Prigen Health Center District Area serves Prigen aand Pandaan - GempolHealth Center District Area serves Gempol and Beji • High Access (ODHA empowerment, counseling, mobile VCT, KDS Youth through Cak and Yuk Pasuruan Organization, social gathering, • Evaluation conducted by the District Health Office and the Provincial once every 1 year and by AIDS Subdit Ministry of Health RI every 2 times a year through data validation. Evaluation mechanisms reporting of patient data, the patient's condition, using a path that Siha report (routine reports done by officers specially bersertifiksi as reporting and Recording), while the monthly inspection of ODHA can be implemented by health workers in Health Center. The health workers do monitor every 1 month after the health condition of the development of the use of drugs with a visit or regular meetings. If the complaint is found additional or complication of other infectious diseases, which if the disease can not be handled by health workers in health centers to hospitals then immediately refer Bangil General Hospital or to a designated referral hospitals.

 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
7. Government of Pasuruan was the initiator of the program odhalink plus commissioned to manage and coordinate the activities Odhalink, identify the location of high risk in Pasuruan, collect, move and utilize resources effectively, ensure budget allocation/funding for HIV/AIDS from the source local-source as well. together with the Health Department with a role as coordinator of the satellite health centers and hospitals in cooperation with the Coordinating antiretroviral drugs as well as the improvement of people living with HIV Referral hospital with infection or additional complaints (opportunistic infections). Organization/institution Non Government (National AIDS Commission and NGOs) play an important role and are recognized as equal partners in the response to HIV/AIDS to reach out to people living with HIV and the group, with special needs, among others, youth, religion, women, professionals who typically do not or difficult to reach by government officials, so that the KPA and NGOs assist in the implementation of Odhalink plus to help provide information to the public also facilitate the monitoring and observation of PLWHA Plus ODHALINK implementation will involve various stakeholders: a. Local Government of Pasuruan Making policy b. Bangil General Hospital Through VCT/CST clinic health service related to diseases caused by HIV/AIDS. VCT clinic serves patients who want to know, consultation and examination before he is known infected or not infected with HIV and CST clinics serve with care, support and provide ARV treatment. c. Pasuruan District Health Office - Through four satellite health centers from 33 health centers existing in Pasuruan regency geographically is now reaching all access services, namely in Prigen, Grati, Purwosari and Gempol which will be increased to Puskesmas Initiation of ART by Satellite Health Center d. NGO Role of NGOs to help realize ODHALINK PLUS as a bridge on ODHA patients with services in hospitals and health centers.

 8. What were the most successful outputs and why was the initiative effective?
8. With the ODHALINK PLUS innovation will provide an outcome that can be seen as follows: a. Increased patient visit PLWHA in health facilities in hospitals and health centers (in 2012: 15; in 2013:48 : in 2014: 133 in 2015:164 in 2016:214) Online Message At the beginning of messaging communication service only between patients with officers now there are 16 people living with HIV who formed the group "Friends of the CST", 35 HIV-positive people who entered as a member of the KDS (Peer Support Groups "Healthy One Heart") where they can open status their HIV to others. Delivery service When people living with HIV do not need every month to Bangil General hospitals, they were able to save between Rp. 22.000 to Rp. 60.000 for money transport. The money they can use to buy basic necessities of daily. High Access a. The spread of information about HIV/AIDS that is true, then more and more organizations and other groups who dare to assist people living with HIV with the formation of the WPA (AIDS Care Residents) at the district level, the HIV Ambassadors Circle of Cak and Yuk Pasuruan b. In 2012, pediatric HIV services are still referred to RSSA Malang but currently (December 2016) there have been 16 children who received HIV care in Bangil General Hospital b. The provision of skills for families of PLWHA This is consistent with the SDGs program number 1 Increased economically valuable skills to reduce poverty in poor and vulnerable populations ,ODHA families get the help of sewing machines and training of Social Services so that now they can increase revenue c. The provision of a comprehensive health care for all ages This is consistent with the third SDGs program The success of treatment and support personnel in the provision of antiretroviral drugs for people living with HIV couples who eventually gave birth to a baby that is negative, it is in accordance with the third SDGs particularly decrease neonatal mortality rate and end the AIDS epidemic d. Provide educational information about the prevention and transmission of HIV / AIDS in schools and communities This is consistent with the fourth SDGs that ensure a decent quality education and inclusive and encourage lifelong learning opportunities for everyone. e. Making policy ODHALINK PLUS No. 72 Year 2016 Establishment of Satellite Health Center boosted policy Satellite Health Center No. 9 2016.

 9. What were the main obstacles encountered and how were they overcome?
9. Pasuruan District Government in implementing ODHALINK PLUS innovation a. General public The persistence of stigma and discrimination in society How to solve this problem by means of persuasion or approach, provision of information, education and continuous b. Patient There are still many people who do not understand and care for HIV disease so many cases Dropout, depression and suicide The fix approach to care and support from staff and family c. Relevant agencies The persistence of stigma, discrimination, and do not care about the transmission of HIV/ AIDS How to cope with counseling, information through mass media • There is still a negative stigma in society = provision of correct information about the modes of transmission and prevention of transmission of HIV • The difficulty of transportation access (fees, transportation, escort) patients to hospitals as referral Bangil General hospital ARV Pasuruan = closer access to antiretroviral therapy in outlying health centers with satellite formation • At a minimum number of officers who have been trained in counseling = held in-house training in the district of Pasuruan • Lack of financial support = support CSR of the companies in the District. Pasuruan Cross-sectoral cooperation is not maximized = increasing support and good cooperation with the government sector, private, and community.

D. Impact and Sustainability

 10. What were the key benefits resulting from this initiative?
A. Online Message • Patients can timely ARV medication; • Obtain clear information on how to drink and how in the event of side effects • Accelerate quick recovery after illness or healthy; • Get a safe, convenient way to open status and feeling of attention • Getting the right information about HIV / AIDS so that more patients understand • Conversation as friends and relatives • Patients are more comfortable and quiet with the treatment given, because it can be consulted directly with officers • Some people are already knowsonline numbers we tried to consult before visiting RSUD Bangil • The patient privacy is guaranteed where patients can devote all the problems associated with the disease. • Patients will get more service: a. Rapid response followed b. It did not take long queue in poly VCT, no need to travel for consultation c. Can consult anywhere, anytime done while working or doing anything No costly to consultation. B. DELIVERY SERVICE • Facilitate decision making ARV drugs can be obtained in a timely • Reducing the burden of transportation for those who do not work; • Getting drugs from people who reliably deliver ART • Strengthen the fabric of friendship officers and the families of patients. • Obtain health is maintained because there is concern of officers and the drug can be taken regularly • Response get quick remedy • It did not take long queue in VCT clinic, no need to travel to take medication • Whenever the drug can be obtained by appointment • Do not take charges / fees for taking drugs C. HIGH ACCES • People are coming alone to want to do VCT to Bangil General Hospital, especially high-risk groups in addition to transvestites, MSM, IDUs, FSWs also wives sir, pregnant women, house keeping, and society in general. • Hospital officials, civil servants who used less concerned and embarrassed to be testing for HIV / AIDS are now already many are beginning to see her voluntarily. • Used to HIV / AIDS patients in Bangil General Hospital always referred to, is now done alone in Bangil General Hospital

 11. Did the initiative improve integrity and/or accountability in public service? (If applicable)
11. With this program indirectly supports the Government in achieving the SDGs and increase government accountability da integrity in public service, supported the preaching among others; a. Magazine Medisiana RS b. Newspapers (Tempo, Radar Bromo Jawa Pos) c. Video d. Youtube http://youtu.be/2c8_xw7x9dQ http://youtu.be/SKbWqmWe2lk http://youtu.be/QZPjLWFHTJk http://youtu.be/0FvSN6DvHNs http://youtu.be/E4nXmLUAHv4 http://youtu.be/rtUVkIXE7_o e. Web address www.rsudbangil.com/odhalink In the course of the service time ODHALINK PLUS: • There is already conducting visits and requested information on the regulation of HIV/AIDS Pasuruan regency from Government of Sragen , Central Java Team consists of Parliament, the Department of Health and Hospitals • Team services Mojokerto hospital in East Java was the process of replicating ODHALINK Plus ODHALINK PLUS is an integrated service, close access and could reduce the occurrence of extortion in place at the time of taking ARV services performed by health workers so that people can access the service without going through brokers. Online Message For the purposes of pulses, each month the officer got help Rp. 100.000/person in the form of pulses. Whereas for the purposes of the Internet network, the current PC (Personal Computer) in the CST-VCT clinic has been equipped with internet connection. For the time being developed ODHAlink SMS gateway through its website (www.rsudbangil.com/odhalink). Everything funding outlined in the budget area Pasuruan will apply not only to the Referral Hospital but later ARV for satellite health centers established as part of a network of LKB-SUFA (Sustainable komperehensif Service) - (Strategic Use For ARV). The service is proven to reduce the fear of patients to disclose their status to the families so that the support of the family made their passion for lifelong antiretroviral therapy Delivery Service VCT-CST Team Hospital Services Bangil currently assisted by KDS "One Heart Healthy" Puskesmas Grati in making ARV distribution to the target area Puskesmas Grati (Lekok, Nguling, Rejoso, Grati, Lumbang). Furthermore, this activity will be supported by the satellite health centers were opened in Puskesmas Prigen (includes Prigen, Pandaan, Sukorejo), Puskesmas Gempol (includes Gempol, Pandaan part, Beji part) and Puskesmas Purwosari (includes Wonorejo, Purwodadi, Purwosari, and partly Sukorejo) High Access At the High Access service that has been done is also able to raise awareness of adult PLHIV when selecting and sorting partner so that when they are able to accept their conditions, they have the confidence to open the heart in men or women encountered. High Access includes contact dating services make the whole.

 12. Were special measures put in place to ensure that the initiative benefits women and girls and improves the situation of the poorest and most vulnerable? (If applicable)
12. Some ODHA widow remained work in the factory with all the risks • The housewife helped by getting the skills of Social Service for the provision of science Pasuruan making clothes, brooches, towels, headbands and assistance free sewing machine. There are 15 women who got help sewing machine • Wife injecting drug users (IDU) who initially relied on her husband's income is not necessarily, directed to receive light from yarn-making skills, key chains and wallets from the skins of animals • When ODHA children of school age must take ARVs every month, with Delivery service they go to school without interrupting their schedule • Pregnant women who come to Ante Natal Care (ANC) when examined HIV rapid regularly, they can be alerted early pregnancy and prevent transmission of the virus to her unborn child • With intense counseling on SMS, a couple of women with HIV / AIDS are willing to do an HIV test with regular schedule Widow PLWHA who are HIV+ and HIV- able confidence to start a business when they get the knowledge and skills. From interviews obtained operating profit of around Rp. 200.000 up to. Rp. 400.000 per day.

Contact Information

Institution Name:   Bangil General Hospital of Pasuruan Regency (RSUD Bangil Kabupaten Pasuruan)
Institution Type:   Local Government  
Contact Person:   Dyah Retno Lestari
Title:   Head of Nursing Division  
Telephone/ Fax:   +6281330714422 (Fax +62343744900
Institution's / Project's Website:  
E-mail:   retnodyah_lestari@yahoo.com  
Address:   Raci, Bangil
Postal Code:   67153
City:   Pasuruan
State/Province:   East Java

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