A delegation of 23 participants from Armenia, Azerbaijan, Belarus, Latvia, Tajikistan, Moldova, Russia, Kazakhstan, Kyrgyzstan and Ukraine became the first in the EECA region to study the procurement of ARV drugs, organized by ECUO jointly with UNICEF. It happened in the framework of the regional program “Partnership for equitable access to HIV care continuum in EECA region” supported by the Global Fund.
Understanding the importance of expanding access to HIV treatment for all PLHIV in Eastern Europe and Central Asia, the ECUO team consistently continues to implement its advocacy strategy. To date, only 28% of PLHIV in the region are covered by the programs of the care continuum. Obviously, to accelerate measures to overcome the HIV/AIDS epidemic, it is advisable to unite efforts of state representatives and NGOs to exchange experience at the sites of regional organizations. Indeed, at a time when governments are coordinating the procurement of necessary medicines, NGOs will play an important role as actors representing the needs and interests of beneficiaries to ensure transparency and quality.
With the support of the Global Fund, the ECUO team organized a three-day internship for the EECA country teams to the UNICEF procurement department in Copenhagen (Denmark) the EECA country teams. The UNICEF Children’s Fund operates under the auspices of the United Nations working in 157 countries around the world. The staff of the UNICEF Copenhagen office counts for 387 employees. More than 180 goodwill ambassadors around the world are now supporting UNICEF programs.
On June 28-30, Copenhagen became a platform that brought together the representatives of NGOs, state structures and regional associations of PLHIV. Each participant asked questions, raised the current issues/challenges of his/her country and shared the experience of successful implementation of advocacy for the procurement of ARV drugs.
At the internship opening, Vladimir Zhovtyak, President of ECUO, welcomed the readiness of the UNICEF team for cooperation and thanked all the participants for their active position, their efforts to improve access to quality drugs and the willingness to improve their skills.
Video: Facebook page of Vladimir Zhovtyak
Ruslan Malyuta, an expert on HIV/AIDS in the CEE/CIS region, during his speech he shared the experience of Ukraine in the organization of ARVs procurement under the management of Vladimir Zhovtyak.
In 2015, the advocacy efforts of Ukraine resulted in the purchase of drugs at 30% cheaper than the market value without losing quality and increasing the volume. This was made possible by using a reduction mechanism in the selection of the supplier, the conclusion of a direct contract with the manufacturing plant and the rejection of the services of intermediaries, the so-called “gasket firms” allowing to save the budget significantly. While Igor Perginets, WHO’s technical consultant, presented the successful experience of Ukraine in 2015 in the advocacy of development and implementation of legal documents necessary for international purchases directly from the suppliers, aiming to get the best conditions for the country while preserving the quality.
Let’s note that the first internship on ARVs’ procurement for the EECA region country teams is also a result of the successful partnership between ECUO and UNICEF. This is a consistent step in the implementation of the Minsk statement (“HIV and TB: treatment for all”) – the joint statement of the Ministries of Health from the Eastern Europe and Central Asia countries. According to the agreements reached in Minsk, the key aspiration of all stakeholders is to take measures to expand access to quality modern therapy with minimal side effects for the treatment of HIV and TB, and to ensure the lowest possible price for modern drugs.
For the internship, the UNICEF team made exhaustive reports that covered all the subtleties of the drugs procurement process, from the needs identification to the products’ delivery. The representatives of the procurement department answered the questions from the participants and made a tour of their warehouses, where they pack and collect a humanitarian aid. It is fascinating that in a warehouse of 20,000 square meters almost all processes are automated. This huge line is served by only 27 people, packing from 800 kg to 1,000 tons of humanitarian aid per day. Speaking about the best practices of the region, UNICEF representatives noted the successful experience of Ukraine and Kazakhstan, describing the planning of purchases, product selection, pricing, market development, etc.
The automated warehouses of UNICEF in Copenhagen. Video: Facebook page of Evgenia Smirnova
Vladimir Zhovtyak at the opening of the section “Overview of NGO participation in promoting transparency and accountability. Proactive role in the perception of international procurement at the country level” noted the following:
“We are striving to reach the most effective result, in other words, to overcome the HIV epidemic in the EECA region, reaching 100% of access to treatment and ensuring a quality life for all PLHIV. This internship, which became possible due to the support and involvement of UNICEF, is a significant step in achieving the goals of the Minsk statement in 2016, supported by the EECA region Ministries of Health. And I want to highlight the work of the international team of ECUO, our partners and the involvement of the representatives from the state structures of the region. Thank you for your active attitude and desire to improve the quality of life of PLHIV and access to treatment.”
The role of NGOs in public procurement. Part 1 Video: Facebook page of Vladimir Zhovtyak
Let’s note that according to the latest data, about 1.5 million people in Eastern Europe and Central Asia live with HIV. Annually, the number of new HIV infections continues to grow, 190,000 new HIV cases were identified in the EECA region. Today, it is obvious that to stop the HIV/AIDS epidemic in our region, the key is to increase the access of people living with HIV to quality modern ART with minimal side effects.
Отзывы участников по результатам мероприятия:
Feedback from the participants on the results of the event:
Igor Kilchevsky, Chairman of the League of PLHIV of the Republic of Moldova, representative of ECUO in Moldova:
“For us, it was very important to visit UNICEF thanks to joint support from ECUO and the Global Fund. Today in Moldova, the Ministry of Health concluded an agreement with UNDP on joint activities in the field of drug provision based on the regulations of the international agencies. For us, as for the community, it is important to understand the terms of these purchases, to see the transparency throughout the process, to understand how the price for a specific drug is formed. The opinion of UNICEF on access to the newest drugs with minimal side effects, especially for children, is of high interest. It was nice to hear that our recommendations on improving the work of UNICEF were received with gratitude and readiness to apply them.”
Aleksandr Hodanovich, Chairman of the Council of the Republican public association “Belarusian Community of People Living with HIV”:
“For me, as a participant of the general meeting of ECUO and a representative of the national PLHIV organization, of high importance was training on the procurement of ARV drugs during the internship in the UNICEF office in Copenhagen. I’ve started to understand better the processes of needs forecasting for ARVs, purchases, supplies, and distribution.
I’ve convinced of the importance of introducing international procurement sites for ARVs based on the experience of other countries presented at the meeting (Ukraine, Kazakhstan).
Questions on the patent and licensing status of medicines are fundamental since there are no specialists in this field in Belarus yet.
This meeting was unique as it was attended by the representatives from the community and the state institution responsible for public procurement of ARVs presenting each country of the region.
I’ve confirmed my view that the opinion of the main recipient of treatment – HIV-positive people – is very important in this process, as only they can advocate for quality, continuous and highly effective HIV treatment in our countries of the EECA region.
Thank you to the organizers for the opportunity to participate in this internship!”
Vladimir Mayanovsky, Chairman of the Coordination Council of the All-Russian NGO “Association of People Living with HIV”, representative of ECUO in the Russian Federation:
“The internship was extremely useful in understanding the procedures of the international procurement and the formation of prices for ARV drugs. It was also important to learn about the experience of countries that buy drugs under this scheme. We were interested in the possibility of purchasing drugs for migrants. The general impression of the internship conducted by ECUO and UNICEF – is a tremendous experience and the opportunity to apply the obtained knowledge in our region.”
Yevgenia Smirnova, Co-Chairman of the Union of the ECUO PLHIV Parents (EECA region):
“I am delighted that we are finally talking about innovation and quality treatment. We need to provide children with the best possible solutions. Unfortunately, Efavirenz, used in Ukraine for HIV treatment, is not the best option.
It took years, but Ukraine has apparently made progress in treating adults. We perfectly understand that this is 15 years of work. One of the most effective and powerful patient communities in the world has been created in our region. At the same time, I want to focus UNICEF’s attention on the fact that in Ukraine children are still dying from AIDS. In 2016, 64 children died, now 70 children have AIDS. The leading causes of mortality are late diagnosis and poor-quality treatment. We are ready to provide you with all the supporting information, the official government data. Moreover, the cases where parents refuse to give therapy to children are quite frequent.
The fact that children in Europe are still dying of AIDS should become a signal to strengthen the effectiveness of all the organizations involved in combating HIV/AIDS. We urge UNICEF, first of all, to promote in every possible way the transition of treatment of children to the newest quality drugs. We know that your political will and strength will help us to carry out this task.
I thank ECUO for a needed and timely initiative.”
Oleg Dymaretsky, director of CO “Meridian” (Ukraine), representative of ECUO in Ukraine, a member of the All-Ukrainian Consortium “Platform of active communities”:
“The internship at UNICEF gave me an understanding of the procurement processes, the community participation in the formation of country requests when working with a medical patent pool. Also, I had an opportunity to highlight the concern of a large part of the PLHIV community of Ukraine with the change of drugs and the appearance of bad quality generics. In addition, we had a possibility to discuss the importance of quality treatment and the change (exclusion) of Efavirenz. The obtained skills will be useful for further work in participation in public quality control and satisfaction of services. Let it be for now! Knowledge is not enough for a deeper participation! Thanks ECUO for organizing such a platform.”
Armen Aghajanov, NGO “Real World, Real People” representative of ECUO in Armenia:
“Participation in the ECUO internship program for purchasing ARVs provided a more detailed overview of the process of UNICEF procurement of ARV drugs and HIV/AIDS medicines, as well as how product planning and selection is made, how the price is generated, and what are the procurement strategies and strategies to impact the commodity markets. During the internship, we had the opportunity to discuss options for community participation in procurement, as well as opportunities for cooperation with governments to improve procurement strategies. It was important to learn and discuss opportunities for joint procurement, which is certainly very important for our region, as there are countries with lower demand for drugs.
The implementation of joint procurements for the region will be able to reduce prices for drugs in countries and improve their quality. The less we pay for the drug, the more it is possible to purchase high-quality drugs in the required quantities.”
Kanat Alseitov, representative of ECUO from a consortium of communities in Kazakhstan:
“The ECUO’s internship at UNICEF gave an opportunity to see the challenges of access to therapy in our EECA region more widely. And in particular to new drugs for children and adolescents. I’ve asserted the opinion that it is necessary to transfer to quality treatment with minimal side effects for children. And we should bring the information to parents that the drugs exist and we should reach for their procurement and assignment.
Recently there was a meeting with a group of parents from Shymkent, where I told in detail about the trip to UNICEF, and three parents were convinced to advocate access to a new scheme based on Dolutegravir. We have already first results. The doctors decided to assign this scheme to one 15 years old teenager, as others caused strong side effects. On Monday, a new scheme comes under surveillance in the hospital. We will immediately deliver this information to the parents of other cities. So that they can do better for their children.”