At 9–11th of December 2020 budget advocacy, sustainability and transparency regional and national experts gathered online to take stock of what has been achieved over the past few years – taking into account the realities of the transition of HIV responses for key populations from donor support to national funding, limited donor resources for the Eastern Europe and Central Asia (EECA) region, and new economic and public health challenges including the COVID-19 pandemic. The dialogue aims to explore whether and how to budget advocacy efforts have impacted state budget funding for HIV services for key populations in the region, what critical elements of budget advocacy have made a difference, and what donors should take next steps to support further efforts by CSOs in budget advocacy for key population HIV services to be fully covered by national budgets in the region. The crises caused by the COVID-19 pandemic have significantly altered situations and contexts and added new urgency to the need to understand how to influence budget decisions effectively. There are huge risks associated with adjustments and replanning of all public health funding that many countries are doing in response to the crises because these changes could lead to lack of funding for HIV responses among key populations.
This meeting is part of the broader regional dialogue and analysis organized by the Eurasian Harm Reduction Association (EHRA) in partnership with Open Society Foundations; the Global Fund to Fight AIDS, Tuberculosis and Malaria; and the Eurasian Coalition on Health, Rights, Gender and Sexual Diversity (ECOM) and supported by the Robert Carr Fund for civil society networks.
This rare gathering of experts is part of ongoing efforts in the region to safeguard and improve people’s health and rights vulnerable to and living with HIV and other stigmatized conditions. Sustainability of services is the ultimate goal, with the transition from external to domestic funding being the process through which countries move as donor support decreases and then stops.
International donors have been withdrawing from support for HIV and other health programs in EECA for several years. Many countries no longer receive or are eligible for, funding from the Global Fund to Fight HIV, Tuberculosis and Malaria (Global Fund). Among other significant funders over the years, the UK Department for International Development (DFID) ended its support in the region several years ago, the US President’s Emergency Plan for AIDS Relief (PEPFAR) provides only small amounts of funding in a few countries, and the Dutch Ministry of Foreign Affairs, the German Agency for International Cooperation (GIZ) and the French 5% Initiative no longer consider the region a priority. Most of these funders provided critical financial and technical support for HIV prevention and other services for key populations, including people who inject drugs, men who have sex with men (MSM) and sex workers. The programs usually cannot survive international donor withdrawals unless they have access to domestic funding, especially from the public sector.
Budget advocacy work and transition experiences across EECA have varied in terms of overall success and the actions taken by civil society advocates, governments and donors to plan for and respond to donor withdrawals. The three-day initial meeting of the dialogue, which was held online and had more than 40 participants each day, included several comprehensive presentations of transition-related activities regionally and at the national level. The five-country examples from Kazakhstan, Kyrgyzstan, Ukraine, Moldova and North Macedonia highlighted different activities and methods used to secure the sustainability of funding for HIV response services specifically for key population – before, during and after transition processes. They served as the basis for group discussions about opportunities and challenges for this type of work across the region. The online meeting concluded with participants proposing suggestions and recommendations for priority actions to promote and ensure investment in health and social services for key populations in EECA.
During January – March 2021 the regional analysis and dialogue “Taking stock of budget advocacy efforts to date in EECA region” will continue with Budget advocacy effort and impact mapping for the past three years in the EECA region and Consultation to develop recommendations for regional partners on investment into sustainability of HIV- services for key affected populations, which is planned to organize in March 2021.
The key lessons learned on a national and regional level, methodical tools for analysis and preliminary recommendations from the initial meeting could be found in the detailed report (download the meeting report)