2015-09-29 13.02.45From 28-30 September, a TBEC delegation attended a high level dialogue in Tbilisi ‘Road to Success’. We joined technical experts, civil society, donors, international agencies and Ministers to discuss the transition of some countries from donor support to domestic funding in Eastern Europe and Central Asia.

The high level regional dialogue, hosted by the Georgian government and organised by the Eurasian Harm Reduction Network, the Global Fund, UNAIDS, UNDP, UNODS, UNFPA and WHO Europe is the first in a series of national dialogues which will develop plans for each countries for transition from Global Fund funding of TB and HIV programmes in the region.

Although domestic financing of TB and HIV responses have been increasing throughout the years, countries are still highly dependent on Global Fund support, especially for services to key populations (81% dependent on external support), TB diagnostics like functioning of GeneXpert (94% dependent on Global Fund) and 2nd line TB drugs (66% dependent on Global Fund support).

With figures such as these, in order to reach the Sustainable Development Goals’ targets of ending TB and HIV as public health threats by 2030, we need not only to sustain but also scale up our responses in the coming years. The funding gaps in health programmes need to be met by domestic funding and health systems financing need to be optimised.

2015-09-29 13.02.33It was clear from the debates that support and direction from the GF during the transition process will be absolutely necessary for a successful transition. Countries need be able to predict levels of Global Fund funding in order to develop time bound transition plans. The World Bank told of the need to optimise current resources by funding evidence-based interventions that have proven impact to decrease the epidemics, such as harm reduction. Panellists also stressed the need for health system reforms including transition from hospital based toward ambulatory models of care for TB, optimizing procurement of drugs including price reduction and use of TRIPS flexibilities will also be needed.

New HIV Infection between 200 and 2014It was noted that driving the HIV epidemic down will only be successful if harmful legal environments are changed to allow for harm reduction services for key affected populations as well as social contracting of NGOs. NGOs have a comparative advantage in providing prevention services both for TB and HIV. Transition will work only if governance structures are inclusive, if communities are empowered and aware of their rights. GF representatives committed to continuing supporting civil society organisations, however this assistance in the future will most likely be through regional grants and not country support.

The GF reiterated that they will continue to support countries during transition but to a different extent. Transition is also a new area for the GF to cope with and they will have to develop a strategy with other stakeholders to make sure it is done in a successful ways. As some Latin American countries have gone through transition there are now examples of successful and unsuccessful transitions and the Global Fund committed to building on this to make sure that progresses made so far were not scaled back. Mark Dybul, Executive Director of the GF emphasised in his keynote speech that despite “rumours” the GF is not exiting the WHO Europe region. However the feeling in Tbilisi is that this commitment will not change reality and that countries together with partners, the Global Fund and all stakeholders including civil society and communities, need to urgently start developing transition plans. Ukraine for instance has already set up an Interagency Working Group on Transition, which will be tasked with developing the national Transition Plan.


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