Emergency situation concerning the sustainability of harm reduction services in Albania, Bosnia and Herzegovina, Bulgaria and Romania

The three regional networks: Correlation – European Harm Reduction Network, Eurasian Harm reduction Network and Drug Policy Network South East Europe were informed by our members organisations about the situation with sustainability of  harm reduction services in Bosnia Herzegovina which is characterised by lack of strategy, policy and funding caused by the delay in establishing national Government for more than a year after the elections, withdrawal of international donors and misunderstandings and low level of cooperation between the governmental institutions and civil society, but also inside the civil society sector providing harm reduction services. The national Strategy for prevention and control of HIV and AIDS has ended (2016) and the Transition plan, developed by the Country Coordinating Mechanism during implementation of The Global Fund funded programme has not been implemented. As a result, the harm reduction services are closed in Sarajevo, Mostar, Bihać and Banja Luka and exist only in Zenica and Tuzla relaying on voluntary work of unpaid Staff and with all supplies already on minimum.

The three Networks expressed our deep concern about the situation and willingness to give contribution to finding solution and ensuring both quick response to the urgent needs and building a sustainable solution. We are ready to provide non-partisan support in identification and advocacy for the best possible approaches to urgently start provision of services to the populations of people who use drugs, sex workers and prisoners and other affected populations and to properly advocate for the sustainability of governmental funding.

The urgent action we are taking is to explore opportunities for emergency bridging funding to ensure survival of existing harm reduction services in the country. The situation is alarming and requires direct action and mobilisation of the international community. The three network have limited resources, so we are now contacting some of our partners and donors, explaining the situation and calling for immediate and urgent support. This could include short-term funding and technical support to ensure a minimum of harm reduction services. So far, we have a promise from the Open Society Foundations for a small grant which would cover basic need for the month of November.

We plan to develop and implement a comprehensive process to achieve sustainable long-term solutions. The activities for long-term solutions target local governments and policy-makers with the aim to ensure sustainable funding for harm reduction services. We already offered our expertise and support in this process, In addition, we would like to engage and involve other relevant stakeholders, such as donors and funders.

As the first concrete long term action we decide to send an appeal to the Global Fund to review their eligibility model of supporting middle income countries, besides Bosnia Herzegovina also Albania, Bulgaria and Romania.

In advance of the upcoming 42nd meeting of the Board of the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) as well as the Global Fund Regional Meeting for Eastern Europe and Central Asia to take place in Istanbul on 26-27 November, 2019, we – civil society and community organisations and networks working in the Eastern Europe and Central Asia (EECA) region for the benefit of key affected populations, including people who use drugs – would like to express our profound concern as to the current lack of sustainable harm reduction services in the South East European countries of Albania, Bosnia and Herzegovina, Bulgaria and Romania, respectively. Taking into consideration the successful results of the recent Sixth Replenishment Conference, we would like to invite the Global Fund to safeguard a part of the catalytic investment funds available for the 2020-2022, including multi-country grants, matching funds and strategic initiatives, in order to sustain life-saving services for people who inject drugs and other vulnerable groups and to incentivise domestic investment in harm reduction in each of these post-transition countries.

41 civil society organisations from Easter Europe and Central Asia supported the letter. We hope that the Global Fund shall understand the situation and support our proposal.

The letter to the Global Fund is available following this link>>>

 

A publication about our project

In the last decade, an increasing number of donors are withdrawing their support for healthcare. This has been especially true for middle-income countries, where the growth of domestic resources was one of the triggers for donor funding reduction. The Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) has termed this process as “transition”.

In 2018 the Open Society Foundations, through the Eurasian Harm Reduction Association (EHRA), initiated the project Budget Advocacy and Monitoring in countries of South East Europe. It provided funding to three transitioning countries in the Balkan region – Bosnia and Herzegovina, Montenegro, and Serbia – through the sub-regional network organization, Drug Policy Network South East Europe (DPNSEE), to support budget advocacy for harm reduction services. The local coordinating organisations are Margina, Juventas and Prevent.

The case study looks at the implementation of this project as one of the demonstrations of the SBF mechanism, with the objectives to:

  • Document the pilot in 3 Balkan countries and to analyse the strengths and weaknesses of this approach and to develop suggestions for improvement; and,
  • Document the results, successes, and challenges of the budget advocacy projects supported through this approach.

Our project serves as a pilot for the Sustainability Bridge Funding (SBF), an idea that has been discussed among donors and civil society organizations as a way of mitigating the negative effects of transition and in providing support for key essential services for communities and key populations. As a safety net mechanism, it should respond to gaps in funding and mitigate adverse effects of donor funding withdrawal.

Please find the document following this link>>>

Too bad politics and prejudice keep getting in the way

Photo: Aris Messinis/AFP via Getty Images

DPNSEE Board member Marios Atzemis contributed to the article

“We know how to end AIDS”, published by Politico

Greece was never known for the quality of its health system. But in 2009, at least among drug users, HIV was not a major threat – just 15 were diagnosed with the virus that year.

Then came the financial crisis and the harsh austerity that followed. In 2011, another 256 drug users learned they had HIV. In 2012, the number was 484. The reason for the explosion: the Greek financial crisis and the harsh austerity measures that followed.

Marios Atzemis was one of the Greek drug users diagnosed with HIV in 2011. He had been addicted to heroin and a regular in Athens’ open-air drug markets well before the crisis. Then in 2010, street services to help drug users stay safe lost a third of their funding. Atzemis stopped seeing the vans that used to distribute fresh syringes, even as new users were entering the scene, shooting newer, cheaper drugs.

As a community of drug users, we didn’t have an effective means of defense,” said Atzemis, now a harm-reduction coordinator with the Association of People Living with HIV Greece Positive Voice) “It was very easy for us to be targeted and to be scapegoats.”

The doctor refused to put him on anti-AIDS antiretroviral medication until he got clean at a rehab clinic – even though the clinic was on the brink of being shut down for lack of funding.

For Atzemis, now 44, this was enough motivation to wean himself off the drugs. “It didn’t work the same for other people,” he said.

For better or worse, Greece shows that a country doesn’t need to fix its entire health system to deal with HIV. As a case in point, its progress on AIDS hasn’t translated into progress on correlated problems like hepatitis C. Those rates rose during the debt crisis and haven’t ebbed much; based on 2017 data, around 62 percent of drug users in Greece have tested positive for hepatitis C.

The crisis-era HIV outbreak marked “the first time that all the stakeholders – NGOs, state structures, every single one – worked together to face this epidemic,” said Atzemis. “And probably the last time.”

To read full article, follow this link>>>

Third conference of the Slovenian NGO Alliance

ZvezaThe Alliance of Non Governmental Organisations for Drugs and Addictions in Slovenia holds its third conference on 19 November 2019 in Ljubljana under the headline “Unconditional shelter for all: Needs and housing for people with psychoactive substance disorder“.

Participation at the Conference is free. Deadline for applications is 31 October 2019. The application form is available following this link>>>

Have a look at the videos from the last year’s conference following this link>>>

Training for the State commission for combating drugs

HOPS – Healthy Options Skopje, on 7 and 8 October 2019 organized an educational workshop on capacity building for the members of the Inter-ministerial state committee for combating illicit production, trade and drug abuse in the Republic of North Macedonia.

This educational workshop was organized as part of the regional project “Sustainability of services for key populations in Eastern Europe and Central Asia” supported by the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria. The activities in the country are implemented by three partner organizations: Stronger together, HERA and HOPS.

The purpose of this workshop was to update the members of the Committee on harm reduction programs, as well as to initiate a coordination process for the preparation of the new national drug strategy which should be developed by end of 2020.

The lecturers of the workshop were: Vlatko Dekov, Advocacy manager and harm reduction expert at HOPS, Lidija Savić, Pharmacist and Chair of the Inter-ministerial committee on drugs, Heidi Sterjova Simonović, project coordinator and Dr Darko Kostovski, Psychiatrist specializing in the field of drug addiction treatment.

Correlation Focal points and expert group meeting

The Correlation – European Harm Reduction Network held its Focal point and expert group meeting from 2 to 4 October 2019 in Helsinki. The meeting gathered 60 participants from 31 countries and territories. Among them, DPNSEE network members are focal points for Albania, Bosnia Herzegovina, Bulgaria (not present at the meeting), Greece, Montenegro, North Macedonia, Romania and Serbia.

The agenda included a wide range of interesting issues including New projects on European level, Results of the first round of monitoring harm reduction, Challenges in Harm Reduction and also Correlation state of affairs and Methadone shortage in Romania. Complementing this agenda, participants were given the opportunity to join a series of workshops on Advocacy, Peer Involvement and Intervention Planning, Monitoring and Evaluation. Building upon this pool of expertise, the event offered the possibility to present developments in the different EU countries in regard to drug policy and harm reduction and to disseminate relevant work and activities.

Since the launch of the monitoring tool for harm reduction organizations, Correlation Focal Points have been working on collecting the required data and information. The tool had more than 100 questions and 35 countries from Europe participated. Some results are strange. For instance, the only 3 countries in Europe which expressed civil society’s good cooperation with governments were Albania, Bosnia Herzegovina and Romania! During the meeting, participants shared their experiences and provided feedback on the tool and the process.

Ms Dagmar Hedrich, Head of the Health consequences and responses sector, Lead scientist for harm reduction at EMCDDA, presented the data collected by the agency. DPNSEE Vice President and Executive Director asked what can we do with outdated data coming from some EMCDDA focal points and how could they include data from candidate and non-EU countries? The reply we got was that EMCDDA’s institutional obligation is to report on 28 EU countries and 2 who pay for their services (Norway and Turkey) and that budget cuts and no funds prevent them to cover more. An interesting view Ms Hedrich proposed is that the civil society organisations can perform social autopsy of overdose deaths of people who were using their services. The implementation researches are one of important potentials of CSOs – qualitative information they can provide. A good model they use is that EMCDDA prepares short reports with key messages, tailored for policy makers, followed by webpages or web based portals which give a full information.

The presentation from the European Centre for Disease Prevention and Control (ECDC) was focused on monitoring in general and on Hepatitis in particular. It emphasized that there is a big problem with low number of those diagnosed for HEP, huge numbers in prisons and lack of accurate data.

On Friday 4, the seminar Wellbeing economy – A way to sustainability in the HIV and AIDS response? was held as an official side event during Finland’s Presidency of the Council of the EU in cooperation with HIV Finland.

Budget analysis presented in Serbia

The budget analysis in Serbia was completed and presented on an event organised jointly by Prevent and DPNSEE in the EU Info Centre in Belgrade on 1 October 2019. The analysis was prepared in scope of the project Budget Advocacy and Monitoring in countries of South East Europe by the team of consultants engaged by Prevent.

The surveys were of a meta-analytic nature, conducted on data and information obtained on the basis of publicly available documents published by state bodies: the Ministry of Health, the Ministry of Finance, the Parliament of the Republic of Serbia, the Customs Administration and the Agency for Business Registers.

The aim of the research was to explore the status and trends of program financing in order to find opportunities and solutions for securing funds for their sustainability.

The analysis clearly shows a continuous decrease in the allocation of funds for preventive health care, regardless of whether the total budget of the Ministry is increased or decreased and whether the budget of the Ministry of Health occupies a higher or lower percentage in the national budget for a given year. The most significant finding is the constantly present difference in the planned and executed budget – the allocated/spent funds are continuously reduced compared to those planned.

Besides the analysis of the budget of the Ministry of Health which was produced, DPNSEE has prepared and presented an analysis of the public calls for prevention of the Ministry of Health. This analysis is available following this link>>>.

Results of the budget advocacy presented

A workshop on Budget advocacy and monitoring in South East Europe was held in Sarajevo, Bosnia Herzegovina from 23 to 25 September 2019. Aim of the workshop was to present and discuss the results of the budget analysis implemented by mr sci Faruk Hadžić dipl ecc with support of the Association Margina team, the coordinating organisation of the regional project Budget Advocacy and Monitoring in countries of South East Europe for the country.

Even though the organisers made a huge effort to invite representatives of various institutions, not many of them participated in the workshop. But, the quality of presentation and facilitation provoked a very fruitful discussion and motivating atmosphere.

The conclusions of the workshop are summarised in one sentence: There is enough money in the system, but planning, analysis and strategic thinking are weak and they hit back as a boomerang.

The contacts established and agreements made are optimistic with hope that in the forthcoming period an open process of designing the system of social contracting of civil society services in Bosnia Herzegovina.

The Analysis of the budgets in Bosnia and Herzegovina is available following this link>>>

 

What does Universal Health Coverage mean for People Who Use Drugs

On 23 September 2019, world leaders adopted a high-level United Nations Political Declaration on universal health coverage (UHC) at the United Nations General Assembly. In adopting the declaration, U.N. Member States have committed to advance towards UHC by investing in four major areas around primary health care.

These include mechanisms to ensure no one suffers financial hardship because they have had to pay for healthcare out of their own pockets and implementing high-impact health interventions to combat diseases and protect women’s and children’s health. In addition, countries must strengthen health workforce and infrastructure and reinforce governance capacity. They will report back on their progress to the U.N. General Assembly in 2023.

The International Network of People who Use Drugs (INPUD) published a Technical Brief which explains how UHC can be both an opportunity and a concern for the health and rights of people who use drugs.

Through sustained diplomacy and negotiation at the political level and strong and concerted advocacy from civil society and communities, UHC is now prominent in the Sustainable Development Goals (SDGs). The principle of the SDGs is ‘leave no one behind’; this should be taken to mean that those on the fringes of society are accorded the same rights to health and wellbeing as the most privileged. People who use drugs, along with other criminalised and marginalised populations, clearly fit into this category.

To read the Technical Brief, follow this link>>>

6-0 Tournament for People Against Addictions

The featured image of this news presents teams of Kethea (Greece) and HOPS (North Macedonia) which, besides sport competition and cooperation in the area of addiction, promote friendship and multi-cultural understanding.

The sixth edition of the 6:0 International People’s Tournament for People Against Addictions was held during the weekend at the Boyana National Football Base of the Bulgarian Football Union (BFU), with participating teams Heart Team, School of Life, Live, HOPS, SVOI, Bilani, Kethea ithaki, Open Eyes, New Beginnings, Remar, Renaissance, Freedom, Solidarity, ON LIFE and KA Sport Jump coming from Bulgaria, Greece, Northern Macedonia, Slovakia, Russia and Ukraine.

The official opening ceremony, held on 13 September, was preceded by a round table with the participation of the Minister of Youth and Sports Krasen Kralev, Deputy Minister of Health Svetlana Yordanova, Deputy BFU Executive Director Anton Popov and representatives of the Sofia Municipality. The round table discussed the problems with dependent behaviour in Bulgaria.

“The fight against youth addiction is a priority topic in the activities of the Ministry of Youth and Sports. One of the main programs of the Ministry with a budget of BGN 2 million a year is the National Program for the implementation of youth activities. In its essence it represents a real counteraction to aggression and all kinds of addictions through the implementation of various preventive activities and the inclusion of sport as a main tool for prevention”, Minister Kralev told the roundtable participants.

Special guests of the tournament are the popular TV presenter, singer and cook Leo Bianchi and former Bulgarian football national Stanislav Angelov. The two will also participate in the event as part of Team Heart.

The project is organized by the Revenche Association and the School for Life Foundation, co-financed by the Municipal Strategy for the Development of Physical Education and Sport of Sofia Municipality and supported by the Sofia – European Capital of Sport initiative.

This event is a citizens’ initiative. The project is organized by specialists with experience in the treatment of addiction who know the problem internally. Since 2015, with the assistance of the Bulgarian Football Union, five tournaments have been held under the common slogan “Not all people are addicts, but all addicts are people!