The Ministry of Health of Kyrgyzstan has formed a multi-disciplinary working group of specialists to plan, coordinate, and implement transition planning for TB and HIV. The group is already staffed by management, procurement, public health, and finance specialists. Representatives of civil society organizations and communities are also included. Other positions will be added.
The working group will be assisted by a technical support group consisting of representatives from international organizations – the United Nations Office of Drugs and Crime, the World Health Organization, Open Society Foundations, UNAIDS – and communities.
The representatives of CSOs and the communities are actively engaged at the decision-making level in the working group, and have suggested most of the initiatives that the working group has adopted, according to Aibar Sultangaziev, executive director of the Partnership Network, an association of 26 local CSOs.
Consultation with the CSOs and the communities are ongoing. The discussion is focused mostly on service provision – in particular, which services should be covered, what elements should be included for each service, and how much they will cost.
The working group has already started developing a road map for the transition. The goal is to have the road map approved by government decree. Once approved, the road map will be made public.
Transition planning is one of the components of Kyrgyzstan’s 3-year TB and HIV grant, which is scheduled to start later this year. A total of $220,000 has been budgeted to develop the capacity of the MOH to manage state disease programs and ensure a smooth transition. Other components of the grants are treatment and referral services; prevention activities for key populations (persons who inject drugs, sex workers, prisoners and men who have sex with men); prevention of mother-to-child transmission of HIV; strengthening of the communities; and human rights.
Although the program has not yet officially started –the framework agreement between the Fund and the government will be signed in March – the MOH, with support from civil society and communities, has already defined the priority directions of the transition. These directions are as follows: (a) strengthening the coordination within vertical disease programs funded by different sources; (b) developing new financing mechanisms to allow for smooth transition and coordination; and (c) developing or improving (as required) the legislative framework to ensure that all program activities are in line with national legislation.
The priority directions are based on previous program experience and informed by recommendations of the Global Fund and other donors.
Reform of the country coordinating mechanism is perceived as one of the key elements of strengthening program coordination during and after the transition process. The reform started several years ago and still going on.
Two issues that the working group will take up are (a) procurement of medicines; and (b) provision of services. Most medicines currently used by HIV and TB program are not registered in Kyrgyzstan. The working group will need to ensure that all medicines that are prequalified by WHO can be allowed into the country without registration by the time the Global Fund grants end in 2018 to avoid delays or other potential difficulties that might cause stock-outs.
Although, according to the law, ministries are allowed to contract NGOs to provide services, and there are precedents in other ministries for contracting NGOs, the MOH lacks the capacity to organize and manage tenders for procuring prevention services. The working group will ensure that training is provided to address this gap. It will also develop quality standards and policies governing the tenders.
The working group expects that as a result of the transition, the programs will be better coordinated and managed. The need for better coordination is underscored by the fact that the programs are currently supported by multiple funders – i.e., not only The Global Fund and the government, but also OSF and PEPFAR. The working group believes that this will lead to better program quality. Mr Sultangaziev said that a recent evaluation of the HIV program, not yet published, revealed several quality-related challenges, such as low adherence rate; limited coverage of testing, resulting in low detection rates; and high default rates from opioid substitution therapy.
“For many years we were seen as a poor country and we thought it was only natural that someone else should resolve our problems by giving us money,” Mr Sultangaziev said, “We needed that support, but now it is time for Kyrgyzstan to learn to be responsible and not have to depend on grants.”