Interview with Ani Herna Sari, Indonesia
Debt2Health can be powerful, but only if it empowers people on the frontlines
This interview with Ani Herna Sari, Chairperson of Rekat Peduli Indonesia, was conducted by Johanna Fipp and Peter Wiessner from Action against AIDS Germany on October 27, 2025. The Global Fund’s Debt2Health (D2H) mechanism enables countries to convert part of their debt obligations into investments in the fight against HIV/AIDS, tuberculosis, and malaria, as well as in strengthening health systems. Germany has played a pioneering role, concluding agreements worth several hundred million euros with multiple countries implementing Global Fund grants. In this second interview of our series, we examine the impact of the initiative on civil society and key populations across different countries. We extend our sincere thanks to Ani Herna Sari for sharing her insights.
Ani Herna Sari: My name is Ani Herna Sari, and I live in Surabaya, Indonesia. I am a tuberculosis (TB) survivor, having experienced both multi-drug-resistant TB (MDR-TB) and drug-sensitive TB. Currently, I serve as the Chairperson of Rekat Peduli Indonesia, an organization that supports people affected by TB, especially those living with MDR-TB, by ensuring access to quality care and helping them live free from stigma. We also engage in community-led monitoring, gathering information from the ground, and reporting challenges or barriers to district health offices and other relevant stakeholders. Indonesia is among the top three countries with the highest TB burden globally. TB continues to be a major public health challenge. Although progress has been made in improving access to diagnosis and treatment, people with drug-resistant TB still face significant obstacles, including difficulties accessing care, stigma, and socioeconomic barriers. Co-infection with HIV is also a concern, particularly among key and vulnerable populations. We have seen reductions in detection and service delivery, which makes 2025 a critical year for continued advocacy for better access and equity.
Johanna Fipp: This conversation is about access to health care, debt burden and the debt2Health mechanism, is access to healthcare in Indonesia equal for everyone, or are there major differences between groups?
Ani Herna Sari: When I first heard about the Debt2Health agreement between Germany and Indonesia, my initial reaction was one of cautious hope. As someone who has lived through TB, not just as a patient, but as a survivor and now an advocate, I know how critical financing is in shaping the lives of millions of people affected by TB. Debt2Health offers something unique: the possibility of transforming financial obligations into life-saving investments. For a country like Indonesia, with its high TB burden, this is not just an economic tool. It is a question of survival, dignity, and justice. The funding itself is coordinated through the Country Coordinating Mechanism (CCM) and technical working groups, and it is recognized as part of the Global Fund allocation. The support mainly focuses on essential programmatic and clinical interventions, case finding, diagnosis, adherence, and service delivery. Equally important is ensuring that part of this funding reaches communities. Community groups work closest to people affected by TB and empowering them ensures sustainability. If a portion of Debt2Health funding could be directly channeled to community engagement and empowerment, it would strengthen the TB response. In Indonesia, the Debt2Health (D2H) mechanism was first implemented during Global Fund Grant Cycle 6 (2021–2023) under the PR Consortium. Some funds remained unspent at the end of that period, and the Global Fund allowed them to be rolled over into Grant Cycle 7 (GC7). In addition, the PR Consortium also received a new D2H allocation under GC7.
Johanna Fipp: How does public debt affect healthcare in your country, and how are shrinking budgets and reductions in foreign development aid impacting TB programs?
Ani Herna Sari: As a community that works closely with people affected by TB, we see every day how shrinking budgets and public debt directly affect lives. Funding for MDR-TB under the Global Fund is already running out, even before 2026. This means fewer patients can access treatment, and those still in care often struggle without the necessary support to complete their therapy. That is why, together with the Ministry of Health, we are now advocating to other ministries, the Ministry of Social Affairs, to help provide social support or enablers for MDR-TB patients, and BPJS, our national health insurance agency, to cover comorbidities and baseline services for MDR-TB. We believe this kind of cross-ministerial collaboration is essential if we want real sustainability beyond donor funding. Indonesia has been fair in including communities in national discussions, but sometimes those representing us at the national level are not fully connected to what’s happening in the field. True representation must come from those who truly understand the challenges faced by communities. We believe that meaningful community engagement and stronger domestic support are key to building a people-centered, sustainable TB response, one that truly leaves no one behind.
Peter Wiessner: Before returning to Debt2Health, I’d like to ask about stigma. TB stigma is something many people in Germany or Europe don’t fully understand. You mentioned your personal story earlier. Could you explain what TB-related stigma looks like in Indonesia?
Ani Herna Sari: From my personal experience, when I had MDR-TB and discovered I was pregnant, the health facility did not know how to manage my case. Many doctors assume that people with MDR-TB are at fault because they “failed” treatment, even when the issue is caused by incorrect prescriptions or systemic failures. In my case, I initially received the wrong medication despite testing TB-negative. After two months, I developed complications and was later diagnosed with MDR-TB. During treatment, I became pregnant. My water broke in the seventh month, and even though I had already tested TB-negative after the first month of treatment, I was placed in an MDR-TB isolation room instead of a maternity ward. I was separated from my baby for almost five days because of this decision. There is still a lot of misinformation. People believe TB can spread through sharing plates or eating together, or that mothers can transmit TB to their children simply by being near them. Across Indonesia’s many islands and diverse cultures, myths persist that TB is caused by curses or bad behavior. This kind of stigma isolates patients and makes recovery much more difficult.
Peter Wiessner: From a community perspective, Debt2Health can bring additional resources to health systems, but how can we ensure these resources truly reach patients and communities?
Ani Herna Sari: Communities must be included at every stage; planning, decision-making, and monitoring. We are the ones working directly with affected people. If communities are part of the process, we can ensure that Debt2Health funds reach those who need them most.
