From 6th-11th June, TBEC members Paul Sommerfeld, TB Alert UK, Bruce Warwick, RESULTS UK , and Zahedul Islam, International HIV/AIDS Alliance in Ukraine, met with TB advocates and other stakeholders in Armenia. Our visit was facilitated by Positive People Armenian Network, an NGO working to provide care and support for people living with HIV.

The main aims of our visit, as with previous country missions, were to meet with key TB stakeholders (local NGOs, international NGOs, government representatives and donor agencies) in order to:

  • Understand in greater detail the challenges for advocacy organisations working on TB or related areas (including the financing of TB advocacy and the broader local NGO landscape).
  • Provide an advocacy workshop for local NGOs in Armenia.
  • To further involve Armenian NGOs in future TBEC activities.

Bilateral Meetings

Armenia local CSO advocacy workshop

TBEC hosts a local advocacy workshop

Throughout the week we held several bilateral meetings with both local and international NGOs. It was clear that when it comes to activities specifically related to TB in Armenia, the main players are international NGOs, including the Armenian Red Cross Society (ARCS),  Medecins San Frontieres (MSF) and Mission East. MSF are heavily engaged with the management of drug-resistant TB and have been working closely with the National TB Centre in order to provide Bedaquiline through compassionate use. ARCS, a sub-recipient of the Global Fund, are working to try and improve treatment adherence through the provision of social support packages for TB patients. It is worth noting that these organisations are providing essential care in Armenia, care that is helping to address the TB problem.

Along with these international NGOs, we also had a chance to meet with local NGOs. The organisations we were able to meet with were all mostly focused on providing support to people living with HIV. It is worth noting that in all the meetings we held it was quite clear that there were very few, if any, established local NGOs whose primary focus was TB. However, the two local NGOs that we were able to meet with (Real World Real People and Positive People Armenian Network) were both clear that if there was support available they would be interested in potentially filling this gap.

Time was also spent meeting with the Director of the National TB Centre and the Ministry of Health. Promisingly, it seemed that these officials were committed to ensuring that Armenia provides the best possible care it can for those with TB. The Director of the NTC seemed highly motivated to improve the situation in country.  Currently, there is a steady move towards increased ambulatory care and in improving the infection control on MDR-TB wards in hospitals. Additionally, improvements are being made to improve infection control on MDR-TB wards improving the working and living conditions for healthcare workers and patients alike.

During these meetings, the question of the sustainability of financing TB care and control in Armenia was raised. Like in many other countries across the region, Armenia has been heavily dependent on external support from donors such as the Global Fund and, as suggested earlier, MSF. Officials did indicate they were aware that this funding may not go on much longer and serious plans were being developed to ensure that the transition from external to internal financing goes smoothly. Plans were already in place for the Government to start purchasing first-line TB drugs within the year, something that is currently done by the Global Fund. On this note, officials did recognise that more should be done to involve local NGOs in the ‘continuum of care’ with regards to TB, including in provision of social support and case-finding. This will be particularly important if external donors start to phase out in the comings years. Other key challenges we heard mentioned several times included the issue of labour migration, case detection, and social support (particularly pshycho-social).

Advocacy Workshop

In addition to bilateral meetings, TBEC hosted an advocacy workshop that was attended by the two local NGOs previously mentioned as well as a number of social support workers, people living with HIV and former TB patients. The aim of the workshop was to help increase individual advocacy skills and to start developing advocacy action plans.

The two-day workshop was a useful opportunity for participants to explore the main challenges associated with their work, the barriers they have experienced and what advocacy tools can be used to overcome these challenges. Having discussed steps in advocacy action and the identification of TB issues for CSOs in Armenia, participants were able to break out into groups to putting into place advocacy action plans. A particularly engaging session was facilitated by members of Positive People Armenian Network, Pink Armenia and Real World Real People. This session explored the local context with specific reference to the Government, Parliament and CCM and what advocacy was appropriate and necessary in these spheres. Participants heard, in detail, about CCM processes and the importance of taking part in regular CSO coalition meetings to discuss CCM agenda points and clarify a joint position on issues of importance.

Donor Meetings

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Garni Temple

The final day of our visit consisted of meetings with key external partners including USAID, the French Embassy and the World Health Organisation. These meetings were particularly useful as they allowed us to relay the messages we had heard with regards to the TB challenges in Armenia. Specifically, we were able to promote the importance of ensuring that local NGOs are supported so that they are able to get more fully involved in TB care and control. Additionally, there was discussion around making the CCM more accountable to local NGOs in the country and ensuring that there is representation of TB patients on the CCM. The French Embassy is soon to have a seat on the CCM and was supportive of the calls to improve CCM procedures, such as ensuring an agenda is sent well in advance to all stakeholders and that there is appropriate representation of communities.

Encouragingly, all three organisations were clear that they hoped to improve the involvement of local NGOs in TB care and control in the coming months and years, specifically noting this need given the prospect of less external donor support in the future.  Promisingly, throughout our final day we were hearing suggestions that USAID already plan to give a grant to the WHO in order to improve CSO capacity in the TB area in Armenia. This was an extremely great piece of news to hear after a week where it was clear there were a lack of local CSOs working on TB despite the fact that there were several capable organisations with the potential to fill this space.  The TB Europe Coalition, working with partners in country, will strive to ensure that local CSOs, particularly those with proven ability, are supported in order to work in the TB field.