Transition process from Global Fond to domestic funding in Croatia Nevenka Mardešić, NGO HELP, Croatia

Some facts before GF 1992. – Ministry of Health (MoH) established first Croatian National Commission for Combating HIV/AIDS. 1992. - established Reference Centre for HIV/AIDS 1993. – MoH adopted National Programme for HIV/ AIDS Prevention 1996. - the first Harm reduction programme started, managed by an NGO “HELP”, 1998 – antiretroviral therapy (ART) became available and fully financed by the Croatian Health Insurance Fund

Croatia- GF grant The main goals of the GF programme: to facilitate the mobilization of Croatian society against HIV infection, in order to maintain the low prevalence of HIV and AIDS in the country to develop HTC sites to increase investment in surveillance

Croatia- GF areas: To maintain the universal access to treatment and improve the psycho-social support to PLWHIV To increase the level of protected behaviors among young people, through school based peer education prevention program To increase access to HTC services, particularly for members of vulnerable groups To implement targeted interventions for people under increased risks To strengthen the HIV surveillance system

Key elements of successfully implemented GF The GF project was not only about funding, it was also about multisectoral collaboration. GF made positive contribution in mobilization of different stakeholders including politicians, NGOs, health care and other professionals Croatia succeeded to maintain a low level HIV epidemic in the past three decades. However, many challenges remain.

Croatia- GF grant Granted resources were in total amount of 4.945.194 USD NGOs received 38% of the overall GF budget The Grant Agreement was signed on the 21th July, 2003 and the program ended on the 30 November, 2006

Preconditions for transition: - Cooperation between government and NGOs since 1999 (legislative basis, successful contracting, disbursement of funds, M&E system in place...) Treatment was always funded by national funds Continuation of funds for mostly salaries and commodities (GF grant supported investments in procurement and reconstruction of facilities)

Trap of low-level epidemic Low-level epidemic usually means low-level priority in the society and health care system. Result of that is challenge of funding, particularly funding of prevention that is not within the scope of the national insurance scheme. And the funds should go where they can truly prevent a case of new HIV infection and have the greatest impact on the epidemic. NGOs have a crucial role in prevention of new infection, and it was recognized by the MoH!

Domestic financing sources for national HIV response MoH through Lottery funds funds managed by the National Drug Control Programme and the Office for Human Rights. Local sources of financing at the municipality level Since 2006, the MoH continuously allocated funds for NGOs granted under GF: HELP, Hepatos Rijeka, HUHIV, Iskorak, Institute, Let, Terra, and Croatian Red Cross.

Spending- State budget 2007: 4.162.008,00 HRK ... 2012: 3.076.988,18 HRK 2013: 3.649.117,63 HRK 2014: 3.015.000,00 HRK 2015: 2.265.000,00 HRK 2016: 2.265.000,00 HRK 2017: 2.265.000,00 HRK

Key milestones: Transition of the governance structures 1992 - National HIV Commission established by the MoH; Reference Centre for HIV/AIDS established 1993 - First National Programme for HIV/AIDS Prevention adopted 2002 - National HIV Commission broadened; parallel Country Coordinating Mechanism (CCM) structure established 2003 - GF project started 2005 - National HIV/ AIDS Plan for 2005-2010 adopted 2006 - End of GF project; CCM discontinued; Commission continued 2011 - National Programme for HIV/AIDS Prevention for 2011-2015 adopted

9 years after GF almost all of the project components are fully covered by domestic financing sources The only GF project component which faced problems during transition was the HIV school education programme, which was piloted under the GF project. In this case, the challenges still to overcome are not of financial nature, but require further improvements of regulatory and procedural issues as well as an open discourse about the principles and objectives of sexual health education in Croatia.

Mitigating faktors for successful transition relatively low and stable epidemic, well institutionalised national HIV response with established governance structures before the GF projects started acknowledgement of a central role for NGOs in the national HIV response. ART was available and financed through domestic resources since 1998 and free of charge for all PLHIV in need,

NGO HELP’s positive example The practice of collaboration between the Institute of Public Health of Split-Dalmatia County and NGO HELP was replicated as a positive example, and other institutes of public health at county level and the CIPH established similar collaborations with some other NGOs and offer HTC at NGO premises. Volunteery work – it’s a magic ingreadiens and crucial effort to continue work despite occasional funding problems

Eduacation of youth-peer educators

Y-Peer education

Thank you for attention! Udruga za pomoć mladima Mihovilova širina 1, 21000 Split www.helponline.hr Tel. 00385 21 346 664