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Priority setting in HIV/AIDS control in West Java Indonesia: an evaluation based on the accountability for
Noor Tromp1, Rozar Prawiranegara2, Harris Subhan Riparev2
1Department of Primary and Community Care, Radboud University Medical Center, Geert Grooteplein Noord No. 21, 6525 EZ Nijmegen, The Netherlands, Medical Research Unit, Faculty of Medicine, Padjadjaran University, Jalan Eijkman No. 28, 40161 Bandung, Indonesia, Department of Economics, Faculty of Economics, Padjadjaran University, Jalan Dipatiukur No. 35, 40132 Bandung, Indonesia and Department of Public Health, Faculty of Medicine, Padjadjaran University, Jalan Eyckman No. 38, 40161 Bandung, Indonesia Department of Primary and Community Care, Radboud University Medical Center, Geert Grooteplein Noord No. 21, 6525 EZ Nijmegen, The Netherlands, Medical Research Unit, Faculty of Medicine, Padjadjaran University, Jalan Eijkman No. 28, 40161 Bandung, Indonesia, Department of Economics, Faculty of Economics, Padjadjaran University, Jalan Dipatiukur No. 35, 40132 Bandung, Indonesia and Department of Public Health, Faculty of Medicine, Padjadjaran University, Jalan Eyckman No. 38, 40161 Bandung, Indonesia Noor.Tromp@radboudumc.nl.
Insights
HIV/AIDS interventions in West Java face challenges due to resource limitations and non-transparent priority setting. Improvements in accountability for reasonableness are needed for fairer decision-making.
Area of Science:
- Public Health
- Health Policy
- Epidemiology
Background:
- Indonesia faces significant challenges in addressing the HIV/AIDS epidemic due to limited resources.
- Priority setting for HIV/AIDS interventions in many regions is often ad hoc and lacks transparency, leading to inequitable outcomes.
Purpose of the Study:
- To evaluate the HIV/AIDS priority setting process in West Java province using the Accountability for Reasonableness (A4R) framework.
- To identify areas for improvement in the fairness and transparency of HIV/AIDS intervention prioritization.
Main Methods:
- Qualitative study involving a review of government documents.
- Semi-structured interviews were conducted with 22 participants involved in HIV/AIDS strategy development in West Java.
Main Results:
- Priority setting criteria were implicitly used, and strategies encompassed a broad range of programs.
- Stakeholder involvement needs enhancement, particularly for the public and people living with HIV/AIDS.
- Mechanisms for appeal and publicity require greater transparency and formalization; public regulations for fair priority setting are absent.
Conclusions:
- West Java must enhance its HIV/AIDS priority setting by addressing all four conditions of the A4R framework.
- Implementing improvements in relevance, publicity, appeals/revision, and enforcement is crucial for equitable resource allocation.
Background:
Indonesia has insufficient resources to adequately respond to the HIV/AIDS epidemic, and thus faces a great challenge in prioritizing interventions. In many countries, such priority setting processes are typically ad hoc and not transparent leading to unfair decisions. Here, we evaluated the priority setting process in HIV/AIDS control in West Java province against the four conditions of the accountability for reasonableness (A4R) framework: relevance, publicity, appeals and revision, and enforcement.
Methods:
We reviewed government documents and conducted semi-structured qualitative interviews based on the A4R framework with 22 participants of the 5-year HIV/AIDS strategy development for 2008-13 (West Java province) and 2007-11 (Bandung).
Results:
We found that criteria for priority setting were used implicitly and that the strategies included a wide range of programmes. Many stakeholders were involved in the process but their contribution could be improved and particularly the public and people living with HIV/AIDS could be better engaged. The use of appeal and publicity mechanisms could be more transparent and formally stated. Public regulations are not yet installed to ensure fair priority setting.
Conclusions:
To increase fairness in HIV/AIDS priority setting, West Java should make improvements on all four conditions of the A4R framework.
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