Kazakhstan Risks Losing Opioid Maintenance Therapy Programs

The outcomes of the assessment of the opioid maintenance treatment (OMT) programs, initiated by the Government of the Republic of Kazakhstan in 2017, may lead to the complete halt of these programs in the country. Multiple violations of human rights were recorded during the assessment, it was conducted in breach of international bioethical standards. Based on that, the Eurasian Harm Reduction Association (EHRA) and Canadian HIV/AIDS Legal Network appealed to United Nations Committee on Economic, Social and Cultural Rights (CESCR) urging the Government of Kazakhstan to provide information on their plans to increase the availability of OMT as well as ensure the respect and protection of human rights of drug-dependent individuals and people living with HIV.

In 2017, only 2,69% of all injecting drug users on the outpatient register in Kazakhstan were receiving OMT, contrary to WHO’s recommendations of at least 20% coverage. OMT programs, initiated in Kazakhstan in 2008, under the recommendations from various international organisations, have not received unanimous support from politicians, law enforcement, and healthcare institutions. In June 2017, the Ministry of the Interior, backed by seven members of the parliament, requested immediate termination of OMT in Kazakhstan. The Prime Minister’s Office soon ordered an evaluation of the OMT programs, which was started at the end of September by the establishment of the Inter-Sectoral Working Group composed of 17 members. On 30 October 2017, the Working Group produced a Resolution with the conclusions that OMT is effective in Kazakhstan and it should be continued with some improvements regarding the accessibility and the quality of services.

However, some members of the Working Group were not satisfied with the positive recommendations and initiated an alternative research. With the help of the police, the new research was conducted without a proper methodology and gravely violating the rights of the OMT patients: a number of interviewed OMT patients were misinformed about the true aims of the research and were threatened or coerced into giving their statements, and they had to give urine for drug testing without the signing of consent forms.

At the end of December, the group provided its findings in a “Special Opinion”, the main conclusion of which was that OMT is not effective and should be terminated, asserting countries that have completely terminated OMT programs. Subsequently, the Ministry of the Interior issued information about the establishment of a new commission for additional assessment of the effectiveness of OMT with the participation of the National Security Committee and Foreign Intelligence Service. As a result, as of January 2018, the admission of new patients in the centers for methadone maintenance therapy was stopped.

“Despite the fact that OMT programs have proven to be one of the best means to decrease the spread of HIV, the Kazakh Government has taken a worrying step, which may have irreversible negative consequences for the livelihood of the country’s population. Primarily, it affects the OMT patients who are seeking alternatives to illicit drug use,” says Dasha Matyushina-Ocheret, EHRA’s Policy Reform Advisor. “The situation is particularly grave, since the Global Fund, which is the main financial donor for harm reduction programs in Kazakhstan, may stop the funding at the end of this year. Therefore, the decision was taken to present a parallel report on the access of people who inject drugs to drug dependence treatment in Kazakhstan to the CESCR as one of the means to help the people in need to continue receiving life-saving opioid substitution therapy.”

This is the second parallel submission by EHRA and Canadian HIV/AIDS Legal Network for the 62nd Pre-Sessional Working Group of the CESCR, which will take place in Geneva, on 3-6 April 2018. Last week, together with the Estonian organisation of people who use psychoactive substances LUNEST, they also tabled a report on the situation of women who use drugs in Estonia.

For more information, please read the Briefing Paper on the Access of People who Inject Drugs to Drug Dependence Treatment in Kazakhstan.

Eligibility List 2018

The Global Fund 2017 Eligibility List identified which country components (HIV/AIDS, tuberculosis or malaria) were eligible to receive an allocation for the year 2018.

Eligibility does not guarantee an allocation. If a country has no eligible components, it does not appear on the list.
Eligibility is determined by a country’s income classification, as measured by Gross National Income (GNI) per capita (World Bank Atlas Method), and official disease burden categorization.

To download the full version of the text, please see the Global Fund 2018 Eligibility List.

Regional Dialogue for the development of a new regional program and a multicountry application to the Global Fund is announced

Dear colleagues, 
 
The Regional Communities Networks Consortium uniting Eurasian Coalition on Male Health (ECOM), Eurasian Harm Reduction Association (EHRA), Eurasian Women’s Network on AIDS (EWNA), Sex Workers’ Rights Advocacy Network (SWAN), Eurasian Network of People Who Use Drugs (ENPUD) is announcing the Regional Dialogue for the development of a new regional program and a multicountry application to the Global Fund, aimed at strengthening sustainable national funding for HIV prevention and treatment programs, especially among key populations in EECA countries.
 
The regional program will be designed to strengthen efforts to improve the effectiveness of planning and monitoring system of programs, to reduce the prices of drugs for HIV, TB and hepatitis treatment and prevention, and strengthen community systems for key populations and people living with HIV.
 
The scope of the program of the Regional Communities Networks Consortium can include any of the EECA countries, except for the Balkan countries, that meet the Global Fund’s eligibility criteria and requirements for multi-country grants.
 
The Regional Dialogue is held from January 30 to February 23 in the form of an online survey, to which all interested organizations, groups and individuals are invited.
You can preview the online survey form by link. Please do not use this form to send your answears and comments, please fill out an online survey.
Please note that the survey contains questions that require response, and questions where answer is not necessary.

New members of the EHRA’s Steering Committee are elected

During the 15-29 January, 2018 Eurasian Harm Reduction Association (EHRA) conducted online Regional Meetings of it’s members to elect new Steering Committee representatives in the Baltic States, Belarus-Ukraine-Moldova, Central Asia, Central Europe, South-Eastern Europe regions. Quorum for the Regional meeting to elect new member needed no less than a half of the members from region and the new Steering Committee member became the person, who got the majority of the votes from voted members. So, how it was:

  1. Central Asia. In total the region has 42 official EHRA members, who were eligible to vote. From those 42 members – 31 participated in the meeting and cast the vote for their candidate, which means, that quorum was met, because 73,81% of members from the region participated in the elections of the SC member. In total 42 people participated in the meeting, but 11 votes were counted as not valid, because these persons were not eligible to vote (not official individual or organizational member of EHRA; don’t have an authorization from the leader of the organization). The results of voting:

– Oxana Ibragimova – 23 votes (74,20% of all valid votes)

– Sagyngali Yelkeyev – 4 votes (12,90% of all valid votes)

– Indira Kazieva – 4 votes (12,90% of all valid votes)

Oxana Ibragimova is elected for 3 years term as EHRA Steering Committee member representing the Central Asia region.

  1. Ukraine-Moldova-Belarus. In total the region has 60 official EHRA members, who were eligible to vote. From those 60 members – 33 participated in the meeting and cast the vote for their candidate, which means, that quorum was met, because 55,00% of members from the region participated in the elections of the SC member. In total 33 people participated in the meeting, 0 votes were counted as not valid. The results of voting:

– Vitalii Lavryk – 16 votes (48,49 % of all valid votes)

– Ala Iatco – 7 votes (21,21% of all valid votes)

– Liudmila Trukhan – 10 votes (30,30 % of all valid votes)

Vitalii Lavryk is elected for 3 years term as EHRA Steering Committee member representing the region of UKkraine-Moldova-Belarus.

  1. Baltics region. In total the region has 19 official EHRA members, who were eligible to vote. From those 19 members – 12 participated in the meeting and cast the vote for their candidate, which means, that quorum was met, because 63,16 % of members from the region participated in the elections of the SC member. In total 12 people participated in the meeting, 0 votes were counted as not valid. The results of voting:

– Jurgita Poškevičiūtė – 8 votes (66,67% of all valid votes)

– Elena Antonova – 4 votes (33,33% of all valid votes)

Jurgita Poškevičiūtė is elected for 3 years term as EHRA Steering Committee member representing Baltic countries region.

 

  1. South-Eastern Europe. In total the region has 21 official EHRA members, who were eligible to vote. From those 21 members – 15 participated in the meeting and cast the vote for their candidate, which means, that quorum was met, because 71,43 % of members from the region participated in the elections of the SC member. In total 26 people participated in the meeting, 11 votes were counted as not valid (not official individual or organizational member of EHRA; don’t have an authorization from the leader of the organization). The results of voting:

– Denis Dedajic – 4 votes (26,67% of all valid votes)

– Samir Ibisevic – 3 votes (20,00% of all valid votes)

– Eroll Shporta – 2 votes (13,33% of all valid votes)

– Yuliya Georgieva – 6 votes (40% of all valid votes)

Yuliya Georgieva is elected for 3 years term as EHRA Steering Committee member representing the South-Eastern Europe region.

  1. Central Europe. In total the region has 11 official EHRA members, who were eligible to vote. From those 11 members – 8 participated in the meeting and cast the vote for their candidate, which means, that quorum was met, because 72,73 % of members from the region participated in the elections of the SC member. In total 9 people participated in the meeting, 1 vote was counted as not valid (not official individual or organizational member of EHRA; don’t have an authorization from the leader of the organization). The results of voting:

– Janko Belin – 1 vote (12,5% of all valid votes)

– David Pešek – 7 votes (87,5% of all valid votes)

David Pešek is elected for 3 years term as EHRA Steering Committee member representing the South-Eastern Europe region.

 

Congratulations to the new elected Steering Committee members!

Human Rights Violations Of Women Who Use Drugs In Estonia Submitted To United Nations

Canadian HIV/AIDS Legal Network, the Estonian organization LUNEST and the Eurasian Harm Reduction Association (EHRA) submitted a report regarding the situation with the enjoyment of social rights among women who use drugs and/or living with HIV in Estonia to the UN Committee on Economic, Social and Cultural Rights (CESCR). The report was compiled based on a number of human rights violations in Estonia, identified during a research study conducted by a team of non-governmental organizations in 2017.

The aim of this submission is to request the Estonian Government to address the issues of health, parental, child protection and labor rights violations incurred by women who use drugs.

An opportunity to voice concerns

Established in 1985, CESCR is a UN human rights body consisting of 18 independent experts that monitor implementation of the International Covenant on Economic, Social and Cultural Rights by its States parties, which are obliged to submit regular reports to the Committee on how the rights are being implemented in their countries. The Committee’s rules allow for international, regional, and national organisations and human rights institutions to submit parallel reports with questions for governments in advance of the dialogue with the states.

“The submission of such reports is a unique opportunity for non-governmental organisations to directly participate in the monitoring of human rights violations in their countries and bring these violations to the attention of UN bodies. We hope that based on our report on women who use drugs in Estonia, CESCR will include these issues into the list of questions for the Estonian Government,” Mikhail Golichenko of Canadian HIV/AIDS Legal Network explains the importance of the submission. “If we succeed and our concerns are included, the Estonian State representatives will be expected to submit replies and explanations to them. Thus, the voices of people who use drugs will be heard and, hopefully, the violations of their rights will be addressed and solved.”

Pre-sessional Working Group Session, during which CESCR will present the Estonian Government with the list of questions will take place in Geneva, on 3-6 April this year. The final report from Estonia will be presented to the Committee at a later stage.

Why Estonia?

Despite rather good overall human rights record in Estonia, people who use drugs still experience discrimination and stigmatisation from a number of state institutions, such as the police, child protection, and public health services. According to the European Drug Report 2017, Estonia has the highest number of mortalities from overdose in Europe (103 deaths per million) and one of the highest number of HIV prevalece attributed to injecting drug use (41.9 cases per million).

“The report to the CESCR means that Estonia, which has shown good progress in terms of providing access to HIV prevention and treatment, if compared to its neighbouring states, still has a long way to go to eliminate systematic violations of human rights against its most vulnerable population groups. What we have learned during our research of women who use drugs last year was unexpected and shocking. The recorded numbers of the misuse of power, arbitrary detentions and deprivation of parental rights is a worrying sign that even such countries as Estonia, which has been long considered as one of the most-developed post-Soviet countries, violate the rights of people who use drugs” Dasha Matyushina-Ocheret, Policy Reform Advisor at EHRA states the reasons behind the report. “We truly hope, that through an open dialogue and cooperation with local and international non-governmental ogranisations, the Estonian authorities will ensure that the rights of vulnerable groups, such as women who use drugs, are respected and protected.”

Draft briefing paper, which served as a basis for the parallel report to CESCR, was conducted in Tallinn, the capital of Estonia, and Northeastern Ida-Virumaa county, were 38 in-depth interviews with women who use drugs were taken and later analysed. Apart from violations of parental rights, non-protection against gender-based violence, labor, health and child rights violations, the study has also found that the respondents lack access to legal and social support services, there are insufficient gender-sensitive services for women who use drugs, including quality opioid substitution treatment and rehabilitation. The study was conducted by Canadian HIV/AIDS Legal Network, the Eurasian Harm Reduction Association and the Estonian organisation LUNEST.

Invitation to participate in the tender for the selection of photographers. Deadline extended.

Eurasian Harm Reduction Association (further EHRA) announces a tender for the selection of photographers for a long-term cooperation with EHRA in Lithuania.

Based on the results of the tender, EHRA will select several photographers, with whom EHRA will conclude long-term contracts.

More information about the Association and specifics of the work you can find on our website http://harmreductioneurasia.org

Type and subject of the tender:

As part of its work, EHRA requires quality, professional photos to fill the site’s content, groups in social networks, to use it in promotional materials (presentations, stands, guides, methodologies, articles, blogs, interviews, project implementation reports to partners and donors).

As a result of the tender, photographers with the highest amount of points will be chosen. Description of work:

– photography (conferences, meetings, round tables, trainings, seminars, etc.; portrait and group photo sessions of the EHRA team); photo processing.

Requirements to participants of the tender/evaluation criteria:

Essential requirement for the participants:

– place of residence – Lithuania;

– knowledge of Russian or English languages (Intermediate level B1 – minimum);

– work experience as a professional photographer at least 3 years;

– tolerance to vulnerable groups of people.

General requirements:

To assess the tender applications, the following criteria will be used (maximum amount of points for each criterion):

Participants must submit:

  1. CV in a free format, which should include:
  • previous work experience as a professional photographer;
  • indication of the cost of services: photography/ photo processing in EURO (1 hour/1 photo).

2 A link to the portfolio of your work (At least 10 examples).

3 Copies of diplomas and certificates.

ATTENTION! If these documents are not provided in full, such application in not considered for evaluation.

Application deadline – 1 p.m., February 05, 2018, Vilnius local time. Please send your documents to Yuliia Holub at julia@harmreductioneurasia.org

Special conditions:

Upon the completion of the tender procedures, EHRA will sign long-term contracts with the selected number of winners on a fixed cost of services per unit basis in EURO (one hour of photography and photo processing of one photo). Further work will be carried out based on the needs of EHRA and according to the timeline and other conditions, which will be decided upon in each individual case.

The submission of documents for participation in the tender does not impose on EHRA any additional obligation to conclude a contract.

As funding from the Global Fund is phased out, Bulgaria struggles to find sustainable financing

With Global Fund support coming to an end, the path towards sustainability of HIV and TB services for key affected populations (KAPs) in Bulgaria is not clear. The consensus among representatives of civil society organizations is that, unfortunately, Bulgaria still has not managed to ensure within its National Strategic Plan for HIV sustainable financing at the required level for the services provided by NGOs for prevention, treatment and reduction of HIV among KAPs. At the same time, NGO advocacy remains weak, and many activists see little recognition by government and local authorities of the NGO role in the response to HIV and TB.
 Author: Ivan Varentsov

With Global Fund support coming to an end, the path towards sustainability of HIV and TB services for key affected populations (KAPs) in Bulgaria is not clear. The consensus among representatives of civil society organizations is that, unfortunately, Bulgaria still has not managed to ensure within its National Strategic Plan for HIV sustainable financing at the required level for the services provided by NGOs for prevention, treatment and reduction of HIV among KAPs. At the same time, NGO advocacy remains weak, and many activists see little recognition by government and local authorities of the NGO role in the response to HIV and TB.

“The lack of a vibrant and meaningful civil society is being felt very strongly right now,” Yuliya Georgieva, from NGO Center for Humane Policy, told Aidspan. “At a time when the Global Fund is finally ending its lengthy presence in the country, it has become clear that there is a complete lack of the civil society energy that is needed to advocate for the necessary funds and mechanisms for an effective continuation of the program.”

Bulgaria is a member of the European Union and is classified by the World Bank as an upper-middle-income country. Bulgaria has not been eligible for funding for HIV since 2015; it received no HIV funding for the current allocation period (2017-2019). The latest HIV grant, which was extended a number of times, ends this month.

Bulgaria’s current TB grant will come to an end in September 2018. Technically, the TB component should be eligible for a transition grant after that. However, earlier this year, the Global Fund Secretariat told Aidspan that the existing grant to the Ministry of Health (MOH) was developed and negotiated with the understanding that Bulgaria would not receive further funding from the Global Fund, and that the necessary measures for a successful transition to domestic funding would be adopted during implementation of the existing grant (see GFO article).

Epidemiological situation and the national response

Bulgaria remains one of the E.U. countries with the lowest HIV incidence: it registers 3.1 new cases per 100,000, or 200-220 new cases annually. According to research conducted by Optima involving modelling HIV epidemics for the next five years, two groups will account for most of the new HIV cases: people who inject drugs (PWIDs) and men who have sex with men (MSM). In the last six years, the proportion of new HIV cases attributed to injection drug use declined by two-thirds; however, it doubled for MSM, who have accounted for 50% of new cases in the last three years. A network of various services for reaching key populations with HIV prevention has been developed: 14 testing and counseling sites; mobile units; outreach work; and drop-in centers.

With respect to TB, the incidence rate more than halved from 48.8 per 100,000 population in 2001 to 21.3 in 2016. But the rate still remains among the highest in the E.U. Treatment success increased from 81% in 2007 to 86% in 2016, and few drug-resistant cases are present (unlike in most of Eastern Europe and Central Asia). NGOs provide TB services across the country among the following groups: inmates (13 prisons); Roma communities (23 sites); children at risk (nine sites); refugees and those seeking refugee status and other migrants (three services); and other groups, such as people who use drugs, and the homeless (11 sites).

Key national documents to ensure sustainable public funding for HIV and TB responses were approved of by the Cabinet of Ministers in March 2017, covering the period 2017-2020. The adoption of these important documents was delayed for several months, due to the rather low priority given to these diseases by the Bulgarian government, and also due to political instability and frequent government changes throughout 2016. The national programs described in these documents contain indicative budgets for the services implemented by NGOs, including for HIV prevention. There are specific budget lines for each key and vulnerable population group for each of 2017, 2018, 2019 and 2020 (see the table for the numbers for 2017 and 2018).

Table: National Program budget for HIV for 2017 and 2018 (BGN)

2017
2018
PWID
281,610 BGN
200,000 BGN
MSM
212,534 BGN
160,000 BGN
SW
156,895 BGN
170,000 BGN
Marginalized ethnic communities (Roma)
105,000 BGN
210,000 BGN
People in prisons
25,000 BGN
50,000 BGN
Refugees, migrants and mobile populations
50,000 BGN
100,000 BGN
Children and young people
55,000 BGN
110,000 BGN
Total for key populations
886,039 BGN
1,000,000 BGN
Total for HIV program
2,808,161 BGN
2,973,309 BGN

As a comparison, NGOs working with key population groups in 2015 effectively spent € 907,588 under the Global Fund grant. There are about two BGN to the euro. It is clear, therefore, that the money planned within the National Program for the most-at-risk groups is less than half of what was previously provided by the Global Fund This will likely have a major impact on the sustainability of the HIV services currently implemented by NGOs. Note, also, as shown in the table, that the sum of money for the PWID and MSM decreases in the second year (2018). The budget for these populations is maintained at this lower level for 2019 and 2020.

Further, as Dr. Georgi Vasilev, one of the authors of a recently published analytical report on contracting public healthcare and social services to CSOs in Bulgaria, told Aidspan: The problem is that these figures show the projected budget; the money actually made available is likely to be less.

Around 600,000 BGN is budgeted are planned annually for TB prevention in 2019 and 2020, the first years without the Global Fund support for the TB response. In comparison, the budget for the TB care and prevention module within the current Global Fund TB grant stands at € 1,504,841 for 2016 and € 1,288,286 for 2017.

Role of NGOs in HIV and TB response

Bulgarian NGOs have been significantly involved in the implementation of the program financed by the Global Fund for the prevention and control of HIV in Bulgaria ever since the program started in 2004. More than 50 NGOs were involved in providing HIV prevention services to KAPs, with 10 NGOs working with PWID; nine NGOs working with sex workers; five NGOs working with MSM; 10 NGOs working with Roma youth; and four NGOs providing support to PLHIV. In addition, 17 mobile units and a number of low threshold centers operating with different risk groups were established and run by different NGOs.

With support from the Global Fund winding down, the key challenges faced by the NGOs and other community groups concern (a) funding; (b) their ability to continue delivering services at the same scale; and (c) how to utilize the capacity built up throughout past years. A few NGOs have already stopped providing HIV and TB services, though many NGOs have managed to survive funding interruptions because of their commitment to the issues.

The major problem with regard to ensuring the sustainability of NGO services to KAPs is the lack of a proper mechanism to allow NGOs to receive governmental funding. According to a recent analysis of this issue conducted by the Eurasian Harm Reduction Network, the existing mechanism for the implementation of NGO contracting was developed only for the purposes of the Global Fund grant. The State Procurement Agency has indicated that the mechanism adopted for the grant cannot be applied to state funding for NGOs. Instead, the Agency said, NGOs need to be contracted according to the provisions of the State Procurement Law. The MOH is still in the process of developing a new procedure for NGO contracting under the NSP. This will result in an interruption in funding for NGOs, and will affect the delivery of services to KAPs. As an interim measure, until the state procurement procedure for NGO contracting is operational, the MOH has instructed regional health inspectorates to hire outreach workers from NGOs previously delivering services, in order to maintain the outreach work into vulnerable communities.

Civil society advocacy

As it seems apparent that the national government has limited financial resources and thus might not fully replace the Global Fund’s support for HIV and TB services in the country, this could be the right time for sustainability- and transition-focused national level advocacy activities to take place in Bulgaria.

At the beginning of July 2017, a three-day civil society workshop took place in Sofia organized by the Eurasian Harm Reduction Network (EHRN) and the TB Europe Coalition (TBEC) with the support of the Global Fund Secretariat. The workshop brought together 23 local participants representing NGOs and affected communities, as well as governmental structures (such as the MOH), the CCM Secretariat and the National Municipalities Association. As a result of the workshop, the following key sustainability- and transition-related activities for this year were identified by the NGO participants:

  • initiate the revision of the national legislation which regulates the contracting procedure to ensure that NGOs are able to receive the governmental funding for HIV and TB prevention services among key affected populations in Bulgaria;
  • support the national budget allocation processes for 2018 to ensure that the required amount of funds for HIV and TB treatment and prevention programs are included and approved in the national budget;
  • explore possibilities of national funding of services for key affected populations in other national programs, such as the National Strategy Against Drugs; and
  • create an informal coalition of community organizations and NGOs for the purpose of coordinating and implementing joint advocacy work.
 According to the report of this workshop, in order to achieve the desired results, Bulgarian civil society has to gather support for their advocacy activities from both internal and external partners. This is particularly sensitive as most of E.U. member countries are normally not eligible for any donor support or development assistance other than that provided by the E.U. itself.

According to Sandra Irbe, Senior Fund Portfolio Manager for the Global Fund, civil society and community representatives could rely on the support of the Global Fund Secretariat for their sustainability-focused advocacy activities. For example, before the end of the current TB grant, NGOs could utilize the remaining support from the Global Fund – such as the CCM Secretariat funding of € 30,000 to finance advocacy meetings, consultations and oversight visits. The Global Fund’s political leverage with country stakeholders could also be exploited, Irbe said. “The Global Fund can also bring NGOs together with regional partners in other countries to learn and discuss transition and sustainability.”

Also, as the current grant for TB runs until September 2018, Irbe said that it is important to fully absorb the funding available with this grant. Some activities that are key for the national TB program might also provide entry points for KAPs to HIV-related services that are required, she added. Finally, she said, this grant could be also used for further modelling effective interventions for domestic financing, taking into account the results of the recent report of the AuTuMN project on the optimization of the strategic investments in TB in Bulgaria.

This article was originally published on aidspan.org

Regional meetings of EHRA members to elect Steering Committee members in the Baltic States, Belarus-Ukraine-Moldova, Central Asia, Central Europe, South-Eastern Europe regions

On 15-29 January, 2018 EHRA conducts online Regional Meetings of it’s members to elect new Steering Committee representatives in the following regions:

1) The Baltic States (Latvia, Lithuania, Estonia);
2) Belarus, Ukraine and Moldova;
3) Central Asia  (Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, Uzbekistan);
4) Central Europe  (Czech Republic, Hungary, Poland, Slovakia, Slovenia);
5) South-Eastern Europe  (Albania, Bosnia-Herzegovina, Bulgaria, Croatia, Kosovo, Macedonia, Montenegro, Romania, Serbia).

All members (individual and organizational), who are from the regions, where elections are taking place and who are approved by the Steering Committee have a right to vote in the Regional meetings.

If you have any questions, please contact General Secretary of the Regional meetings – Eliza Kurcevič members@harmreductioneurasia.org

 

The Baltic States

Elena Antonova

Estonia

Know your candidate
CV (rus)     Motivation letter

Jurgita Poskeviciute

Lithuania

Know your candidate
CV   Motivation Letter

 

Belarus, Moldova, Ukraine

Ala Iatco

Moldova

Know your candidate
CV   Motivation Letter

 

Vitalii Lavryk

Ukraine

Know your candidate
CV (rus)   Motivation letter

 

Liudmila Trukhan

Belarus

Know your candidate
CV (rus)   Motivation Letter

 

Central Asia


Sagyngali Yelkeyev

Kazakhstan

Know your candidate
CV (rus)   Motivation Letter

Oxana Ibragimova

Kazakhstan

Know your candidate
CV (rus)   Motivation letter

 

 

 

 

 

Indira Kazieva

Kyrgyzstan

Know your candidate
CV (rus)    Motivation Letter

 

Central Europe

David Pesek

Czech Republic

Know your candidate
CV   Motivation Letter

Janko Belin

Slovenia

Know your candidate
CV   Motivation Letter

 

 

South-Eastern Europe

Denis Dedajic

Bosnia and Herzegovina

Know your candidate
CV   Motivation Letter

Eroll Shporta

Kosovo

Know your candidate
CV   Motivation Letter

Samir Ibisevic

Bosnia and Herzegovina

Know your candidate
CV   Motivation Letter

Yulia Georgieva

Bulgaria

Know your candidate
CV    Motivation Letter

 

Sustainability, Transition and Co-financing of programs supported by the Global Fund. Guidance Note

This document covers definitions and principles of sustainability and transition within the Global Fund context, as well as other terms related to the implementation of the STC policy.

Guidance on what is recommended for all countries to embed sustainability considerations into planning and program design as well as an overview of what is required for applicants to align with the STC policy:

  • Co-financing requirements – for all countries
  • Focus of application requirements – for middle income countries
  • A transition work-plan to submit with the funding request – for components applying for “transition funding” .

Full version of the document can be found here: http://eecaplatform.org/wp-content/uploads/2018/04/core_sustainabilityandtransition_guidancenote_en.pdf

Global Fund grant to Belarus in 2015 was conditional on the government developing a social contracting mechanism

Author: Ivan Varentsov

A social contracting mechanism which would allow the government to contract with NGOs to deliver prevention programs to key affected populations in Belarus is “under construction.” It is a slow process and there are still some uncertainties about how well it will function.

Background

A mechanism allowing the government to co-finance social services and projects being implemented by NGOs has existed in the Republic of Belarus for a number of years and has been regulated under the Social Services Law. However, under this law, it is not possible to financially support the provision of NGO-based HIV prevention services among key affected populations.

An analysis carried out by Belorussian NGO “ACT” in 2016 (on file with the author) identified the following barriers to government financing of NGO-based HIV prevention activities imposed by the Social Services Law:

  • subsidies are provided only for salaries;
  • subsidies for social projects are provided only where the government commits to paying 50% of the costs (or less); the NGO commits to paying at least 50% of the costs; and the NGO possesses funds to cover its share;
  • subsidies were available only for services to be provided to “citizens in difficult life situations”; people who inject drugs (PWID), sex workers and men who have sex with men (MSM) are not considered to fit this definition under the legislation;
  • the Social Services Law does not cover health care; there is no legislation covering social contracting for health care and, therefore, HIV prevention services;
  • “outreach worker” is not among the types of jobs listed in the Belorussian official job classifier, so it is not possible to include salaries for them within social contracting under the Social Services Law; and
  • under the Social Services Law, services can be provided only upon the written consent of the recipient of the services, so services cannot be accessed anonymously, which effectively makes it impossible to provide services to key affected populations.
 In November 2015, a grant agreement in the amount of $12,309,479 to support the HIV response was signed between the Global Fund and the Republic of Belarus for the period 1 January 2016 to 31 December 2018. According to the Grant Confirmation document (on file with the author) signed between the Global Fund and the Government of Belarus, among other matters, the parties agreed that in order to support prevention services for key populations before 30 September 2016 the Government of Belarus has to ensure the development of a social contracting or other relevant financial mechanism allowing NGOs to receive governmental funding for these purposes.

It is important to mention here that under the new funding model introduced by the Global Fund in 2013, before the grant confirmation (previously called the grant agreement) is signed, a Framework Agreement outlining all of the terms and conditions of the grant has to be signed between the Global Fund and the relevant government. The grant confirmation becomes an integral part of the Framework Agreement.

“Introduction of the social contracting mechanism for HIV prevention into legislation became possible mainly due to the fact that the Framework Agreement signed between the Global Fund and the Belorussian Government in October 2015 has the status of law in the Republic of Belarus. The grant agreement which was signed by the Global Fund and the principal recipient on behalf of the Ministry of Health is an integral part of the Framework Agreement. Therefore, the obligation to establish the relevant social contracting mechanism was confirmed by the Belorussian government legislatively,” explained Elena Fisenko, Head of the HIV division of the Global Fund Grants Management Department in the Republican Theoretical and Practical Centre for Medical Technologies, Informatization, Management and Economics of Healthcare of the Republic of Belarus.

This obligation on the part of the government resulted in the inclusion in early 2016 of a number of HIV-related activities, including those focused on key affected populations (KAPS), into Sub-Program 5 (“HIV prevention”) of the Governmental Program “Health of Nation and Demographic Security of the Republic of Belarus” for 2016–2020 –– implying that the provision of governmental subsidies to NGOs for implementation of the activities would start in 2017. Necessary funds were budgeted for these purposes, but this was done before the legislation to allow for social contracting was actually being developed.

Protracted process of the mechanism introduction

To ensure the development and introduction of the proper social contracting mechanism in the health care sphere allowing NGOs to receive governmental funding for HIV prevention activities among KAPs, the process of changing the relevant legislation (The Law on Prevention of Socially Communicable Diseases and HIVwas initiated in 2016. It took more than a year to adopt the necessary amendments and pass the new version of the law –– the process was completed only in July 2017. Moreover, an additional six months were needed to prepare and enact all necessary subordinate legislation once the law comes into effect on 19 January 2018.

Initially, this mechanism was expected to start working by the end of 2016, but this never happened.

“Changes in legislation happen very slowly. It is really fast that in two years we managed to have legislation changed and prepare all regulations and procedures for approval of the social contracting mechanism in health care. It could have been done in 2016 only if relevant changes in legislation had been launched in 2014–2015,” said Valery Zhurakovski, an expert in the NGO “ACT,” a local organization advocating for introduction of the social contracting mechanism in health care, and particularly in the sphere of HIV prevention since 2010.

Consequences of the delay for HIV prevention programs

The government’s Program for HIV Prevention 2016–2020 included a plan to start funding NGOs to deliver services through a social contracting mechanism starting in 2017. It was expected that the Global Fund would remain the main donor of these programs in 2016, and that its share of the funding would then start to decline, finally ending by 2019 –– whereas government funding through the social contracting mechanism would start increasing in 2017, and would continue to grow, thus ensuring a smooth transition from the Global Fund’s support of HIV prevention programs among key affected populations to full government funding by 2020 (see table). But this didn’t happen in reality.

Table: Planned budget of the Governmental Program of HIV Prevention for 2016–2020

Objectives of the program: Reduction of HIV transmission among populations with high risk of infection (injection drug users and their sexual partners; male and female sex workers; MSM; prisoners; adolescence practicing high risk behaviors.
Ordering party Sources of funding Amount of funding (Belarus rubles)
Total 2016 2017 2018 2019 2020
Global Fund 81,300,200 35,925,200 27,713,400 19,661,600 0 0
Oblast government, Minsk government Local budgets 162,641,400 548,300 17,087,400 33.612,800 53,804,900 57,598,000

 

Because the social contracting mechanism was not yet developed, the funds being planned for 2017 under the Governmental Program on HIV Prevention for 2016–2020 for support of NGO-based HIV prevention activities were spent on other needs that the regional governments deemed important.

Nevertheless, a government financial contribution to prevention services for key populations in 2017 was partly ensured through supporting the work of 10 HIV prevention units based in government healthcare facilities that provided anonymous counselling to people who use drugs. This partially reduced the additional financial burden on the Global Fund grant in 2017 caused by the necessity to ensure the provision of a decent level of prevention services in the absence of government funding through the social contracting mechanism.

“As it is clear that in 2018 prevention services will again not be fully covered by government funding through the social contracting mechanism, the Ministry of Health decided to considerably increase its purchase of ARVs from the governmental budget in 2018. Thus, funds initially budgeted for that purpose within the Global Fund grant could be reprogrammed to support prevention services among affected populations,” Fisenko said.

Social contracting mechanism

According to the government’s draft “Regulations on the conditions and procedures of social contracting in the area of socially communicable diseases and HIV prevention” (on file with the author), social contracting will be implemented by providing NGOs with “subsidies” from local budgets for services and (or) projects aimed at preventing socially communicable diseases and HIV. (In Belarus, all official documents use the term “subsidies” to describe the funding available through social contracting.) Subsidies for the implementation of projects will be granted under condition of partial co-financing by the NGOs, likely at the level of 20%. The subsidies may cover a wide range of expenses, including: NGO employees’ salaries; administrative expenses (i.e. rent, stationery, bank expenses, office equipment maintenance); project activities; and the purchase of items to be distributed (such as syringes, needles, sterile napkins, motivation packs, lubricants, condoms and information materials).

Social contracting will be implemented on the local (oblast) level. The contracting will be managed by the oblasts, particularly the health care committees which will be responsible for announcing tenders. Funds will be provided via the relevant government programs –– in the case of HIV prevention, the Governmental Program on HIV Prevention for 2016–2020. For each tender, the process will produce a winning bid (or bids) from among the NGOs that participated, after which the oblast will arrange for contracts to be signed and the subsidies to be provided.

It is expected that contracts with the implementers could be for a period of up to five years, depending on the framework and timelines of the government programs. However, Fisenko told Aidspan that funding will most likely be provided one year at a time.

The draft regulations do not mention specific target groups. ACT’s Valery Zhurakovski explained: “The epidemiology can vary from oblast to oblast and thus it will be up to each oblast to determine what the target groups are for the funding.”

According to the draft criteria for evaluating the tender proposals (on file with the author), among the factors to be considered are (a) the work experience of the organization in the area of socially communicable diseases and HIV prevention; and (b) experience working with the representatives of the target groups –– i.e. the intended recipients of the service.

Potential obstacles for the introduction of the social contracting mechanism

Experts outlined some of the problems that may be encountered when introducing the social contracting mechanism. One potential problem is related to decision to implement the mechanism at the oblast level rather than the republican (i.e. central government) level. “In local budgets, funds are allocated first to certain obligatory budget lines,” explained Irina Statkevich, CCM member, and Head of the local NGO “Positive Movement.” “Social contracting is not one of those lines. Thus, in the event of a budget deficit, funding within the local budget would be spent first on the priority areas, and the activities to be supported within the social contracting mechanism can appear to have no financing at all if there are not enough funds left over.”

Another possible problem is that the majority of the local bureaucrats have no previous experience with social contracting, especially in the area of HIV prevention for key affected populations. And the idea to allocate funds to support the work among such groups as PWID, MSM and sex workers may seem as a quite a revolutionary idea for most of them.

“I am not sure about authorities’ readiness to name in tendering specifications the target groups in a way we do,” Zhurakovski said. “There was no precedent up to now to have them in official documents.”

Zhurakovski added: “Also, in some places, local authorities consider the grown-up working population to be the target group for HIV prevention programs. In such cases, workplace interventions to prevent HIV may become the priority for them. That’s why some local bureaucrats may decide to allocate part of funds planned within the government program for these purposes.”

According to Elena Fisenko, an additional problem is that the budget for 2018 has already been set, based on laws and regulations already in effect. The amendments to the law introducing social contracting in prevention of socially communicable diseases and HIV are effective only as of January 2018. Thus, no oblast government has budgeted funding for social contracting for 2018. “In practice, it will mean that approximately in February or March 2018, oblast governments will have to change their already approved budgets which, in any case, can be done only on a quarterly basis. And the best-case scenario is that money for social contracting will appear in local budgets starting from the second quarter of 2018,” said Fisenko.

The role of civil society

The importance of the role of civil society representatives in the introduction of the social contracting mechanism for socially communicable diseases and HIV prevention in Belarus deserves to be mentioned separately. On the one hand, experts who contributed to this article highlighted the transparency of the process of developing the social contracting mechanism by the authorities, as well as the possibility for NGO representatives to participate in this process. On the other hand, for a number of years, civil society representatives were actively advocating for adoption of this law and also for keeping to the principles of NGOs work in providing prevention services to key affected populations within the framework of this mechanism. The NGO “ACT” merits a special mention as it has been leading the advocacy work on social contracting in HIV prevention for many years and had vast experience in dealing with the Ministry of Labour and Social Protection in the context of social contracting implementation under the Law on Social Services. For this reason, the representatives of ACT took an active part in development of all key documentation on social contracting in Belarus, including the development of relevant legislation, bylaws, drafts of resolutions of the Council of Ministers, and so on.

It should also be mentioned that advocacy activities of ACT with respect to a social contracting mechanism have been financed for a number of years from Global Fund grants. This can serve as a good example for how the Global Fund could successfully contribute in middle-income countries to the transition from donors’ support of HIV prevention services for key affected populations to national funding.

“Our work is focused not only on the social contracting. We are also advocating for the creation of the enabling environment for the work of NGOs in the country in general, including exploring other options for attracting funding –– such as foreign grants or donations, charity and also changes in the approach for the taxation in this sphere,” Zhurakovski said. “We are in active on-going communication with the relevant department regarding the possibility of changing the procedure for NGOs for registration of foreign grants or donations in Belarus by lowering the threshold. We work closely with the Ministry of Finance, the revenue authority and Parliament regarding changes in the approach to taxation of local fundraising. We understand that a social contracting mechanism is not able to solve all the problems and cover all needs. Organizations will nevertheless need other resources and it is necessary to make it easier for them to get the access to the resources needed as well as to facilitate this process.”

Original publication on aidspan.org