IMPROVED TB/HIV PREVENTION & CARE – BUILDING MODELS FOR THE FUTURE

Country: Kazakhstan || Duration: 2014 – 2019 || Donor: Directorate-General for International Cooperation (DGIS), Dutch Ministry of Foreign Affairs || Budget: EUR 7.5 million

GOALS:

  • Development of model for effective partnership between government and public sectors of health care and organisation of civil society that provide TB-HIV services in Almaty, Kazakhstan.
  • Scaling up access of population to quality patient-oriented services on TB and HIV.

BACKGROUND:

As envisaged in the 2012-2016 strategy, the Global Fund (GF) transitioned to a new allocation-based investment model in 2014, the New Funding Model (NFM). Through the NFM, the GF requires countries to transition to inclusive health sector governance within a country dialogue process. The NFM country dialogue process is meant to ensure inclusive grant preparation, implementation and monitoring in optimal alignment with national health planning cycles. The NFM also requires countries to work towards financial sustainability of quality and patient centered health services that are responsive to health care needs. This is especially pertinent as countries graduate out of GF support.

National TB Programs (NTPs) operate in increasingly complex environments, facing a great number of opportunities, challenges and expectations that require strong leadership and management skills. Challenge TB (CTB), through their Global Fund Hub, will assess and strengthen the governance and management capacity of NTPs to ensure a robust national TB control response resulting in higher GF ratings. New methodologies will be developed and applied to deliver appropriate technical advice, broaden local partnerships, engage local academia and expand inclusive local ownership through strengthened local leadership and capacity building.

The Dutch Ministry of Foreign Affairs (DGIS) committed 7.5 million euros to KNCV to work in direct collaboration with the USAID funded Challenge TB project with a focus on GF support to TB/HIV programs. KNCV proposes a framework based on three key objectives described below, with the goals of increasing and maintaining GF performance and strengthening the base for a sustained country response. The proposed framework aligns with Dutch policy priorities. KNCV will contribute to “making Global Fund money work” by offering technical assistance to Global Fund supported TB/HIV programs. The support of DGIS will be fully integrated with the Challenge TB Global Fund Hub.

The DGIS work plan is three fold: 1) develop and implement a model to strengthen engagement with the private sector (non-NTP partners including NGOs) in selected countries; 2) implement the technical assistance model developed by USAID in non-Challenge TB countries and 3) provide technical support for implementation of shorter, patient centered treatment for TB. A fourth component of the work plan, not specifically linked with CTB, is the engagement of KNCV in the policy making processes at GF board level.

To give greater strength to our interventions we will involve organizations including AIDS Foundation East-West (AFEW), HIVOS and PharmAccess. We also will partner with local civil society and NGOs that work with key populations and those most at risk for TB and TB/HIV.

OBJECTIVE:

Strengthening engagement of the non-public sector to provide quality patient centered TB/HIV services.

Engaging with the non-public sector (private providers and civil society) is essential to the inclusiveness requirements of the NFM. Within this first objective, we aim to develop a model that enables effective partnerships between (local) governments, private health care providers (PHCP) and civil society organizations. We aim to pave the way towards a broader provider base and informed community demand for accessible, quality and patient centered TB/HIV services in the non-public sector.

We expect the following changes:

  • Government (national and decentralized) increases recognition of the important role of the non-public sector for high quality TB/HIV service delivery. They support an enabling environment: financial resources, quality assurance, supplies and training;
  • PHCPs are willing and able to provide TB/HIV services according to agreed upon standards and actively report within National HMIS;
  • Civil society is an active participant in monitoring quality of services;
  • Clients have affordable options and trust in PHCP service provision;
  • There will be stronger and more effective linkages between government, PHCP and civil society.

Our model will be developed through a step-wise approach where not all expected changes will be addressed at once. Depending on context and need, one entry point will be selected in each country focusing on either the non-public health care providers or civil society. Government will not be the entry point but engaged as a stakeholder, and thus an indirect target for advocacy for policy change and acceptance of the non-public sector as a partner for TB/HIV care delivery.

In year one, we will support countries in mapping out the non-public sector players, health system infrastructure and how they are currently contributing to health care delivery and the GF country dialogue processes, focusing on the gaps. We will define strategies to strengthen the engagement and quality of service provision by the non-public sector and strengthen the linkage to public health support structures. Where applicable, the mapping exercise will also identify how non-public sector services are financed, as well as non-public sector involvement in financing health care with the view to strengthening sustainability and investment for the future of TB/HIV care once GF support has ended.

We will start with three countries in year one that will simultaneously act as a pilot for our approach. If the model is successful, we will increase support in the original three countries and scale up to an additional two that have approved TB/HIV GF Grants. We envision supporting five countries to strengthen their strategic engagement with the non-public sector as a way of fully capturing the delivery, scale-up and health finance potential harnessed with the non-public health care sector as well as supporting the quality of care standards in this sector.

Engaging with the non-public sector is essential to the inclusiveness requirements of the NFM. With funding from the Dutch Ministry of Foreign Affairs, KNCV with three Dutch Partner International organizations; AFEW, HIVOS and PharmAccess aim to develop a model that enables effective partnerships between (local) governments, private health care providers (PHCP) and civil society organizations. We aim to pave the way towards a broader provider base and informed community demand for accessible, quality and patient centered TB/HIV services in the non-public sector.

PLANNED ACTIVITIES:

  • Development of informational materials on TB and HIV, a brochure titled “The Rights of Patients”, a brochure for family members of patients with HIV/TB, a booklet with a list of service providers;
  • Training on “Client-centred counselling of patients with HIV and TB”;
  • Development of a training package on HIV and TB for local NGOs;
  • Creation of a network of NGOs
  • Development of a web platform for the exchange information about HIV and TB among local NGOs, individuals and representatives of medical organisations;
  • Organisation of round-table meetings with key stakeholders;
  • Provision of small grant programmes for local NGOs.