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
Presenter Dr. Tetyana Semigina

• 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).

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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.

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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
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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

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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 HIVinfection/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
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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,

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)

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

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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

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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)

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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

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Finally

• For every complex problem, there is a solution
  which is simple, direct and wrong Mencken