tajikistan: optimizing service delivery: promoting linkages, integration and collaboration
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Tajikistan: Optimizing service delivery: Promoting linkages, integration and
collaboration
Dr. Tedla MezemirProgramme Manager , UNDP Tajikistan
• Background Information• Approaches of optimizing service delivery
through promoting linkages, integration and coordination
• Challenges and perceived risks • Resolving challenges• Lessons Learnt
Presentation Outline
GENERAL HIV PROJECT INFORMATION
Project title (Round 8)
Strengthening the supportive environment and scaling up prevention, treatment and care to contain HIV epidemic in Tajikistan
Principal Recepient United Nations Development Programme
Period covered Phase 1: 01/10/2009 to 30/09/2011Phase 2: 01/10/2011 to 30/09/2014
Budget Phase 1: $ 20,028,139.45 Phase 2: € 17,050,694
Partners /SRs8 Governmental Structures14 Local Non-governmental Organizations5 International Organizations
HIV/AIDS Project: Key Achievements as of 1 January 2012
At-risk groups reached by HIV prevention
- Reached cumulatively 10 223 IDUs (denominator - 25,000)- Reached cumulatively 9 420 SWs (denominator - 12,500)- Reached cumulatively 2 732 MSM (denominator - 30,000)- Reached yearly 4 580 prison inmates
Vulnerable groups covered by peer education on HIV prevention
- Covered cumulatively 618 724 youth aged 15-24- Covered cumulatively 1 154 033 labor migrants and vulnerable women- Covered cumulatively 17 718 uniformed staff
ARVT received - Cumulatively 121 pregnant women received ARVT- Cumulatively 769 PLHIV currently on ARVT
Voluntary counseling and testing
- Counseled and tested 5 114 IDUs yearly- Counseled and tested 4 247 SWs yearly- Counseled and tested 181 789 pregnant women yearly
Condoms - Distributed cumulatively 15 804 358
Opiod Substitution Therapy
- Received cumulatively 296 IDUs in three sites
Direct Cost for Harm Reduction Program
Business model of Harm Reduction program
Nine components of Harm Reduction program:• Needle and syringe programmes (NSPs)• Opioid substitution therapy (OST) and other drug dependence treatment• HIV testing and counselling (T&C)• Antiretroviral therapy (ART)• Prevention and treatment of sexually transmitted infections (STIs)• Condom programmes for IDUs and their sexual partners• Targeted information, education and communication (IEC) for IDUs and
their sexual partners• Vaccination, diagnosis and treatment of viral hepatitis• Prevention, diagnosis and treatment of tuberculosis (TB).
HIV Intervention & Harm Reduction Among IDUs
Service flow for IDUs – from client prospect
Provision of commodities for
safe sexual behavior
Consultations of various
specialists*
Awareness raising
(trainings, sessions, IEC
materials)
Social support and care
Outreach work: peer
support and referral
Low threshold services
Technical collaboration and integration of Services for IDUs – Provider prospect
Governmental entities Civil society/ NGOs
Donors
Prevention, Treatment,
care and support for
IDUs
Prevention, Treatment,
care and support for
IDUs
Linkages between key players of HIV programs working with IDUs
National collaborative essentials on HIV/AIDS (Roles and responsibilities)
Civil society/ NGOs
Governmental entities
Donors
BREAKTHROUGH HIV IMPLEMENTED INTERVENTIONS
Opiod Substitution Therapy launch (authorized by the Government in 2009)
Dushanbe-based site opened in June 2010; Khujand-based site opened in February 2011;Khorog-based site opened in June 2011; As of April 2012, 230 IDUs/PLHIV under OST
Needle/Syringe Exchange program launch in prison (authorized by MoJ in 2009)
In March 2010 a pilot NSE point was opened in prison to supply with sterile equipment for IDU-prisoners; it is anticipated to open another NSE point in summer 2012; As of 1 April 2012, 35 prisoners use the services of NSE
Main Challenges
Other Challenges•Time-sensitive procurement of life-saving and diagnostic health products such as test kits in extremely difficult circumstances (budget deficit, difficulties with delivery to final destination due to different reasons such as geographical location, changes of specifications, inadequate planning and projection of country needs, fluctuation of the prices on global market)•Lack and frequent turn over of qualified human resources.•Inadequate regular coordination among donors and national stakeholders
Perceived risks
• Harm Reduction program sustainability: Huge infrastructure development such as building labs, hospitals will need sustainable maintenance, HR and running cost in the future… This is perceived as risk beyond constructions
• Reliance on external funding to HIV/AIDS programs : All commodities, drugs, lab supplies and major HR cost covered by GF project which …
• Long term risks: Narcotic drug – market situation in the country (Possibility of abrupt increase of IDUs; outburst of HIV epidemics)
UNDP’s approach in enhancing HR program
• Following strict UNDP recruitment and tender rules on subcontracting CSOs;
• Consistency of capacity building of GoT and civil society organizations;
• Promote positive relationships between GoT and civil society organizations;
• Establishment and strengthening horizontal and vertical partnerships in HIV programs;
• M&E: Advance planning, joint M&E with partners, collaborative approach in addressing obstacles;
Lessons Learnt
• To optimize service delivery it is important to ensures coordination's at donors level, at implementers level as well as integration of services at service delivery points
• Identifying challenges and risks through monitoring , regular surveillance and studies to institute timely risk mitigation plans and customized approach to the situation
Thank you for your attention
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