Wednesday 4 February 2009

Money is like muck, not good except it be spread

Probably all of you have seen Lucy Williamson's report Tackling Indonesia's HIV spread on the BBC web site. Lucy has been doing a lot of research for her articles about HIV here, including meeting with us collectively at Spiritia, and separate meetings with several of us - thanks for the lunch, Lucy!

Lucy refers to 72 districts. I assume that is the number that will be supported by the new Global Fund project. But there are in fact more than 450 districts and municipalities in 33 provinces in Indonesia. Most provinces are as big as a country elsewhere. But the big problem with the decentralization that Lucy refers to is that it didn't devolve autonomy to the provinces, but directly two levels down to the districts. This leaves the provinces with a less than clear role. Worse, it often seems to add an insulating layer between the national policies and the local implementation.

Some districts are indeed acting as role models. For instance, Jembrana in the north-west of Bali (off the tourist - and tourist dollar - track) has managed to provide free health and education to all. It has also set up an amazing computer network, to which all government offices and services are connected. If Jembrana can do it, why not others?

As the article notes, the huge Global Fund grant will support responses in less than half of the provinces, and less than a quarter of the districts. Yes, it covers the notorious 'hot-spots', and (as Bob Magnani of FHI notes) that focus is essential for effective prevention. But for treatment? How do we tell people with HIV in the other provinces, sorry, you'll be looked after when (if) the next Global Fund Round clicks in. In the meantime, well, be patient - and try to survive. I fear we are further extending the inequities that already exist - clearly urban dwellers with HIV are better served than those in the villages.

I agree that the resources are spread very thinly. But I still do not understand why countries like Malawi can scale-up access to antiretroviral therapy so much more successfully than Indonesia.

BTW, following up on my post of a couple of days back (Stand by to crash), I had good news. Radnet managed to recover all the data from the failed hard disk, and our web site was back up yesterday afternoon, without any effort by me (other than pulling what remains of my hair out!). Now to ensure that proper backups are done...

Babé

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