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