This guide is intended to inform community activists from key affected populations (KAPs), civil society organizations (CSOs), and community-based organizations (CBOs) on how to engage in meaningful, transparent, and accountable budget advocacy towards domestic government at national or subnational level. The regional focus of this guide is Eastern Europe and Central Asia (EECA), although it can also be used by individuals from other regions.
Eastern Europe and Central Asia (EECA) is one of two regions, along with Latin America and the Caribbean, where planning for the transition away from Global Fund support is most advanced. The following table shows components in the various categories of transition from Global Fund support
* In the first column, only components still active as recently as 2015 are listed.
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Guidance from World Health Organization (WHO), United Nations Office on Drugs and Crime (UNODC) and Joint United Nations Programme on HIV/AIDS (UNAIDS) suggests that reversing an HIV epidemic requires 60% of all people who inject drugs (PWID) to be reached regularly by a needle syringe program (NSP), and that 40% of all opiate users be enrolled in opioid substitution therapy (OST).
Governments of Central and East Europe and Central Asia (CEECA) provide less than 15% of harm reduction funding needed in the region, which indicates region’s strong dependency on international donors who support both NSP and OST. At the same time, many of the countries in the CEECA region are becoming ineligible to receive donor funding due to increasing GNP per capita level. There are no more countries in CEECA that are classified as low-income – the funding priority for key donors such as the Global Fund to Fight AIDS, Tuberculosis and Malaria.
Epidemics among PWID cannot be reversed without greater and sustained state funding of harm reduction. Investments are needed to improve service quality and coverage level of both NSP and OST. Governments and other domestic sources have responsibility for meeting these investment needs. Their increased and sustained engagement is essential because the Global Fund is swiftly withdrawing from the region to concentrate on supporting low-income countries across the globe.
One of the key priorities of Eurasian Harm Reduction Association (EHRA) is to build capacity of PWID communities in CEECA in budget advocacy – a process enabling civil society organizations and communities to monitor and influence state decisions for the allocation of public funds towards harm reduction programs and better solutions safeguarding people’s health.
Budget advocacy by communities may have the greatest impact on actions of authorities, and in its turn, on the lives of people. With that in mind we believe that:
- It is crucially important to engage PWID community in planning through estimating the unmet needs for harm reduction services and defining priority items for a policy agenda change and financing;
- Allow for direct financing of civil society through social contracting or similar mechanisms, to deliver harm reduction and HIV and TB services to PWID, is the most evident way for the governments to sustain services and funding;
- An important consideration is that cost-effectiveness can best be obtained not by cutting services, but by making them more efficient through their optimization.
Increasing national funding should go hand in hand with reversing harsh prohibition laws and change of enforcement policies that discriminate PWID. Otherwise scale-up in funding would not convert to increased program coverage.