International funding of health programs has been experiencing significant constraints, leading to the first moves to shift financial burden from external donors to domestic sources. When it is essential that countries are able to scale up and sustain programs to achieve lasting impact in fight against HIV and its comorbidities available packages and quality of HR services are decreasing, fewer services for KP are being supported. Lack of political support for HR, not only as HIV prevention measure but as social service, is one of the main obstacles to sustainable and sufficient funding for quality programs.
Case studies were undertaken in Georgia, North Macedonia, Ukraine and Kyrgyzstan in 2021 to assess how the transition from international funding affected service provision.
Main results: Despite slight increase in funding for OAT, allocated funds from Global Fund and local budgets for HR programs have significantly decreased. This had an influence on procurement of consumables and reduced list of services in a package.
Program progress indicators have increased and are likely to grow further. Focus of services shifted from their quality and clients’ needs to number of units to reach.
OAT and NSP programs require constant technical support of service providers, advanced professional training for doctors and peer consultants, procurement of high-quality consumables, developed quality standards of service provision that are being monitored and supervised.
Recommendations:
Increase budget for HR programs
Adopt framework standards for NSP that cover standard operation procedures and recommended package of services for different drug scenes, responding to needs of PWUD.
Introduce realistic indicators responding to broad understanding of HR goals
Conduct regular monitoring and evaluation of quality of NSP and OAT, including client satisfaction.
Ensure meaningful involvement of KP in decision-making, continued progress on addressing human rights–related barriers
Introduce emergency funding to ensure success of sustainability of HR services.