1. Financial sustainability of the AIDS Response in EECA Dr. Viorel Soltan, MPH, MBA, PhD

2. Sustainability Benefits: ability to produce and maintain health outcomes for individuals and populations Institutionalization: ability to ensure program activities (incorporation of new programs into existing systems and structures) Capacity to deliver programs --------------------------------------------------------------- Financial sustainability - when the program is able to deliver products and services to generate outcomes and achieve its goal in a cost effective manner.

3. EECA domestic funding Public spending: governments are increasingly responsible to fund disease-related programs Prioritization & Gov support : diagnosis and treatment Substantial gap exists regarding complex interventions as treatment and prevention among KAP (PWID, SWs, MSM) Only 11% investments are directed to KAP (UNAIDS, 2011)

4. EECA domestic funding (cont.) UNAIDS, 2011

5. EECA domestic funding (cont.) Lack of support to civil society / community based activities – social contracting Romania example (potential evolution for Balcan countries) Dependency from external funding is high (4 countries are fully dependent on ART) From 70% to 90% of funding for HIV programs for KAP comes from external donors.

6. The Global Fund TGF is the largest donor, including HR (over US$ 1.5 billion for the period of 2002-2016) ~40% counter-part financing (20/40/60) NFM: not less than 50% dedicated to KAP Min 65% (75%) for LLMIC (ULMIC) for ART, lab services and treatment support in 3 years Graduation: countries need to develop strategies for sustainability beyond TGF.

7. Costs & Prices Efficiency: how well HIV programs perform Effectiveness: how useful is what HIV programs deliver Systemic factors (corruption) Procurement issues (pooled procurement, international procurement mechanisms etc.) TRIPS Plus requirements (Ukraine, Georgia and Moldova example)

8. EECA to do list Invest smart – Better prioritization (focus on KAP) – Innovative programs (patient centered) – TB collaborative activities in HIV programs etc. Develop social contracting Institutionalize community oriented services Develop SMART plans for graduation Social accountability / advocate for Gov ownership and takeover