Executive Summary

Despite pros and cons of the vertical approach in providing assistance to the people with HIV/AIDS, most results of HIV/AIDS researches and the latest evaluation by the National AIDS Commission of 2011 concluded that policy responses programs to combat HIV/AIDS in Indonesia have been scattered and have not been well-aligned or strengthened the health system in the country. This brings enormous challenges in bringing the HIV response up to an effective and efficient level. With more cases reported from 341 districts and cities in the whole 33 provinces in Indonesia and even more responses implemented by the Indonesian government either with or without the supports from various donors, it is obvious that all efforts in providing better prevention programs, care, and treatment, as well as reduction of exposure to HIV/AIDS needs to be revisited.

The Center for Health Policy and Management (CHPM) is proposing a research to Department Foreign Affairs and Trade (DFAT), Australian Government to assess how the HIV/AIDS policy programming and implementation is currently set up within the existing health system framework in Indonesia. With the decentralization context in the country it will be worthwhile to see how adaptive the health system especially at district level currently is in absorbing the growing demand of HIV/AIDS responses. Focusing on major issues of HIV/AIDS responses in the country through the lens of health system, this research will not only assist Indonesian government in strengthening its HIV/AIDS response program and determine the future of HIV/AIDS programming in the country, but also will assist DFAT in rebalancing its engagement with the government of Indonesia in the future. In practical term the research activities will be clustered into three components.First, policy analysis to map out the current policy and programming approach in HIV response in Indonesia and to assess to what extent has or is the Indonesian health system has or will be able to address HIV/AIDS epidemics. Second, the research will explore options of optimum delivery model that will enable effective scaling-up of complex intervention of HIV/AIDS within the framework of the current Indonesian health system in a highly decentralized context by also taking into account the demand of other basic health services.Third, is strengthening the knowledge management network with other 9 universities in 8 selected provinces in Indonesia.CHPM will work together with the universities involved to ensure that collaboration is in place and agreed research action plan is implemented. Notably with Atmajaya University, CHPM will collaborate in stronger partnership to conduct this research.

Over the two and a half years of the proposed research period, expected major outputs will include but not limited to the following.

• A map of Indonesian government policies for HIV/AIDS prevention, care, support and treatment and impact mitigation within the health system that affects other sectors' policies at national and sub-national levels.
• A collection and analysis of various good policy practices in the health system at national and subnational levels with analysis of strength and weakness, as well as opportunity and risks for each of the case studies.
• A policy model to strengthen the current Indonesian health system to increase the effectiveness of HIV-AIDS responses programs.
• A national AIDS policy network consisting of researchers, policy makers and intermediaries as a form of knowledge management hubs established to advocate better HIV-AIDS policy development and implementation.

The research method will utilizea logical framework modified from the AIDSTAR-Two Framework on Assessing Health System Performance in AIDS Response. By utilizing this logical framework, the research will consist of two main activities: (1) policy analysis, and (2) policy model development. To support the production of knowledge and utilization of the knowledge for policy development, the research also will implement the third main activity which is development of knowledge management hub and advocacy.

The research will use standardized instruments for collecting primary qualitative data collection through interviews and focused group discussions with key informants at national and subnational levels. Primary data are used to provide better understanding on the implementation of current AIDS policies and programming at different levels of administration including barriers and enabling factors in achieving the objectives HIV/AIDS policy response or programs. Secondary data will be used to map the existing policies and programs related to health system and HIV/AIDS at national and subnational levels.
Combination of Health in Transition Method (HiT) and Health System Assessment (HSRA), both were developed by WHO, will be used to assess health system performance mapping. CHPM is proposing to complete these three main activities in the span of two and half year period.

To ensure quality and sustainability of the result of the research CHPM is proposing a management structure of the research implementation plan. CHPM has also prepared quality assurance steps to be followed throughout the research span of time, a risk management plan, and a monitoring and evaluation plan. Details of the organization, quality assurance, risk management, and the monitoring and evaluation plan are provided towards the end of this research proposal.