Klinik Yayasan Angsamerah as a Model of Public and Private Partnership in Providing MSM (Men who have sex with Men) Services
In Indonesia, the rate of HIV infection among MSM has risen steadily over the past years. Unfortunately, the number of MSM who are accessing health services including HIV and AIDS services are still very limited. One of the main reasons behind this is the widespread discriminative behavior projected by the health providers toward MSM, which creates a strong barrier for MSM in accessing the health services. Consequently, it becomes very challenging to reduce the number of HIV infection among MSM. Therefore, there is a strong need to develop a specific strategy in reaching out to the MSM population and providing HIV and AIDS and other health services to them. Moreover, in order to ensure effectiveness the public and private sector need to work together in providing these services. This article will discuss the strategy carried out by Klinik Yayasan Angsamerah in providing services for MSM, as an example of a good practice of public-private partnership.
Klinik Yayasan Angsamerah: A Partnership for Qualified and Affordable Services
Angsamerah has two clinics; Angsamerah Clinic which is located in Menteng and Klinik Yayasan Angsamerah (KYA) in Jakarta Selatan. Angsamerah Clinic was established in 2010, and as a high-end clinic it serves patients who are mostly represent the upper-middle class population. Over time, there is a significant increase in the number of patients who take the HIV test in this clinic. Angsamerah is concerned with this because it understood that due to the economic constraints, most of the populations are still having difficulties in getting good quality and non-discriminative health services that are affordable. Responding to this, KYA was then being established in late 2013.
Although a non-profit, KYA is still a private clinic that needs to cover its operational costs independently. In order to make sure that it can provide same level of services as Angsamerah Clinic while at the same time maintaining its affordability, KYA mobilizes funding from different sources. To date, there are a number of organizations that provide financial support to KYA through a cost-sharing mechanism, such as SUM II-USAID and COFRA Foundation. The Indonesian’s Ministry of Health also provides its support by supplying free reagent for tests and a number of free treatments. In addition, 10% of the profit coming from Angsamerah Clinic is paid to KYA. And within KYA, there is also a cross-subsidy between the general patients and the patients referred by the NGOs who partnered with KYA. By using this strategy, KYA’s price range can be far more affordable compared to the clinic that is located in Menteng – although the level of quality of both services are the same.
Angsamerah’s Strategy in MSM Services: What makes it Different?
Nurlan Silitonga M.D., founder and director of Angsamerah, states that the philosophy of Angsamerah is to provide good quality health services that are friendly and inclusive to everyone, regardless of their sex, sexual orientation, marital status, and other identities. Although Angsamerah does not specifically target its services toward MSM or other key populations, this inclusive philosophy has created an enabling environment for them in using the services provided by Angsamerah. This can be seen in the profile of Angsamerah patients, where 75% of the patients are male and 50% among them are MSM.
This inclusiveness also drives the strategy being used by Angsamerah in serving the MSM population. Angsamerah understands that due to the pervasive hetero-normative culture within our society, confidentiality becomes a very important aspect for most of the MSM. Therefore, Angsamerah uses an appointment system which allows patients to get services without having to go through a long line. With this, the possibility of encountering other patients at the clinic becomes very slim – thus ensuring the patient’s privacy. In addition, patients can also use pseudonym as long as it is consistent to allow for an easier tracking of the medical record.
Another strategy implemented by Angsamerah is to provide the whole array of services within the same building, and even within the same room – the examination room. This means that unlike the common practice in other health services, Angsamerah patients do not have to go to different rooms in order to get the treatment, lab tests, medicines, or making a payment. For example, patients who want to take the HIV test can get the result directly from Angsamerah’s lab. If they are detected as positive, the patient can get counseling from a trained doctor who will explain the available options. When the patients chose to carry on with the subsequent test, they can get the CD4 test in Angsamerah because the machine is available on-site.
Currently, Angsamerah still process the viral load test externally, but the patient will not be referred to that external lab. Instead, Angsamerah will do this process on their behalf. And in situation where the patient needs to start the ARV treatment, they can access the free ARV provided by the government through Angsamerah. These whole processes made it easier for the patients to get the health services they need, while also ensuring their privacy.
In order to actively introduce the clinic to the MSM population, KYA works with 7 local NGOs who serve MSM and other key population such as female or male sex workers, transgenders, and IDUs. These NGOs referred their clients to KYA for health services, particularly HIV testing and treatment. According to Felix Neuenschwander, the project manager of Angsamerah, since 2013 KYA has provided HIV test for 300 MSM. Among this number, 20% was indicated HIV positive and most of them continue with HIV treatment provided by KYA.
With these strategies, KYA witnessed success in the high number of positive feedback from its patients, including the MSM patients. The number of MSM patients also keeps on increasing. Therefore, it can be concluded that through the public-private partnership model, KYA has contributed in increasing the availability of friendly, good quality, and affordable HIV and AIDS services to MSM population. To ensure that these types of services can be accessed by wider population, Angsamerah keeps on working to replicate their success.
In 2015, Angsamerah provided a consultation and technical assistance to 6 clinics located in Purwokerto, Semarang, Jakarta, Batam and Papua. Angsamerah is hoping that through a public-private partnership, there can be more health services that are good quality, friendly, non-discriminative and affordable for MSM and other key population.
This article focuses on KYA as health provider that uses a public and private partnership model. When ‘Angsamerah’ is used, it means that the writer is referring to both Angsamerah Clinic and KYA at the same time.