A workshop hosted on July 21-22 in Istanbul aimed to provide more nuanced guidance to the countries in Eastern Europe and Central Asia on sustainability of HIV and TB programs, as most of them are bracing for what they see as an inevitable further reduction in their support from the Global Fund.
EECA countries received just 3% of the more than $12 billion allocated in 2014 under the new funding model (NFM), which has represented a 46% reduction in support for HIV programs and 37% for TB programs. This precipitous decline sought to redress the balance in funding, to amend support to countries that had been over-allocated under the rounds-based approach compared to their share of the global burden of disease.
While the post-2017 strategy remains under development, these countries are all preparing for what they see as a certain inevitability in their Global Fund envelopes shrinking further during the next allocations period – making it fundamentally important that they develop transition scenarios to ensure that programs supported by the Fund remain in place, with new sources of investment.
Workshop participants representing the Stop-TB partnership, the Fund’s own Technical Evaluation and Review Group (TERG), civil society, local government and other foundations gathered in the Turkish capital to develop a way forward in this modified financial landscape, using the Fund’s Framework for Sustainability and Transition as a roadmap.
Country teams were asked to identify what was most important to them, and what priorities – with timelines – needed to be included in any transition framework. The countries were also asked to identify areas where they would require technical support to smooth the transition. They were then given the opportunity to present their vision for a post-Global Fund national program to other donors, in order to begin to solicit other sources of investment for their interventions.
A policy statement developed during a pre-meeting of civil society groups on 12-13 July in Moldova emphasized the importance of ensuring that the transition is a smooth one, according to Anna Dovbakh, deputy director for information and technical support of EHRN.
“Discussions have changed our minds and we are seriously understanding that there will be no more Global Fund money and that it is up to us to fill the gaps,” she told Aidspan. “All of the Global Fund investments will be wasted if the default position is to close the programs down. The past will become the golden age of harm reduction and that just cannot happen; we’ve seen the consequences already, in Serbia and Montenegro [where donor supported programs were closed].”
In the final statement that emerged from the two-day meeting, civil society organizations emphasized the need for the Fund to “develop and implement a strategy for responsible and successful transition to domestic funding for middle-income countries.”
Three EECA countries – Estonia, Romania and Croatia – were included in a review commissioned in 2013 of sustainability-related challenges. This review, currently underway by the TERG, is hinging on a series of questions that seek to define what ‘success’ looks like when it comes to transition and financial sustainability.
It is likely that the preliminary findings from a similar research project conducted in four other EECA countries with Global Fund support will build on, or corroborate the TERG review results. Research carried out by Georgian NGO, CIF (Curatio International Foundation) in Belarus, Bulgaria, Georgia and Ukraine tested an assessment tool that countries will eventually be able to use to plot their own courses towards transition.
According to Ketevan Chkhatarashviili, president of CIF Georgia, the research, supported by civil society engagement can only help to provide a comprehensive picture of the type and extent of challenges countries are going to confront and have to overcome in order to ensure the longevity of programs initiated with Global Fund support and cement the gains made in mitigating the burden of disease.
“The Fund heard the views and expectations from constituency representatives, and understood that transition planning is not only a financial issue but also linked to legal and systems issues as well,” she told Aidspan.
EECA regional manager Nicolas Cantau said that the EECA region is confronted with the “double challenge” of scaling up the response to the fight against drug resistant TB and HIV while sustaining the progresses achieved over the past 10 years.
“We are speaking about ‘sustainable scale up’ where increased domestic funding need to be invested in high impact interventions in the frame of fully funded national strategic plans,” he told Aidspan in an email. “Resources requested by countries under the NFM have broadly been in line with the Global Fund investment guidance; this workshop is part of a series of event that the Global Fund is co-organizing with regional networks and technical partners to develop with countries transition frameworks for sustainable impact."