Making Anticipated Results Possible (MARP): Expanding the HIV Responses

Dr Christoph Hamelmann

Regional Team Leader (Europe and Central Asia) and Senior Advisor (Arab States)HIV, Health and Development

Global Coordinator, Secretariat of the UN informal Interagency Task Team on Sustainable Procurement in the Health Sector (SPHS)

UNDP Istanbul Regional Hub

7th Regional HIV and AIDS ConferenceSarajevo, 28-29 May 2015

Plenary Session 1: Exit Strategy

Expanding the HIV Response:Our Coordinates

• Getting to Zero: Infections, death, discrimination

• Target 3.3: By 2030, end AIDS epidemic• Target 3.8: Universal health coverage

Fast Track!Towards Sustainable Development Goals

Making Anticipated Results Possible (MARP): Expanding the HIV Responses

Dr Christoph Hamelmann

Regional Team Leader (Europe and Central Asia) and Senior Advisor (Arab States)HIV, Health and Development

Global Coordinator, Secretariat of the UN informal Interagency Task Team on Sustainable Procurement in the Health Sector (SPHS)

UNDP Istanbul Regional Hub

7th Regional HIV and AIDS ConferenceSarajevo, 28-29 May 2015

Transition Strategy

HIV Epidemic in EECA

• The HIV epidemic is still growing1

• The number of PLHIV increased from 860,000 to 1,1 million between 2001 and 20131

• AIDS related deaths increased by 5% between 2005 and 20131

• 57 percent of all new HIV infections are attributable to the sharing of syringes and needles2

• Treatment coverage was 21% in 20131

1 UNAIDS GAP report, 2014.2 GFATM. Turning the Tide Against HIV and Tuberculosis - Global Fund Investment Guidance for Eastern Europe and

Central Asia, 2014

HIV Epidemic in EECA

• HIV testing and counseling among key populations remains insufficient, which leads to delayed diagnosis of HIV infections and late treatment initiation.

• Access to harm reduction services - including opioid substitution therapy as well as needle and syringe exchange programs - remained limited.

• Rights violations, stigma and discrimination towards people living with and affected by HIV are still key characteristics of the epidemic in the EECA region

*Kosovo UN1244

*

Source: Global Fund

HIV Infections and GF Status in SEECountry PLHIV

est.Newly diagnosed (2013)

PLHIV on ART (2013)

Main key population among newly HIV diagnosed

GF status (source: GF)

Albania1 <1000 117 335 85% HS Financial closure

Bosnia & Herzegovina2 n/a 21 (2014) 114 50% MSM Active

Bulgaria1 n/a 200 626 (2012) MSM/PWID/HS Active

Croatia3 n/a 92 (2014) 7938 85% MSM Closed

FYR Macedonia4 <200 37 (2014) 90 68% MSM Active

Montenegro5 n/a 10 65 60% MSM Active

Romania1,6 16 000 507 8 809 55% HS Closed

Serbia7 3 000 147 1165 64% MSM Closed

Slovenia6 n/a 44 n/a 61% MSM No

Sources: 1UNAIDS, 2 UNDP BiH, 3 IPH Croatia, 4 IPH FYR Macedonia, 5 IPH Montenegro , 6 ECDC, 7 IPH Serbia, 8 University hospital for infectious disease

Global Fund HIV Investment in SEECountry or territory Income

categoryDisease burden

Total grant US$ End date Eligibility

Albania UMI Low 5 459 367 31.03.2015 Transition

Bosnia & Herzegovina UMI Low 40 923 294 30.11.2015 No

Bulgaria UMI High 50 451 295 31.12.2015 NGO rule

Croatia High income Low 4 944 324 30.11.2006 No

Kosovo UN 1244 Upper LMI Low 6 837 726 30.06.2015 Eligible

FYR Macedonia UMI Low 20 061 369 31.12.2016 No

Montenegro UMI Low 8 803 621 30.06.2015 No

Romania UMI High 37 671 819 30.06.2010 NGO rule

Serbia UMI High 30 628 736 30.09.2014 Eligible

Slovenia High income Low - - No

Source: GFATM website

UNDP’s Regional Project on Sustainable Financing of National HIV Responses

• Started in 2012• Involves currently 14 countries in EECA, with particular focus

on countries with UNDP PR-ship of Global Fund grants• Supports governments, civil society organizations, affected

key populations and PLHIV• Collaborates closely with UNAIDS and other co-sponsors• Involves a team of regional and country office UNDP staff and

national and international consultants

Concepts and Components:Getting Started

• Rights-based approach• Understanding the national context

disease burden health system structures including health financing legal and regulatory frameworks

• Know your epidemic• Know your response: National and international goals,

objectives and targets, current achievements and gaps

Concepts and Components:What Needs to Be Transitioned?

• Which programme components are externally funded?

• To what amount (absolute and percentage, by component and total)?

• Who is providing these services (public, private for-profit, private non-profit)?

Concepts and Components:What Needs to Be Transitioned?

Prevention (P) ($)

P A ($)Pub ($)

F-P/NGO ($)

P B ($)Pub ($)

F-P/NGO ($)

P C ($)Pub ($)

F-P/NGO ($)

Treatment (T) ($)

T A ($)Pub ($)

F-P/NGO ($)

T B ($)Pub ($)

F-P/NGO ($)

T C ($)Pub ($)

F-P/NGO ($)

Others (O) ($)

O A ($)Pub ($)

F-P/NGO ($)

B B ($)Pub ($)

F-P/NGO ($)

O C ($)Pub ($)

F-P/NGO ($) Prevention Treatment Others Total

02468

101214161820

ExternalDomestic

$

External funds details

Concepts and Components:Can we achieve more for a $?

• Technical efficiency

• Allocative efficiency

Concepts and Components:Technical Efficiency

Factor costs

Human resources

Commodities

Others

Service delivery models

Central / de-central

Public / private

Others

Others

Infrastructure

Critical enablers

Others

Unit costs

Service output

Defined quality standard

Concepts and Components:Allocative Efficiency

Current budget, current allocation Current budget, optimized allocation

Concepts and Components:Allocative Efficiency

http://www.eurasia.undp.org/content/dam/rbec/docs/UNDP%20Modelling%20Tajikistan_English.pdf

In Focus: NGO Social ContractingProgramme components Budget allocated

to NGOs ($)

% of line

budget

National/sub-national

/local level (%)

Prevention PWID 679,868 47.7 0/0/100

MSM 224,881 86.4 0/0/100

SW 219,846 90.3 0/0/100

Prison inmates 106,226 77.4 0/0/100

Youth 468,546 87.5 0/0/100

Roma and

migrants

426,328 93.0 0/100/0

Prevention subtotal 2,125,695 69.5 0/20/80

Psychosocial support

subtotal

654,390 61.3 100/0/0

Enabling environment

subtotal

325,409 93.0 28/4/68

TOTAL 3,105,494 35.1 24/14/62

In Focus: NGO Social Contracting

Country Fact Sheets

• Current NGO service provision and NGO landscape• Legal and regulatory frameworks for NGO social

contracting• Prerequisites for service provision• Quality control and assurance• Best practices examples

In Focus:Access to Affordable Medicines

http://www.eurasia.undp.org/content/rbec/en/home/ourwork/hiv_aids/in_depth/sustainable-financing-of-hiv-responses/

Concepts and Components:Transition – Where to?

Prevention (P) ($)

P A ($)Pub ($)

F-P/NGO ($)

P B ($)Pub ($)

F-P/NGO ($)

P C ($)Pub ($)

F-P/NGO ($)

Treatment (T) ($)

T A ($)Pub ($)

F-P/NGO ($)

T B ($)Pub ($)

F-P/NGO ($)

T C ($)Pub ($)

F-P/NGO ($)

Others (O) ($)

O A ($)Pub ($)

F-P/NGO ($)

B B ($)Pub ($)

F-P/NGO ($)

Sub-national budgets

Annual total ($)

To absorb ($) (% of total)

National budgets

Annual total ($)

To absorb ($) (% of total)

Local budgets

Annual total ($)

To absorb ($) (% of total)

Resources: AB

D E AD

E

FC

External funds details

Domestic funds details

Example CroatiaAdditional Domestic Funding Sourcing

Example A:Part of lottery fund went to PWID

programmes2014: $ 220,000Joint call for application from Ministry

of Social Care and Youth, MoH, and Commissariat for Drug Control

Example B:MoH budget2014 call for health programmes

(including harm reduction): $18,000

2014 call for psychosicial support: $462,000 (for PLHIV: $ 161,000)

Example C:Part of Lottery fund for a three-years health programmes of NGOs in implementation of national strategies2014: $ 915,000 ($ 728,000 for HIV-related programmes)14 NGOs: harm reduction (including NSP), psychosocial support, MSM and others

Scaling-up to universal access

Universal access: rights-based approach, SDG 3 target and highest impact

DALYs averted

Involvement of NGO Networks

• Sub-national networks (example: Vojvodinian HIV network of NGOs and public institutions – coordination, joint applications, advocacy on local and sub-national level, Serbia)

• National networks (example: USOP – Union of PLHIV organisations in Serbia, advocacy, enabling environment at the national level, Serbia)

• Regional (example: NeLP – 18 low prevalence countries in Central and South Eastern Europe, coordinations and advocacy for access to targeted prevention, testing, treatment)

Know Your Rights, Use Your Laws

A Handbook for:

• People who live with HIV• Their families and friends• People at higher risk of HIV• Their families and friends• Activists, supporters• Service planers and providers

http://www.undp.org/content/dam/rbec/docs/UNDP%20HIV%20and%20Rights%20UK_web.pdf

United Nations Development Programme

christoph.hamelmann@undp.org

Twitter: @cahamelmann

Timur Abdullaev, Predrag Duric, Boyan Konstantinov, John Macauley