Currently there are several national CSOs in Moldova providing services to vulnerable and key populations and people living with HIV. These services include psychosocial support, prevention programming, and harm reduction. Funding for this work has come predominately from The Global Fund and has been administered by an NGO principal recipient, the Center for Health Policies and Studies. According to UNAIDS, civil society organizations benefit from some modest in-kind support from the Moldovan Government, such as provision of rapid tests and local authority office space.
In addition, Moldova is recognized as an example of good practices in the HIV response due to its successful implementation of harm reduction programs in communities and prisons.
Moldova was one of the six countries included in a UNAIDS study of governments that have allocated funding to civil society organizations. (See separate article in this issue for a summary of the study.)
In anticipation of the reduction of Global Fund funding, the Moldovan Government has indicated it will assume the cost of all antiretroviral therapy, including second- and third-line therapies, treatment monitoring and patient follow-up, through the Ministry of Health budget and the national health insurance program. (See GFO article on transition planning in Moldova.)
UNAIDS said that in 2014, the MOH set aside money in its budget to support one prevention project focusing on people who use drugs, to be implemented by a national NGO. The MOH plans to increase its commitment to fund two harm reduction projects per year starting in 2016. “The national AIDS program acknowledges that community organizations should implement these programs, because they are better equipped and better trusted by key populations than state agencies.”
According to UNAIDS, to be able to allocate funding to NGOs, the Moldovan Government needs to approve a new normative framework that defines a mechanism for financing health NGOs. A technical working group under the MOH has developed the framework, but due to changes in the government, as of September 2015 the framework had not yet been approved. “The funding set aside in 2014 and 2014 for NGO programming has lapsed,” UNAIDS said.
In August 2015, the National Health Insurance Fund also announced a mechanism to finance NGO prevention programs, the details of which are still to be worked out, UNAIDS said.
Even when these new mechanisms are in place, UNAIDS said, it is unclear whether funding will be sufficient to meet the needs of the community component of the HIV response. “NGOs anticipate that unless additional funding is made available, they will be unable to continue offering the current levels of services.”
Regulatory hurdles have turned out to be more time-consuming than was anticipated, UNAIDS said, which may delay the smooth transition to country-financed support for community responses. “NGOs from Moldova and elsewhere in the region have argued it is crucial to monitor levels of funding available to support the community component of the response. If funding decreases and community services are discontinued, the gains achieved so far in addressing the epidemic could be in jeopardy.”
|Viorel Soltan, Director, Centre for Health Policies and Studies|
When contacted by GFO, Viorel Soltan, Director of Center for Health Policies and Studies, said that while Moldova continues to implement harm reduction programs recommended by the World Health Organization in communities and prisons, the costs of these programs are still allocated from external funding, primarily from The Global Fund. Since 2014, he said, the Government of Moldova has partially covered antiretroviral therapy, and has supported treatment monitoring and patient follow-up through domestic funding.
Soltan said that the CCM is currently developing a sustainability plan and is documenting existing experience on investments and cost-effectiveness of harm reduction interventions, as well as existing mechanisms of government funding of NGOs in the region. The country is assessing the funding situation of the national HIV program in the context of transitioning from international to domestic support.
Soltan told GFO that recently, as part of the Harm Reduction Works – Fund It! initiative, a high level national dialogue was held in Chisinau on successful transition to national funding of harm reduction in the context of HIV response in Moldova. He said that the event was attended by high level officials of the government, The Global Fund, UNAIDS, the U.N. Office on Drugs and Crime (UNODC), as well as representatives of local partners, NGOs, and communities.
According to Soltan, during the event participants reiterated their commitment to the government taking over the costs of the national program, and agreed on concrete actions to be taken by the government, experts, NGOs, community organizations, multilaterals, and donors in order to ensure a smooth transition from international to national funding of the HIV response and to sustain harm reduction programs. Among other important outcomes of this dialogue, Soltan said, the government officials agreed to put in place relevant mechanisms to sub-contract NGO services through National Health Insurance Fund and Ministry of Health budgets in 2016.
|Alexandr Curasov, Executive Director, Positive Initiative Association|
Alexandr Curasov, Executive Director of the Positive Initiative Association, told GFO that the government, The Global Fund, development partners, and donors have already reached the point where they realize one simple thing: Communities living with or affected by infections are equal partners and should be involved meaningfully if Moldova really wants to stop an epidemics and save lives. “It is time to move from declared partnership to the genuine partnership,” he said.
We are not only patients,” Curasov explained. “We possess the unique expertise and capabilities for contributing to each stage of the response to the epidemics, from planning the strategy and action, budget development, implementation and monitoring, to searching for the resources.”
Curasov said that what is needed is an atmosphere of transparency and accountability from both the state and the civil society. “Transparency, accountability and equal partnership will allow us to achieve efficient results, achieve optimal use of resources, and have consistent, flexible, and creative approaches in resolving problems,” he said. “We invested a lot in the communities for quite long time, so now it is time to give them an opportunity to apply their potential.”
Tinatin Zardiashvili, our correspondent in Eastern Europe and Central Asia, contributed reporting for this article.