SUM II (TRG) Implementing Mechanism Narrative

The SUM II Program, was specifically designed to address the need to build capacity of local government and civil society organizations (CSOs) to deliver services sustainably. The main objectives of the SUM II Project are to: 1) Provide targeted assistance in organizational performance required to scale up effective, integrated HIV interventions that lead to substantial and measurable behavior change among MARPs; and 2) Provide and monitor small grants to qualified CSOs to support the scale-up of integrated interventions in hotspots, where there is a high concentration of one or more MARP and where high-risk behavior is prevalent, including DKI Jakarta, East Java, Papua, Riau islands and North Sumatra.

SUM II will strengthen the capacity of CSOs in the HIV response by providing targeted TA to indigenous CSOs that will eventually become leaders and mentors for other CSOs in their communities. While Year 1 of the project was spent conducting baseline assessments for the selection of promising NGOs, the primary function of FY12-14 will be to build the capacity of these CSOs to manage their services and programs more effectively, increase their ability to leverage funding other than USG funds, and graduate these organizations into technical assistance providers for other community organizations. At the same time, capacity building on organization performance for district governments will also be provided by SUM II. As a result, efficiency gains, along with proper and sustainable transition of CSOs from SUM II to partner governments or other organizations can then be achieved. Monitoring and Evaluation plans for included activities are reviewed and revised on an annual basis.

Similar to HVOP, SUM II will support CSOs to improve organizational performance of MARPs-based care, support and treatment for FSWs, MSM, Waria and PWIDs. HBHC will include TA and support for management of post-counseling, adherence, psycho-social support, and positive prevention aimed at reducing morbidity and mortality among PLHIV. During 2012, SUM II will encourage the establishment of up to 15 MARP-based support groups.

SUM II will support Spiritias provincial catalyst and local peer support groups for PLHIV that are ensconced in SUMs provinces and districts, including Papua, offering an opportunity for collaboration with SUM in our targeted intervention sites. In addition, SUM II organizational and program TA and grant support to Spiritia will build its capacity to manage its network.

Our activities are implemented to supplement national program efforts in/for underserved areas and groups, and are thus fully linked with national program efforts. However, this is an under-developed program area in the national program, and thus coverage with services that approximate global good practices is low.

SUM II will provide TA that will legalize un-registered CSOs by securing legal entity status according to Indonesian laws and regulations; strengthen organizational governance by re-visiting and developing organizational vision and mission statements, organizational constitutions, organizational management and operational structures and standard operating procedures; promote strategic organizational thinking and longer term planning by developing 3-year strategic plans and annual work plans through one-to-one mentoring and facilitation; develop sound financial management practices and establish organization-wide standard operating procedures; and build CSO capacity in community mobilization through advocacy and community empowerment by applying best practices and evidence based decision making approach. The TA will be provided by local institutions specializing in these technical areas using SUMs Manuals for supporting CSOs to promote consistency and sustainability.

In 2013, SUM II will continue working to improve monitoring and evaluation of performance indicators for CSOs. In 2012 SUM II expanded its approach to capacity building by partnering with SurveyMETER (October 2012) to support SUM IIs responsibility for CSO monitoring and evaluation. In 2012 SUM II assumed complete responsibility for CSO monitoring and evaluation (M&E), including monthly recordkeeping and reporting, population-based surveys at CSO intervention sites, and qualitative assessments at intervention sites, such as focus group discussions. SUM IIs partner SurveyMETER is providing on-the-job training and coaching to CSOs. SUM II is also replacing the proprietary database programmed for CSOs, which is costly to maintain and update, and has hampered CSO staff from learning how to manipulate and analyze data, use it to identify obstacles to service delivery, and present and take appropriate action.

In September 2012, SUM II introduced Epi info 7 and CommCare to two SUM II Principal CSOs in DKI Jakarta to pilot test the integration of the two technologies, and in 2013 this integration will be scaled up to three additional Principle CSO partners in East Java, and eventually to Papua, West Papua, North Sumatra, Riau Islands, and West and Central Java. CSOs are enthusiastic about both technologies and see their potential to improve HIV program results. CommCare Mobile and Epi info 7 will enable real-time reporting by field workers and eliminate the data entry task at the CSO office. Together, these technologies will significantly improve CSO outreach, case management and recordkeeping, problem solving, and reporting. CommCare is a mobile phone-based data management tool that SUM II and CommCare customized to Indonesia. Epi info 7 is a series of tools for routine data gathering, database management, and analysis. It was developed by CDC for use by CSOs and community health workers to manage databases for surveillance and other tasks. It is easily used in places with limited network connectivity or limited resources for commercial software and professional IT support. When integrated together, Epi info 7 and CommCare enables CSO field workers to collect and record client data on their phones, which can then be uploaded and synced with the CSO data management system Epi info 7 without the need for data re-entry.

SUM II will work with SurveyMETER to provide training and coaching to CSOs in doing regular surveys to measure the outputs and outcomes of provided services. Surveys will be designed on an annual basis, and may be conducted more frequently, e.g., twice a year. CSOs are expected to use the results of the survey for CSO decision making for advocacy and future plans, and disseminate results to stakeholders at district levels were they provide services.

In 2013 SUM II will work with a number of partner CSOs to formulate the concept for model centers of excellence, where the health provider builds a network with CSOs and community organization in MARPs services, and involves them in all levels of planning and implementation. SUM II will identify and engage one local TA provider with expertise in clinical management to assist with formulation of the approach.

SUM II TA provider organizations will continue to provide training and coaching to 28 CSOs in 22 districts in DKI Jakarta, East Java, Central Java, North Sumatera, Riau Islands and Papua. SUM II has identified two CSOs in West Papua that it will partner with in 2013. Seven Principal CSOs will provide technical assistance in project management and community organizations to developing CSOs that work in expansion sites, including MARPs hotspots in the same district/province or neighboring district/province. Yayasan Penabulu, a well-established NGO based in Jakarta is providing financial management training, coaching and system development to SUM II CSO partners in DKI Jakarta, East Java, Central Java, North Sumatera and Riau Islands to improve institutional-based financial management performance and establish sound accounting systems. Likewise, Circle and Satunama, well-known organizations based in Yogyakarta and specializing in organizational development TA will train and coach our CSOs to improve their strategic and annual planning and budgeting, leadership and management performance, human resources, mobilizing MARPs and communities, and advocacy. Yayasan KIPRa, a Papua-specialized community development NGO is receiving mentoring from Penabulu and Satunama for organizational strengthening, in order to more effectively provide SUM II CSO partners in Papua and West Papua with organizational performance TA, including financial management. SurveyMETER will provide technical training in the development of monitoring and evaluation systems, data analysis, and how to use results for decision making and to strengthen networks with health providers and the CSOs non-SUM II partners. OPSI will provide technical capacity to SUM II CSO partners in Papua and West Papua in community organizations to the specific MARPs, e.g., MSM, TG, and CSWs. The goal is to develop CSOs training and facilitation skills in community empowerment and advocacy. OPSI will accelerate community organization services by working directly with MARPs and simultaneously coaching the CSOs in Papua and West Papua to facilitate FSWs, MSM, TG communities in community organizations.

SUM II will also continue to provide training and coaching to CSOs for advocacy and resource mobilization using the Resource Estimation Tool for Advocacy (RETA). In 2013, SUM II will train SUM II CSO partners in Jakarta and East Java to produce resource gap estimations based on RETA, government budget and response analysis results, with the goal to develop advocacy agendas and instruments, e.g., policy briefs and advocacy plans. SUM II will continue to provide RETA training and coaching to CSOs in 2013 that leads to the CSOs successfully advocating for more resources, and mobilizing communities and leaders. Papua and West Papua will be the top priority in the use of RETA both for MARPs and the general population. Moreover, SUM II staff in Papua, Medan, and Riau Islands regions will be trained on know-how to provide technical assistance to CSOs in the use of RETA for MARPs.

SUM II supports CSOs engaged in increasing demand for testing and counseling among MARPs. CSOs are funded to work with MARP indigenous leaders to develop drop-in centers in communities. The MARP-based centers are socially and geographically acceptable to MARPs and provide education and information related to HIV prevention and care. They also provide pre-counseling services to MARPs if MARP members are already trained as co-counselors or lay-counselors.

Support to CSOs also includes training and coaching to be counselors at the drop-in centers conducting pre- and post-counseling. SUM II CSO partners will participate in the training and coaching provided by TA organizations to improve partnership performance with community health centers (Puskesmas) that provide STI and HCT services. The CSOs are expected to be equal partners of Puskesmas in planning, in reviewing performance of services, and in addressing loss of follow up clients. Wherever workable, the CSOs will second the MARP (co- or lay-counselors) to be local health providers of VCT services.

National HIV prevalence by risk population based on the 2011 IBBS is as follows:

IDU: 30.0% - 36.4%

CSW (direct): 3.6% 25.0%

CSW (indirect): 2.3% - 2.9%

MSM: 2.4% - 17.0%

TG: 14% - 31.0%

HRM: 0.8%

In 2013, SUM II will make a decision on the feasibility of rapid testing by CSOs and private providers. SUM II is already investigating current legal, policy, regulatory and/or operational barriers that prevent CSOs from providing rapid HIV tests. SUM II will investigate these barriers and determine whether HIV rapid testing is feasible by CSOs. If a rapid testing process is found to be feasible, a pilot rapid testing program will be developed and evaluated in at least two provinces (most likely East Java and Papua). The pilot and associated evaluation will be used to build support for introduction of more accessible HIV testing for MARPs nationally. Where CSOs can provide counseling and HIV rapid testing through outreach or through linking MARPs to testing at safe spaces drop-in centers, CSO offices, etc. the reach of HCT can be rapidly expanded among MARPs.

If SUM IIs investigation determines rapid testing by CSOs is not feasible, it will look at the feasibility of rapid testing by private providers.

SUM II is already identifying private clinics currently providing subsidized HIV and STI services and prepared to expand to underserved hotspots in targeted cities and districts. For example, in January 2013 SUM II provided a small grant to Angsamerah clinic to establish a satellite clinic at a hotspot in South Jakarta in collaboration with Principal CSO, YKB, and others. SUM II and Angsamerah are co-funding the satellite clinic. Angsamerah is a private clinic specializing in sexual and reproductive health. The satellite clinic will provide free HIV testing, STI screening (syphilis and genital discharge), CD4 count testing and counseling (through collaboration with Provincial Health Office and Provincial AIDS Commission). It is expected that the clinic will become a model that can be replicated in other areas of Jakarta

SUM II will also support CSOs establishing clinics or expanding their clinical services to include HIV and STI testing and counseling services. Some CSOs already provide primary health care services in or near our intervention sites and are prepared to include HIV and STI services with additional support from SUM II.

SUM II provides TA and small grants to CSOs for services to MARPs and PLHIV, and mobilization and community self-reliance activities aimed at prevention of HIV infection from sexual transmission. CSOs provide services to brothel- and non-brothel, including street-based, FSWs, MSM, Waria, (transgender persons), and IDUs. In Papua, CSOs are also providing services to indigenous men and women, and high-risk men. Specifically in Papua, activities aimed at indigenous women and girls include engaging faith-based and womens organizations in HCT and ways to minimize risk of partner violence in Papua. In Riau Islands and North Sumatera, high-risk men are also a target of CSO services. The participation of MARPs, PLHIV, high risk men (and in Papua indigenous men and women) at all levels of program planning, implementation, and evaluation is believed to improve their sexual and health-seeking behaviors.

To respond to the needs of private health services for MARPs, SUM II will provide small grants and TA to private clinics in Jakarta and Papua to improve MARPs access to STI, HCT, and post-exposure prophylaxis. TA to be provided will focus on clinical management, establishing external relationships with stakeholders, and networking with the CSOs and CBOs.

Seven Principal CSOs (five designated in 2012 and two additional CSOs, both in Papua designated in 2013) will receive additional TA and a second cycle of grants to enable them to become local capacity building mentors to developing CSOs and non-SUM II CSOs. Principal CSOs are also expanding coverage of HIV and STI services in multiple ways (through SUM II TA and grants) to other similar intervention sites; to new geographical areas; by adding new programs that target different most-at-risk populations; to intervention sites formerly covered by other CSOs; by mentoring and providing TA support to small CSOs, CBOs and FBOs that enables expansion of coverage; and by engaging private clinics to provide HIV and STI services.

SUM II Principal CSO partners, as part of the grant agreements, will also build partnerships with other projects that serve MARPs and PLHIV in a district so that HIV programs are mainstreamed in these project activities; they will build linkages with multiple stakeholders and local government to promote mainstreaming of HIV programs and services across departments of local government; and they will start local initiatives for comprehensive HIV programs that include the private sector.

Following a combination prevention model, SUM II-supported CSOs provide all groups with a standard package of community-based services, including outreach, community organizations/mobilization for self-help systems to increase access to risk reduction counseling, access to prevention commodities (condoms, lubes, clean needles and syringes), targeted media/internet-based behavior change communications, and referral for clinic-based services (MTCT, HCT, STI management, and CST for PLHIV). SUM II provides TA to establish equal partnership with local health providers for services plan, review coverage and quality, and address loss of follow-up to the services.

SUM IIs CSO partners in Jakarta, Surabaya, Medan, and Batam provide IDUs with services of intervention aimed at advocacy for policy reform, planning and budgeting for the HIV program, community mobilization, raising the prominence of MARP leaders and champions, and reducing stigma and discrimination. It should be noted that CSOs servicing IDUs are now focusing on harm reduction, in particular needle exchange, MMT, HCT and STI. SUM II will provide training and coaching to CSOs to improve CSO performance in community organization/mobilization to expand their services and increase IDUs participation at all levels of planning and implementation of harm reduction services. In 2013, SUM II will also promote crossover interventions of injecting drug use and sexual transmission.

SUM II is providing TA to CSOs in DKI Jakarta, East Java, North Sumatera and Riau Islands to develop advocacy plans for March 2013 local government budget discussions. In 2012, a SUM II CSO partner in East Java received IDR 46 million (approximately $4,760) from the national and local narcotic boards.

CSOs serving the IDU communities in East Java and DKI Jakarta participated in SUM IIs adaptation of the Resource Estimation Tool for Advocacy (RETA) to create an IDU version. This version is enabling estimates of resource needs to scale up HIV services to IDUs in DKI Jakarta and East Java based on population size estimates, HIV prevalence and projections over the coming 5 years, HIV service targets for the coming 5 years, and mapping of available and anticipated resources for the target HIV programs (to allow estimation of resource gaps). The CSOs participated in the series of RETA use, application, and advocacy planning workshops held in Jakarta and Surabaya with representatives of provincial and district NACs and departments of health.

In 2013, two new technologies will support SUM II CSO partners in program evaluation. CommCare Mobile and Epi info 7 will enable real-time reporting by field workers and eliminate the data entry task at the CSO office (see Strategic Information below). Karisma was one of two Principal CSOs selected to pilot test CommCare Mobile in 2012 and they will assist in introducing the new technology to developing CSOs in DKI Jakarta.

In 2013 SUM II will continue to engage in local structural interventions aimed at advocacy for policy reform, planning and budgeting for the HIV program, community mobilization, raising the prominence of MARP and PLHIV leaders and champions, and reducing stigma and discrimination. SUM IIs focus on IDUs will be on preventing sexual transmission as requested by the NAC.

SUM II local TA providers will continue to provide CSOs with workplace-based training, coaching and systems development to improve organizational performance and expand coverage of HIV and STI services to IDU communities.

In 2012, SUM II expanded its program of activities to Papua, including TA and small grants for HIV/AIDS prevention programs among indigenous men and women (ages 15 to 49 to be targeted by CSOs) in Jayapura, Mimika, Jayawijaya Districts. These programs in the three districts are integrated into the existing social activities at the community, involving participation of church, tribal, youth, and women leaders.

In 2013, two CSOs working in the three districts will provide education on sexual health, promotion of abstinence/be faithful, pre and post HIV counseling and testing, and education and referral for ante- and post natal care in the context of preventing mother-to-child transmission. Their activities will include protecting the rights of women and girls who tested HIV positive through HCT and PMTCT programs and ensuring adequate support is provided through CSOs for follow-up care, support and treatment services in Papua.

Also in 2013, SUM II will adapt the Resource Estimation Tool for Advocacy (RETA) for Papua by creating a general population version. This version will allow inputs of population size estimates for identified sub-populations, such as indigenous women and girls who are being targeted for HIV prevention and care programming, including PMTCT programs in Jayawijaya District. A general population version of RETA will function using the same rationale as the original RETA versions: estimating resource needs to scale up HIV services based on population size estimates, HIV prevalence and projections over the coming 5 years, HIV service targets for the coming 5 years, and mapping of available and anticipated resources for the target HIV programs (to allow estimation of resource gaps).

In 2013, SUM II will expand to Papua two technologies that will support program evaluation, including the PMTCT activities described above. CommCare Mobile and Epi info 7, already introduced in DKI Jakarta and soon-to-be in East Java, will enable real-time reporting by field workers and eliminate the data entry task at the CSO office (see Strategic Information below).