Attn.: partner organisations, representatives of the civil society and patient organisations operating in the TB field in the Eastern Europe and Central Asia (EECA) region.
The all-Ukrainian non-governmental organisations – "Stop TB Together" Coalition of Organisations and "Ukrainians Against TB" Public Movement" Foundation – as Ukraine's biggest specialised anti-TB civil society organisations welcome European consolidation of the efforts to fight TB. One of the manifestations of this consolidation can be a project of the Moldovan organisation of PAS, "TB Regional EECA Project on Strengthening Health Systems for Effective TB and DR-TB Control (TB-REP)", which is planned to be implemented in Ukraine too. The application is being prepared for submission to the Global Fund to Fight AIDS, Tuberculosis and Malaria (GF).
Although Ukrainian non-governmental organisations weren't engaged in the development of the project, and the project's final edition wasn't presented to local organisations for discussion and issue of recommendations, we obtained a concept of this application on 14 January 2015.
We deem it necessary to offer our opinion about both the application's content and the process for its finalisation before submission to the Global Fund.
Regarding the application preparation process:
1. The project is planned to be implemented in a number of the EECA region's post-Soviet countries. In this connection, there're questions concerning the absence of local non-governmental organisations, patient groups and the region's medical society in the formulation of at least the general view of the needs and priorities of the countries and TB control national programmes which, in our opinion, should underlie the planning of any long-term project. We recognise the need for quick development and submission of applications before announced deadlines, which often predetermines the narrow circle of specialists involved, and don't want to question the qualifications or efforts of those who worked on the application. But the absence of legitimate representatives of the general public of the region's countries in the development of the application raises the risk that the application may be formed in such a way as to take account of certain (and, perhaps, narrow) interests of individual organisations rather than the real needs of the region, which could reduce support for the project within the region and the effectiveness of its implementation.
2. It's also difficult to comment on the fact that all the documentation was provided and discussion of the application took place through circulars in English only, and that all the concept currently exists in English only. Although it has been told more than once about the need to switch to regional languages (at the very least, to translate documents into Russian) for working in the EECA region, first of all, for holding discussions with the public within a country. Work on preparation of the PAS application doesn't take account of these needs.
On the approaches to advocacy in the application:
1. The application assigns a major role as an expert in developing recommendations on improving the approaches to TB prevention, detection and treatment within the EECA healthcare systems to well-known world expert centres: London Economics School (LSE) and London School of Hygiene and Tropical Medicine (LSHTM). Experts of these schools have visited the region's countries several times as part of various evaluation missions, and their recommendations on changing the approaches to TB treatment have been provided in publications, WHO complex evaluations and other framework guidelines. We have no doubt that this time too the project's authors had in mind development of certain recommendations, to which end numerous visits, monitoring missions, two regional conferences (see below, comments on the budget) and other activities were included in the budget. But, as we see it, the project should be focused not so much on the development of another set of external recommendations as on the promotion of constructive partnership in the countries between the government and representatives of the civil society and patient organisations, in connection with an expected withdrawal of international donors from the EECA region. As a result of the withdrawal of donors, the role of national governments in the financing of national TB programmes will increase significantly, so the advocacy direction will change radically. While previously advocacy organisations were mainly financed from abroad and promoted external approaches to prevention and treatment that weren't country-adapted, now that there's going to be a switch to state financing, the civil society needs recommendations and approaches oriented at the needs of patients existing in their countries, which requires national expert review and taking account of the opinion of national specialists. In this respect, the application doesn't meet the needs of the moment in the countries, since it doesn't engage national experts.
2. The approaches to advocacy at the government level ("Top-down advocacy") leave us perplexed. The project only provides for development of recommendations with the help of external experts and – through focus groups at the government level, including through invitation of high-up officials to international conferences – lobbying of approval of these approaches directly at the ministry level. But the key element is missing – adaptation and modification of proposed approaches through implementers of national TB programmes – both the medical sector and medical workers and the public, as well as development of local recommendations based on assessment of the sector's potential (capacity assessment). Without this element, implementation of any patient-oriented programmes is impossible. This "direct" advocacy ("Top-down advocacy") of international approaches – one that goes past the medical society and patients – might be even dangerous and could lead to unilateral uncontrolled acts by governments, with already undemocratic and complex relations between the government and the civil society in a number of the region's countries.
On the application's budget:
1. The budget item on small grants for in-country advocacy ("Bottom-up advocacy") comes as an unpleasant surprise. While there's virtually no donor support for the development of the potential of the civil society and TB patient organisations, the project envisages truly ridiculous financing – 20,000 USD per country – for national advocacy, including both in Parliament and in country regions that have certain peculiarities. Such priorities of the application's developers call into question the effectiveness of the project as a whole and the extent to which it meets a region's needs for strengthening the potential of civil society organisations.
Despite these critical comments, we still believe it's possible to prepare an application that will better meet the current needs of the civil society in the countries and to carry out successful activity aimed at improving the effectiveness of the healthcare systems in the EECA region.
We wish the organisers success in implementation of the project and will watch the process intently.
For our part, we preserve the right to inform our partners in Ukraine, the Committee on Public Health of the Verkhovna Rada of Ukraine and the Representative Offices of the European Commission and the European Union in Ukraine about our vision and recommendations on the running of this project in Ukraine and in the region as a whole.
Yours sincerely,
Vitalii Rudenko, chairman of the board of "Ukrainians Against TB" Public Movement" Foundation
Igor Gorbasenko, co-head of "Stop TB Together" Coalition of Organisations, member of Ukraine's CCM