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