Recently, Indonesia's health
services have begun to scale up the implementation of harm reduction in Surabaya. From a positive standpoint,
government support for this program is improving, though there are down sides as
well.
Broadly speaking, public health services are improving health care provision for injecting drug users. Both service providers and program implementers are increasingly integrating their efforts in HIV prevention programs. At the same time, implementation has not yet included integrating law enforcement agencies and the general community, let alone improving drug policy. As a result, we can expect to see problems emerging in the future that will affect the overall implementation of harm reduction programs. In addition, the lack of active involvement by civil society through the coordination of the National AIDS Commission, and the lack of advocacy clout at relevant agencies, will make it difficult to improve relevant policies.
Other policies will create obstacles for full implementation of the harm reduction program. For one, beneficiaries must pay a fee every time they access these services, including syringe services. Although the nominal cost is pretty small (Rp 2,500, or US25 cents) this still has a big effect, considering that the drug user community has received free harm reduction services from civil society for so long. These fees are also not comparable with HIV programs, which are free of charge.
Meanwhile, there are some logistical problems relating to syringe distribution. The needles being distributed need to be assessed by the government in order to make sure that they actually meet the community's needs. Also, the provincial and city health department has not set a limit or quota for services in each unit that provides Methadone Maintenance Therapy. In order to encourage patients to use public health services, hospitals have continued to accept patients without providing recommendations for referral services to satellite agencies. Some agencies are therefore overrun with patients who could be accessing services in other parts of town, and this will affect the quality of service patients can receive.
MMT services are also not yet complete. For example, during the intake process, until recently health services have not provided urine tests. Urine tests are standard in the provision of MMT, as a way to identify whether or not patients are still injecting drugs. In addition, clinics that offer MMT are not yet providing psychological counseling or consultation rooms. This shortcoming combines with the infrastructure of MMT clinics to make these spaces unfriendly to patients. Some service rooms seem like prisons, heightening the feeling IDU patients have that they are receiving a lower standard of care than are other patients.
In sum, it is essential that the evaluation of health care for injection drug users in this government program be conducted with full involvement by the beneficiaries, who can help to provide a balanced view. These views should be solicited and collected not only through research, surveys and other metrics that evaluate aid projects, but should involve the stakeholders directly expressing their views at all levels of the program.
The
perspectives of program beneficiaries (in this case, injecting drug users) are
important to the sustainability of HIV prevention, and important in helping to
target those programs effectively. Bringing in the perspectives of program
beneficiaries helps to create a fair process - rather than positioning program
beneficiaries as commodities or objects of assistance by a government program.
Rudhy Sinyo is General Coordinator of East Java
Action, www.eastjavaaction.org.
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