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The report was prepared by David Otiashvili, M.D., Ph.D., for EHRN between June and August 2015. The author collected and reviewed a range of background materials and gathered input from key informants familiar with the Global Fund projects in reviewed countries. The desk review included analysis of country reports, program evaluation reports and data from international organizations. In-depth interviews with country respondents covered topics related to the progress of Global Fund funded programs, and the process of preparation for transition to domestic funding. Key informants included fund portfolio managers (FPMs), recipients of Global Fund grants, members of Country Coordinating Mechanisms (CCMs), representatives of civil society organizations and key affected groups in 11 countries reviewed in this report. EHRN is grateful to all who contributed to this document. The publication was prepared with generous financial support from the International Council of AIDS Service Organizations (ICASO). The views expressed in this publication do not necessarily reflect the donor’s official position.  

Advocacy materials

An open letter signed by a number of  organizations representing civil society including key affected populations from different Eastern Europe and Central Asia (EECA) countries and their partner organizations from other regions. The letter is addressed to the members of the Global Fund Board preparing for its 34th meeting on 16 -17 November 2015.

This report explores the transition-related situation in Belarus, describes challenges associated with ensuring sustainability of HIV programs in this country and provides recommendations that can be taken into consideration by stakeholders engaged with and/or affected by the transition.

EHRN’s previous Strategy expired at the end of 2014. Thus, EHRN members, Steering Committee and regional and international partners undertook rigorous analysis of EHRN’s performance in implementing our Strategy in 2010-2014 and developed a new Strategy for 2015-2019. The results of the strategic planning process clearly indicate that we, as harm reduction sector, must mobilize to prepare for and be able to adequately respond to considerable shifts in policy and funding landscape in the region.

With reductions in Global Fund support and lack of funding available from other donors, the EECA region now faces the challenge of raising domestic resources for these programs. The lack of transition and sustainability planning heightens the risk of countries losing the progress they have made over the last decade with Global Fund support. This case study examines the situation in Bulgaria and makes recommendations to the Global Fund, national governments, civil society, and other donors for easing the transition and safeguarding previous gains in HIV prevention in Bulgaria.

This document has been developed from the experiences and lessons learned during the development and implementation of Central Asian Regional HIV/AIDS Programme (CARHAP) harm reduction (HR) programmes for HIV and AIDS prevention in the Central Asian (CA) countries of Kyrgyzstan, Tajikistan and Uzbekistan between 2005 and 2012. The primary purpose of this booklet is to provide practical guidance and advice based on international best practice as reflected by local evidence and experience. To this end we have used individual and organisational examples of CARHAP‟s work to illustrate substantial points throughout. CARHAP has focused on provision of grants, capacity building, strategic planning, management skills and knowledge and technical skills for service provision which have been adapted to the individual circumstances and the situation in each country and to local contexts. Technical assistance has also been provided to promote networking among harm reduction service organisations (HRSOs) and to create coalitions for effective advocacy directed at governments and donors.

The Central Asia Regional HIV/AIDS Programme (CARHAP) was established in 2004 with the aim to contribute to averting a generalised HIV epidemic in the Kyrgyz Republic, Tajikistan and Uzbekistan. The actual implementation of the programme started in 2005, with a focus on reducing high-risk behaviours among most-at-risk populations (MARPs), especially people who inject drugs (PWID), sex workers (SWs) and men who have sex with men (MSM).   CARHAP has been investing in strengthening the capacity of harm-reduction service organisations (HRSOs), and the development of technical standards and guidelines for harm-reduction services. Monitoring and evaluation (M&E) has been a key priority for CARHAP since the onset of the programme. CARHAP and its partners have also developed and implemented tools for Client Behaviour Assessments (CBA), to assess and monitor behaviour changes among programme clients, and thus evaluate the results of the programme (outcome level). The Quality Management Toolkit (QMT) complements the  Management-Information System (MIS) and CBA tools by focusing on the quality of services, and the necessary organisational capacity of partner organisations to deliver these (high) quality services. 

Resolution adopted by the Participants of the Regional High Level Dialogue on Successful Transition to Domestic Funding of HIV and TB Response in EECA "ROAD TO SUCCESS" (Tbilisi, Georgia, 28-30 September 2015), including the Ministries of Health of Eastern European and Central Asian (EECA) countries, such as Belarus, Georgia, Lithuania, Moldova, Tajikistan, international partners, Joint United Nations Program on HIV/AIDS (UNAIDS), the Eurasian Harm Reduction Network (EHRN), East Europe and Central Asia Union of People Living with HIV (ECUO), Eurasian Network of People Who Use Drugs (ENPUD), Sex Workers Rights Advocacy Network (SWAN), Eurasian Coalition on Male Health, Eurasian Network of Women on AIDS, International Coalition on Treatment Preparedness for Eastern Europe and Central Asia (ITPCru) and TB Europe Coalition.

Croatia successfully implemented the GF project ‘Scaling-up HIV/AIDS response in Croatia (2003- 2006)’, continued funding preventive activities after the project ended, and was able to keep the HIV epidemic at the low level. This report presents an overview of the implementation of the GF project and transition process to national financing mechanisms in Croatia. Project sustainability activities were continuously implemented through the stakeholder network. Despite limited resources due the long-term financial crisis and some problems and challenges, this transition is an example of good practice and could indicate strategies for sustainability of preventive HIV/AIDS programmes, particularly in countries from South Eastern and Eastern Europe, using the financial resources available through the GF projects. The experiences from a successfully implemented GF project and its sustainability have shown the importance of joint work and multisectoral collaboration between governmental institutions and civil society. In addition, it shows that GF does not only provide financial resources, but makes a positive contribution in developing a national response by building partnerships, collaboration, and investing in people.

Report on the results of the “Technical consultation on transition to domestic funding of HIV and TB responses and their programatis sustainability in EECA” which took place in Istanbul on 21 – 22 of July 2015 and was organized y the Global Fund together with EHRN. This report includes the presentation of Transition and Sustainability Principles and Draft Framework for Transition to Sustainability developed as an outcome of this consultation, and will be discussed on 29.09 and 30.09 within the Regional Dialogue.