Ludmila Trukhan: "Beginning in 2016 all programs will gradually transition to funding from local budgets"

29 September 2015

The Global Fund will continue working in Belarus for another three years, but the process of transitioning all prevention programs to national funding has already begun. Slowly, but gradually, one program after another are taken on by local budgets – at the oblast and rayon levels.

The first Belorussian pilot OST (opioid substitution treatment) project was written in 2002 in response to the first HIV outbreak among people who injected drugs, registered in Svetlogorsk. But then we could not find a donor. In December 2004 the Global Fund started its operations in the country and allocated funds first to support the existing needle exchange programs and in 2007 – to support OST programs.

– Our law enforcement officers visited Poland and Lithuania to study the experience of OST programs. According to the Global Fund grant plans, the first sites were to open in 2005. But in fact three years passed while negotiations and approvals of the legal framework were taking place. Gomel state drug treatment clinic demonstrated courage and started the first pilot project.

One site?

– Yes. And in two years of its operations experts of the Ministry of Health conducted an evaluation of this site. This was the evaluation of the quality of life. We found that among clients of the opioid substitution treatment programs imprisonment rates significantly decreased, compared to those on the «wait list». This was an important argument in support of the program and since 2009 opioid substitution treatment sites have opened in other Belarus cities.

The second evaluation was conducted in 2013. This evaluation looked at the socio-economic effectiveness of the program and was conducted not only by drug treatment specialists, but also by economists. It showed that the program is truly effective. As a result, today 19 sites of opioid treatment are operational in Belarus. Coverage as of early 2015 was 1083 clients.

Please tell, how these program is funded?

– From the very beginning funding was joint: rent and utility bills have always been paid from the state budget. Since last year, local budgets have also paid for security alarm system, transportation and staff - from funds allocated for drug treatment centers.

So is that national-municipal funding?

– No, the funding comes exclusively from local sources: provided by rayons and oblasts. There is no republic level funding.

How about methadone?

– Methadone will be procured with the Global Fund funding until 2018. And beginning in 2019 – funds will be allocated in the republican budget.

How about other prevention programs?

– Since 2004 until now the Global Fund funds 100% of needle and syringe programs. But from the beginning all new projects were based in community organizations as well as governmental healthcare institutions. Beginning 2016 gradual transition of all programs to local budgets is planned.

Are antiretroviral drugs purchased with the funds from the Global Fund or the national budget?

- Procurement of antiretroviral drugs in Belarus is carried out mainly at the expense of the Global Fund. The first purchase by the State (national budget) was made in 19 December 2012. In 2014 the country established the manufacture of drugs for HIV infection treatment. But when the drugs were procured with the state budget funds the prices were higher than when the drugs were paid by the Global Fund. It was therefore decided to use the international procurement mechanism for now, but to give priority to domestic manufacturers: that is, ARV drugs that are produced in the country will be paid for from the national budget. And those that are not produced in the country will be procured at the expense of the Global Fund. It is expected that the list of names of drugs purchased by the state, will gradually grow, the Global Fund, respectively, will reduce financing antiretroviral drug procurement, and, in the end, the country will transition to drug procurement fully paid from the republican budget.

Does this mean that the Global Fund has not left yet and the state already began to “take on” the programs? 

– The Global Fund will remain in the country in 2016–2018.  And in connection to this fact, in the State Program on HIV Infection Prevention for 2016-2020 clearly states that the Global Fund funding for harm reduction programs will be gradually decreasing and the share of national funding will be increasing with complete transition to national funding expected in 2019.

 In other words, do you have a plan of transition national funding?

– Yes, we have the plan and this is our State Program on HIV Infection Prevention for 2016-2020 that is currently undergoing final approvals.

We have concerns about the fact that no mechanism to fund NGOs from local budgets was developed. But as regards needle and syringe exchange programs, we have described the process of their partial transfer to health services. We hope that they will take on needle exchange programs and will meet the condition of hiring outreach and social workers from among the representatives of community organizations and the community of people who use drugs. It is necessary to continue these activities: by the end of 2018 we plan to increase the coverage of needle and syringe programs up to 60%.

Are you going to expand the existing program of opioid substitution therapy?

– Yes. The estimated number of opiate users is 18,450 people. However, only about 5% is now covered by opioid substitution treatment. By the end of 2018 we plan to increase this figure to 26%. An ambitious target, but at the beginning of next year we plan to assess the number of drug users in cities with a high risk of drug addiction. And then the number of opiate users will be exactly determined. In recent years there have been major changes in the drug scene: a growing number of people who use stimulants, including injecting drugs. In Minsk, now there is an outbreak of HIV infection among those who in the past two years used "speed." And if, for example, early in Minsk the share of drug users accounted for about 30% of new HIV cases, now this figure increased up to 75%.

It is very good that at the "Regional Dialogue" high level meeting there will be a separate session devoted to new drugs. This is a very important topic for Belarus.