Building sustainable HIV service delivery model at a local level in Ukraine Iaremenko Oleksii USAID HIV Reform in Action Project, Deloitte consulting LLP

Components of the sustainable model Remove legal and policy barriers to scale-up of HIV services Advocacy for increased local funding for HIV New financing models introduction The significant financial dependence on external donor resources (67.41% of total HIV funding) threatens the sustainability and availability of critical HIV services in the near future. As donor funding for HIV programming continues to decline in middle-income countries, Ukraine needs to revise its national HIV/AIDS response strategy, funding allocations, and optimize current service delivery models. During 2016 and 20117, local we implementing ‘Building a sustainable model for the provision of critical services to key populations and people living with HIV at the local level’ in 7 high-burden regions og Ukraine Pilots cover 14 geographical locations – city and raions The key components of the sustainable model include: (1) Advocacy for increased local funding for HIV rapid testing and social services; (2) Removal of policy and legal barriers to service provision by local government and NGOs; (3) Introduction of new financing models, including social order and MAT-co-payment mechanisms; (4) Decentralization and integration of HIV services to primary PHC; and (5) Optimization of human resources for community-level service delivery. Decentralization of HIV services to PHC providers

Lessons learned (1) increased 14 local budget allocations for HIV responses from $225K in 2015 to $1.96M in 2017 This approach at the local level helped to achieve a significant increase in the sustainability of HIV services through local government strengthening, mobilization of local financial resources, budgeting and costing of critical HIV services, Local level advocacy efforts resulted in strengthened partnerships between government and civil society in HIV service delivery and increased 14 local budget allocations for HIV responses from $225K in 2015 to $1.96M in 2017.

Lessons learned (2) HTS decentralized in PHC (25 PHC providers in 2015 to 225 in 2017) HIV Rapid Test-kits for HIV Diagnostics in Pilot areas increased MAT co-financing mechanism piloted 3 pilot regions, new MAT site opened NGOs are contracted from Local budgets to provide preventive and/or support services through social contracting mechanism with budget 50K USD decentralization of HIV testing services (involvement of PHC in testing), provision of ART (opening of new ART sites), opening of new MAT sites, promotion of the provision of MAT upon prescription and piloting of the MAT co-payment model, introduction of social order, training of local change agents and service providers.

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