10.5958/0973-5674.2019.00161.8 HIV/AIDS Control Program in Health Office of Jayawiya District: Empowerment and Logistic Study

Theresia Falentina Resubuna1, Darmawansyah1, Muhammad Tahir Abdullah1, Ridwan Amiruddin1, Syamsuar Manyullei1

1Public Health of Graduate School, Department of Health Policy and Administration, Faculty of Public Health, Hasanuddin University,

Abstract Lack of community empowerment and gaps in the availability and use of logistics reflect different levels of local capacity, follow-up mechanisms, and local cultural norms and attitudes towards HIV/AIDS prevention program. This research aims to examine the human resources in HIV/AIDS prevention programs in Jayawijaya . This research uses a qualitative research design with a case study approach. Data were collected by in-depth interviews on 18 information and 1 group of Focus Group Discussion (FGD). Determination of research informants with purposive procedures, consisting of District Health Officer, Regional AIDS Commission, Head of Public health services, HIV/AIDS Program Holder and Non-Government Organization. The results of this study indicated that community empowerment in the context of the HIV/AIDS prevention program in Jayawijaya District was the involvement of local NGOs to support the success of the program and the presence of Posyandu cadres who also played an active role in HIV/AIDS prevention programs. While the logistics of the HIV/AIDS prevention program in originated from the Central Government, procurement by the Health Office and international NGO assistance. The logistics distribution of HIV/AIDS at all levels starting from the Provincial Health Office to the service units in Puskesmas and hospitals were carried out through provincial decentralization. This study recommends an integrated response in community empowerment and equitable distribution of logistics among people with HIV/AIDS in .

Keywords: Empowerment, Logistic, HIV/AIDS, Jayawijaya.

Introduction responded to by the establishment of the 1994 AIDS Commission and followed by various international Papua in 2011, with a population of only 1.5% of cooperation, both bilateral (USAID, Australian Aids Indonesia’s population, contributed more than 15% of and DfID) and multilateral cooperation (GFATM, all new HIV cases in Indonesia1. The Papua Province UN, Indonesia Partnership funds, and non-government includes those facing health problems, especially HIV/ institutions6. In general, HIV and AIDS policymaking is AIDS2,3. Based on provincial data up to March 2016, intended to strengthen and sharpen the response to socio- there are 1,836 of 15,871 AIDS sufferers and 9,362 political conditions that changed from the transition of people with HIV who died. Based on regions, the most the New Order era (from 1987 to 1998) to the era of affected areas were in Jayawijaya Regency about 5,293 decentralized autonomy (from 1999 to present)7. cases, and followed by (4,162 cases), Regency (4,162 cases), City (3,762 The Jayawijaya DHO in carrying out its duties cases), Jayapura District (1,813 cases) and Merauke oversees 13 Health Centers. In the organizational (1,807 cases)4. Various efforts have been made by the structure, the part that oversees HIV/AIDS prevention is government in overcoming the problem of HIV/AIDS. the Eradication of Communicable Diseases and the TB But the HIV/AIDS epidemic continues to remain along / HIV Control Sub-Sector. All Health Centers provide with the rampant drug use in Indonesia5. HIV/AIDS services totaling 5,293 cases in 2017 with the highest number of cases occurring in the Wamena City Sporadic control to HIV/AIDS has begun since the Health Center Working Area totaling 1,682 cases and first case was discovered in 1987, which was formally 202 Indian Journal of Physiotherapy and Occupational Therapy, October-December 2019, Vol. 13, No. 4 followed by Hom Hom Puskesmes and Elekma Health Data Analysis and Validity Centers in the second and third positions4. Wamena Hospital and Kalvari Clinic are reference centers for Qualitative data analysis as an effort carried out patients with HIV/AIDS. by working and data, organizing data, sorting into manageable units, synthesizing them, looking for and Capacity constraints (human resources and finding patterns, discovering what is important and what infrastructure), attitudes and culture influence efforts is learned and interpreting the results of research themes. to prevent mother-to-child transmission and promote The validity of data by triangulation of sources, method, follow-up care for couples of mothers and infants2. and theories. According to previous study, there was a relationship of knowledge (p= 0.001), attitude (p= 0.006), husband’s Results role (p= 0.000), and the role of health workers (p= Community Empowerment 0.001) with the effort of pregnant women in prevention of HIV transmission to infants8. Gaps in availability and Community empowerment has been established in use reflect different levels of local capacity, mechanisms various central and regional government policies as a for follow-up, and local cultural norms and attitudes form of mechanism for community participation from towards HIV/AIDS. Based on the explanation above, the lower levels in supporting access to health and social the researcher argues that there is a need for research services from those infected. Community empowerment related to the implementation of decentralization in the is an important strategy to eliminate discrimination HIV/AIDS prevention program in Jayawijaya District against people infected with HIV/AIDS. Community Health Office (DHO) which is focused on aspects of participation in the context of non-governmental empowerment and logistics. organizations (NGOs), at the operational level, is the role of KPAD. KPAD conducts guidance and empowerment Materials and Method in local non-governmental organizations.

Study Design ... KPA’s role is to empower local non-governmental This study uses a qualitative research approach organizations. Those local NGOs are supported more by with a case study design in Jayawijaya District, Papua KPA Jayawijaya district ... - GYA informant, Head of Province. This is based on the consideration that AIDS, TB and Malaria Section of Health Office. qualitative research is very well used to explore and At present, there are several NGOs engaged in understand the meanings of a number of individuals or HIV/AIDS prevention programs in Jayawijaya District, 9 groups . namely Yukemdi, Tangan Peduli, YPKN, YTHP Data Sources and Yuhumi Inane and 4 groups of street children. Empowerment activities carried out by NGOs are Primary data was sourced from 18 informants training, assistance in taking medicines, distribution consisting of DPRD officials, Provincial Health Service, of condoms, counseling on HIV, Reproductive Health District Health Office, Bappeda, Village Child Protection and others. The Health Office, in this case, took part to Group/ KPAD, Puskesmas, Non-Governmental provide material for training activities carried out by Organizations (NGOs) and ODHA Communities. While NGOs. secondary data is legislation related to HIV/AIDS and other credible written data sources that can be used in .... the provision of activity support in the form of this study. funds that they have to hold accountable every year, each NGO is given a million assistance, then they are Data Collection accountable every year. Then there are also possible empowerment activities such as training, LKB sulfa Data collection through in-depth interviews, training involving also cadres, then there is also observations, document review, and focus group empowerment at any level of NGOs such as them and this discussions. Participants involved in the FGD of this health office also provides materials during the activity - study researched informants who were considered to activities in these local NGOs ... - GYA informants, Head have information relating to the topic of the research. of AIDS, TB and Malaria Section for Health Services. Indian Journal of Physiotherapy and Occupational Therapy, October-December 2019, Vol. 13, No. 4 203 Some NGOs carry out activities that have been The dissemination of mass media is done in carried out by other NGOs. Overlapping activities also collaboration with other government agencies and occur between NGOs and Puskesmas. There have been NGOs. It is expected that the decentralization of logistics activities that have been carried out by NGOs which have can also be carried out at the District level by the DHO. been carried out by the Puskesmas or vice versa. For District decentralization gives the District authority to example, visit mobile activities carried out by NGOs and regulate drug needs, regulate reserves, distribution and budgeted funding, it turned out that these activities had monitor records and reporting11. been carried out by the Puskesmas. So that coordination is needed and sit together between NGOs and also with Discussion Puskesmas to determine who does what. Empowerment Community Empowerment was also carried out on the PLWHA community by forming Peer Support Groups. The current community empowerment in the implementation of the HIV/AIDS prevention program Logistic Program of HIV/AIDS in Jayawijaya at the Jayawijaya DHO is the involvement of Posyandu Regency cadres. Posyandu cadres are trained and given monthly The HIV/AIDS program logistics is a prevention incentives. In addition to carrying out their duties at the service activity which comes from 2 (two) sources, 1) the Posyandu, some cadres also carry out activities related to procurement from the Province and 2) the State Budget the HIV/AIDS program. This happened to the cadre of and the Health Office of the Jayawijaya Regency. the working area of the Polebaga Health Center, where cadres acted as PMOs for HIV sufferers. This effort was ..... the first is clear from national procurement for successful where the Polebaga Health Center reached ARV drugs and also for the rapid availability of HIV zero for HIV sufferers who were lost to follow-up. testing from the national level. Then the regency held Community activity is also shown in the Asokobal health the consumables, consumables and also what the name center work area, where there are groups of mothers who for the cdform cartridge, this was carried out by the routinely provide information to the public about HIV/ district itself, and also later for the adequacy for firalot AIDS under the direction of the church pastor. examination assisted by donors ... - FGD results, HIV/ AIDS Programmer Health Service. However, the community empowerment model that took place in Pelebaga and Asolokobal Health Management of ARV logistics is carried out with Centers was not carried out by other Puskesmas in the a system of 1 (one) door in the Provincial Health working area of the Jayawijaya District Health Office. Office through the Health Pharmacy Installation. This Some Puskesmas do not encourage cadres to be actively system is called decentralized logistics. Pharmaceutical involved in HIV/AIDS programs. In fact, the presence installations in the Papua Province have very strong of cadres from the local community is needed to assist networks up to the district level to the Puskesmas. The patients who are undergoing HIV counseling and testing Provincial Health Office regulates the distribution of until the treatment stage. ARVs to the district level by ensuring the distribution chain reaches districts/cities. The distribution process to The results of this study also found that the the service level is the DHO authority. community had not been involved in the HIV/AIDS program planning process. The cultural approach is one The distribution of HIV Logistics to service units of the factors that must be considered in HIV/AIDS is carried out by the Pharmacy Installation of DHO. prevention programs12. Cultural approaches must be Before 2017, the decentralization of logistics from encouraged in health development in Papua, including the Province was channeled to districts/cities through HIV/AIDS prevention programs. The tracking process hospitals. Since 2017, the logistics of HIV originating of people with HIV/AIDS who lost to follow-up cannot from the Provincial Health Service has been submitted be done without involving community leaders and to the Pharmacy Installation of DHO. Hospitals and religious leaders in the community/village environment. health centers as HIV/AIDS service units every month So, this needs to be considered in order to increase make logistical requests for HIV/AIDS to the Pharmacy patient retention of treatment. Installation of DHO by entering LBPHA reports10. 204 Indian Journal of Physiotherapy and Occupational Therapy, October-December 2019, Vol. 13, No. 4 How far the commitment of regional governments HIV/AIDS sufferers at each Puskesmas. The problem not to tackle HIV/AIDS cannot be separated from the that arises in connection with the distribution of logistics interaction and communication between stakeholders to the Puskesmas is the delay of the Puskesmas in in Jayawijaya District, both government and non- entering LBPHA reports. This delay is caused by more government sectors. This must be a concern because the workloads held by HIV/AIDS program holders at the commitment and policies of the local government are Puskesmas. basically the results of the communication process over the HIV and AIDS problems faced by the Jayawijaya Some HIV/AIDS program holders not only handle Regency government. Communication between and prepare reports for HIV/AIDS, but also for other stakeholders will influence other needs such as financing, diseases such as tuberculosis and malaria. The problem provision of human resources, and others. Sectoral ego of storage, supervision and the process of using logistics is still an obstacle in HIV/AIDS prevention programs13. is still a problem in some Puskesmas. This was found in several health centers whose reagent logistics for Logistic diagnostic tests reached the expired date. The problem is that the reagent is still stored in the pharmaceutical The logistics management of the program includes drug storage rack that will be used. This shows that the planning, procurement, storage, distribution, use logistics of HIV/AIDS has not been carried out by the and supervision of drugs and medical equipment Health Office to ensure the logistics available for use by for prevention, diagnostics, and therapy. Logistics Puskesmas are in accordance with HIV/AIDS service management in the health system is carried out by the standards. The presence of expired reagents also shows Ministry of Health and DHO. the presence of unused reagents with two reasons, the The procurement of drugs and medical equipment number of reagents requested is not in accordance with for HIV/AIDS prevention and therapy is currently still the estimated number of cases and the level of reagent dependent, especially from foreign aid, except ARVs used by Puskesmas staff was low. This is also influenced and some reagents prepared entirely by the Ministry of by the high number of HIV/AIDS patients who are lost Health. In general, policies related to pharmaceutical to follow-up. preparations are regulated in Government Regulation Conclusion No. 72/1998 concerning Safeguarding of Pharmaceutical Preparations and Medical Devices, which mandates the Community empowerment, in the context of the procurement of methadone and ARVs prepared by the HIV/AIDS prevention program, involved local NGOs central government. to support the success of the program. Some NGOs routinely carry out activities of HIV/AIDS with financial Knowledge, access to ARVs and compliance are assistance from KPAD. very important in maintaining the quality of PLWHA. In a previous study14, there were differences in knowledge, The logistics of the HIV/AIDS prevention program access to ARVs and compliance before and after the in Jayawijaya originates from the Central Government, provision of ARV-based health education interventions procurement by the Health Office and international and compliance of the Support Group (CAASG) in NGO assistance. Logistics distribution of HIV/AIDS PLWHA in Bulukumba. In addition to procurement by starting from Provincial level to the public health center the Central Government, HIV/AIDS logistics was also and hospitals is run through a one-stop system based conducted by the Jayawijaya District Health Office. The on patient data and proposed needs, and routinely types of logistics held by the Department of Health are distributed every month. consumables, consumables, and CD4 cartridges. Some types of logistics are also assisted by foreign donors Ethical Clearance: Taken from Ethics committee to back up the types of logistics that are lacking or not at the Faculty of Public Health, Hasanuddin University available. Indonesia.

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