HIV Reform in Action USAID Project Newsletter No 1 January 2015
Index 3 4 7 9 Foreword by Nata Avaliani Consolidating Efforts to Support HIV Reform in Ukraine Development of Regional AIDS Programs Workshop in Tbilisi 12 14 16 Work in the Regions The Project Activities in the Lviv Oblast Activities in the Dnipropetrovsk Oblast Project Work in the Poltava Oblast 17 Working Meeting on Human Resources for HIV/AIDS This newsletter was made possible due to the funding provided by the U.S. President s Emergency Plan for AIDS Relief through the United States Agency for International Development (USAID) under the terms of the HIV Reform in Action Program, award number AID-121-A-13-00007. The contents do not necessarily reflect the opinion of PEPFAR or USAID. 2 HIV Reform in Action USAID Project. 72 Horkoho Street, office 117, Kyiv, 03150, Ukraine Telephone: (+380) 44 200 5521. Email: info@hivreforminaction.org
Dear Readers! This is the first issue of the HIV Reform in Action Project newsletter. Our newsletter will update you on how our Project contributes to health reform for HIV/AIDS and specifically in areas of policy, finance and human resources. We are pleased to summarize our work in 2014, which turned out to be much more challenging than expected. Ukraine s National AIDS Program for 2014-2018 only became effective in December 2014. Additionally, the Global Fund grant which currently finances the purchase of drugs and direct provision of HIV services, specifically AIDS prevention, will terminate financial support at the end of 2017. The goal of our Project is to strengthen Ukraine s health system to ensure effective and sustainable delivery of HIV/AIDS prevention, care and treatment services to key populations. This five year project implemented by Deloitte Consulting LLP runs from October 2013 through September 2018. Our project worked in three oblasts across Ukraine including Dnipropetrovsk, Lviv and Poltava. Next year we will expand project activities into additional oblasts. Our work in the regions is very important and we will cover oblast activities in upcoming issues. The newsletter will soon be published on our website hivreforminaction.org, and today you can subscribe to it by sending an e-mail request to: info@hivreforminaction.org. Have a Peaceful and Happy New Year! Nata Avaliani, Chief of Party HIV Reform in Action - USAID Project Deloitte Consulting LLP 3
Consolidating efforts to support HIV reform On November 20, 2014, HIV Reform in Action, a USAID Project, held a Stakeholder Meeting Consolidating efforts to support HIV reform in Ukraine. During this event, more than 80 representatives of government agencies, international partners, non-governmental stakeholders, academic sector and expert community discussed HIV/AIDS reforms in the context of the health reform in Ukraine.
The meeting participants were greeted by Oleksandr Sych, Vice Prime Minister of Ukraine, who appreciated the collaboration of governmental and non-governmental entities in the field of HIV response at national and international level. The first full membership of Ukraine in the UNAIDS Coordination Board proves the world recognition of our HIV/AIDS response efforts. It has become possible due to close collaboration with international organizations: UNAIDS, UNICEF, WHO, USAID. However, we wouldn t have been so successful without the consolidation of efforts at the national level and involvement of NGOs, emphasized the Vice Prime Minister. He also sited of the approval of the National AIDS Program for 2014 2018. This topic was continued by Charles Lerman, Director of the Office of Health of the USAID/Ukraine, who mentioned the following in his welcoming speech, The National AIDS Program was approved by the Verkhovna Rada and the President of Ukraine. It is critical that NAP interventions are fully implemented and the regional AIDS programs are based on regional priorities and complement NAP activities. The participants of the meeting moderated by Mariya Makovetska, Project Deputy Chief of Party, were also greeted by Ibrahim Shehata, Project Director of Deloitte Consulting LLP, which implements HIV RiA Project in Ukraine from October 2013 through September 2018. This meeting helped stakeholders and counterparts to share strategic ideas and consolidate efforts to support reforms in the field of HIV/AIDS program planning, budgeting and service provision, said Nata Avaliani, HIV reform in Action Project Chief of Party. She underlined that the sustainability of preventive interventions for the most at-risk populations is in the focus of the project s efforts as those populations are currently almost 100% dependent on the external funding coming to an end in mid-2017. With the significant reduction of the Global Fund resources and difficult socio-economic situation in Ukraine, it is of critical importance to prioritize activities, reform the health system and develop new cost-effective service delivery strategies. Olena Yeshchenko, Acting Head of the State Service of Ukraine on HIV and Other Socially Dangerous Diseases, spoke about the challenges resulting from the Global Fund phase-out and the termination of the State Service, while Volodymyr Kurpita, Head of the MOH SAG Expert Group, presented the draft Strategy of Ukraine s health reform and answered questions of the audience. Notably, after the meeting of November 20, another SAG member Oleksandr Kvitashvili was appointed the Minister of Health of Ukraine and promised to present the Strategy on December 3. Ihor Perehinets, Deputy Head of the WHO Country Office in Ukraine, presented his vision of the health reform in Ukraine. Eleonora Gvozdeva, Strategic Information Adviser of the UNAIDS Country Office in Ukraine, made a presentation on the Investment Case as the opportunity to estimate costs and define best modalities for HIV prevention, care and support services, while Natalia Nizova, Director of the Ukrainian Center for Diseases Control, focused on HR for HIV challenges in the context of health reform. 5
During the meeting, successful pilot projects were discussed after the presentations made by USAID-funded projects RESPOND, RESPECT, Health Financing and Governance (HFG- Ukraine), Strengthening TB Control in Ukraine, as well as by Poltava NGO Svitlo Nadii, Network of PLHIV and International HIV/AIDS Alliance in Ukraine. The Stakeholder Meeting was followed by another meeting on November 21 for the Project regional counterparts, during which the Project strategic activities were presented. Current situation and problems of HIV response in pilot regions, components of regional AIDS programs were described by representatives of health departments from the Dnipropetrovsk, Lviv and Poltava oblasts. Also, on November 21, the health sector financing and HR strengthening were discussed. The workshop on HRH for HIV was conducted as well. 6
HIV Reform in Action Project helps implement the National AIDS Program and develop related regional programs On October 20, 2014, the Verkhovna Rada of Ukraine adopted a Law on Approval of the National AIDS Program (NAP) for 2014-2018. According to the NAP, currently there are over 129 000 people living with HIV and enrolled in care, HIV prevalence is 283.6 per 100 000, and more than 24 000 people live with AIDS. In 1987-2012, 28 498 people died of AIDS-associated diseases. The purpose of the NAP is to reduce HIV / AIDS morbidity and mortality, provide quality, accessible and affordable prevention and diagnostics services, specifically for key affected populations (KAPs), treatment, care and support services for PLHIV as part of health system reform. Although the HIV incidence rate has decreased (from 16.8% in 2006 to 3.6% in 2011), the number of reported HIV infections has been growing annually, with the level of access to treatment, especially among KAPs, dramatically low, says NAP. NAP financing is to be provided by national and local budgets, the Global Fund to Fight AIDS, Tuberculosis and Malaria (which approved a grant for Ukraine until December 31, 2017) and other sources. Similar to the NAP, each region is expected to develop its own regional AIDS program, taking into account NAP activities. And this is the purpose of the technical assistance of HIV Reform in Action Project provided to the regions of Ukraine. In particular, such TA was received by Oblast HIV and TB Coordination Councils in Lviv, Dnipropetrovsk and Poltava. Special emphasis during the development of programs is made on the multisectoral cooperation and input from governmental and non-governmental sectors, KAPs and so on. 7
After the successful launch of the Project activities in these three regions, the State Service of Ukraine on HIV and Other Socially Dangerous Diseases invited HIV Reform in Action Project to provide technical assistance for the development of other regional programs in the country. The Project contributed to the December meetings/seminars for the specialists from ministries and institutions involved in the NAP implementation, chief physicians of AIDS centers and M&E experts, who learnt how to plan regional activities, calculate their cost and set indicators based on the situation in the region. Regional experts were offered a financial tool developed by the Project based on the national tool. This tool contains numbers and indicators from the NAP, however, they were calculated for each region. Therefore, the region will be able to receive evidence-based indicators of prevention and treatment coverage, planned procurement of drugs, laboratory and diagnostic equipment, as well as a detailed inventory of all procurements envisaged for the oblast. The process was facilitated by the Project Health Financing Advisor Kateryna Sharapka. In 2015, the Project intends to continue assisting with the development of regional programs in close collaboration with the regions. 8
Ukraine s delegation took part in Sustainability workshop in Tbilisi On September 22-24, 2014, in Tbilisi, in partnership with the EU project Broader introduction of effective HIV prevention strategies targeting most-at-risk populations in Eastern Europe, implemented by the International HIV/AIDS Alliance in Ukraine, the regional workshop Sustainability mechanisms of HIV medical and social services for key populations took place. 9
10 The workshop in Tbilisi was focused on current models/mechanisms ensuring sustainability of priority services for key populations in Eastern Europe, South Caucasus and Central Asia. The workshop was attended by the Ukraine s delegation consisting of the representatives of the MoH, MSP, MoF, the State Service of Ukraine on HIV and Other Socially Dangerous Diseases, UCDC and key NGOs. Advisors to HIV Reform in Action Project Zhanna Parkhomenko (HRH) and Julia Zhytkova (Capacity Building) co-facilitated the discussions and contributed to the development of models/ mechanisms ensuring sustainability of medical and social services for key populations in the region. Regional legislative framework was analyzed for the availability of institutionalized mechanisms and sources of funding for medical and social services to key populations, as well as the mechanisms to attract state funding for KAP services and develop an NGO sector. The meeting participants analyzed risks and barriers in service provision sustainability, as well as further steps to implement the strategy on providing medical and social services for KAPs with the state financial support. The workshop also discussed the possibilities of regional collaboration and advocacy of continuous access of KAPs to medical and social services. Using service mapping tools, based on WHO guidelines, the participants analyzed the availability, challenges and gaps related to the existing mechanisms of service provision to KAPs. Representatives from Eastern Europe, South Caucasus and Central Asia presented best practices in funding medical and social services for PLHIV, FSW and MSM. Among other best practices, great interest was shown towards self-
payment system and free treatment of Hep C in prisons (Georgia), provision of prevention services, including MAT, using funds of the State Medical Insurance Company (Moldova), social contracting mechanism at the national level (Belarus), financing of services for KAPs at the local level (Poltava, Ukraine), state out-of-budget fund (Tajikistan) and 5 different levels of service delivery funding sources (Russian Federation). Based on the outcomes of the Tbilisi workshop, the International HIV/AIDS Alliance is preparing a publication on best practices in delivery/sustainable financing of HIV services for KAPs. Ukraine s delegation, the biggest among the participating countries due to HIV Reform in Action Project support, was quite proactive in discussing and presenting best practices. To finalize proposals made by the Ukraine s delegation members, a follow-up meeting took place in Kyiv a week after participants had returned from Georgia. During that follow-up meeting, next steps required to ensure the sustainability of HIV prevention services were discussed. Based on the results of meetings in Tbilisi and Kyiv, inter-sectorial dialogue among representatives of key ministries of Ukraine was established, specifically, to identify various financial mechanisms/ tools able to support sustainability of services for KAPs. The State Service and MSP requested for TA to develop methodology guidelines, standards and other regulatory documents on provision of preventive services. 11
Project Activities in the Lviv Oblast The experts in the Lviv oblast received substantial assistance from the HIV Reform in Action Project staff for the development of the oblast AIDS program for 2015-2018. During the first meeting of the Multisectoral Working Group (MWG) under the Lviv Oblast HIV/AIDS and Other Socially Dangerous Diseases Coordination Council, held on December 3-4, the experts had a number of consultations and scheduled follow-up meetings to finalize and submit the draft Program to relevant committees for consideration. HIV Reform in Action Project was also actively involved in the World AIDS Day events in the Lviv oblast. As part of the oblast IEC campaign on active detection of PLHIV, with the Project support, the workshop on HIV issues was conducted on November 27 for specialists in infections and social workers. The main goal of the workshop was to discuss HIV prevention and diagnostics issues in the Lviv oblast and plan activities for 2015. Also, the forum discussed issues related to the analysis of the system of continuous provision of quality, accessible and affordable HIV prevention and diagnostics services, specifically to key affected populations (KAPs), in the Lviv oblast. The main problems of the effectiveness of prevention for KAPs and procedure of work with families in crisis, including temporarily displaced persons, were discussed. On November 28, the Lviv Press Club hosted the press conference organized by the Project, during which the representatives of governmental and non-governmental organizations presented the options for detection and prevention of HIV / AIDS and prospects for treatment and provision of services, joint efforts to combat the epidemics, and discussed impact of migration on the spread of HIV / AIDS in the Lviv oblast. 12
With the technical support of the Project, other events on the occasion of the World AIDS Day were organized by the Lviv oblast center of social services for families, children and youth. Jointly with the National Technical University, lectures on HIV transmission and its consequences in Ukraine and the Lviv oblast were delivered. In order to draw public attention to the problem of HIV spread and prevention and promote tolerance towards PLHIV, participants of the event walked to the monument of Ivan Franko in Lviv. In addition, a red ribbon flash mob was organized in the yard of the Lviv Technical University. To promote a healthy lifestyleand to draw children s attention to the issues of transimssion of HIV and primary prevention, a contest of children s drawings Children against AIDS among schoolchildren aged 8-16 was organized. The winners were announced in the second half of December 2014. The organizing team hopes that these events will promote tolerance towards PLHIV. Oleksandra Khudoba, Project Coordinator in the Lviv oblast 13
Activities in the Dnipropetrovsk oblast 14 HIV Reform in Action Project activities in the Dnipropetrovsk oblast have been successful in the development of regional capacity as regards evidence-based and gender-sensitive HIV policy making.
In particular, with the support of the Project, members of the Multisectoral Working Group under the Oblast TB and HIV Coordination Council held two meetings in late October and early December 2014 dedicated to the preparation of the Infectious Socially Dangerous Diseases Program of the Dnipropetrovsk oblast. More than 20 representatives of oblast government agencies and NGOs are involved in the development of the oblast program. During the meetings, the experience and results obtained during the implementation of the previous program for 2008-2014 were discussed and priorities of HIV prevention, treatment, care and support of PLHIV at the oblast level in the coming five-year period were identified. in the region. The draft oblast program envisages more profound HIV testing of the general population and more allocations for the procurement of medicines for OI treatment from the oblast budget. The draft new oblast program includes the piloting of innovative forms of organization of medical care to PLHIV, including social contracting mechanism and so on. For the first time, the oblast AIDS program, in addition to people who inject drugs and prisoners, refer to female sex workers, men who have sex with men and most at-risk adolescents as key affected populations. The draft regional program is submitted to the Health Department of the Dnipropetrovsk Oblast State Administration for finalization, approval and further submission to the Oblast Council for consideration. As a result of the Project support, amounts of funding for HIV / AIDS response at the oblast level from the national budget and the Global Fund to Fight AIDS, TB and Malaria have been identified. When drafting the AIDS program of the Dnipropetrovsk oblast for 2015-2018, regional experts made detailed expenditure estimates from budgets of all levels for its implementation, and clearly defined quantitative performance indicators and expected results. Anna Kolokhina, Project Coordinator in the Dnipropetrovsk oblast The draft AIDS program of the Dnipropetrovsk oblast for 2015-2018 fully complies with the aims and objectives of the National AIDS Program for 2014-2018, but also takes into account the specificity of the HIV epidemics 15
Project work in the Poltava oblast HIV Reform in Action Project started in the Poltava oblast in September 2014 with the collection of epidemiological statistics in the region, assessment of priorities of local policy and analysis of capacity of NGOs to influence the local policy ensuring sustainability of HIV / AIDS services. Project experts visited Poltava and met the representatives of authorities, healthcare facilities and non-governmental organizations directly involved in HIV response and policy development in the oblast. During the visit, Project staff participated in the meeting of the Poltava Oblast HIV and TB Coordination Council, presented strategic plans of the Project and established cooperation with local partners. The Regional Project Coordinator is currently involved in the development of the oblast program together with local authorities and healthcare facilities. It should be noted that this draft program has become an outstanding success in the process of local HIV policy making, because it was drafted by a large number of players. The expertise of the Project staff and rationalization of needs were important for the local authorities to understand the need in sustainable HIV / AIDS service delivery in the region. The draft program has been submitted for consideration to the Poltava Oblast Council and is to be approved. Yuriy Nestulia, Project Coordinator in the Poltava oblast 16
Working meeting on human resources for HIV/AIDS On December 23, the Ukrainian Center for Diseases Control of the Ministry of Health of Ukraine and HIV Reform in Action Project held a working meeting in Kyiv on the development of human resources for HIV in Ukraine. During this event, the experts discussed proposals to the strategy of the development of the HR capacity and institutionalization of the training experience of international TA projects in the field of HIV response. The participants were welcomed by the Acting Head of the State Service of Ukraine on HIV and Other Socially Dangerous Diseases Olena Yeshchenko, Senior HIV/AIDS Advisor of the Office of Health of the USAID/ Ukraine Paola Pavlenko, UCDC Director, Prof. Natalia Nizova and COP of the USAID HIV Reform in Action Project Nata Avaliani. Oleksandr Tolstanov, Deputy Director of the National Medical Academy of Postgraduate Education named after P.L. Shupyk, presented on the organization of training for the staff working in the field of HIV / AIDS in the public system of postgraduate education. The head of the training center of the NGO Chas Zhyttia Plus Svitlana Antoniak shared the experience of the national training center in the development of human resources for HIV under the implementation of the Global Fund to Fight AIDS, Tuberculosis and Malaria grant programs. Zhanna Parkhomenko, Project Health Systems Strengthening/HR Advisor presented the results of the HR needs assessment situation analysis. The experience of the I-TECH project in the development of HR needs monitoring tools was presented by the Project Director Anna Shapoval, while the achievements of the RESPOND Project in assessing HR needs for HIV were presented by the Project Senior Adviser Alla Boyko. The work of the Vinnytsia clinical training center was presented by Ihor Matkovskyi, Chief Physician of the Vinnytsia Oblast AIDS Center. The participants agreed to establish a working group that would address the HRH for HIV issues and use resources of national structures of international TA projects. 17