The Eurasian Harm Reduction Association (EHRA) have published the report Republic of Serbia: Benchmarking Sustainability of the HIV Response in the Context of Transition from donor to domestic funding.
The aim of this analysis is to assess the fulfilment of HIV-related sustainability commitments given by the Government of Serbia in the context of the country’s transition from Global Fund support to national funding and uses the EHRA methodology, Benchmarking Sustainability of the HIV Response in the Context of Transition from Donor Funding which seeks to evaluate the achievement of the commitments by the Serbian Government to ensure the sustainability of HIV programmes. As a part of this study, the government’s commitments have been identified and prioritised and data collected to inform the extent to which those commitments have been fulfilled as planned.
Overall, the Government of the Republic of Serbia has shown moderate progress in fulfilling its transition and sustainability-related commitments. During the assessment, the commitments made by different health system domains have been reviewed, as well as the status of commitments made by different HIV programmatic areas. Out of 6 health system domains, significant progress was achieved in service delivery and human resources; average progress in drugs, supplies and equipment, and in data and information; while moderate progress has been made in health financing; and fairly low progress in governance.
With respect to programmatic areas, significant progress has been made concerning human rights, while substantial progress has been made in the fulfilment of the commitments related to prevention, treatment and support.
This publication was prepared by Maja Stošić, MD, PhD, EHRA Consultant.
The publication was published within the framework of the regional project called “Sustainability of Services for Key Populations in Eastern Europe and Central Asia” which is carried out by the Alliance for Public Health, in a consortium with the 100% Life (All-Ukrainian Network of PLWH), the Central Asian HIV’ Association and the Eurasian Key Populations Health Network with the aid from the Global Fund to Fight AIDS, Tuberculosis, and Malaria.
Eurasian Harm Reduction Association (EHRA) just published the case study “The Challenges of Global Fund Transition in Albania: HIV Prevention Services for Key Populations on the Brink of Collapse” which looks at the challenges which could be faced by country in sustaining HIV prevention programmes among KAPs, implemented primarily by civil society organisations (CSO’s), as a result of the withdrawal of the Global Fund through the transition period.
The purpose of this report is to identify gaps and challenges faced by CSO’s in the transition from Global Fund assistance to government support of services for key populations (KP) under the 2017-2019 grant. Whilst the funding commitment by government institutions is to absorb all costs, the methodology to prepare for this transition, and also the strategy to transfer costs, is unclear.
We hope that the information and arguments presented in this case study as well as the recommendations could be used by the civil society and communities representatives to support their sustainability and transition related advocacy activities as well as to establish the communication with other potential donors to persuade them to establish a ‘safety net‘ through which bridging funds can be made available to address the sustainability related challenges faced by KPs services in country.
HIV Prevention Services for Key Populations on the Brink of Collapse
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).
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.
