Advocacy for increased domestic funding led by CSOs and PRs, and strongly underpinned by the Global Fund’s conditions put to the government of Ukraine, has achieved outstanding results. Communities, empowered by the Global Fund, have been able to partner with the Ministry of Health. CSOs participated in the budget calculation, planning and discussions that resulted in an increased commitment to finance ARV, MDR-TB, Hepatitis C and OST treatments.
In September 2016 the parliament of Ukraine aimed to increase financing treatment of Tuberculosis (TB) by 141% and HIV by 132%. The allocations are planned to cover the treatment of multi drug resistant (MDR) TB, provide antiretroviral (ARV) therapy plus test-kits for HIV. The state budget also contains increased funding for Hepatitis by approximately $540,000.
Since 2014 the health budget has declined mostly due to the recent Russian intervention, the occupation of Crimea and the associated increases to the defense budget. The official commitment to increase the HIV and TB treatment budget by approximately 140% is unprecedented in the country and when translated into the number of people who actually benefit, 34,000 more HIV patients, 25,000 more TB and 600 more Hepatitis C patients receive treatment.
In addition, for the first time in its history, the Ukraine government has included an opioid substitution therapy (OST) allocation of $6.6 million into the state budget. The Ministry of Health has also allocated more than $0.5 million for purchasing Methadone that will allow an additional 500 patients to access the OST program, which is currently only limited to 8,881 patients.
Although this draft budget for 2017 awaits further discussion and approval, CSOs celebrated the victory after intensive negotiations with the government. According to Dmytro Sherembey, the head of Coordination Council in the Network of People Living with HIV/AIDS, one of the PRs for the GF program in Ukraine, the most important achievement is that the behaviour towards health financing of the government is changing. “The ministry took the side of the patients. To me the figures within this increased budget represent the lives of 70,000 people, said Mr. Sherembey, “We have been able to influence policy and there is a realistic chance now that treatment coverage of HIV patients in 2017 might reach 90%, however the next goal is to reach full coverage.”
The leaders from Alliance for Public Health, another PR of the GF program implementing the harm reduction component, are not as optimistic in regards to the OST funding commitment and are looking forward to final approval of the budget in December. However, according to Pavel Scala, Associate Director: Policy and Partnership, “increased allocations and the declaration for readiness to finance the OST is definitely a progressive step. This is a joint achievement of the Global Fund, CSOs and all partners.”
Mr. Sherembey also acknowledged the role of the Global Fund in the success, according to him, of the strong position of the Global Fund in requiring the domestic contribution as a condition to finance the programs in Ukraine and the substantial investment made in developing and empowering community organizations. “The Global Fund has played an important role in influencing the governmental officials, but the biggest achievement of the Global Fund in Ukraine is a human capital, strengthened communities and activists”-said Sherembey.
In August, the Ministry of Health started updating the clinical guidelines for HIV and Hepatitis-C and removed patents from several first line ARVs. The Global Fund Portfolio Manager in Ukraine, George Sakvarelidze evaluated these changes as “breakthroughs, which together with increased funding and standardization of the protocols, will boost the ART coverage significantly and support sustainable scale-up and future transition”.
According to Mr. Sakvarelidze, “the sustainability and transition plan is being signed by the Government of Ukraine and will serve as roadmap for sustainable transition of TB HIV programs towards state funding”.
In the near future, the Ministry of Health also plans to approve the introduction of OST in the penal system. According to Vitaliy Tkachuk, Policy and Advocacy Director, Network of People Living with HIV/AIDS, “the introduction of OST in prisons is not only a financial achievement, but an ethical and methodological victory, as earlier the government was always against it despite our strong arguments backed up by evidence from the western world”.
The next stage forward for CSO advocacy in Ukraine is, by the end of this year, is to monitor implementation of the financial commitments made by the government. In October, the head of the Global Fund Grant Management Division will visit the country with the purpose to review the agenda for the sustainability of HIV and TB programs in Ukraine, and to meet with Prime Minister Volodymyr Groysman.