Making Anticipated Results Possible
(MARP): Expanding the HIV Responses
Dr Christoph Hamelmann
Regional Team Leader (Europe and Central Asia) and Senior Advisor (Arab States)
HIV, Health and Development
Global Coordinator, Secretariat of the UN informal Interagency Task Team on Sustainable
Procurement in the Health Sector (SPHS)
UNDP Istanbul Regional Hub
7th Regional HIV and AIDS Conference
Sarajevo, 28-29 May 2015
Plenary Session 1: Exit Strategy

Expanding the HIV Response:
Our Coordinates
• Getting to Zero: Infections, death,
discrimination
• Target 3.3: By 2030, end AIDS epidemic
• Target 3.8: Universal health coverage
Fast Track!
Towards
Sustainable
Development Goals

Making Anticipated Results Possible
(MARP): Expanding the HIV Responses
Dr Christoph Hamelmann
Regional Team Leader (Europe and Central Asia) and Senior Advisor (Arab States)
HIV, Health and Development
Global Coordinator, Secretariat of the UN informal Interagency Task Team on Sustainable
Procurement in the Health Sector (SPHS)
UNDP Istanbul Regional Hub
7th Regional HIV and AIDS Conference
Sarajevo, 28-29 May 2015
Transition Strategy

HIV Epidemic in EECA
• The HIV epidemic is still growing1
• The number of PLHIV increased from 860,000 to 1,1 million
between 2001 and 20131
• AIDS related deaths increased by 5% between 2005 and 20131
• 57 percent of all new HIV infections are attributable to the
sharing of syringes and needles2
• Treatment coverage was 21% in 20131
1 UNAIDS GAP report, 2014.
2 GFATM. Turning the Tide Against HIV and Tuberculosis - Global Fund Investment Guidance for Eastern Europe and
Central Asia, 2014

HIV Epidemic in EECA
• HIV testing and counseling among key populations remains
insufficient, which leads to delayed diagnosis of HIV infections
and late treatment initiation.
• Access to harm reduction services - including opioid
substitution therapy as well as needle and syringe exchange
programs - remained limited.
• Rights violations, stigma and discrimination towards people
living with and affected by HIV are still key characteristics of
the epidemic in the EECA region

*Kosovo UN1244
*
Source: Global Fund

HIV Infections and GF Status in SEE
Country PLHIV
est.
Newly
diagnosed
(2013)
PLHIV on
ART (2013)
Main key population
among newly HIV
diagnosed
GF status
(source: GF)
Albania1
<1000 117 335 85% HS Financial closure
Bosnia & Herzegovina2 n/a 21 (2014) 114 50% MSM Active
Bulgaria1 n/a 200 626 (2012) MSM/PWID/HS Active
Croatia3 n/a 92 (2014) 7938 85% MSM Closed
FYR Macedonia4 <200 37 (2014) 90 68% MSM Active
Montenegro5 n/a 10 65 60% MSM Active
Romania1,6 16 000 507 8 809 55% HS Closed
Serbia7 3 000 147 1165 64% MSM Closed
Slovenia6 n/a 44 n/a 61% MSM No
Sources: 1UNAIDS, 2 UNDP BiH, 3 IPH Croatia, 4 IPH FYR Macedonia, 5 IPH Montenegro , 6 ECDC, 7 IPH Serbia, 8 University hospital for infectious disease

Global Fund HIV Investment in SEE
Country or territory Income
category
Disease
burden
Total grant US$ End date Eligibility
Albania UMI Low 5 459 367 31.03.2015 Transition
Bosnia & Herzegovina UMI Low 40 923 294 30.11.2015 No
Bulgaria UMI High 50 451 295 31.12.2015 NGO rule
Croatia High income Low 4 944 324 30.11.2006 No
Kosovo UN 1244 Upper LMI Low 6 837 726 30.06.2015 Eligible
FYR Macedonia UMI Low 20 061 369 31.12.2016 No
Montenegro UMI Low 8 803 621 30.06.2015 No
Romania UMI High 37 671 819 30.06.2010 NGO rule
Serbia UMI High 30 628 736 30.09.2014 Eligible
Slovenia High income Low - - No
Source: GFATM website

UNDP’s Regional Project on Sustainable
Financing of National HIV Responses
• Started in 2012
• Involves currently 14 countries in EECA, with particular focus
on countries with UNDP PR-ship of Global Fund grants
• Supports governments, civil society organizations, affected
key populations and PLHIV
• Collaborates closely with UNAIDS and other co-sponsors
• Involves a team of regional and country office UNDP staff and
national and international consultants

Concepts and Components:
Getting Started
• Rights-based approach
• Understanding the national context
 disease burden
 health system structures including health financing
 legal and regulatory frameworks
• Know your epidemic
• Know your response: National and international goals,
objectives and targets, current achievements and gaps

Concepts and Components:
What Needs to Be Transitioned?
• Which programme components are externally
funded?
• To what amount (absolute and percentage, by
component and total)?
• Who is providing these services (public, private for-
profit, private non-profit)?

Concepts and Components:
What Needs to Be Transitioned?
Prevention (P) ($)
P A ($)
Pu
b
($)
F-P/NGO
($)
P B ($)
Pu
b
($)
F-P/NGO
($)
P C ($)
Pu
b
($)
F-P/NGO
($)
Treatment (T) ($)
T A ($)
Pu
b
($)
F-P/NGO
($)
T B ($)
Pu
b
($)
F-P/NGO
($)
T C ($)
Pu
b
($)
F-P/NGO
($)
Others (O) ($)
O A ($)
Pu
b
($)
F-P/NGO
($)
B B ($)
Pu
b
($)
F-P/NGO
($)
O C ($)
Pu
b
($)
F-P/NGO
($)
0
5
10
15
20
Prevention Treatment Others Total
External
Domestic
$
External funds details

Concepts and Components:
Can we achieve more for a $?
• Technical efficiency
• Allocative efficiency

Concepts and Components:
Technical Efficiency
Factor costs
Human resources
Commodities
Others
Service delivery
models
Central / de-central
Public / private
Others
Others
Infrastructure
Critical enablers
Others
Unit costs
Service output
Defined quality standard

Concepts and Components:
Allocative Efficiency
Current budget, current allocation Current budget, optimized allocation

Concepts and Components:
Allocative Efficiency
http://www.eurasia.undp.org/content/dam/rbec/docs/UNDP%20
Modelling%20Tajikistan_English.pdf

In Focus: NGO Social Contracting
Programme components Budget allocated to
NGOs ($)
% of line
budget
National/sub-national
/local level (%)
Prevention PWID 679,868 47.7 0/0/100
MSM 224,881 86.4 0/0/100
SW 219,846 90.3 0/0/100
Prison inmates 106,226 77.4 0/0/100
Youth 468,546 87.5 0/0/100
Roma and migrants 426,328 93.0 0/100/0
Prevention subtotal 2,125,695 69.5 0/20/80
Psychosocial support subtotal 654,390 61.3 100/0/0
Enabling environment subtotal 325,409 93.0 28/4/68
TOTAL 3,105,494 35.1 24/14/62

In Focus: NGO Social Contracting
Country Fact Sheets
• Current NGO service provision and NGO landscape
• Legal and regulatory frameworks for NGO social
contracting
• Prerequisites for service provision
• Quality control and assurance
• Best practices examples

In Focus:
Access to Affordable Medicines
http://www.eurasia.undp.org/content/rbec/en/home/ourwork/hiv_aids/in_depth/sustainable-financing-of-hiv-responses/

Concepts and Components:
Transition – Where to?
Prevention (P) ($)
P A ($)
Pu
b
($)
F-P/NGO
($)
P B ($)
Pu
b
($)
F-P/NGO
($)
P C ($)
Pu
b
($)
F-P/NGO
($)
Treatment (T) ($)
T A ($)
Pu
b
($)
F-P/NGO
($)
T B ($)
Pu
b
($)
F-P/NGO
($)
T C ($)
Pu
b
($)
F-P/NGO
($)
Others (O) ($)
O A ($)
Pu
b
($)
F-P/NGO
($)
B B ($)
Pu
b
($)
F-P/NGO
($)
Sub-national budgets
Annual total ($)
To absorb ($) (% of total)
National budgets
Annual total ($)
To absorb ($) (% of total)
Local budgets
Annual total ($)
To absorb ($) (% of total)
Resources: A
B
D E A
D
E
FC
External funds details
Domestic funds details

Example Croatia
Additional Domestic Funding Sourcing
Example A:
Part of lottery fund went to PWID
programmes
2014: $ 220,000
Joint call for application from
Ministry of Social Care and Youth,
MoH, and Commissariat for Drug
Control
Example B:
MoH budget
2014 call for health programmes
(including harm reduction):
$18,000
2014 call for psychosicial support:
$462,000 (for PLHIV: $ 161,000)
Example C:
Part of Lottery fund for a three-years health programmes of NGOs in implementation
of national strategies
2014: $ 915,000 ($ 728,000 for HIV-related programmes)
14 NGOs: harm reduction (including NSP), psychosocial support, MSM and others

Scaling-up to universal access

Universal access: rights-based approach,
SDG 3 target and highest impact
DALYs averted

Involvement of NGO Networks
• Sub-national networks (example: Vojvodinian HIV network of
NGOs and public institutions – coordination, joint
applications, advocacy on local and sub-national level, Serbia)
• National networks (example: USOP – Union of PLHIV
organisations in Serbia, advocacy, enabling environment at
the national level, Serbia)
• Regional (example: NeLP – 18 low prevalence countries in
Central and South Eastern Europe, coordinations and
advocacy for access to targeted prevention, testing,
treatment)

Know Your Rights, Use Your Laws
A Handbook for:
• People who live with HIV
• Their families and friends
• People at higher risk of HIV
• Their families and friends
• Activists, supporters
• Service planers and providers
http://www.undp.org/content/dam/rbec/docs/UNDP%20HIV%20and%20Rights%20UK_web.pdf

United Nations Development Programme
christoph.hamelmann@undp.org
Twitter: @cahamelmann
Timur Abdullaev, Predrag Duric,
Boyan Konstantinov, John Macauley