1. Overview of quarter reports provided by the national sub- recipients for the January - March, 2017

2. Outline Achievements Key activities Success stories
Positive changes in the following areas on a local/national level:
Domestic investments in harm reduction became higher and more monitored
Mechanisms of NGOs contracting to provide HR services are sufficient
High quality and sustainable HR program
Civil society and PWUD community involvement in HR funding decisions
Key activities
Activities / events that were the most important within the project to make the difference on achievements
Success stories
Advocacy technology, an event or other activity, your personal/organization development or way to mobilize community – anything that the national partner finds important to their work and want to share with other countries in the region

3. Abbreviations
PWUD – people who use drugs SR – sub-recipient of the grant SSR – sub-sub recipient of the grant and representatives of PWUD community (working under supervision of SR) IG – initiative group of SSR The Regional Program – The Regional Program “Harm Reduction Works – Fund It!” CCM – country coordination mechanism (the supervision body on country level of funding received from the Global Fund against AIDS, Tuberculosis and Malaria) HR – Harm Reduction programs OST – Opioid substitute treatment NSP – Needles and syringes programs PLHIV – people living with HIV

4. National partners/Sub-recipients
Lithuania – The coalition “I can live” Moldova – UORN Kazakhstan – The Union of people living with HIV (“KazSojuz”) Tajikistan – SpinPlius Belarus – The Positive movement (“Pozitivnoe dvizhenie”) Georgia – Georgian harm reduction network (GHRN)

5. Achievements
Georgia
Drug legislation amendment package under discussion by the Georgian parliament at Health Care and Human Rights Committees
Restrictive drug policy and lack of legal base for the needle exchange and other harm reduction activities have been one of the barriers for smooth implementation of HIV program
The changes are introduced by the National Drug Policy Platform, where GHRN is one of the leading partners
The National Drug policy Platform is established by Georgian Drug Users Community Group (GeNPUD) in April 2016, bringing together 33 entities representing civil society; it sets up thematic working groups to discuss various issues; the government has pledged to work with the platform
Slight liberalization of marihuana use since 2017
The Constitutional Court of Georgia delivered judgment #3/1/855 (Feb., 2017) declaring the imprisonment unconstitutional for purchase and possession of up to 100 gm raw marihuana
The Constitutional Court of Georgia declared unconstitutional the imprisonment under the both: administrative and criminal responsibility, for purchase or possession of dried marijuana up to 70 grams, use of marijuana or its manufacturing for personal purposes
Still  under administrative code there is a fine of 500 GEL, under the Criminal Code also fine of at least 1000 GEL and the community service for dried marijuana’s illegal manufacturing, purchase, storage or illegal consumption

6. Achievements
Belarus
The Order of the Ministry of Health ( №74) "On the establishment of pilot working groups for the prevention of the spread of HIV infection among injecting drug users“ was developed:
It de-facto provides the ground for NSP funding from local budgets.
The order was developed on the basis of the methodological manual for Planning the Cost of HIV Prevention among Vulnerable Populations (№ 309, г); the manual is the first manual on the organization of NSP approved by the MoH; it was developed by the Pozitivnoe Dvizenie
The concept of sustainable development of the system of prevention, treatment, care and support related to HIV/AIDS and tuberculosis was adopted/approved by the Ministry of Health in 2017
In addition, the plan of the concept realization was also approved by the Ministry of Health in 2017
The acts establish a package of Harm Reduction at the national level and they give ground for the state funding
The acts denote possible financing mechanisms (functional groups and state social contracting)
The Pozitivnoe Dvizenie provided its recommendations and advocated for inclusion of social contracting as the mean of funding

7. Achievements
Moldova
The Ministry of Health of Moldova and the National Health Insurance Company (NHIC) signed the order establishing the Coordination Council for: 1. determining the priorities for using funds from the Preventive Fund and 2. approving the Project-based funding regulation
It means that the government obligation is put into action stating to initiate funding of two harm reduction projects from the funds of the preventive fund (NHIC), for a total of 2 million lei, in a short time (approx. since July 2017)
The regulations on funding of two harm reduction projects from the preventive fund (NHIC) were created
Many practicalities how to organize the funding need still to be established
UORN continuously conducted advocacy including study-visit of representatives of NHIC and the Ministry of Health to Poland so that they could learn new practices of funding and see positive results (together with EHRN)
New OST site has been open in Falesti since March 2017
UORN organised meetings with PWUD in the city, round-tables with local authorities and public health staff
New municipalities are willing to open OST sites when they know the benefits of the site and see the demand for the services; additionally, it is relatively convenient because OST is paid from National Compulsory health Insurance Funds and sites can be open using existing health centres infrastructure
Currently the advocacy to open new site in Orhei is carried on
The Center for Policies and Analysis in Public Health (PAS Center) is preparing to purchase buprenorphine as a pilot project
UORN is negotiating with representatives of the narcological dispensary and representatives of the Ministry of Health to review the Protocol of OST programs to include the use of buprenorphine

8. Achievements Kazakhstan
On 31 January, 2017 the OST site was opened in Alma-Ata:
6 clients were in the treatment on 31 March,2017 (planned for 50 people)
KazSojuz has participated actively in all public hearings and provided necessary recommendations; KazSojuz is a member of admission to the treatment group
Even though methadone is registered as medication, still it needs to be incorporated into Guaranteed amount of medical free assistance; then OST treatment will become a consistent part of national health system (no the status of SOT program is a pilot)
it is planned to increase the coverage of clients on the site through informing outreach workers of the AIDS Center and through self-help groups
New OST sites are planned in Ridder and Zyryanovsk
KazSojuz is collecting the potential clients signatures and participate in public hearings
Under development: the order of the Ministry of Health and Social Protection on the introduction of universal rapid HIV testing, including through NGOs
methodical manual for the provision of rapid HIV testing of PWUD and their sexual partners through NGOs will be approved alongside the order
KazSojuz is an active participants of the working group including provision of recommendations and monitoring the progress
Under development: Strategy "Plan of accelerated measures to prevent new HIV infections in the Republic of Kazakhstan in accordance with the UNAIDS strategy “ and its roadmap; Responsible authority – republican AIDS center

9. Achievements Lithuania Tajikistan
In the beginning of 2017 the new amendment to OST order was adopted. From 2017 the methadone may be given not only to patients, but also to their relatives when a patient cannot reach the methadone site due to health and other problems
The advocacy was made by the Vilnius Center for Addictive Disorders in order to optimise workload for their personnel and make more effective treatment for clients
Tajikistan
The National HIV Program for was approved by the government (23 Feb., 2017)
it was supplemented with the roadmap that allocated funds for each expected result. Unfortunately, in the program and its plan it is not stayed which part of funds will be covered by the government (the Global Fund may remain as the main source of funding)
SpinPlius recommendations were incorporated in the Program; the Program has separate sections on actions for PWUD and in prisons
Development of the new national proposal to the Global Fund for the period (with application deadline in May)
The first draft of the proposal is developed and civil society recommendations are included

10. Negative trends Lithuania
Updated NSP funding procedures description, No. V-907 (July 7, 2016) - the number of deliverable syringes and needles increased to 7 (instead of 3);
the official letters and meetings with the Ministry of Health were crucial in achieving the increased quotas of syringes and expecting to achieve the delivery of Naloxone
more specific provisions on overdose prevention (naloxone) and expansion of peer-to-peer services that we had proposed were not included (more advocacy is needed)

11. 3rd year work plan implementation/ Key facts
Lithuania
Discussion of project results and outcomes with SR members/experts; furthering discussion on PWID decriminalization, planning next steps (reprogramed for 4th year)
Study visit to good NSP practice site (reprogramed for 4th year)

12. 3rd year work plan implementation/ Not conducted activities
Lithuania
Discussion of project results and outcomes with SR members/experts; furthering discussion on PWID decriminalization, planning next steps (reprogramed for 4th year)
Study visit to good NSP practice site (reprogramed for 4th year)
Moldova
Training on developing a strategic plan for the development of the PWUD community in Moldova for 2018 (reprogramed for 4th year)
Quality control in the provision of services (reprogramed for 4th year)
Visits to Moldova on the exchange of experience for specialists from the Transnistria
Training on the exchange of experience in the field of budget advocacy in order to familiarize with the Poltava experience in ensuring the sustainability of services. Support from OA "Light of Hope" (Poltava) (reprogramed for 4th year)
Media and social campaigns to increase the level of public responsibility to the problems of women using drugs
Kazakhstan
Organization of an information campaign to raise public awareness of methadone and increase tolerance towards women who use drugs (postponed until 2017 June)
Participation of the SR/SSR in the action on The AIDS Candlelight Memorial (May 15, 2016). Creation of the multimedia photo quill "Kazakhstan: I remember!" to remember those died from AIDS (in progress until 2017 June)
Holding the action "Understand. Make the right decision" on Facebook on the International Day against Drug Trafficking (postponed until 2017 June)

13. 3rd year work plan implementation/ Not conducted activities
Tajikistan
Photo exhibition about the Harm Reduction Program and development of videos about Harm Reduction in Tajikistan
Extended meeting of partners. Co-organization of the event with the republican AIDS center to present the New National Program on HIV / AIDS Control for
Forum "Women - life!“ (gender sensitive approach to Harm Reduction in Tajikistan)
Meeting of the working group under the CCM to facilitate the development of road maps for the implementation of OST and NSP in Tajikistan for
Meeting of the working group under the CCM to discuss "Coordination of activities for financing the harm reduction program among partner for "
"Relations with governmental officials” training for SR and SSR, community members; it will be held before the extended working meeting with partners
Training on team building with SSRs
Belarus
National Dialogue/high-level meeting
Update of the advocacy targets map
Monitoring and analysis of funds spent on HIV prevention both by the ministry of health and NGOs
Training of community in fundraising and fundraising conducted by community to organise the OST clients’ meeting

14. 3rd year work plan implementation/ general overview
Too many workplans and roadmaps for the national partners to implement during one year
Many advocacy events result in development of additional plans for social contracting, OST protocols and many other issues
SRs cannot implement all plans and monitor all of them during the year as a result they:
SR implement national roadmaps and other plans and fill in these activity in our workplan
SR follow our workplan and do not fully monitor important national activities (“no funding” to implement other activities)
There is a need for more flexible workplans (and their budgets) so that our initial advocacy would be in line with arising national priorities

15. 3rd year work plan implementation/ general overview
Too many targets and advocacy goals for the short period of time
Advocacy plans (2015), budget advocacy plans (2017), national priorities and internal organisational interest resulted in too many advocacy goals
SRs activities are not consisted from one to another and they seem to be fragmented (two activities for gender services, 2 activities on OST protocols etc)
The strategic approach is rarely seen in the workplans (one key activity and many smaller supporting ones)
Moldova is rather an exception that has clear focus on 2 pilot NSP projects advocacy when key events are supported with small preparation meetings and social/media campaigns
There is a need for clear goals and their prioritisation with allocation limits, e.g. the first goal – 60 per cent of budget/activities, the second goal – 30 per cent etc

16. 3rd year work plan implementation/ general overview
Activities in workplans and applied advocacy tools lack creativity and ambition (monotony)
The most common types of national activities are: participation in working groups, small-scale meetings with public officials, round-tables and printed material (usually brochures and other practical material); some countries have social campaigns
However, the high amount of meetings do not directly result in progress/impact especially when the political situation is unstable or key public officials change
More sustainable tools that are rarely used on local level: analytical reports and their visualisation, shocking/drastic media campaigns/arguments, co-organisation of high level events with wide participation, partnership outside “HIV/TB circle”
Wider range of advocacy tools has come on the regional level: analytical reports, study-tours and National dialogues (co-organised with key stakeholders)
More creativity and ambition is necessary from the regional level as national partners use regional events as learning-by-doing experience that can be further applied locally
Example: if the round of study-tours was successful, the national partners will start to ask for other study-tours by themselves (from their budget), while EHRN could propose another new tool for them to try implement
On the regional level the examples of ambitious advocacy, catchy media campaigns and/or anti- stigmatisation campaigns could help to broaden national partners tools
For instance, the Global Fund itself uses the initiative “RED” to promote its actions and target in Africa

17. 3rd year work plan implementation/ general overview
Inclusion of institutional/organisational activities into advocacy plans
Many internal organisational activities are presented as advocacy activities in workplans (e.g. voluntary lawyers training, OST practitioners’ conference, brochures and white books)
It seems to be logical as for some national partners EHRN grant is the main source of institutional funding; however, then it seems that many advocacy activities do not result in any results and the advocacy becomes inefficient
Therefore, it could be reasonable to make the additional part in the workplans (next to regional events, advocacy, project management) that would be dedicated to the strengthening of the institutional capacity of the national partner’s organisation; it could allow to monitor how much budget is allocated on “non advocacy”

18. 3rd year work plan implementation/ general overview
Workplan activities lack sustainability and productiveness
Workplans contained activities that do not result in any actual advocacy action or tangible result
For instance, monitoring in order to monitor but not to provide recommendations, study-tours to NSP sites to learn experience, but not to provide comprehensive overview of NSP sites in the country; development of recommendations that are not planned to be presented
Some activities were already „uncertain“ at the planning phase (e.g. political will, elections, stigma, co-funding) and eventually they were late in implementation
Some activities dependent on implementation of other activities:
If the national program is approved, then we will organise national dialogue; if the national dialogue is organised, we will review the advocacy allies map etc
While planning, workplans should avoid co-dependent activities; as it was advised, the strategic approach should be introduced, when small activities implementation support big one, but not vice verse when depending on one big activities, many small may occur
While planning activities it could be beneficial to add the degree of risk (low – implemented for sure; medium and high); while risky activities could not be planned for the last half of the year
It should be clear what results / effect advocacy activities would have on local/national level:
For instance, if it produces many reports, but any general statement and conclusions, then such activities could be replaced with others; if national partners produce recommendations, then they need to plan where they will present them
We could have internal agreement on blocks of activities while preparing workplans (report + meeting to present it; site visits + report+meeting to present etc)

19. 3rd year work plan implementation/ general overview
Problems to complete media / campaigns activities
Many incomplete activities were related to media / social campaigns/ photo exhibitions that were either wrongly planned, or too difficult for national partners to implement on time; while, other countries, e.g. Lithuania, did not have any strong media activity
One reason was involvement of PWUD/SSRs that were difficult to organise; the video prepared by the community were rejected for the translation in national media; more training and mentoring on video is necessary
Other issues concerned the planning as it was difficult to estimate actual time needed to collect information and proceeded with well-established campaign
In Moldova, the budget was allocated on external media consultant and no money was left to conduct the campaign
National partners could benefit from additional trainings on media campaigns and their implementation
Webinars or other continuous support from EHRN communication team (including some small tasks) could improve national partners’ skills

20. Key activities. Lithuania
Budget advocacy workshop (27-28 March, 2017)
10 participants from NGOs and the Vilnius Center for Addictive Disorders
The purpose was to establish the budget advocacy plan and strategy for the year (for NSP sites in different municipalities)
The plan was developed containing the following information:
Funding amount target, overview of different budget options, legal regulation (documentation) needed at the Ministry of Health and the Department for drugs, tobacco and alcohol control, targeted partner institutions, partners and associated parties
Additionally, the issue of express HIV testing was overviewed indicating alternatives (in Lithuania only staff with medical licence can do express HIV testing)
As a result of the workshop the following advocacy goal for 2018 was established:
To advocate for centralized NSP supplies purchase from the national budget, while personnel and office/infrastructure could be covered from municipal budgets
Also it was advised to try different tools in advocacy. Currently, the Coalition works mainly through small-scale meeting with ministries officials:
Few high-level meetings with participation of wider audience may serve better (especially if key stakeholders are engaged in the organization of the event);
Media should be engaged in drug topics so that drug topics should be made attractive; provocative media campaigns
Analytical reports with well-developed arguments and messages with focus on few issues; visually-well presented results
Use of favorable conditions such as youth support for drug decriminalization (dissatisfaction against drug raids at night clubs)

21. Key activities. Lithuania
High level meeting with the Ministry of Health (20 January, 2017)
17 participants from the Ministry of Health, the Ministry of Finance, Adviser to the Prime Minister, Visaginas Municipality, Red Cross and other NGOs working in Harm Reduction field
The main subject was the NSP sites establishment in new target municipalities according to the Program No ESFA-V-62 of the EU Social Fund “The prevention, diagnostics, treatment improvement and coverage for addictive disorders ”
It was the first meeting when the European Social Fund agency discussed together with the minister of Finance possibility to temporary fund not only NSP sites infrastructure, but also staff salaries
Further steps were agreed:
To evaluate the possibilities to support the NSP management and maintenance costs;
To discuss the possible Program changes with the representatives of the Vilnius center for addictive disorders and the Minister of Health;
To prepare the description of the NSP staff, tolls and services.

22. Key activities. Lithuania
The round of meetings with municipalities (January - March, 2017)
5 municipalities in total: Kaunas (January 12), Visaginas (27 February), Varena (3 March), Marijampole (6 March) and Alytus (13 March)
Around 20 participants per one round table including representatives from the Vilnius Centre for Addictive Disorders, the Department for drugs, tobacco and alcohol control, the Minister of Health and the adviser to the Prime Minister
The level of municipality attendees was very high: mayors or deputy mayors
Roundtable discussions addressed the following issues:
Psychoactive substance use in municipalities and its situation overview (for municipalities it is always difficult to acclaim that they have drug-users and need to support their rights for health);
Harm reduction benefits for municipalities (Low-threshold services offices and OST, mainly what OST is, its effect on human and society; the positive Vilnius experience)
Opportunities of Harm Reduction programs development in municipalities (the implementation of plan to reduce health disparities financed from the Structural fund of the European Union);
Harm reduction services development needs and opportunities in a particular municipality (debate)
Each round table was also focused on specific problem of the municipality:
In Marijampole, many cases are registered when people are punished for drugs disposal without intentions to distribute; in 2015 it was 110 cases in 100 thousand citizens;
In Alytus even OST site exists, the personnel is reluctant to have more clients; for the moment of round table, only 5 clients were in the OST program
in Kaunas the average OST doze is twice smaller than the OST recommendations are;
In Visaginas, the drug users number is on average higher than in Lithuania; however, the municipality does not have NSP and OST sites.
It was obvious that the high stigma again drug users and their rights exist throughout Lithuania. During all discussions, it was always hard to emphasize drug users’ health support rather than drug use prevention. It was hard to accept that people use drugs and still they have right for health treatment. NSP sites operate generally thanks to volunteers.
General outcome of the round-tables:
It was agreed that the Coalition and municipalities will continue cooperation to develop Harm Reduction facilities in municipalities.
Municipalities together with NSP providers will apply to get some support for NSO sites from the EU Structural Fund
In some municipalities, local media participated in meetings and prepared positive informational materials afterwards.
The participation of PWUD at round-tables was of different success. For instance, active PWUD activist form Jonava could not participated as one of them were working or few others were arrested. In Marijampole, the PWUD who participated in the Regional program trainings died and others changed their phone numbers disappearing. However, in Alytus and Klaipeda many PWUD participated in collecting signatures to support statement for higher quality of OST sites. Also they were present and active during round tables.

23. Key activities. Moldova
Meeting on Harm Reduction Program in Transnistria (March 22, 2017)
17 participants including NGOs, PWUD and representatives of public health institutions
The purpose of the meeting is to determine the prospects for the development of Harm Reduction programs in Transnistria, within municipal sustainable development and recognizing new forms of interaction with the target group
The main issues were discussed:
Standardization of services for vulnerable groups as a factor of sustainable development
special attention should be paid to health services accreditation, funding by National Health Insurance Company, funding from national/local budgets, NGO accreditation, whether Harm Reduction services can be recognized as supplemented to other social services that are already provided
Mobile-clinics, new forms of work with key groups. Beltsy experience
Potential of NSP development in health centres for PWUD; Example of projects that attract vulnerable groups to TB diagnosis and treatment
NGOs working in the field of Harm Reduction should collaborate with other services that are provided for vulnerable groups; For instance, NSP services are available on sites where vulnerable groups get TB treatment and vice verse; sometimes the possibility to get new syringes serves as motivation for PWUD to get TB diagnosis and treatment
Cooperation with other institutions, especially with police
The actions that were agreed on:
Importance of HR: the common agreement was reached that Harm Reduction services should be equally important within heath/social services for key vulnerable groups in Transnistria; HR should be financed by diverse sources not only AIDS centre; NGO and PWUD should be engaged in service provision;
Workplan: another common meeting to develop working plan is needed to be organised
High-level meetings: in order to develop Harm Reduction services in Transnistria more high-level meetings should be organised; list of participants should include a wide range of stakeholders – public officials, government, public health representatives, doctors, NGOs and police; PWUD are expected to be well prepared with clear arguments and messages

24. Key activities. Moldova
Workshop on integration of community-led monitoring into national HIV programs monitoring system (January 26-27, 2017)
Organised by EHRN, in Vilnius for Moldova and Georgia
10 participants from Moldova including SR, SSR and representatives of Soros foundation and national HIV programs coordination unit
The purpose of the meeting was to develop recommendations and a plan for integration of PWUD based monitoring into national monitoring system
The following plan was developed:
What Harm Reduction services: NSP and other services for key population groups such as ARV/TB treatment as it is a part of HIV prevention plan (OST is monitored under psychological/ health centres services)
The normative document: the National monitoring plan of HIV prevention measures in Moldova (separate section on key population based monitoring)
Funding: domestic state budget (the same as for the National monitoring plan)
Methods: few focus groups and questionnaires
Timeline: once per year
Target group: NSP users and other key population groups
The following recommendations were agreed on:
SSRs are responsible for advocacy of the plan and its incorporation into the National monitoring plan; information collection; data procession and development of recommendations and conclusions;
SR are responsible for Introduction of this topic into the National Plan (Official request); data procession and development of recommendations and conclusions; support during piloting phase; supervision of the incorporation process
Governmental body (Role of the Coordinating Unit for HIV and AIDS (I. Kondrat)): development of NSP monitoring model, its presentation on CCM and its advocacy on the national level; cooperation with SR to gather SSR feedback
EHRN is responsible for support provision to develop the methodology (monitoring module)
Other issues that were not solved during the workshop (but are highly important for similar activities):
Coordination between SR and the governmental body to review methodology and monitoring body (the clear mechanism should be established as SR cannot directly push the representatives from the government)
Number of meeting to present the methodology for SSRs
The mechanism to proceed the data (what level of data/recommendations is expected form SSR and SR), so that the form could be developed by SR/SSR and offered to the governmental body for the incorporation
The piloting process (when, how many sites etc) as the sites and clients should be prepared in advance

25. Key activities. Tajikistan
Civil Society and Community Organization Forum, Dushanbe (17 March 2017)
Tajikistan has been in the process of drafting the application for the Global Fund allocation on HIV and TB programs for (May 2017); NGOs and community organizations had to present their suggestions and priorities to the proposal;
The Forum was organized by the SR, Spin Plus, with technical support of EHRN (agenda development and facilitation of the Forum)
Among 41 participants – representatives of community, international organizations (including the Global Fund), harm reduction service providers, members of AIDS Center, representatives of governmental institutions 
The main concern of civil society was:
how to preserve the available services in the context of reduced funding from the GF
what innovations can be proposed in the current application
The GenPud experience of advocacy through community mobilization was presented; it was highly relevant as in Tajikistan key affected populations communities has only recently started to engage in advocacy
The main outcome of the Forum:
Civil society and community have discussed and formulated recommendations for the proposal;
The results of the Forum / protocols were sent for consultations to other partners;
After receiving the final version of recommendations they were sent to the working group under the Regional AIDS center to form a new GF application
The special attention was paid to Harm reduction programs needs;

26. Key activities. Georgia
Study visit of Georgian governmental officials to Czech Republic (14-16 Feb., 2017)
10 representatives from the Ministry of Labor, Health and Social Affairs, the National Center of Disease Control and Public Health, the Ministry of Interior, the Ministry of Justice, Police Academy, Open Society Foundation Georgia and Georgian Harm Reduction Network;
According to the delegation, the most interesting issues were:
The model of secretariat of national drug policy commission, especially functioning of its monitoring center (as Georgia is about to establish the drug monitoring center which will be empowered to conduct drug-related researches and analysis)
The model of generating evidence for assessment of national policies and strategies, as well as further correction of plans based on the results (this component needs serious enhancement/development in the field of drug policy in Georgia)
The model of existence of regional strategies, as well as model of regional and local coordinators involved into implementation (not currently applied in Georgia)
Georgia is in the process of drug policy liberalization on both executive and legislative levels, the models of Czech drug policy and its legislative frameworks
Czech model provides social service status to low threshold programs and service provider drop-in centers, as well as allocates important part of funding for this services.
As Georgia is preparing for overtake of the low-threshold and harm reduction services from the Global Fund program, standardization of preventive, including harm reduction programs is highly interesting
As noticed by the Deputy Minister of Internal affairs: “First in my life I had visited harm reduction programs. I did not know amout the diversity of services these programs are being providing to people who inject drugs. These are really very needed services, they are just created for this vulnerable population.”
Following to the study trip, the formal meeting was held between the natonal coordinators of Georgia and Czech Republic in Tbilisi

27. Key activities. Georgia
Civil Society Organization Forum, (23 Feb. 2017, Tbilisi)
Attendees included around 90 participants including officials from the Ministry of Health and CCM, as well as Global Fund (Senior Fund Portfolio Manager for Georgia);
Agenda:
current status of local and regional Harm Reduction programs
how Georgia’s drug policy influences the service delivery
how establishment of the National Platform of Drug Policy strategically addresses the emerging challenges in terms of policy/service advocacy and awareness raising activities for building support towards drug user communities within the society at large
other forms of stigma and discrimination/ barrier to access HIV services/ patients’ view and suggested ways of elimination
The main outcome of the event:
The representative from the Minister of Health of Georgia stressed the need for an effective transition of programs for the response to HIV, TB, the continuation of the fight against hepatitis C, especially in terms of harm reduction and prevention programs implemented by NGOs.
The importance and the effectiveness of CSOs, including community based groups, involvement in country’s HIV/HCV response;
Statement of HR programs as one of the key millstones for country HIV/HCV response;
High profile visibility for the Regional Program “Harm Reduction Works-Fund It!” and its importance in the transition thought the region.
As a success factor of the Regional Program, in a welcome speech, the representative of the Global Fund Tsovinar Sakanyan noted the special importance of the community participation and shared the positive experience of training in budget advocacy organized by EHRN within the framework of the Regional Seminar "Budget Advocacy in Transition" ( )

28. Key activities. Belarus
National forum of PWUD, Minsk (28 Feb – 1 March, 2017)
The “Pozitivnoe dvizhenie” together with PWUD initiative group from Minsk organised the event that covered representatives from all main cities of Belarus
The goal was to create communication space for dialogue between people who use drugs and specialists from various fields, who help them
More than 70 participants including OST clients (50 from outside Minsk) and experts (such as doctor- psychiatrist-narcolosits)
The main outcome of the event:
It was the first national meeting of OST clients where they exchanged their experience and issues (local level)
Participants received the latest information about OST programs in Belarus
People who use drugs established their organisation named “Tvoj shans”
Feedback on the needs of OST clients and the quality of OST programs was collected to be presented to narcologists (2 weeks after the forum)
Website on violation of OST clients rights: Pereboi.by
More:

29. Key activities. Belarus
The best and modern practice of substitution therapy in narcology, Minsk (13 March, 2017)
28 participants, mainly psychiatrists and narcologists, from various Belarus regions addressed the following issues:
Participants received the feedback on OST quality (based on 38 clients’ questionnaires collected in February, 2017), where the following was identified as the main issues: methadone treatment at places with of freedom restrictions; OST as a prescribed treatment (independent use for several days); Express testing for hemocontact infections; well-functioning social support/work; consultations of practitioners of somatic profile
OST practitioners were informed on the need to liberalize the functioning of the offices of ZTM (based on OST clients presentation, O. Aizberg’s overview of OST sites and others)
Alternatives to solve existing problems in OST provision were discussed (e.g. flexible working hours, admission barriers)
The following was agreed during the meeting:
To include the form of standard agreement between the health care institution and the patient in the regulation (order) on OST sites
A list of necessary legal and regulatory acts, as well as the main orders that they should include was developed and agreed on (the responsibility was also allocated)
OST practitioners agreed to improve current OST sites conditions independently from regulatory changes
The organisation of the meeting was approved the Ministry of Health; therefore the wide participation of OST practitioners was possible

30. Key activity. Kazakhstan
Two local roundtables on Attracting resources from local budgets for the sustainability of harm reduction programs (NSP/OST) aimed at HIV prevention, (9 Feb., Temirtau and 28 Feb., Ust- Kamenogorsk)
Participants: representatives of local decision-makers and key affected groups, NSP/OST service providers
The aim of the meeting:
To share implementation results of OST/NSP programs and their development plans in Kazakhstan regions with key stakeholders
To discuss options to fund from the local budget
To develop recommendations how to attract local funding to local NSP/OST programs
Results of the meeting:
The SSR and community representatives were actively involved in the round tables; discussed their problems with “open faces” and arguments;
The issue got support from some local decision-makers who will mentor in budget advocacy cycle (what, when and how)
The main presentations were made by the governmental institutions and other partners; therefore it would be beneficial to have SR/SSR their own analysis to compliment the governmental depiction (OST/NSP sites map, analysis of local social contracting)
The mechanism of budget advocacy was developed:
to analyse budget formation cycle on local level and social contracting award mechanisms
to collect arguments to promote social contracting in the field of Harm Reduction
to widen partnership and establish working group on local funding (including NGOs, AIDS center, PWUD and other local governmental institutions)
to prepare messages/requests for the local group of experts in Health, the Public council and the local parliament;
The mass-media should be also involved in the process

31. Key activity. Kazakhstan
Two SSRs’ and SRs’ study visits to other OST sites in Taraz and Uralsk, Kazakhstan (Jan. 16 and March 24, 2017)
The aim of the visits was to meet new community leaders and mobilise PWUD community in new towns.
The information collected during the sites visits will be analysed and used to prepare the OST in Kazakhstan map; a brief description of OST sites will accompany the map - site and NGO contacts, photos, how to find the site, what additional services are provided by NGOs or social workers (green color would signal that site works in full capacity, yellow-site works, but too many customers, red-no site, need)
In Taraz, the OST site was open in Its capacity is around 25 people, but currently only 20 clients are in the program. Therefore, the further actions to investigate barriers to treatment are needed;
In Uralsk 26 people are in the OST program: 2 women and 24 men. Schedule of OST services is very uncomfortable – during work days it works from 8:00 to 10:30, on weekends - from 9:00 to 10:30. In the town non-governmental AIDS service organizations do not operate at all.

32. Success practice. Moldova
Collaboration with Local Public Administrations (LPA) - Primates and District Councils (Jan. – March 2017)
Stigmatization of drug users and people living with HIV leads that harm reduction programs are rarely considered as improving the health and social well-being of society. At local levels, it is more acute:
To overcome all these barriers of the provision of Harm Reduction services on local level, a systematic approach aimed at strengthening the activities of the Local Public Administrations is needed;
Securing investments from Local Public Administrations is as important as financing the HR programs at the national level.
5 round tables were held at the Local Public Administrations (LPA) in Donduseni, Orhei, Balti, Falesti, Ungheni.
Participants were chairmen and vice-chairmen of the District Councils, mayors and vice mayors of LPA, other LPA representatives, representatives of police commissariats, representatives of administrations of the Health Institutions, other decision-makers
The following results were achieved:
LPA will initiate the process of developing Local Plans for the Prevention and Control of HIV / AIDS and Sexually Transmitted Infections for ;
Organizations implementing Harm Reduction Programs at local levels will participate in the development of the local plans
All recommendations of the organizations implementing Harm Reduction Programs at local level will be included in the local plans
All LPA, where meetings were held, are ready and open for cooperation and partnership
Key success factor: External support, provided by UORN, positively and constructively influenced the consolidation of partnership at local levels engaging organizations implementing Harm Reduction Programs, LPA and decision-makers

33. Success practice. Tajikistan
The SSR’s organization Khujand prepared the audio report for local radio station
During Jan. – March 2017 the Khujand developed the audio report providing information on Harm Reduction programs (NSP, OST and other low threshold services) in the Sughd region, Tajikistan.
The program audience was the entire Sughd region
The aim was achieved: to make as much people as possible to hear about the Harm Reduction services, their barriers such as sustainability and limited funding
To make the audio report possible, the key steps were undertaken:
To have status of organisation and professional reputation gained throughout the Program implementation at local level
To establish partnership with local radio station
To make the draft scrip of the program and agree on it with radio
Any other additional external support was needed

34. Success practice. Georgia
Round-table on local funding for HCV treatment in Kutaisi (31 March, 2017)
NGO Rubiconi (SSR Kutaisi) with support of the NGO Phoenix (SSR Ozurgeti), GHRN and Médecins du Monde organized the roundtable meeting with the Head of Kutaisi Municipality Health Department;
Context: since January 2017, within NSP it is possible to test HCV for free (in public health centres it costs 90 lari); it is the first of tests for enrolment in HCV elimination program. The follow-up analysis showed that only 7 percent of positively tested NSP clients (N=200) continued testing procedures to be enrolled into HCV elimination. The reason is lack of finance as further testing is expensive
The aim was to achieve co funding to pre diagnostics for HCV treatment enrolment.
The preparation process included:
The preliminary discussion about stakeholders and arguments through budget advocacy training held in December 2016
The strategic numbers were prepared: number of PWID/potential beneficiaries- 100 (GHRN/Rubikon data base already having undergone antibody screening and ready to go for RNA and genotyping in case of financial support); the need funding for their testing was also calculated.
The team gathered and studied strategic papers on spending and proposed scheme of co-funding partially by NCDC/Lugar complemented by the Municipality Health budget savings
The local budget advocacy team implemented several meetings with the Kutaisi municipality representatives; the team found allies in the municipality administration (chair of the Health committee)
The results of the meeting:
The funding request was presented to the municipality administration;
Municipality expressed its concerns and will to collaborate;
The proposal of co-funding is under discussion by the Municipality Health Care department.

35. Success story. Belarus
Mobilisation of OST clients to come to OST client’s Forum (28 Feb – 1 March, 2017)
As the OST clients’ forum was the first of such kind in Belarus, the many issues arisen while mobilising people to come to Minsk from all Belarus regions and ensuring their safe participation.
The structure of the event and presentation topics were discussed at meetings with PWUD initiative group of the Regional Program, while invitations to potential participants from entire Belarus were distributed using various channels:
Internet channels: website of Pozitivnoe Dvizenie, social networks; the online registration form was created and distributed
After few on-line registrations, it became obvious that OST clients rarely use Internet for communication, mainly from mobile phones; therefore for them it is hard to register online
The registration had to be made in person, so activists of Minsk initiative groups talked about the Forum when they visited OST sites in various regions
Another approach was collaboration with OST program practitioners; they hang announcements on OST sites as well as they told about the Forum to their clients
As a result around 50 participants from all Belarus regions came to Minsk and actively participated in the Forum
Another problem related to OST clients’ mobilisation was to ensure the continuous OST treatment:
In Belarus there is no practice to give prescribed methadone for independent use for several days, therefore it was necessary to organise OST in Minsk;
However, two issues were detected: in Minsk OST practitioners had never before served OST clients from other cities and OST clients from other cities also did not have experience in getting OST outside their cities
At first OST sites in Minsk refused to serve Forum participants
However then the cooperation was established: local OST practitioners prepared prescription orders for OST clients from outside Minsk (with the help of PWUD initiative group); based on this prescription 2 OST sites in Minsk served the clients. 50 people were divided into smaller groups and were accompanied by PWUD initiative group and PWUD consultants.
Belarus experience shows that in order to mobilise national PWUD communities:
Adequate information is needed on PWUD community language
The information must be distributed through PWUD communication channels (priori analysis of such channels is necessary)
Peer-to-peer approach works the best but still some support from main stakeholders such as OST practitioners is necessary

36. Success story. Lithuania
The Coalition “I can live” participation in organisation of Regional Harm Reduction conference (4-6 April, 2017)
The Coalition supported the organisation process from the beginning with key engagements in:
A meeting with the Minister of Health Aurelijus Veryga on 23 of January;
A meeting with Prime Minister's Advisor Paulius Gradeckas on 9 of February;
5 round table discussions in different municipalities February-March, when mayors of municipalities were invited to the conference
The Coalition also was responsible to form the Lithuanian delegation on the Conference; they succeeded attracting:
3 speakers;
10 PWID community representatives from 4 municipalities;
~10 NGO representatives from 5 municipalities (mostly – NSP sites);
~10 government institutions representatives (including Prime Minister's Advisor).
On the 6th of April a high level round table discussion “Balanced drug policy: public health as the main purpose and tool” was organized together with Estonian Parliament member Ken-Marti Vaher and Czech Republic Parliament member Jindrich Voboril. Lithuanian parliament members also took part. Harm reduction and drug policy best practices were discussed.
For the conference and round table discussion an infographic about Lithuanian drug policy prepared and distributed to target politicians (see the next slide).
Continuing this idea, The Coalition started to prepare more infographics for similar issues
The epidemiological drug policy and HIV prevention situation overview and focus data prepared and distributed to the mass media. This information can be used in any corresponding media, events and communication means (in Lithuanian)
The main achievements:
Networking with various partners and allies;
NSP sites thoughout Lithuania mobilization and incorporation into the Regional Program advocacy (e.g. Alytus NSP, Klaipeda NSP, Marijampole NSP and others took part in the conference);
Michael Kazackin, a special representative of the UN for HIV/AIDS for East Europe and Central Asia, expressed his concern and recommendations in public for Lithuanian Vice-Minister of health regarding the harm reduction and non-availability of Naloxone in Lithuania.
Lesson learned: The Vice-Minister of health was a new officer without any personal/advocacy contact and preparation; left soon after her presentation without getting in personal contact.