Incorporating transition considerations into the new Global Fund funding cycle Mauro Guarinieri Senior Technical Adviser, Community Responses and Drug Use, Community Rights and Gender Department 4-6 April 2017 Vilnius, Lithuania Regional Harm Reduction Conference 2017 - HARM REDUCTION IN THE NEW ENVIRONMENT

Global Fund Investment guidance in EECA (2014-2017) Promote universal access to anti-retroviral therapy, with special focus on KPs Enhance access to comprehensive harm reduction services for PWID, including those in prisons. Promote universal access to timely and quality diagnosis and treatment of all forms of TB. Special focus on migrants, (ex)prisoners.

Sustainability and Transition in a Global Fund Context The ability of a health program or country to both maintain and scale up service coverage to a level, in line with epidemiological context, that will provide for continuing control of a public health problem and support efforts for elimination of the three diseases, even after the removal of external funding by the Global Fund and other major external donors. Relevant to all countries designs Transition The process by which a country moves towards fully funding and implementing its health programs independent of Global Fund support while continuing to sustain the gains and scaling up as appropriate Transition preparedness should be a priority for all LMI countries with ‘low’ and ‘moderate’ disease burden and all UMI countries

How does the STC Policy relate to the 2017-2022 Strategy? The Global Fund Strategy 2017-2022 places a strong emphasis on the need to support sustainable responses for epidemic control and successful transitions away from direct grant support. It also stresses the need to support countries to use existing resources more efficiently and to increase domestic resource mobilization. MAXIMIZE IMPACT AGAINST HIV, TB AND MALARIA BUILD RESILIENT & SUSTAINABLE SYSTEMS FOR HEALTH PROMOTE & PROTECT HUMAN RIGHTS AND GENDER EQUALITY MOBILIZE INCREASED RESOURCES

What is it designed to do? RISK Financial Programmatic Alignment Governance The policy takes a proactive approach to addressing the sustainability challenges and transition risks faced by a broad range of countries and grant components

Why is it important? Challenges and lessons learned Service Continuation Governance Programmatic Risks Data Risks Financial Dependency MONTENEGRO

But resources for key affected population is funded by GF and others external donors 81% of HIV funding for key population interventions (IDU, MSM, FSW and vulnerable populations) is funded by external resources. Similar trends are observed for TB detection care and support among vulnerable groups and TB/HIV programming. Source: From George’s presentation

Global Fund Allocations for 2017 -2019 Allocation Period $296.5 M Transition 2017-2019: Albania and Turkmenistan Transition 2020-2022: Armenia Transition 2023 -2025: Kazakhstan Newly eligible 2017-2019: HIV: Serbia, Montenegro and Kazakshtan

Some key messages Global Fund STC policy calls on all countries to plan for and embed sustainability considerations within national strategies, program design, grant design, and implementation Data trends in the region indicate need for continued investment in prevention and harm reduction services. Cost of treatment outweighs cost of prevention. Due to their linkage to communities and ability to connect KP to health services, civil society needs to be seen as an integral part of health services. Transition is a process that extends beyond grant closure, therefore opportunities for available support should be fully harnessed. Governments, donors, technical agencies, multilateral agencies and civil society organizations all have a role to play to ensure smooth transition processes as a matter of “shared responsibility”. Current mechanisms are not enough, the new mechanisms are needed for successful continuation of activities

Thank you!