According to a case study conducted by the European Harm Reduction Network, the Global Fund’s decision to stop providing new funding for the HIV program in Serbia as of 2014 happened without any transition planning to ensure that harm reduction (and other) programs would be able to continue.
A report on the case study was published in August 2015. The 12-page report, entitled “The impact of the Global Fund’s withdrawal on harm reduction programs,” was prepared by a mixed group of experts representing EHRN and Serbian civil society organizations. The report described the initial results of the Global Fund’s withdrawal and presented recommendations for local governments, CSOs, the Fund itself, and other donors on how to avoid similar complications in other countries which might soon also become ineligible for Global Fund support.
As a result of changes to the Global Fund’s eligibility criteria in 2011, a number of upper-middle-income countries in Eastern Europe and Central Asia with low or moderate disease burdens became ineligible for new HIV funding. Serbia was one of the countries affected, having been classified as a UMI country in 2012. Although Serbia continued to receive funding for existing HIV grants until 2013, the country did not receive an allocation for HIV for the period 2014-2016 under the new funding model.
The report said that the status of harm reduction and other programs from 2014 on depends on the readiness, willingness and ability of the Government of Serbia to fund the programs. In this environment, the report said, “politically unpopular” groups such as people who use drugs are at risk of being neglected.
The Global Fund financed harm reduction programs in Serbia between 2006 and 2014, covering needle exchange, opioid substitution therapy and outreach activities. By 2013, OST was available through methadone centers in 29 health facilities, with the Global Fund providing most of the financing in 26 of them. The government has continued to provide OST in 23 of the centers.
However, what will happen to the 4,285 clients of needle exchange outreach programs is up in the air. The programs were funded almost entirely with Global Fund money and were provided by CSOs. According to the report, up to 50 grassroots organizations providing outreach services to key affected populations lost up to 90% of their funding after the Global Fund withdrew its support. No alternative financing mechanisms have been put in place to ensure sustained funding for the grassroots organizations.
Although the case study report warns about the risks for increased HIV and hepatitis C rates, there are no figures presented to estimate the public heath–related impact of stopping HIV prevention activities among key populations.
The report states that
“As Global Fund support to the EECA region decreases, it is critical to ensure the transition to domestic financing takes into consideration a country’s readiness, willingness, and ability to assume greater responsibility for HIV and AIDS programming. Serbia’s experience clearly illustrates that if the cessation of Global Fund support is not accompanied by credible government sustainability plans and financial commitments, years of investments are threatened and the health and well-being of marginalized communities endangered. This could result in the reversal of hard won gains in HIV prevention and treatment and lead to spikes in HIV, hepatitis C, and AIDS.”
Although in 2015 the Global Fund reclassified Serbia’s HIV disease burden to “high,” the report said, it is not clear yet whether, under the Fund’s eligibility criteria, Serbia’s HIV component will be eligible for funding for the next allocation period (2017-2019).