HIV and AIDS control activities in Bali Province are vertically organised, lack integration at point of delivery and are heavily reliant on funding from donor agencies. Bali Province is currently developing an ‘exit strategy’ from donor funding, with strong emphasis on integration policy to maximise program efficiency and sustainability. This study explored barriers to implementing integration of HIV and AIDS services into community health centres (Puskesmas) and potential solutions.
Methods: A policy analysis was completed using a qualitative design. Policy documents were analysed to identify components of current overarching frameworks relevant to integration. In-depth interviews were conducted with 10 respondents to explore the perspectives of policy makers and other stakeholders. Data were analysed using a thematic method and presented using a narrative approach. results: Barriers to integration included lack of infrastructure and funding arrangements, lack of program linkages at Puskesmas, lack of inter-sectoral linkages, high turnover and rotation of staff, lack of skills and training, lack of incentives program for increased workload and lack of community awareness about HIV services availability at Puskesmas. Several steps need to be taken to enable implementation of integration. HIV-AIDS funding should be pooled at Bali Province Department of Health and distributed based on Puskesmas capacity and need. Training should be conducted with Puskesmas staff to promote HIV-AIDS services as core business and encourage program cross-linking. Partnerships should be formed between Puskesmas and lay counsellors to raise awareness of Puskesmas services.
Conclusion: The findings of this study can be used to inform implementation of a health system strengthening approach for HIV-AIDS control measures in Bali Province. Puskesmas integration should also be considered as a policy option by other provinces in Indonesia where HIV prevalence is high and the main route of transmission is heterosexual contact.
