1. Daan van der Gouwe John-Peter Kools
Preliminary findings of Final Evaluation Harm Reduction Works – Fund It!
Daan van der Gouwe
John-Peter Kools

2. Process of Final Evaluation
Duration: 3 months
Country visits: Belarus, Georgia, Kazakhstan, Lithuania, Moldova, Tajikistan
Period: 23/1 – 24-2, 2017
Number of interviews in-country: ± 85
Total number of respondents: ± 110
and desk review of available reports and documents
Change as you wish, but would be important to give some figures (e.g. number of interview) to tell people what you indeed put lots of efforts in this evaluation and you’re the expert 
This slide should also give people information about methodology, a small indication that you had no conflict of interest, or you had it… or maybe a small joke that you will have conflict of interest with anything that aimed to improve quality and funding of harm reduction services…

3. Limitations Regional Program not yet finished
Final evaluation not yet finished
Achievements often cannot be attributed to Regional Program only
Change as you wish, but would be important to give some figures (e.g. number of interview) to tell people what you indeed put lots of efforts in this evaluation and you’re the expert 
This slide should also give people information about methodology, a small indication that you had no conflict of interest, or you had it… or maybe a small joke that you will have conflict of interest with anything that aimed to improve quality and funding of harm reduction services…

4. Challenging environment
1. Regional level challenges:
HIV/HCV/TB epidemics started in the region in 90s. ‘Concentrated’, ‘Advanced concentrated’.
All countries have Soviet Union health systems heritage:
Focused on treatment & in-patient rather than prevention and outpatient/community-based. Vertical ‘silo’s’, no interlinkage
Narcology approach; focused on ‘cure’, severe barriers due to Narcological Register
Social conservatism (‘social dangerous behaviors’), big stigma
2. National level challenges:
Substantial differences in political situation/ trends: in EU (Lithuania), towards EU (Moldova, Georgia), Russia former best friend (Belarus), Central Asian specifics
GFATM initiated services for harm reduction in 2000s. Now GFATM pulling out, in transition
Limited governmental commitment towards HR (policies/regulations)
No/very limited allocation for harm reduction, competing needs (‘cancer, child leukemia’)
Few structured civil society organizations/ involvement
Upcoming new trends in drug use/ new drugs
3. Community level challenges
Overall organizational issues of community activities (‘toll of marginalization/illegality’, individual champions)
Sustainability issues limited support and funding
Very limited ‘meaningful involvement’ in local and national policy making
Problems surrounding eligibility of civil society organization to apply for / receive funding

5. Design of the Regional Program
Coverage: 6 countries – Belarus, Georgia, Kazakhstan, Lithuania, Moldova and Tajikistan
Duration: 3 years (began on April 1, 2014) & Extension till end of 2017
The Program goal is to strengthen advocacy by civil society, including people who use drugs, for sufficient, strategic and sustainable investments in harm reduction as HIV prevention in the region of Eastern Europe and Central Asia (EECA).
Focus on:
Mobilization of key populations (injecting drug use is key driver, increasingly sexual transmission)
Increased coverage of services
Allocative efficiency
Enabling social contracting mechanism

6. Was the Program effective in obtaining the overall goals?
Yes
From the overall perspective, the Regional Program made a significant contribution to the current positive harm reduction developments in the region;
There are substantial changes towards increased domestic funding in Moldova, Belarus, Georgia, Kazakhstan;
Integrated approach used (“sustainable funding via focused advocacy and community involvement”) was the major driver of this success.
Continuous personal and technical support by EHRN Staff to SR/ SSRS in all countries (esp. Olya Belaeva)

7. Did it work on community level?
Yes, especially for advocacy
Multi-year unrestricted funding provided by the Regional Program
Guidance and support by:
EHRN (advocacy, PR and community experts)
Global Fund
Other civil society partners (e.g. SRs)
Training on notably advocacy (in order to ’build your case’, using video to document, disseminate via social media)
Regional exchange and inspiration
Bottom-up advocacy acknowledged the value of PWUD community
Next step: beyond individual leadership

8. Did it work for countries?
In some countries, stagnation regarding harm reduction was overcome (e.g. KZ: 8 years pilot; MD: after 3 attempts now inclusion in the national budgets; BEL: funded by the State)
The used methodology was useful in assessing the gaps in quality and quantity of services in the countries
Regional and National high-level meetings worked well in providing a platform for dialogue and exchange of good practices
Support on enabling social contracting worked well (e.g. in BEL, and in MD and GE the protocols and procedures for quality HR service delivery and contracting are currently been drafted)
The used method of targeted budget advocacy (‘involve finance specialists in social advocacy’) worked well
Study visits worked very effectively in understanding/ acceptance of harm reduction and increased collaboration between stakeholders

9. Country-level key results
Belarus/Georgia:
Start of domestic funding for NSP and OST in 2016
Regulating social contracting in 2017
Kazakhstan:
Registration of OST in 2016, increased OST-coverage, increased community mobilization
Lithuania:
Increased community mobilization, increased cooperation among various stakeholders
Moldova:
Detailed preparations for inclusion of NSP and OST via National Health Insurance in 2018
Tajikistan:
Increased community mobilization, increased cooperation between various stakeholders, increased political will to support/fund harm reduction

10. Regional results
Limited experience of regional programs in general – there are no ‘working models’ and it is ‘learning by doing’
The working approach (providing tools, structures and flexibility) worked well
Multi-country approach is effective (e.g. in order to compare countries input and results)
Cross-sectoral partnerships are effective

11. Conclusion
Given the limitations (funding environment, extremely complex and challenging region, only 6 countries, not including Russia and Ukraine):
Very successful:
Created momentum and catalyzed positive developments for sustainable funding
Enabled civil society involvement/ contracting
Strengthened collaborations and partnerships (multi-level)
Provided new tools, key targets and outlined a ’road ahead’
Provided genuine ‘meaningful involvement’ of communities
Empowered PWUD communities in all countries
Increased understanding/ acceptance of harm reduction at state level

12. Challenges No substantial increase in coverage of OST/NSP
Sustainability of community mobilization in most countries unsure
Addressing needs of ATS/ NPS users
Effective advocacy work is time-consuming, takes more time
Economic crisis hampering sustainability of program objectives
Ongoing stigmatization and discrimination of PWUD
Restrictive drug laws and drug policy

13. and finally
Regional Program lasts until the end of 2017:
Funding still needs to be allocated
Coverage may still increase
SR/SSRs will continue to work towards achievement of objectives