Gregory Vergus: “So far there is no such thing as the Global Fund addressing the issue of its own departure: How will these programs transition to the state?"

30 September 2015

Gregory Vergus represents at the Regional Dialogue the International Treatment Preparedness Coalition (International Treatment Preparedness Coalition, ITPCru) and the movement of "Patient monitoring". He is going to Tbilisi to understand how the countries will transition to national funding and what this means for access to treatment. He also would like to share the experience of Russia - after the Global Fund Russia has been through a lot: including major disruptions and the transition to decentralized procurement, and now, it seems, once again the country is heading toward a single vendor option.

– The first «break through» was enrolling 50 thousand people. Then – 70 thousand. And when the Global Fund was leaving, over 90 thousand new patients were enrolled in the treatment programs. I may be mistaken, I do not have exact numbers with me, but the numbers were approximately like this. In the beginning it looked wired – that we began such mass enrollment into treatment programs. But, it seems to me, that this was very useful for our healthcare system, whether they wanted it or not, the system began “spinning”. And this happened – the system began to work with people from various vulnerable groups. And medical specialists came to understanding that their patients are no longer the same crowd, they no longer agree to stay in lines, arrive at 7am, etc. The process has started and the healthcare system began to change for the better. And the people finally got their pills.

Did the Russian Ministry of Health promise to support all the programs the Global Fund?

 – As I recall, the Ministry of Health promised this in the form of an oral statement at the EECA conference on HIV / AIDS in (Conference on HIV/AIDS in Eastern Europe and Central Asia, EECAAC). I cannot recall whether there were any written statements. In terms of prevention, they did not support anything. And there are two issues.

First – policy issue. And second – maybe I simply do not know – but there is no such thing as the Global Fund addressing the issue of its own departure: how will these programs transition to the state? I did not see that in Russia then and I do not see this in other countries now.

Do you mean that there is no plan or strategy for transition?

– No. And I am afraid that in some countries the same may happen to treatment as what happened to prevention programs in Russia. And we should start thinking about this right now.

Russia did not take over the funding of prevention programs. And what about treatment?

– There have been positive changes as regards treatment in our country: the government started to allocate money for treatment. Not always very efficiently, and, as we see by the latest changes, the state is trying to cut expenses – but, at the same time, it is trying to increase the number of people on treatment, using a variety of mechanisms to lower prices. This has not been observed in other countries yet.

Gradually, our government is beginning to understand that we must live with its own funds and take care of its own citizens. At least in terms of treatment.

Now in Russia is the process of transitioning to a single procurement system. We do not really understand how it will be implemented, and there are so many bad scenarios. But the government’s intention is understandable – it is necessary to move away from the current chaos.

What are your expectations as you come to Tbilisi?

– It is very important for me to understand how the Global Fund will be leaving countries and what will happen to access to treatment; it is important that countries are not left with unregistered drugs. I really trust what harm reduction programs do. But as for treatment – it is important to clearly understand the details. There are a lot of nuances, and in some cases, perhaps even the Global Fund will not be allowed to participate in negotiations on the future treatment. This is first.

And secondly - we want to share our experience of working with the price control and with the analysis of the legislation governing procurement and pricing. We must help colleagues, so that they understand what they will face after the Global Fund leaves and medicines will be procured by the government. Because the level of expertise in the analysis of legislation, economic analysis of drug procurement, analysis of intellectual property as a price reduction mechanism – in the region is very low. Only now all begin to learn and understand how important this is.