The Indonesian Experience: Government and civil society partnership model for expanding coverage of harm reduction Dr. Nafsiah Mboi, SpA, MPH Secretary.

The Indonesian Experience:

Government and civil society partnership model for expanding coverage of harm reduction

Dr. Nafsiah Mboi, SpA, MPHSecretary to the National AIDS CommissionPresented at UN RTF ICAAP SYMPOSIA

Twin epidemic of drugs and AIDS:

o IDU driven, almost all provinces are reporting a growing drug user community

Issues:

Criminalization of drug users

Prohibitive drug laws 5 and 22/1997

Drug users are a covert & underground community, unprotected by the public system, isolated from society

Prisons are filled with young drug users, increasing vulnerability to HIV, Hep C, sexual abuse, etc

No access to health care fear of arrest + stigma & discrimination from health providers

Issues:

o [1999- 2006] drug users as a community not recognized by government; programs very little consultation; drug users mere projects’ targets not involved in any form of planning;

o Presidential Regulation75 /2006 about Nat. AIDS Comm

Civil society rep. : equal members of the Commission

Drug users, PLHIV, sex workers, academics, etc. all active & participating members in policy making meetings

The journey towards partnership

o Coord Min for People’s Welfare/ Chair NAC: reg 2/2007: “harm reduction” = public policy for HIV prev and care for people who inject drugs IDUs NOT criminals , they have Human Rights

Then there was the drug users movement: - local communities organized themselves- a national network was established (2007)- consistently providing inputs to ensure the public health system accommodates drug users needs

The journey towards partnership

It took the realization from both parties, government and civil society:

The government…

o drug users = citizens, protected from human rights violation, violence, abuse and any form of discrimination

o drug users (in and out of prisons) are not denied their human rights, including the right to life, education, health care etc

Civil society…

o educated itself concerning civic rights and obligations

o became contributing members of society, monitors the running of the public ‘engine’: social, economic, legal, health, etc

o Learned to become an agent of change when system doesn’t accommodate their needs

It took the realization from both parties, government and civil society:

o Org & financial support to the National Drug Users Network, incl Drug Users Congress 2007 & 2009

o NAC established: (WG) gender & human rights all elements of civil society: legal aid, human rights group, women’s movement groups, etc.

o HR WG all levels: Aids Comm, Health, Police, Narc Board, CSO, Org Drug victims, prison officials, etc for planning, coordination, M&E

o Together: Govt, CSO, drug users, PLHIV networks, support efforts for drug law reform

Indonesian drug users communities actively involved in policy making processes from national to the local levels

o The government’s commitment and support to universal access for prevention and care:

o domestic resources : e.g. Jakarta supports all public health centres for NSP and some including MMT, Pontianak, Mataram, etc

o Increasing coverage, particularly among drug users (+ IPF, GFATM, AUSAID)

Combining forces to scale up….

4 411

0 0 1107

69

17

120

182

147

113

79

65

55

68

1044

0

20

40

60

80

100

120

140

160

180

200

2002 2003 2004 2005 2006 2007 2008

Total NEP NEP at Primary Health Care NEP at NGOsSource: NAC

NSP until Dec 2008

2 2 2 24

9

14

0 0 0 0

6

11

17

0 0 01 1

4 42 2 2 3

11

24

35

0

5

10

15

20

25

30

35

40

2002 2003 2004 2005 2006 2007 Dec 2008

at hospital at PHC at Prison TOTALSource: NAC

MMT – Dec 2008

The trust of the people in the leaders reflects the confidence of the leaders in the people.

Paulo Freire

Terima kasihThank you