Overview of national advocacy challenges and state of affairs January-March 2016 2016-05-18

Lithuania: changes in environment Negative: During January-March 2016 the minister of Health changed so the advocacy process has started over again: the rhetoric of the new minister corresponds to aims of the Regional Program and policy тhe minister will be in charge till the new elections (October 2016)

Lithuania: advocacy challenges Municipalities are slow in establishment of their internal commission that reviews question of OST Changes in staff/leadership of the department responsible for EU structural funds management Last-minute cancelation of meetings with acting head of the EU structural fund department Reluctance of the Ministry of Health to have formal high-level dialogue

Lithuania: progress in advocacy tasks (1) Advocate for the increase of geographical NSP coverage and HR services access up to 60% territory: In progress: inclusion of SR (sub-recipient of grant) into the observers group of the steering committee of the assimilation of EU funds for HR (Harm Reduction) (the department under the Ministry of Health); participation in advocacy meetings with municipalities Advocate for the improvement of the quality of HR services and to initiate changes in the National HR regulation: In progress: based on round table with the Ministry of Health working group on regulation of nalaxone distribution was established Advocate for adequate and permanent national and local funding (50 % and 50 %) for NSP: In progress: inclusion of SR into the observers group of the steering committee of the assimilation of EU funds for HR (the department under the Ministry of Health);

Lithuania: progress in advocacy tasks (2) Advocate for the geographical OST coverage till 40% territory: In progress: inclusion of SR into the observers group of the steering committee of the assimilation of EU funds for HR (the department under the Ministry of Health); participation in advocacy meetings with municipalities Advocate for improvement of the OST services quality: In progress: the Ministry of Health wrote the letter to the Prison Department where the Ministry of Health does not forbid officially OST in prisons Advocate for an adequate and permanent national and local funding for OST: In progress: participation in advocacy meetings with municipalities

Belarus: changes in environment Positive: Preparation and ratification of National program on nation health and demographic security of Belarus for 2016-2020: Its N. 5 sub-program includes prevention of HIV infection Therefore prevention among PWUD (People who use drugs) is included in the national strategy and national funding is foreseen

Belarus: advocacy challenges Partners from other NGOs do not always invite to take part in key events for HR topic Partners from other NGOs do not include HR topic in a program of key events for HR topic Decision-makers not always willing to include representatives of NGOS in developing normative base Uncertainty whether representatives of PWUD community come prepared and “sober” to key meetings with decision-makers Representatives of PWUD needs a lot of technical support (including logistics and working skills) from experts to complete their advocacy tasks

Belarus: progress in advocacy tasks (1) Advocate for NSP funding is included in national program on HIV prevention 2016-2020: Completed: NSP and OST funding is included in the national program on HIV prevention 2016-2020 Advocate for implementation of a process of NSP funding from national sources: In progress: participation in normative base development Advocate for development of mechanism to plan financial expenses on OST and NSP from local budgets: In progress: dissemination and development of a manual on the calculation of costs of HR services (NSP);

Belarus: progress in advocacy tasks (2) Advocate for adequate conditions for social contracting of NGOs: In progress: participations in meetings with local authorities and their familiarizing with the recommendation for the law on socially important diseases Advocate for decrease of stigma to HR program in society: In progress: participation and organization of meeting and events with participation of decision makers and PWUDs Advocate for monitoring of expenditure on NSP and OST for 2016 – 2018 from GF, republican and local budgets: In progress: planning of initial analysis of current expenses on NSP

Belarus: progress in advocacy tasks (3) Advocate for development of OST in Belarus: In progress: provision of support to SSRs visits to regions and their participation in meetings with regional PWUD community and partners (representatives of police and health students/workers) Advocate for strengthening the status of OST as medical service: In progress: provision of support to PWUD community in sending advocacy letters to the Ministry of Health and their meeting with health students/workers

Georgia: changes in environment Negative: Intensified actions against drugs use by the government: Changes in drug scene leading to use of pharmacy drugs Massive searches and arrests of drug users Forced “taking from streets” for drug testing Positive: Uncontrolled drug testing taking people from streets resulted in: Emerging support to the protection of PWUD humans rights among general public Higher media attention Higher pressure on law enforcement agencies

Georgia: advocacy challenges Lack of internal GHRN expertise in advocacy (staff difficulties)

Georgia: progress in advocacy tasks (1) Advocate for contribution to decreasing the OST price for state methadone patients: In progress: participation in negotiations with Ministry of Health, Labour and Social Affairs (MoLSHA) and municipal healthcare departments to ensure affordable methadone price and developing sound arguments (the report in Q8-Q9) Advocate for legal changes to ensure “take away” methadone in OST: In progress: participation in negotiations with MoLSHA and municipal healthcare departments to ensure affordable methadone price and developing sound arguments (the report in Q8-Q9) Advocate for widening of OST coverage (by 2018 – 5400 people up to 12%): Completed: the coverage indicator is already integrated in the national HIV AIDS plan.

Georgia: progress in advocacy tasks (2) Advocate for increase of government funding of NSP services that is reflected in the Transition plan to national funding: In progress: participation in the process of development of the Transition Plan (working group and meetings) Advocate for improvement of Legal Environment for NSP to eliminate barriers for the access to NSP services: In progress: participation in meeting with the Ministry of Internal Affairs for discussing the service delivery barriers caused by chasing the outreach and social workers of NSP services

Tajikistan: changes in environment Negative: Media is reluctant to HR topic especially when other national events and festive days take place

Tajikistan: advocacy challenges Advocacy process is long and time consuming: It is necessary to keep in touch with high-level partners constantly It is necessary to put advocacy efforts constantly (including events and meetings) Change may take more than half year since advocacy efforts start Introduction of HR component into study programs for social workers is difficult as not all relevant documents are received from partners on time

Tajikistan: progress in advocacy tasks (1) Advocate for expansion of geographical OST coverage in Tajikistan: In progress: provision of comments and adjustment of the national program on HIV/AIDS prevention 2016-2020 (working meetings) Advocate for contribution to increase in quality of HR program Advocate for contribution to development of gender sensitive programs with focus on both drawing female PWUD to OST and increasing their quality of life Postponed: due to focus on the national program on HIV/AIDS prevention

Tajikistan: progress in advocacy tasks (2) Advocate for development of roadmap of OST program realization for 2016-2018 including the mechanism of introduction and application of OST In progress: making advocacy efforts through meetings and events to include the year 2018 into the roadmap developing by the Republic Drug Treatment center and the Ministry of Health and Social Protection Advocate for development of a plan to finance HR programs that would be included in the national program 2016-2020 In progress: participation in meeting related to the budget of the national program on HIV/AIDS prevention 2016-2020 Advocate for contribution to involvement of law enforcement agencies in HR program provision (protection of clients) Completed: MoU signed between police of Kuliaba and SSR (Svon Plius)

Tajikistan: progress in advocacy tasks (3) Advocate for contribution to integration of agencies helping PWUD, ministry of health and Social Protection, AIDS agency, Drugs treatment agency, Tuberculosis agency Canceled: it was realized naturally while working on other tasks Advocate for assistance to introduce HR learning module for social workers at State National University In progress: participation in working group (manuals, study program) and dissimilation of existing material Advocate for piloting mechanisms to allocate public funds to NGOs In progress: piloting mechanisms to provide/use existing primary health care facilities in Dushanbe for HR services and joint work on HIV and other infections prevention in primary health care institutions (working meetings)

Tajikistan: progress in advocacy tasks (4) Introduction of integrated package of HR services for PWUD via NGOs Postponed: the task depends on piloting mechanisms for allocation of public funds to NGOs

Kazakhstan: changes in environment Negative: Since 2015 decreasing oil prices and devaluation of local currency Revision of national budget spending including HR programs Under the state program of health development for 2016-2019, HR services were not funded while HIV prevention was degraded to municipal budgets

Kazakhstan: advocacy challenges SR does not identify advocacy challenges in their work

Kazakhstan: progress in advocacy tasks (1) Advocate for methadone registration: Completed: it was promised by the ministry of Health and Social Development that methadone has been registered as medical drug at then end 2015/beginning 2016 (waiting for a legal act) Advocate for incorporation of OST program in national health care system: In progress: participation in public hearings and working group creation Advocate for increase of PWUD awareness of OST including female PWUD: In progress: continuing provision of technical support and information to community

Kazakhstan: progress in advocacy tasks (2) Advocate for lasting allocation of national funding on NSP: Canceled/Postponed: advocacy efforts are in planning phase Advocate to pilot the delivery of express testing conducted through NGOs: Advocate for increase of NSP services quality including provision of gender-sensitive services

Kazakhstan: progress in advocacy tasks (3) Advocate for allocation of social contracting to NGOs working in HR from state and municipal budgets: In progress: amendments to the legislative act on NGOs work were adopted; conduct of working activities on increasing awareness including national dialogue, seminar for representatives of civil society and recommendations on further activities

Moldova: changes in environment Positive: In Q8 new government was elected and new ministries were appointed: With elected ministries it became possible to organize high-level meeting and other events Negotiations for the national dialogue has started The list of advocacy targets (partners) was adjusted

Moldova: advocacy challenges Difficult to arrange dates for round table with ministers: Continuous communication with high-level partners No feedback on realization of decisions taken by ministries: Continuous communication with high-level partners and monitoring of situation with provision of updates Stereotypes of some social workers toward OST services

Moldova: progress in advocacy tasks (1) Advocate for allocation of state funding on national HIV program: In progress: participation in different level meetings and negotiations with ministries Advocate for development of mechanism to finance NGO through state budget and Compulsory health insurance funds In progress: conduct of campaign to influence Compulsory health insurance funds Advocate donors to finance OST/NSP funding lack in 2018 and later; in Transnistria to finance NSP since 2018 Canceled: focus on provision of state funding for OST/NSP Advocate to increase OST coverage to 3.5% PWUD: Completed: sites are opened in 3 new cities; working to increase coverage till 5% PWUD and identifying OST needs in Faleshty

Moldova: progress in advocacy tasks (2) Advocate to increase of responsibility towards female PWUD In progress: participation in events and development of the letter (about women having limited access to integrated services) to members of the parliament Advocate to include Buprenorfin in OST program: In progress: preparations to the meeting with director of Policy and Analysis Department in the Ministry of Health Ensure access to HR services by PWUD community in Transnistria Realization is being held in cooperation with other organizations in the region