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HARM REDUCTION FINANCING LANDSCAPE ANALYSIS IN INDONESIA
In 2022, HRI partnered with Subhan Hamonangan, who used an HRI tool to assess the landscape for increasing domestic financing for harm reduction in Indonesia. This report outlines the process used and the findings that emerged, covering the operational landscape for community-led, community-based and civil society organisations and the financial landscape for harm reduction. It maps advocacy opportunities and partnerships and makes key recommendations for increasing the domestic harm reduction financing.
- The implementation of the harm reduction programme in Indonesia was initiated in 2007. It began with the signing of a Memorandum of Understanding between the National Narcotic Board and the National AIDS Commission with aims to prevent HIV transmission among people who inject drugs.
- The participation and contribution of community-based organisations in implementing the drug harm reduction programme (PDBN) has been regulated through Minister of Health Regulation No. 55 of 2015 on Reducing Harm to Injecting Drug Users.
- Presidential Regulation No. 16 of 2018 on The Procurement of Government Goods And Services, regulates the type of swakelola (self-management) permitted, and consists of four types of self-management. Self-management type 3 is the only mechanism allowing civil society organisations to be involved in implementing the procurement of goods and services planned by the government (similar to social contracting).
- Harm reduction programmes and HIV prevention services for people who inject drugs are included in the Ministry of Health’s strategic plan and the National HIV Action Plan.
- Domestic financing for harm reduction in Indonesia began in 2010 with the initiation of the methadone maintenance programme in three hospitals in Jakarta, Bandung, and Bali.
- As methadone maintenance treatment (MMT) has been part of the government strategy, funding for this programme has consistently been provided each year. However, funding for this and other harm reduction components is decreasing.
- The government uses international donor funding to procure needles and syringes for the needle and syringe programmes, which threatens the sustainability of these services.
- The national health insurance scheme does not cover any components of harm reduction.
- The largest international grant for HIV prevention and treatment programmes in Indonesia, including harm reduction, comes from the Global Fund. Harm reduction programme implementation falls within the prevention module (distributed to all three principal recipients) and covers activities including outreach, supporting activities for MMT, needle and syringe procurement, and other general components including TB-HIV screening and testing, and antiretrovirals.
- Harm reduction funding in Indonesia has been reducing. One justification provided for this has been a decrease in the estimated number of people who inject drugs. Another is that people who inject drugs are deterred from accessing public health services due to the strict implementation of a criminal justice approach through national laws on narcotics.
- Apart from the Global Fund, international donor support comes from USAID grants through EpiC and Linkages, but these do not include specific support for harm reduction interventions.
Recommendations for actions to improve the domestic funding landscape in Indonesia
- Develop harm reduction programmes for people who use and inject drugs based on the recommendations from the World Health Organization.
- Develop a harm reduction financing transition plan involving financing sectors such as the Social Security Administering Agency as potential funding sources for harm reduction programme budgets.
- Reactivate harm reduction working groups at the national and sub-national levels to increase active participation of civil society in every stage of planning and financing processes.
- Develop a harm reduction road map as an effort to initiate a joint work programme among harm reduction implementers.
- Disseminate community information and build the capacity of CSOs (civil society organisations), CLOs (community led organisations), and CBOs (community based organisations) implementing harm reduction related to the bureaucratic system, as well as work planning systems and government funding.
- Disseminate community information to CSOs, CLOs, and CBOs implementing harm reduction-related policies.
- Develop partnerships and networks between implementers of harm reduction programmes and CSOs working on budget advocacy issues in general.