IV. Research Method
4.1. Research Design and Procedure
The research on "The Integration of HIV and AIDS Response into the National Health System Framework" will be conducted with a cross-sectional design, qualitative method, and inductive approach. It will also use a research principle on theory building and explanatory research (Gilson & Raphaely, 2008; Walt et al., 2008) as well as the principle grounded research (Glaser
& Strauss, 1967; Strauss & Golbin, 1998).
This approach assumes that the various abstractions or a deep understanding on the research will be produced at the end of the research. The conceptual model used in this research (see diagram 1), will be used as a reference to develop a list of questions and analysis, whereas the inductive approach will be used to develop a grounded understanding to what extent the HIV and AIDS is integrated into the national health system framework, based on patterns or themes which arise in the research results. The inductive approach will be based on the framework taken from Creswell, 2003 "The inductive Logic of Research in a Qualitative Study" (See Figure 2).
Figure 2. The logic framework of inductive approach in the research of “The integration of HIV and AIDS response efforts into the national health system framework.”
Stage III: Researchers im[plement triangulation proses by combining the results of primary and secondary data to get a descriptive picture about
condition of the sub-system at each research location.
Stage V: Researchers draw conclusions on the integration level based on the previous stages so as to get an idea on what and how the integration of
HIV and AIDS into the national health system in each level (district/city, provincial and national).
Stage IV: Researchers extract information to identify the integration level based on key words in each sub-system dimension. Subjective scoring will be used to determine the integration degree of each individual sub-system
in accordance with HIV and AIDS response efforts.
Stage II: Researchers categorize (e.g. coding) the research results of primary data, secondary data, and stakeholder analysis in each location
in sort of summary. The primary data grouping is based on issues/success arising in three HIV and AIDS response efforts (e.g.
prevention, CST: care,support, treatment and impact mitigation) against the seven sub- systems, as well as trends based on coverage and access.
Whereas the stakeholder analysis will identify the actors on HIV and AIDS response in terms of their roles, interests and resources
Stage I: Researchers collect two types of data (primary and secondary data) on the performance of health sub-system against HIV and AIDS response. Researchers will also conduct a stakeholder analysis
in each region
Figure 2 illustrates the research stages based on a logical framework of inductive approach.
Starting from the bottom of the figure the research procedures will be conducted in five stages as follows:
The first stage, the local research team will perform a primary data and secondary data collection, and stakeholder analysis.
The primary data collection will be conducted through focus group discussions in workshops and in-depth interviews by using instruments and guidelines developed by the core team of CHPM, local researchers, and consultative group appointed in this collaborative research program. The two-day workshop will be held separately in two selected districts and cities. The researchers from the selected universities will facilitate the workshop and record the process.
The informants who will get involved in the Regional Government Working Unit (SKPD), community organizations, stakeholders, health workers, representatives of key population groups, and civil society organizations which are located in each district and municipality.
Informants will be divided into groups to discuss the assigned sub-systems concerning the three HIV and AIDS services (Prevention, CTS – Care, Treatment, and Support, and impact mitigation).
The grouping will be based on the correlation between the tasks and basic functions of informants on the required the sub-system.
The in-depth interviews will be conducted at the national and provincial levels to some informants as follows: 1) the national level (e.g. Ministry of Health, Subdit P2PL; NAC;
Bappenas; Menkumham, Menkokesra; networks of key populations (e.g. GWL-INA, OPSI , etc.), and RSCM); and 2) the provincial level (e.g. Health Department; provincial AIDS commision, Bappeda, and hospitals).
The secondary data collection as the supporting data covers the data for each sub-system that will be collected with the indicators developed and prepared by a core team of CHPM, local researchers and "consultative group". The sources and secondary data collection mechanism can be agreed with the informant. The list of informants based on seven sub-division of health system can be seen in Appendix 8.
The stakeholder analysis will also be conducted, which may be done through observation and interview the informant during in-depth interviews. This analysis is to observe which actors that play a major role in HIV and AIDS response, both the ones who support and the ones who hamper.
The second stage, the researchers will categorize the data based on thematic codes in a form of summary. The summary resulted from the primary data collection will be presented in matrix and grouped by issues or success identified from all seven sub-systems to HIV and AIDS responses (e.g. Prevention, Care-treatment-support and impact mitigation). These will be detailed in the analysis section and appendix 5 in the table containing a summary of field results of primary data). The summary of stakeholder analysis will be writen in terms of roles, interests and its resources (See Appendix 1).
The third stage, the researchers conduct a triangulation to verify and validate the results of primary and secondary data. At this stage, the picture of the condition and the interaction of each sub- system in each location will be obtained.
The fourth stage, the researchers draw a conclusion on the integration level for each dimension of the sub-system to HIV and AIDS response (e.g prevention, Care-treatment-suppot and impact mitigation) based on a scoring system previously done. The description of the integration level will be referred to definitions used in researches on integration issues and health system conducted in Indonesia and other countries (Conseil et al., 2010; Desai et al., 2010). In brief, the seven sub-systems on health will be classified based on 26 dimensions, in which key words will be determined for each dimension (See appendix 2). Subjectively the scoring will be used and then the integration level is determined based on three categories as follows: "not integrated",
"partially integrated", and " fully integrated" (see the analysis section and appendix 6 and 7 for scoring table and the integration level of sub-system based on dimention, administratin level and HIV and AIDS response efforts).
The fifth stage, the researchers draw a conclusion based on the available results to get the picture as to what and how the integration HIV and AIDS response efforts into the national
health system at each level (district/city, province and national) is. What are the implications of the outcomes towards HIV and AIDS policies and program will be discussed during this stage.
There will be eight reports, each representing the research locations and another report that reprepresents the result at the national level. All reports will be compiled into one final report before being disseminated at the national, provincial, and district/city level.