Ukraine: coordination of the response to HIV/AIDS epidemic on national and local levels

1. Ukraine:coordination of the response to HIV/AIDS epidemic on national and local levels Research Institution- Kyiv-Mohyla Academy (Ukraine) Partners - London School of Hygiene and Tropical Medicine (UK), the Royal College of Surgeons (Ireland). The Research Funder - the Open Society Institute (USA). Presenter: Dr. Tetyana Semigina

2. State of HIV/AIDS epidemic in Ukraine • Ukraine has the highest prevalence of HIV among the post-soviet countries. • Epidemic is still considered as concentrated(IDUs). But the proportion of sexually transmitted HIV cases is currently alarmingly increasing. • Global Health Initiatives in Ukraine: • Global Fund Programs (since 2004):1st round – 90 mln USD, 6th round – 150 mln USD. Implemented by INGO • World Bank:TB-HIV Loan, 2003*/06: $60mln ($30mln HIV: loan stopped and renewed) • USAID, DFID, SIDA, UNICEF, UNAIDS, TPAA, Renaissance Foundation (Soros network), Elton John Foundation, Bill Clinton Foundation, etc. NaUKMA, 2007

3. Research Methodology • The study combines both analytical desk research (document review) and field procedures: 1st stage: documentary review, interviews national stakeholders. 2d stage: documentary review, interviews with 93 HIV-services’ clients, interviews with 88 HIV-services’ providers, interviews with 34 local stakeholders, interviews with 39 local NGOs, 12 facility survey • Sites selection: • 3 regions – Kyiv, Odessa, Lviv NaUKMA, 2007

4. Implementation of HIV policy • Documentary analysis: • Ukraine has a complicated and fragmented system of administrative bodies implementing and monitoring HIV/AIDS policy. • National stakeholders interviews: • Main policy actor – Ministry of Health, but other actors has an influence NaUKMA, 2007

5. Administration, structures, departments of local executive power bodies Coordination mechanisms Verkhovna Rada (Parliament) of Ukraine The Cabinet of Ministry of Ukraine ? Government commission on issues to fight HIV/AIDS Donor Organizations) Interim Special Commission of Verkhovna Rada of Ukraine in Problems of HIV /AIDS, TB and Drug Addiction National Coordination Council on issues of the prevention of HIV–infection/AIDS spreading NGO (national) Committee on AIDS and TB Ministries of Ukraine Labour and Social Policy Family, Youth and Sports Issues Finance Defence Educati-on and Science Health Ukrainian HIV/AIDS Centre Coordinating Monitoring and Evaluation Regional AIDS Centres NGO (regional) State Oblast Administrations NaUKMA, 2007

6. Overall coordination challenges • National and regional stakeholders interviews + interviews with NGOs:Coordination is considered a serious problem for HIV/AIDS policy • Many coordination bodies have been established (and then abolished) • Overlap of responsibilities and functions of executive bodies on national and regional levels • Separation between health system and social services (mainly provided by NGOs) • Weak cooperation between services, underdeveloped referral system, NaUKMA, 2007

7. GF Impact on coordination (respondents’ views) • 2005- establishment of the National Coordination Council • 2005-2006 – establishment of the regional and local coordination committees • 2006 – International HIV/AIDS Alliance in Ukraine: regional coordinators (in some areas) NaUKMA, 2007

8. Regional Coordination Committees activities (respondents’ views) • Kyiv:ambivalent attitudes • NGOs were critical, civil servants - positive • Odesa: positive attitude • strong commitment of governor, coordination forum of NGOs, referral system, proactive position of the regional coordinator • Lviv: negative attitude • formal existence of the committee NaUKMA, 2007

9. Factors influencing local coordination (respondents’ views) • indifference of authorities in the activities of coordination mechanisms • inability of representatives of NGOs to lobby their ideas, proposals, innovations to the full extent through decisions of coordination councils • flow of members who represent authorities within the council • absence of financial incentives for members of coordination councils • forming councils without representation of all interested parties NaUKMA, 2007

10. Rationale • Problems with coordination named by respondents can mean that we have: • something to be coordinated (scale up of services, mainly due to GHI) • development of civil society and idea for the necessity of the horizontal level of public policy (strengthening of capacities of the NGO representing MAP) • introduction the idea of the multisectoral approach to combat HIV/AIDS (promotion of new approaches and new forms of cooperation) NaUKMA, 2007

11. Underpinning issues • To a considerable degree coordination challenges are the result of: • the specific of the political process in Ukraine, • political traditions in management, • lack of publicity and coherence of health policy in general, • short time of NGO activities in Ukraine, • absence of integrated care/support NaUKMA, 2007

12. Finally… “For every complex problem, there is a solution which is simple, direct and wrong”Mencken NaUKMA, 2007