Papua has only 1% of the total population in Indonesia, but more than 20% of all HIV positive people and over 35% of all AIDS patients in the country. This year MSF will start an antiretroviral treatment program for HIV patients.

2003 is a crucial year for Medecins Sans Frontieres (MSF) in Indonesia as the organisation is implementing a strategic shift in its operations there. In the past, MSF focused its interventions mainly on emergency response such as epidemics, natural disasters or internal conflicts. This year sees the start of a new approach with a focus on longer term programs for TB and AIDS treatment.

MSF will also investigate new possibilities for malaria treatment in the places where it is already present, such as West Papua and Ambon. "We will concentrate mainly on remote places that seem forgotten by the authorities in Jakarta, because we have an added value there," explained François Fille, Operational Coordinator for MSF in Brussels.

"Last year, we already started an AIDS-care program in Merauke city, at the south east of West Papua province, with medical care in the district hospital.

Papua has only 1% of the total population in Indonesia, but more than 20% of all HIV positive people and over 35% of all AIDS patients in the country. This year we will start an antiretroviral treatment program for HIV patients."

Tuberculosis rates as the third cause of mortality in Indonesia. MSF plans to initiate a TB treatment program in Ambon, the Moluccas. The organisation is also investigating possibilities to introduce artesunate combined therapies in malaria treatment protocols of the health centres.

Indonesia's post-Suharto health care system has not yet recovered from the past five years of chaos and corruption remains a problem. The health care system in remote areas is not a top priority for Jakarta.

Furthermore, West Papua and other remote regions are becoming autonomous and have to generate incomes themselves to sustain public structures. There is a lack of medical staff and of investments in the medical structures or equipment.

Access to health care is declining and the response to chronic illnesses and epidemics is very weak. "Over the past year we have seen a change in the humanitarian context of Indonesia," said Fille.

"The medical urgencies caused by internal conflicts have decreased; but at the same time the health structures in war-torn islands don't get enough support. It is time to adapt to the new reality by exploring other ways for MSF to intervene.

Parasitical and infectious diseases - such as malaria, AIDS and TB - are major public health issues in the remote areas, for which we have a lot of experience and knowledge. Therefore we consider it is our role to start developing new treatment strategies. This is a new era for MSF in Indonesia."