Approximate CSCS fees are $20,500 which cover support for desk and non-desk positions overseas for

CDC.

New/Continuing Activity: New Activity

Continuing Activity:

Program Budget Code: 18 - OHSS Health Systems Strengthening

Total Planned Funding for Program Budget Code: $800,000

Total Planned Funding for Program Budget Code: $0

Program Area Narrative:

Program Area: Health Systems Strengthening

Health systems strengthening and policy is a key area of focus for the USG/Russia program, particularly in this phase-down

period as the USG program transitions to a program that emphasizes technical assistance and dissemination of effective

approaches in HIV prevention and care. USG implementing partners will continue to contribute to Russia's implementation of the

United Nations' "Three Ones" principles and to support Russia in reaching its Universal Access targets. Following the conclusion

of Presidential and Parliamentary elections last year, Russia's National Commission on HIV resumed its work in April 2008. In

May 2008, Russia held the second national consultation to assess Russia's progress to date towards reaching 2010 Universal

Access targets. While noting significant progress towards targets set for the prevention of mother-to-child transmission, HIV

testing and counseling, and anti-retroviral treatment, participants from the Government of Russia (GOR) and Russian civil society

recognized the need to boost prevention activities for most at-risk populations, as current programs only reach 24% of injecting

drug users (IDUs), 36% of commercial sex workers (CSWs), and 16% of men having sex with men (MSM). Contributions of civil

society and external partners were central to the completion of Russia's second UNGASS report for 2006/2007. The foundation

for the UNGASS progress report is the national strategic information (SI) system supported in part by USG partners, UNAIDS and

WHO for routine and sentinel surveillance data as well as special studies.

The GOR is demonstrating a growing commitment to address the weaknesses in programming as identified in the UNGASS

report and by stakeholders such as NGOs and external partners (USG, Global Fund (GF) and UN groups). One example is the

doubling of the prevention budget under the National Priority project up to $17 million in 2008. This includes continued support,

albeit limited for federal tenders for prevention programs through the NGO community such as last year's three year, $2M award

made to a local NGO consortium to develop outreach programs. However, this is not enough, given the continued concentration

of the epidemic in Russia among MARPs and in light of the GOR commitment to repaying its HIV grants from the GF in the

cumulative amount of $217M. The continued engagement of external partners such as the USG will help catalyze GOR

resources to better target priority areas in order to contain the epidemic.

Last year, with World Bank, USG and UNAIDS support, the Ministry of Health and Social Development (MOHSD) organized the

review and adoption of 50 new normative guidelines on HIV prevention, treatment and care, an essential step forward to solidify

effective implementation of new policies and programmatic approaches. Although there has been progress in strengthening

HIV/AIDS policy, programming and system development, many challenges remain. The doubling of the GOR prevention budget

represents less than four percent of the total funds allocated for HIV-related programs in Russia. GOR authorities recognize the

existence of gaps in its implementation of the "Three Ones": there is still no official national HIV strategy; although a National

Governmental HIV Commission has been established, it does not have a sufficiently high level of multi-sector representation to

enable interagency coordination within the GOR; coordination with NGOs and international agencies needs to be improved, and

stigma and discrimination towards HIV-positive people continues to be problem in Russia, including among the medical

professions and employers.

With FY 2009 funding, UNAIDS partners will continue their collaboration with the GOR and will develop a plan to assist the

MOHSD and the Federal AIDS Center in dissemination and monitoring of the use of the recently completed and approved

normative guidelines on HIV prevention, treatment and care. Shoring up full implementation of the "Three Ones" will continue to

be a priority area for USG support to UNAIDS in FY09. USG will also continue to support UNAIDS in facilitating the development

of a unified HIV strategy by the GOR. Continued support for the capacity building and involvement of civil society in policy making

forums at national and regional levels will further efforts to both de-stigmatize attitudes towards the most at-risk populations

(MARPs) and to ensure that policy decisions are well-informed and meet the needs of target groups.

In FY 2009, the USG will develop an overall dissemination strategy, based on successes of the past few years of the USG HIV

program. The goal of this effort will be to establish a sustainable approach to dissemination of key practices endorsed by the

USG. These practices and approaches are tools that can help the Russian health care system adapt to meet the needs of the

growing epidemic and number of people living with HIV/AIDS (PLWHA) who will be coming for treatment and care in the next few

years. Each innovative activity will have an appropriate pathway for dissemination at additional regional levels and federal level.

For example, UNAIDS support will include institutionalization of a unified HIV M&E program in collaboration with the Federal AIDS

Service and other government organizations. Together with the Federal Service, USG plans to support UNAIDS for providing

technical advice through the seven Federal Okrugs (districts) to improve their collaboration within the unified system on data

collection, submission, and analysis. At the second consultation on Universal Access, participants recommended the further

institutionalization of the SI framework (see SI section). This will include, importantly, the National AIDS Spending Assessment

and its use not only at the national level but also in the regions. As the methodology for systematic monitoring of HIV/AIDS

financial flows at national and sub-national levels are refined, a training curriculum will be finalized and disseminated. Continued

investment of small amounts of USG funding will help catalyze not just major increases in Russian funding, but ensure that these

resources are targeted in the most effective way.

Another example will be the development of a plan for dissemination of the decentralized approach to HIV health systems as

promoted in St. Petersburg and Togliatti, with 2008 funding (see success story). USG partners will develop a strategic approach

for disseminating this model to other parts of Russia. This may include the creation of a dissemination team to develop the

package of documents, training modules, technical assistance plans, and a strategy for dissemination in coordination with the

GOR. It is envisioned that USG partners will provide targeted technical expertise for training of trainers to supplement the

regional MOH experts or institutes who would lead the process. There may be opportunities to secure regional government

commitment to this effort once the package of services and approaches is prepared and shared with the regions. FY09 funds will

be used to implement the dissemination and transition the model to GOR.

USG implementing partners will capitalize on Russia's commitment to Universal Access processes and targets to promote needed

policies and adequate funding for effective programs, especially for MARPs. To assist the GOR in formulating sound policies and

plans to reach their ambitious target for universal access by 2010, USG implementing partners will support the dissemination of

best practices from USG-supported regions, regions supported by the Global Fund (GF) and other external donors, and regions

participating in the National Priority Project on Health. One potential venue for sharing this will be Federal level HIV conferences

and roundtables. This year, the US National Institutes of Health (NIH) will contribute to the Russian HIV meeting planned for May

2009. The dissemination of best practices in HIV prevention, treatment and care developed with USG support will help the GOR

build its programs based on the experiences of governmental institutions, NGOs, faith-based organizations (FBOs), community-

based organizations (CBOs), and businesses.

Central to the continued involvement of NGO and civil society in HIV programming in Russia is the need to strengthen

partnerships with the GOR and to develop mechanisms to formalize relationships. There are over 200 NGOs working in the area

of HIV/AIDS in Russia (UNAIDS database), and although the external partners such as USG and Global Fund have increased

support to them in recent years, GOR funding and collaborative systems for partnering with governmental service providers

remain insufficient. USG implementing partners will continue to support a dialogue with the GOR on developing contractual or

other mechanisms to fund NGOs to provide HIV/AIDS prevention and care services. In 2009, the USG will explore ways to

incorporate best practices of USG and other NGO partners and outline an effective strategy for informing government of the

successes the NGO interventions in order to aid GOR representatives in planning for future collaboration, including support for

additional government tenders and financial support. This effort may include links with national NGO networks working on

HIV/AIDS to facilitate their participation with the GOR in the development of a joint platform for action.

Similar to the GOR, the faith-based community has demonstrated an ongoing and broadened commitment to the fight against

HIV/AIDS. Five denominations (Baptist, Lutheran of Ingria, Lutheran, Catholic and Evangelic) have either developed or adopted a

strategic framework on HIV/AIDS, building on the first such framework developed by the Russian Orthodox Church with USG

support. The Inter-Church Committee on HIV/AIDS has expanded to include the Jewish community as observers, and in co-

operation with the Islamic community, the Committee is currently organizing the Second Inter-Religious Conference on HIV/AIDS,

which is expected to result in the establishment of the Inter-Religious Committee on HIV/AIDS. Regional Inter-Church

Committees on HIV/AIDS have been formed in St. Petersburg, Orenburg and Kaliningrad, meeting quarterly to co-ordinate efforts.

Importantly, the issue of faith based organizations' (FBO) involvement in the Russian response to HIV/AIDS was recently included

in the agenda of the Council of PLWHA. This PLWHA Council has developed concrete proposals on cooperation with churches in

the South and Far East regions of Russia and has nominated a focal point to develop a strategy of co-operation with churches

and maintain working relationships with them.

The faith-based community plays a significant role in policy advocacy and has the potential to contribute more to HIV/AIDS

programs in Russia. With FY 2009 funds, UNDP partners will continue their successful work with faith-based leaders at the

national level to strengthen the policy environment to reduce stigma and discrimination within the religious community and to

develop sustainable and measurable systems for continued and expanded FBO involvement. Efforts towards the development of

a multi-religion HIV strategic framework will continue to be supported. UNDP will expand their HIV policy development activities

with the Russian Orthodox Church to include other religions. Beginning with a conference in November 2008, the existing Inter-

Church Council currently supported by the USG will be expanded to become an Inter-Religious Council as a way to improve

collaboration on HIV/AIDS between different sects at national and local levels. The conference will be the first step to secure the

commitment of other senior religious leaders and to disseminate best practices in HIV prevention and care piloted by FBOs in

Russia. Continued USG assistance for faith-based policy dialogue will further support efforts to share best practices, possibly

through exchange visits between the different regions, as well as providing for technical advice and training for new faith-based

partners engaging in Russia's response to HIV/AIDS.

In FY09, the USG will continue to develop alliances with the private sector in Russia. Leveraging private sector resources and

involving the private sector in social program development and implementation will be one of the key directions in the upcoming

years. Building on the existing strong collaboration of TransAtlantic Partners Against AIDS and the Global Business Coalition

(TPAA/GBC) with the private sector, including the Business Against AIDS Coalition and other business alliances, the USG will

support the development of the Public-Private Partnership (PPP) model for HIV/AIDS. TPAA/GBC has strong partnerships with

the private sector, government, and legislators (through the Parliamentary Working group on HIV/AIDS and TB), and is well

positioned to advance PPP policy development. Policy briefs, round-table discussions with partners, and PPP best practices

dissemination activities will facilitate the establishment of the PPP as a model of government and private sector collaboration on

HIV/AIDS. This model and approach can then be applied to build alliances to confront other socially significant problems.

Products/Outputs:

?Facilitate NGO and civil society participation with the GOR in the development of a joint platform for action to address MARPs.

?Increased GOR funding for NGOs to provide HIV outreach and care to MARPs.

?National Aids Spending Assessment institutionalized.

?Strengthened support of religious leadership of the faith-based response for HIV/AIDS issues and programs.

?Stigma and discrimination associated with HIV and substance abuse decreased.

?Official national HIV strategy developed and/or quarterly meetings of the National HIV Governmental Commission held.

Table 3.3.18: