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>>>

 

Transition from Global Fund support to national funding: role, opportunities and priorities for civil society in Albania

Source:

The workshop “Transition from Global Fund support of HIV and TB programs to national funding: role, opportunities and priorities for civil society in Albania” took place in Tirana, the capital city of Albania, on 23 – 24 of October and gathered 29 participants including civil society representatives, CCM members, representatives of the Global Fund CRG Team and CCM Hub (online), experts from neighbouring countries and representatives of the governmental structures.

Albanian HIV and TB components became ineligible for regular funding after the 2014–2016 allocations were announced and therefore Albania became eligible to receive transition funding. It will receive a three-year transition grant within the 2017-2019 allocation period. This transition grant is expected to start in January 2020 and will be a significantly lower level of investment—about one third the value of current Global Fund grants. The implementation of the current Global Fund HIV and TB grant is ending in December 2019.

According to the estimated annual needs to sustain HIV and TB responses prior to submitting the transition grant request, Albania’s needs approximately US $3 million to address its two epidemics effectively. Hence US $9 million is required over 2020-2022, the three-year period of the transition grant. With an allocation of just under US $6 million within the current HIV and TB grants, roughly 60% of the funding need is currently being met. Without significant increases in domestic funding, the funding gap is expected to grow in the coming years. Moreover, the services for key affected populations (KAPs) are largely implemented by civil society. Their scale, quality and delivery models are to be improved under the new transition grant. So far, these services have not been funded from domestic resources, though there is an office for civil society and general funding for civil society groups in the country. The national strategies on HIV and TB are expiring in 2019. The Global Fund, under its pilot ‘CCM Evolution Project,’ supports Albania’s HIV and TB governance reforms although with no clear outcome so far.

Community and civil society advocacy is critical at this conjunction of processes to ensure sustainability of the response. But at the same time the transition Funding Request 2020- 2022 poses a direct challenge to the services provided by NGOs being sub-recipients of the Global Fund grant. It is expected that starting from 2020 the number of NGOs supported by Global Fund will become twice lower, decreasing from 12 to 5. It is not clear what happens with the activities implemented by those 7 NGOs left behind and which exactly NGOs this will be.

Taking this context into account, the Eurasian Harm Reduction Association (EHRA) in coordination with the Global Fund Secretariat, decided to organize a workshop for civil society and community representatives in Albania. The workshop aimed to help improve the understanding of local civil society representatives involved in the country’s HIV and TB responses, of the Global Fund transition-related processes currently taking place in country and also to stimulate ideas, plans and opportunities for their meaningful engagement into such processes to ensure the sustainability of HIV and TB response among key affected populations in Albania.

The participants first heard the information about the steps being taken by the government to prepare for transition of HIV/TB prevention interventions from the Global Fund’s support and also about the transition-related risks for HIV response and civil society services. Representatives of the Ministry of Finance and Ministry of Health updated the participants on the work being done to secure funding and social contracting from national and local authorities including on the public budget cycles, possibilities to advocate and influence the budget at central and local level. Guest activists from North Macedonia and Montenegro shared their lessons learnt from the transition experiences of their countries with regard to budget advocacy efforts being taken by civil society in these countries to sustain HIV response among KAPs. The representative of the Agency for Support of Civil Society informed the participants about the opportunities of funding available for NGOs, including those related to public health. On the second day of the event the participants also had the opportunity to discuss and plan the advocacy steps need to be taken by civil society in nearest future to ensure the sustainability of services for KAPs as well as to discuss their Global Fund related TA needs and plan the possible content of the potential requests for the support within the Global Fund CRG TA Program.

DPNSEE President Vlatko Dekov presenting lessons learnt from North Macedonia

Genci Muçollari, Executive Director at DPNSEE member organisation Aksion Plus who participated in the workshop, thinks that “It was an interesting workshop though we were expecting high level presentation from the GF and the Ministry of Health and Social Protection (MHSP). World Health Organisation representatives were attending, other NGOs as well. Above all discussions among partners, the role of the MHSP and the Albanian government is very important to ensure a gradual transition from Global Fund to state funds through social contracting and other ways of contribution both in money and in kind to programs and activities covered before by GF. The workshop organizers presented some of the funding opportunities from other regional donors and call for proposals in order to support activities after the GF.

The event was organized by the Regional Platform for Communication and Coordination for the EECA Region, hosted by Eurasian Harm Reduction Association (EHRA).

US Senate plans increasing the contribution to the Global Fund by 15.6%

One month before the Replenishment Conference to be hosted in Lyon, France, good news came from the US.  Their Senate plans increasing the contribution of this single largest donor of the Global Fund by 15.6%! This is the first increase in six years and the third largest increase since the Global Fund was founded. The Senate included language affirming it anticipates funding at this level through the Global Fund’s 6th Replenishment cycle.

Excerpts from the media release of the Friends of the Global Fight Against AIDS, Tuberculosis and Malaria

Today the Senate Appropriations Committee posted the State, Foreign Operations, and Related Programs fiscal year 2020 funding bill, increasing funding for the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) to $1.56 billion in fiscal year 2020, a 15.6 percent increase from the previous year. The bill is expected to be considered by the full Senate.

The report accompanying the appropriations bill also specified that the Senate Committee anticipates maintaining this appropriation level in fiscal years 2021 and 2022, coinciding with the Global Fund’s Sixth Replenishment cycle:

“The Committee recommends $1,560,000,000 for a U.S. contribution to the Global Fund. In advance of the Global Fund Replenishment Conference in 2019, the Committee anticipates that the United States will pledge not less than this amount for each of the three fiscal years pertaining to the Global Fund’s Sixth Replenishment. The Committee does not support the administration’s proposal to amend the longstanding matching rates for U.S. contributions to the Global Fund and expects the United States to continue to match other donor contributions at a rate of $1 for every $2 received from other donors.”

A $1.56 billion annual appropriation would translate to a $4.68 billion U.S. contribution over the three-year Replenishment cycle, helping the Global Fund meet its goal of at least $14 billion.

Congress has firmly rejected the President’s proposed cuts and affirmed America’s support for the Global Fund and dedication to ending the world’s deadliest infectious diseases.

Over the summer, several countries announced their pledges for the next three years – Germany, Switzerland, Canada, the European Union, Italy, Japan, UK, South Korea, even India. All will increase their contributions. The European countries (and the EU together with the individual countries are the largest contributor to the Global Fund!) in average increase by 15%.

Global Fund Replenishment Conference FAQ

The Global Fund Replenishment Conference that takes place every 3 years. The aim of the conference is to raise funds and mobilize partners in the fight to end AIDS, TB and malaria.

The sixth Replenishment conference will take place on October 10 in Lyon, France at Palais des congrès de Lyon. This is the first time France (the second largest donor to the Fund) is playing host.

The target for the Sixth Replenishment Conference is to collect 14 billion USD over the next 3 years. This is an ambitious target, but the funds would save 16 million lives and prevent 234 million new infections between 2021 and 2023.

If you want to know more, read the FAQ webpage created by RED following this link>>>.

Countries increase their support to the Global Fund

During the G7 Summit in Biarritz, France, Chancellor Angela Merkel announced a pledge of €1 billion for the upcoming three-year period, representing a 17.6% increase.

Germany is the fourth-largest donor to the Global Fund. Germany’s investments have helped the Global Fund partnership save more than 27 million lives and reduce deaths from AIDS, TB and malaria by one-third. As a leading voice in global health and development, Germany has advocated the need for international cooperation around global health security, health systems strengthening and antimicrobial resistance. It strongly endorses the need to reduce inequalities in accessing health care, overcoming human rights and gender barriers.

The Global Fund welcomed the government of Italy’s announcement that it will contribute €161 million to the Global Fund over the next three years, as also announced in Biarritz by Prime Minister Giuseppe Conte. This pledge – representing a 15% increase from Italy’s previous contribution – is a clear demonstration of the country’s commitment to end the epidemics of HIV, tuberculosis and malaria.

Italy has been a strong supporter of the Global Fund since it was established in 2002. Italy hosted the first meeting of donors to replenish the Global Fund’s resources in Rome in 2005. It has also played a key role in shaping Global Fund’s policies, including advancing human rights, building stronger systems of health and investing in challenging operating environments.

The Swiss Federal Council approved a contribution of CHF64 million to the Global Fund’s Sixth Replenishment. This is the highest contribution ever granted by Switzerland to the Global Fund.

Switzerland shares a seat with Canada and Australia on the Global Fund Board. With this representation, Switzerland plays a key role in initiating and shaping discussions on issues such as embedding the fight against the three diseases in the broader universal health coverage agenda, strengthening Country Coordinating Mechanisms, and promoting the role of civil society and the provision of health services to vulnerable and marginalized populations.

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France will host the Global Fund’s Sixth Replenishment pledging conference in Lyon 9 – 10 October 2019. The Global Fund seeks to raise at least US$14 billion for the next three years to help save 16 million lives, cut the mortality rate from HIV, TB and malaria in half, and build stronger health systems by 2023.

The Global Fund Replenishment Conference aims to further mobilize efforts to end the epidemics of three of the world’s most devastating diseases by 2030, in line with the Sustainable Development Goals.

EU announces record €550 million contribution to Global Fund

The EU announced a €550 million pledge to The Global Fund during the G7 summit in Biarritz. European Council President Tusk, representing the EU at this year’s G7, made the announcement. It comes ahead of the Global Fund donors’ conference that will take place in October in Lyon, as more support is needed so that developing countries can improve their health systems, reach universal health coverage and help end the 3 epidemics by 2030.

The Global Fund seeks to raise at least €12.6 billion (US$14 billion) for the period 2020-2022. By 2023, these funds should help save an additional 16 million lives, avert 234 million infections, cut the mortality rate from AIDS, tuberculosis and malaria in half, and build stronger health systems.

Today’s pledge is made under the assumption that the EU’s new Multiannual Financial Framework for the period from 2021-2027 and the new external action instrument, which would provide the budget for today’s pledge, are adopted broadly along the lines proposed by the European Commission.

On top of the overall €1.3 billion contributions made to global initiatives such as the Global Fund, the Global Vaccination Alliance (GAVI) or the WHO’s universal health coverage partnership, the EU’s development cooperation supports with additional €1.3 billion the health sector in 17 countries (mostly in Africa) during the period 2014-2020.

In global health, the EU focuses on equitable and accessible health care, sustainability of health systems, human rights, women and girls, and private sector engagement.

For more Information about the EU and the Global Fund to fight AIDS, tuberculosis and malaria partnership, follow this link>>>

Canada announces increased commitment to Global Fund

Maryam Monsef, Minister of International Development and Minister for Women and Gender Equality, announced that Canada will pledge $930.4 million to the Global Fund for 2020 to 2022, an increase of close to 16% from 2016. Tackling these infectious disease epidemics is key to protecting global health and addressing the health needs of the most vulnerable, including women and girls, around the world. The Minister made this announcement on 22 August 2019 while participating in an armchair discussion with prominent Canadian and international academic and civil-society representatives. This announcement is made ahead of the Global Fund’s Sixth Replenishment Conference, which will be held in France in the fall.

This pledge follows the Government of Canada’s historic commitment to increase global health funding to $1.4 billion annually on average by 2023. Canada’s approach to global health includes maternal, new-born and child health and comprehensive sexual and reproductive health and rights and services.

Canada is at the forefront of international efforts to improve the health of the poorest and most vulnerable, especially women, girls and adolescent girls. This is why Canada is joining forces with the Global Fund to Fight AIDS, Tuberculosis and Malaria to end these epidemics for good by increasing its contribution to the Fund.

Transition of TB program in Romania

Source: Regional Civil Society and Community Support, Coordination and Communication Platform – EECA

35 participants including civil society representatives, CCM members, Global Fund Portfolio Manager, experts from neighbouring countries and representatives of the governmental structures gathered in Bucharest on 13 – 14 of June at a workshop “Transition from the Global Fund support of TB program to national funding: understanding the role, opportunities and priorities for civil society in Romania” to discuss what they can do for a greater sustainability of the country’s responses to the TB and HIV epidemics.

Based on the Global Fund Board’s decision in November 2016 on the allocation of resources for the 2017-2019 allocation period, Romania has been allocated € 4,052,972 for tuberculosis and building resilient and sustainable systems for health. The implementation of this new TB grant in Romania formally started in March 2019 and it is planned to finish its implementation in March 2021. This grant is being considered as the last TB grant for the country to support the transition processes. Although the new Global Fund 2019 Eligibility List does mention Romania as being eligible for TB funding again, yet, the eligibility does not guarantee an allocation, and it is not clear if Romania will be allocated any further funding to support the TB response in 2020 – 2022.

Although Romania is ineligible to receive Global Fund funding for HIV response since 2010 when its last Global Fund HIV grant came to an end, the current “transition grant”, as well as all previous TB grants to Romania, includes a significant component on HIV prevention among key affected populations (KPs). Therefore, civil society mobilization for joint advocacy to ensure the domestic funding of HIV prevention activities among KPs is essential.

At the same time, according to the Global Fund’s Eligibility List 2019 Romania may be eligible for an allocation for HIV/AIDS for non-governmental or civil society organizations if the country demonstrates the barriers to providing funding for interventions for key populations, as supported by the country’s epidemiology. The Global Fund Secretariat will assess whether the criteria have been met at the time of determining allocations for the 2020-2022 allocation period. The decision on the countries‘ allocations within the next 2020-2022 allocation period to be made by the Global Fund Board in November 2019.

EHRA representatives visit

As the DPNSEE project Budget Advocacy and Monitoring in countries of South East Europe funded by Open Society Foundations (OSF) through Eurasian Harm Reduction Association (EHRA) is about to come to an end in April this year, EHRA Financial Director Tatiana Fomicheva and Sustainability and Transition Adviser Ivan Varentsov visited DPNSEE on 17 and 18 April 2019. The purposes of the visit were to make an oversight of the project related documents and provide support with regard to the development of the final financial report.

EHRA representatives had an opportunity to meet with representatives of the national coordinator organisations MarginaJuventas and Prevent and get to know better their achievements and challenges while implementing the project. It was also interesting to discuss lessons learnt, possible next steps and follow up actions. All three indicated that the main issue they faced was lack of information or very slow response to provide them by the authorities. Understanding this obstacle, an agreement was made that DPNSEE and partner organisations will propose to extend the project by September 2019.

Our guests presented us the EHRA activities in the scope of the Global Fund HIV multi-country project, content of the workshop on human rights issues for the Balkan region planned for autumn this year and the Global Fund Community, Rights and Gender Technical Assistance Program. For this occasion, we also invited our colleagues from Serbian partner and member organisations DugaGAJPTimok Youth Centre and Čovekoljublje.

For our guests, we also arranged meetings with Dr Jasmina Tanasić, Head of the Department for Social Affairs at the Standing Conference of Towns and Municipalities and Primarius Dr Danijela Simić, Head of Department for HIV infection, STI, viral hepatitis and tuberculosis, Centre for Prevention and Control of Diseases, at the Institute of Public Health of Serbia “Dr Milan Jovanović Batut”.

The visit will help to better document the approach, process and results of our project as well as the lessons learnt. Documenting this our joint experience as a regional best practice and example of small grants to NGOs in recently transitioned of transitioning countries to support their sustainability and transition related advocacy activities can be of benefit to the Sustainability Bridge Funding that is about to be created by a group of international donors led by the OSF.

People before politics

Ahead of the 26th Harm Reduction International conference, Harm Reduction International has launched a Call to Action on harm reduction funding and the Global Fund to Fight AIDS, TB and Malaria 6th replenishment.

Funding and political support for harm reduction is in crisis in many countries around the world. Harm reduction is evidence-based, cost effective and has a positive impact on individual and community health. While harm reduction is far broader than HIV prevention, this call to action centres on galvanising urgent action to secure a strong 6th replenishment of the Global Fund, in recognition of the significant impact of HIV and TB on people who use drugs.

The Global Fund aims to raise at least US$14 billion at its 6th replenishment, which will be invested from 2020-22. We believe that more funding is required and support the call of the Global Fund Advocates Network (GFAN) for a replenishment of $18 billion. This will enable the Global Fund to step up the fight to end HIV, TB and malaria, and we urge Global Fund donors to be ambitious in their pledges. A strong and fully-funded Global Fund is vital to the harm reduction response and to delivering on government commitments to end AIDS by 2030.

The Call is on

  • Governments, philanthropic donors and the private sector to step up and fully fund the Global Fund, to make ambitious pledges to ensure the US$18 billion target is reached.
  • Governments to put “People before politics” and ensure that people who use drugs are not left behind in the fight to end AIDS by 2030
  • The Global Fund Board to safeguard catalytic investment funds, regardless of replenishment outcome, in order to sustain life-saving services for people who inject drugs and to incentivise domestic investment in harm reduction.

You can read the Call to Action following this link>>>

You can add your organisation’s name to this call to action via the form here>>>

You can share the Call to Action with your networks/other organisations and on social media, using this tweet