Effective CSO-government engagement on domestic HIV budgets: Case examples from Indonesia

Sustainable HIV Financing in Transition (SHIFT)

Background SHIFT defines sustainability as the ability of a country and/or health systems to maintain and scale-up the HIV response, in line with the epidemiological context, that will provide for continuing implementation of quality prevention, treatment and care interventions, as well as support for human rights and gender equality, towards elimination of HIV, even after reduction and/or termination of external funding. Sustainable funding for civil society organizations (CSO) and community groups is a critical issue that could significantly compromise the HIV response in Asia over coming years.

Background (2) The resources need to meet 90-90-90 targets by 2030 in Asia is estimated to be second only to the need in Africa - while Africa's disease burden drives the resource need, Asia's population size accounts for the need (Hetch, R. (Ed.) 2013. Cost & Choices: Financing the long-term fight against AIDS. Aids2031) Significant gains have been made in involving CSO and community representatives in expanding treatment coverage and preventing transmission across the region. These successes will be compromised if these individuals and groups are not supported to participate effectively in discussions related to HIV financing.

Background (3) The SHIFT project was designed to support advocacy, capacity building and use of strategic information in order to facilitate meaningful CSO engagement in discussions related to sustainable financing and transitions towards domestic funding in Indonesia, Malaysia, the Philippines and Thailand. The SHIFT project was designed to unpack four relevant technical areas: fiscal space, allocative efficiency, transition planning, and domestic funding mechanisms for CSO.

Indonesia Situation Indonesia is entering a period of transition from external funding dependence into independently funded, due to Indonesia's economic growth which is predicted to become upper middle income country (UMIC) after 2020. In the past 10 years Indonesia's dependence on external financing is actually low except for priority health programs such as HIV, TB, Malaria and Immunization. Indonesia does not yet have a transition plan in preparation for the sustainability of the HIV program. Contextual issues that play a role are Health financing reform (JKN implementation) and Decentralization (local role in program implementation and financing) Indonesia's conservative social norms have made it difficult to secure and maintain adequate political commitment to civil society and key population networks over the years. As the financial and political landscape evolves, civil society is having to discover the best way to engage with the government in the response to ensure that essential services are maintained and expanded for those most are risk.

As of 2015, Indonesia was not yet on course to end HIV and AIDS by 2030

Relying solely on treatment as prevention has far less impact than if primary prevention is scaled-up along with treatment – the GoI needs to expand funding for primary prevention

SHIFT RESPONSE OF THIS SITUATION Collaboration between the HIV NGO and non HIV NG. In Indonesia: IAC with Seknas Fitra (Indonesian Forum for Budget Transparency) Conducted a desk review of pre-budget consultations and exercises done by government transparency watch groups in Indonesia. FITRA conducted in-depth interviews and focus group discussions with government and various civil society organizations to find best practices of effective CSO engagement on HIV budget advocacy.

OUR FINDINGS Governments are most responsive to arguments in which their performance is compared to other districts. This method relies on the so-called social comparison heuristic—a fundamental human disposition for endeavouring to not underperform peers. By presenting budgetary analysis that indicated more harmonious budget allocations in nearby districts, government officials were more motivated to make changes in their own budgets. Critics towards local governments is not malignant as long as they are done in a constructive manner by proposing solutions and willing to compromise.

- continue Every interaction with government officials are opportunities to build their capacity. FITRA offers training opportunities to build the capacity of CSOs to cultivate good working relationships with their local governments.

Conclusions Long term strategies in persuading policymakers, in conjunction to the future absence of large international donors, civil society in Indonesia will likely be compelled to discover the importance of effectively engaging government in advocacies to increase fiscal space. Doing so effectively will not only require intensify technical assistance but also to build working, non-adversarial relationship with local governments. FITRA is doing this by offering to build government officials’ capacity and by using social comparison heuristic between similar districts.

THANK YOU Authors: P. Loh1, D. Solares1, Y. Nurhidayat2*, S. Putri3 Corresponding Author: Y. Nurhidayat -Indonesia Institution(s): 1Asia Pacific Coalition on Male Sexual Health (APCOM), Bangkok, Thailand, 2Indonesian Forum for Budget Transparency (Seknas FITRA), Jakarta, Indonesia 3Indonesia AIDS Coalition (IAC) Contact : Sindi Putri, Indonesia AIDS Coalition Email : sindi@iac.or.id