BG (2)In early July this year TB Europe Coalition joined with the European Harm Reduction Network to organise a three-day advocacy workshop that, uniquely, brought together activists from both HIV, TB and Harm reduction local NGOs in Bulgaria. The aim of the workshop was to prepare civil society for the consequences of Global Fund withdrawal from Bulgaria and the subsequent cut in financial support for the national HIV and TB programmes. The Global Fund has been providing partial funding for the National HIV and TB Control and Prevention programmes since the early 2000s, supporting essential services in the national TB response including purchase of the second-line TB drugs for the drug resistant TB patients, and implementation of infection control measures. With donor support and domestic funding in place, Bulgaria has made some progress in responding to HIV and TB epidemics in the country. Civil society has played a key role in reversing epidemics due to their comparative advantage of reaching out and providing services to most-at-risk communities, where TB and HIV epidemics are concentrated. As NGOs’ work has been almost exclusively funded by international donors, the withdrawal of the GF creates obstacles for the continuation of essential outreach and prevention services, provided by NGOs.

Although the Bulgarian government has adopted a new TB and HIV programmes and budget for 2017-2020 earlier this year, they haven’t been able to contract NGOs to provide services, as there are some legal barriers for fast track contracting of civil society organisations. As a result, the NGOs carrying out HIV outreach and prevention work have not received any funding since the GF support stopped in May of this year. At the moment, the NGOs have either stopped providing services or are doing so on a voluntary basis and had to let go some of their staff. Now the NGOs fear that the situation will repeat itself next year after the Global Fund withdrawal of TB funding in 2018. In addition, the current level of committed domestic funding is insufficient for the full range of interventions previously funded by the GF. For example, funds for preventive care and social support services for patients, provided by NGOs, are limited.

Thus, the workshop aimed to help civil society to have a better understating of the challenges linked with the transition process, to outline and agree advocacy strategy goals in the short and medium term in light of current challenges, and to train civil society on how best to engage with key government officials. After two days of intensive training, civil society organisations and activists had a chance to put their skills into practice and to get across their current concerns, during a 2 hour meeting with key government officials.

TBEC and EHRN workshops and online trainings aim to increase the capacity and capability of civil society and also to allow civil society to see the “full picture” of TB control and prevention in their own country more clearly, especially when comparing TB responses in neighbouring countries. Comparison allows identifying not just shortcomings, but also successes, strengthening the argument in favour of health reform and greater civil society engagement. For example, the social contracting of Bulgarian NGOs within the Global Fund framework has long been considered to be one of the best examples of civil society engagement in TB response. This has made a significant contribution to the incredible result of TB incidence in Bulgaria decreasing by half since the early 2000s.

Furthermore, TB Europe Coalition’s physical presence often provides civil society with much needed support in dealing with national government either by providing additional pressure on officials to take local civil society concerns seriously, or by showcasing best practices and problem-solving approaches successfully used in other countries. For example, in this Bulgarian workshop, civil society representatives came from Montenegro and Serbia to talk about how their civil society networks have responded to Global Fund withdrawal of financial support for TB and HIV national programmes.

TB Europe Coalition believes that stronger and more active national civil societies are at the centre of an effective response to individual health issues within the countries and around the region. By empowering, promoting and supporting the coordination of civil society organisations working across TB issues in each country, TBEC members are able to call for health system reforms, participate in policy processes and advocate for increased financial commitments at the regional and international levels, contributing to the overall achievement of universal healthcare. TBEC believes that its true strengths lay with its members, committed individuals and civil society organisations to end TB epidemic in the region and around the globe. Thus, TB Europe Coalition continues to actively identify, train and engage the key civil society organisations and individuals, working on TB at national level, as was the case in Bulgaria.

If you are interested to read more, please click on the link.

To read the EHRN report on the results of the Workshop for civil society organizations on advocacy of sustainability and transition processes in the fields of HIV, tuberculosis and harm reduction in Bulgaria which took place on July 5-6 in Sofia, please click here.

by Anete Cook


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