Pavlo Rozenko,  Minister of Social Policy of Ukraine (2014-16),  Deputy Prime Minister of Ukraine (2016-2020)

 

Over the past two years, the procurement of public services from non-governmental organizations in the field of treatment and prevention of HIV, AIDS and tuberculosis, support and care for people with these diseases became possible.

Back in 2017, at the initiative of activists, a "Transition Plan" from donor and charitable funding was proposed for the fight against these diseases in Ukraine which escalated to an epidemic scale in the country since Soviet times. Three years ago, no one could have imagined that such ambitions could come true.

It was hard to believe that Ukraine would transit to direct state engagement from the donor funding, to which the state implementers were accustomed and found very convenient. The ProZorro system already existed, proving to be an effective anti-corruption and anti-bureaucratic tool - but procurement through this platform was associated with something very tangible, like a commodity, trade or business. And such large-scale problems as HIV, AIDS and tuberculosis, their multidisciplinary pathways and solution programs that cannot be limited to bidding, somehow seemed unfitting into this platform. The state has been turning a blind eye to many problems, from the lack of medicines to the staff shortage of patient support specialists.

The historical and art analogy comes to mind: the long-suffering and long-lasting confrontation in the late 1980s in the United States over the officially noneistent tools and specialists in the treatment of HIV and AIDS. This "cold war" was waged between the state (impersonated by FDA, a special agency at the US Ministry of Health, which monopolized the oversight over circulation of food and all medicines, and, among other things, issued patents to favored developments and banned unwelcome ones) and, on the other hand, private initiatives, volunteers and private foundations. One of these private initiatives was the Dallas Buyers Club, which, unlike the state, quickly offered effective courses of treatment, prevention, and immune system support. Meanwhile, the FDA was sluggishly testing a single proprietary drug that showed no efficiency, failing to patent any competing developments. This situation lasted for many years and cost hundreds of thousands of lives. The litigation between the two parties dragged on, people died. Those who survived, left public clinics and single drug testing courses and sought help from private initiatives, which have already successfully returned patients from the brink of death. However, the latter proved that the most effective approach was to maintain immune system response, a reasonable dosage of drugs and regular use of vitamin complexes.

And this happened in the prosperous, economically strong United States, that have always set an example for Ukraine, even allowing for the situation in the eighties. These real events inspired the namesake Oscar-winning movie, The Dallas Buyers Club. The protagonist, the founder of the Club, as well as his real-life prototype, had lived seven years instead of the 30 days portended by the doctors and saved thousands of lives.

Today, fortunately, Ukraine has managed to take important steps, starting from the emergence of the initiative Plan to the accelerated awareness and response of the state.

At the initiative of the charitable organization "100% Life", the implementation of the Transition Plan was launched. Then, the State Institution “Public Health Center of the Ministry of Health of Ukraine” (*hereinafter - the Center for Public Health) acceded to the joint and systematic planning of procurement of drugs and expert services. This institution was established by the Ministry of Health of Ukraine five years ago. In collaboration with NGOs, they developed a roadmap for addressing long-term challenges: "Strategies to ensure a sustainable response to the TB epidemic, including DR-TB, and HIV/AIDS until 2020".

The main achievement of this strategic group of the Transition Plan, which fundamentally shifted the immovable stone of the three epidemics, was the development and implementation of completely new mechanisms for cooperation between the Government and non-governmental organizations. It enabled NGOs to fully cooperate with local governments. This was a real breakthrough in the legislation - for the first time government agencies were able to procure services from NGOs. Such services are tested by many years of experience, and their staff is passionate about their work and caring for the patients.

Let's remember, stage by stage, how this process became possible.

During 2018-2019, the Cabinet of Ministers adopted two important Resolutions that ensured significant changes in the procedure for using the funds provided in the state budget for the implementation of health care programs. They allowed the use of existing programs of the Ministry of Health (namely the Budget Program Implementation Code 2301400) to finance services for HIV prevention and key populations and for the care and support of people living with HIV from the national budget.

The latter document established a new and clear procedure for the implementation of these services from July 1, 2019. And then the Ministry of Health with its Order "On Approval of the Procedure for the Provision of Services for Care and Support of People Living with HIV" established a clear algorithm for the provision of treatment and prevention services.

Sumy and Poltava oblasts were the first to finance HIV/AIDS and TB programs from the local budget. In 2018, the first significant funds for a period of one year were allocated for them from the State Budget of Ukraine (see infographic).

Thus, from July 1, 2019, the state budget ensures legal funding for HIV prevention, care and support services. The state procures services through the ProZorro e-procurement system. This approach has created a number of transparent opportunities for the formation of all necessary tools at the national level. The open governmental contracting has finally lent a helping hand to private initiatives and charities.

The new model of procurement of medicines and services in the field of public health enabled to hold numerous bidding processes in all regions of Ukraine. Fifty non-governmental organizations specializing in support programs for HIV, AIDS and TB were awarded contracts, and these NGOs signed long-awaited agreements with the CPH.

Thanks to the efforts of the CO "100% Life" on the capacity building of regional NGOs, as a result of expanding access to treatment (in particular, lower prices for HIV drugs within the state budget procurement), we saw the opportunity to use them to cover social services for people living with HIV. In 2019, savings on treatment in Ukraine have made available a considerable funding, and these economic actions allowed to use the money to procure social services for people living with HIV.

Although the year 2020 was a tough one due to quarantine, the efforts of local activists in ten regions of Ukraine helped ensure the allocation of the necessary funds from local budgets for social services for the care and support of TB patients.

In the first half of the year, the activities of the joint project with the charity organization "Light of Hope" attracted local budget funds for HIV and AIDS prevention programs, the procurement of social services. Such institutionalization of social services with the participation of local budgets also related to the assistance to parents and (or) caregivers of HIV-infected children, the children themselves and children with disabilities.

Thus, our consistent Transition Plan has provided a direct linkage between the Government and non-governmental organizations. This has significantly increased the scope and quality of services for people living with HIV, AIDS and tuberculosis. NGOs move away from the previous role of some naïve "young scouts", volunteer activists forking just for the emotional reward, begin to perform professional social work and be responsible for its outcome. The government has also joined the partnership in this difficult and virtuous work: it conducts seminars and organizes training courses on working through ProZorro.

What does this good story show and how will it develop? For us, this is definitely not about the notorious saying about good intentions that pave the way to hell. After all, we thank these people of good will, who helped to save thousands of lives. We appreciate volunteers who have been selflessly helping the sick for many years. Nongovernmental foundations that allocated or raised funds, implemented national scale programs, while having no definite status and being largely ignored by the state. All of them, like Ron Woodruff of the Dallas Buyers Club, valued human life, fought for justice, and broke through the walls to set up dialogue with the state. But the state is us. It does not exist without us. And we see that sooner or later every such wall will fall, or a door will open. You just have to continue being the ones who can find a common language, build a bridge and make the transition.