Assessment to assist with Partnership Framework

New/Continuing Activity: New Activity

Continuing Activity:

Program Budget Code: 18 - OHSS Health Systems Strengthening

Total Planned Funding for Program Budget Code: $2,300,000

Total Planned Funding for Program Budget Code: $0

Program Area Narrative:

Over the past several years the role of civil society in the planning, implementation and monitoring of HIV/AIDS interventions has

increased dramatically. NGOs and other civil society organizations actively participate in national and regional level policy and

strategy councils and work closely with government services to implement programs. A unique collaborative relationship has

evolved between civil society and government service providers at many sites to provide models for a continuum of preventive,

treatment and follow-up care to PLWHA.

The USG remains the primary financial supporter of organizational and systems strengthening activities to enhance national and

local responses to the epidemic in both governmental and nongovernmental settings. This investment is carefully leveraged with

civil society and public sector programming in order to improve HIV/AIDS program outputs and outcomes. The USG, through its

implementing partners, works with more than 100 NGOs and civil society groups. Most of these organizations have only been

created in the last several years, and, though many provide valuable services, most are organizationally nascent. Only two or

three are currently capable of directly receiving and managing donor funds, though many have received small grants from a

variety of national and international donors.

Weak institutional capacity among nascent civil society groups, particularly in smaller communities, limits access to services of the

more marginalized and highest risk groups. The GF Round Six Grant aims to rapidly and significantly scale up service provision

to a wide variety of high risk populations, including in small towns and communities, by mobilizing both NGO and public sector

service providers, in part through the provision of small grants. Ongoing strengthening of technical and

management/administrative capacity of both public sector and civil society organizations is vital to the achievement of the

ambitious goals elaborated in the GF proposal.

With the goal of leveraging GF Round 6 resources and assuring their effective and efficient use, the USG will continue to make

service capacity building a high priority in FY 2009 and dedicate resources to building on work undertaken to date. Through a

flagship HIV/AIDS Service Capacity project that got underway during FY 2008, the USG in FY 2009 will continue to support and

leverage GF efforts to strengthen HIV/AIDS service provision through a comprehensive program of capacity development. Efforts

will provide technical, management and administrative capacity development to organizations to enable them to make effective

use of GF and other resources to meet national HIV/AIDS program universal coverage goals. Activities will continue to: build local

capacity to reduce policy, legal, regulatory and fiscal barriers that inhibit access to quality HIV/AIDS prevention, treatment care

and support services in line with international standards; strengthen and expand linkages between public and civil society service

providers to enhance the provision of a continuum of care for HIV infected and affected individuals and their families, particularly

within vulnerable populations; increase the capacity of public and non-governmental organizations to ensure sustainable delivery

of quality services; and implement and assess innovative approaches to increase access of highly marginalized MARPS to

HIV/AIDS prevention, treatment, care and support services.

In addition to ongoing work in civil society capacity development, COP 2009 resources will: enhance the role of the multisectoral

National Council on HIV/AIDS and TB and the Committee on HIV/AIDS and TB within the Ministry of Health in supporting

multisectoral planning, implementation, budgeting and monitoring of the National AIDS Program as well as donor and

implementing partner coordination; provide continued strengthening of regional level HIV/AIDS and TB coordination council

capacity to develop and implement effective HIV/AIDS policies and strategies and enhance regional planning, budgeting,

implementing and monitoring of programs.

With COP 2009 resources, the USG will provide ongoing assistance to improve HIV/AIDS drug and commodity procurement and

supply management systems. The National Law on HIV/AIDS commits the Government of Ukraine to universal access to HIV

treatment and care, with free treatment for all patients with HIV/AIDS. If this target is to be successfully achieved and sustained,

optimal utilization of resources and improvements in pharmaceutical management capacity to ensure uninterrupted supplies of

drugs and commodities is urgently needed. Currently, however, resource utilization and associated availability of drugs and

commodities for HIV/AIDS testing and treatment is suboptimal. Poor procurement practices, frequent stockouts of supplies, poor

quantification of needs and inadequate management of supplies significantly limit the government's capacity to ensure a steady

supply of required drugs and commodities.

Using resources obtained through centrally supported TA to address GF implementation bottlenecks, the USG joined with WHO

and the EU to support an assessment of HIV/AIDS drug and commodity procurement systems. Based on the findings of the joint

assessment, the USG will, in early 2009, provide assistance in developing a GOU plan for the sustainable uptake of GF-supported

patients on ARVs, as well as a capacity development plan to strengthen HIV/AIDS drug and commodity procurement. During the

next year, the USG will provide targeted TA to address key elements of this capacity development framework in order to

strengthen GOU capacity to increase access to HIV-related drugs and commodities.

Improving the procurement and management of HIV/AIDS drugs and commodities is a high-leverage opportunity to strengthen

health service systems which affect implementation of the entire National AIDS Program. Moreover, it is an intervention that builds

on and complements the capacity development/systems strengthening work that the USG is currently undertaking in its HIV/AIDS

program. Promoting good governance principles through best pharmaceutical management practices can increase transparency

and accountability in how decisions are made in health sector procurement and improve the effectiveness of actions taken in drug

procurement and distribution. Effective governance in the pharmaceutical sector promotes more effective health programs by

ensuring appropriate operational level policies and standards are in place and implemented, by combating corruption and

promoting efficiency, and by ensuring equitable access to medicines in a transparent manner.

Finally, COP 2009 resources will also be applied to a number of important policy areas, including

the development of anti-discrimination laws and policies to ensure the legal protection of MARPs living with HIV; strengthening the

role of NGOs in the delivery of prevention services, including voluntary counseling and testing services, to IDUs and other most at

risk groups; and enhancing the role of Parliament in the development of an appropriate enabling environment for the expansion of

services for MARPs.

Table 3.3.18: