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HARM REDUCTION BUDGET ADVOCACY APPROACH March, 2015

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HARM REDUCTION BUDGET ADVOCACY APPROACH FOR EASTERN EUROPE AND CENTRAL ASIA EHRN approach to influence budget decisions that affect the sustainability of Harm Reduction Programs The development of the approach is part of the EHRN three year regional program “Harm Reduction Works – Fund It” financially supported by the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund). The goal of the Regional Program is to strengthen advocacy by civil society, including people who use drugs, for sufficient, strategic and sustainable investments in harm reduction as HIV prevention in the region of Eastern Europe and Central Asia. The approach is developed, conceptualize and authored by MA Darko Antik, Coordinator for Budget Monitoring and Analysis; Jasminka Friscik, Executive Director and D-r. Borjan Pavlovski, Coordinator for Public Health and Women’s Health; from the Association for Emancipation, Solidarity and Equality of Women (ESE) from Macedonia.

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WHY HARM REDUCTION NEED BUDGET ENGAGEMENT?

Harm reduction is facing hard times now in the region. The political opposition to and insufficient funding of both harm reduction services and advocacy have had negative consequences for the lives of the 3.3 million injecting drug users living in EECA. Despite increasing income levels and increase in the number of middle and upper-middle-income countries in the region, most of them still require financial support from international donors – the challenge is that these resources are becoming progressively unavailable for the region.

Despite formal commitments to humane drug policy principles, many countries in the region have failed to treat drug use as a public health issue. Some countries, in fact, regressed back to more repressive rhetoric directed at people who use drugs (PWUD). As a result of repressive drug policies and lack of national funding for harm reduction programs, PWUD living in the region experience legal pressures and barriers when accessing healthcare services. This, in turn, leads to more infections, higher mortality rates and continued imprisonment of more and more PWUD.

The need to address these challenges lies at the core of EHRN’s Strategy. One of the key strategic tasks for the region’s harm reduction programs and EHRN is finding solutions to ensure sustainability of the programs and gradual, responsible transition towards funding of harm reduction from alternative sources, including state and municipal programs and budgets. Network must mobilize for change!1

1 EHRN Strategy 2015 – 2019, http://www.harm-reduction.org/ehrn-strategy-2015-2019-time-mobilize-change

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INTRODUCTION

All countries in the EECA, including Moldova, Georgia, Lithuania, Belarus, Kazakhstan and Tajikistan, have signed and ratified the International Convent on Economic, Social and Cultural Rights (ICESCR) and committed to work toward the granting of economic, social and cultural rights of their citizens, including labour rights, rights to health, right to education and right to an adequate standard of living. With Article 2 of the ICESCR the countries have also committed, to provide maximum available resource for realization of their citizen’s rights, including people who use drugs; secure progressive realization of the rights, through provision of adequate amount of funds in the national budgets; and avoid discrimination in planning and provision of services and planning and distribution of budget funds.

Through the commitment to use maximum available resources the governments have obliged themselves to undertake any activity in order to collect/mobilize enough resources to secure progressive enjoyment of the citizen’s rights, including the rights of the people who use drugs. This means that the government should make all the efforts to raise its revenues, as long as they do not achieve fuller realization of the economic, social and cultural rights of the citizens, including those who use drugs.

The obligation for progressive realization of the rights does not mean that the government must provide more funds in the budget for a specific right, this means that the government provides adequate and targeted amount of funds and effectively use those funds.

Despite the previous two obligations, the obligation for non-discrimination must be fulfilled by the government immediately. This means that the governments must ensure that all the citizens have equal access to the available benefits.

The Harm Reduction Budget Advocacy Approach for Eastern Europe and Central Asia is a final product that summarizes the recent activities of the Euro Asia Harm Reduction Network (EHRN) in providing technical assistance and support, creating opportunities and facilitating the transition period, for integration of the harm reduction services into the national health and social care system and securing allocation of public funds to those services. The approach also introduces the next phase of EHRN to support and strengthen the budget advocacy activities of the Civil Society Organizations in the region.

The Harm Reduction Budget Advocacy Approach main objective is to inform and inspire the Civil Society Organisations (CSOs) in Eastern Europe and Central Asia, that work on implementation of Harm Reduction Programs, to be actively engaged in the national level budget processes in order to ensure the sustainability of the harm reduction services and programs and secure more funds form national sources for those programs and services.

This approach provides information on: what budget advocacy in harm reduction is; why the budget advocacy is important for harm reduction; what are the phases in harm reduction policies and budgets processes; how EHRN see the budget advocacy approach in harm reduction; provide overview on the role of the civil society and EHRN in the policy and budget processes; and finally suggest tools which are necessary in order civil society organizations and communities to be actively engaged in the policy and budget processes.

This approach may serve as a starting point for development of country specific models for

budget advocacy in harm reduction.

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I. WHAT IS BUDGET ADVOCACY IN HARM REDUCTION? “Health budget advocacy is about lobbying and campaigning to change the way public resources are used to deliver health services. By analyzing how healthcare is funded and how budgets are drawn up, civil society groups will have more opportunity to influence how the government prioritizes health spending.”2

The budget advocacy in harm reduction means, undertaking specific and well conceptualized strategic actions from CSO working in the area of harm reduction and communities/people who use drugs, to influence the government decisions in allocation and realization of the public health budgets, influence the provision of services, as well as enhance the transparency and accountability of the governmental institutions/service providers.

Budget advocacy in harm reduction includes series of actions developed to convince people who develop and enact laws or policies and distribute resources among all public sectors and within the public health sector specifically. This process is intended to bring changes in the public budget development and implementation in benefit of people who use drugs.

The ultimate target of the Budget Advocacy in harm reduction are the key governmental representatives (key decision makers) in order to initiate and achieve changes in the national budgets, in favour of the users of harm reduction programs.

Changes in the communities (awareness raising and mobilization); campaigning for making a

public pleasure, writing policy briefs, organize public events, have direct meetings with the governmental representatives and building alliances, are some of the steps/strategies how to achieve the ultimate advocacy goal.

For implementation of the budget advocacy process in the area of harm reduction it is very

important to have budget evidence that will support your strategies (evidence how the government use the excising funds for harm reduction or the budget funds in general, evidence of how the government make it budget allocation priorities and where is harm reduction as governmental priority, what are the possible sources for revenues from the national budgets which can be used for funding of the harm reduction programs, etc).

2 Health Sector Budget Advocacy, Save the Children, 2012, page 2

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II. WHY BUDGET ADVOCACY IS IMPORTANT FOR HARM REDUCTION?

Budgets are essential policy documents. Budgets are used as instrument for implementation of the international conventions and national standards leading to achieving the promotion of the welfare of the people who use drugs. Better outcomes in the health sector and any other sectors depend not just on allocations but also on actual execution and proper use of those allocations. The execution and proper use of budgeted funds can be improved trough budget work (budget advocacy). Civil society organizations who work in the area of harm reduction and people who use drugs, can be involved in participatory budgeting, public revenues and expenditures tracking, monitoring public service delivery, lobbying, etc.

Poor investment in harm reduction services, reflects the low priority of the governments attach to this issue when coming to budget planning and implementation. The denial of the needs of the people who use drugs in the national policies and budget could become things of the past, as civil society organizations and the people who use drugs gradually become part of the budget process (budget formulation, budget enactments, budget implementation and budget oversight). It is important to remember that budget work can be done by everyone. It is an adaptable tool that can be used in many different environments.

People who use drugs are equal members of the communities, entitled for full enjoyment of the basic human rights and obliged with certain responsibility they need to fulfil.

People who use drugs, as employees, as business owners and employers, as consumers of goods and services provided by the public and the private sectors, pay taxes and other public fees and gives significant amount of funds to the government in order to be able to satisfy their basic needs. On the other hand, people who use drugs, as part of the national electorate have the power to influence the change of government i.e. to vote or vote against politicians depending on the way how they represent their interests.

The real intention of the government, to satisfy the need of the people who use drugs, can be proved solely through proper allocation of funds into the national budgets. Meanwhile, all necessary policies which regulate and facilitate the use of the allocated budget funds should be developed and adopted previously or updated during their implementation. The policy and budget beneficiaries will never enjoy the benefits or will have limited access to them if: the country has policies but do not allocate funds in the budgets for their implementation; the country has budgets but do not have clear policies which regulate the use of the allocated funds; or have poor quality policies and insufficient funds budgeted.

All the decision made by the government, or more precisely the decisions which the government has a real intention to implement, must be translated into the public budgets. Public budgets ultimately shape the policy outcomes.

Thus, the engagement of the civil society in the budget process, is essential for ensuring that

people who use drugs are part of the process and their voice is taken in consideration when the decision are made.

The formulation of the public health budges and the public budgets, in general in most of the countries in EECA, is left on government elites and bureaucrats, who are mostly guided by political interests in their decisions, and do not take the public interest and citizens priorities when allocating/distributing the funds among the budget users and budget sectors. Even after allocation of

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funds in the budget for specific issues, the budget users and sectors compete among each other when the realization of the budget funds take place (example: the Treasury Departments and the Ministry of finance, during the realization of the budget funds, are setting payment priorities which can be different than those determinate with the enacted budgets). The role of the civil society is to make constant pressure and demand changes, in the processes and the behaviour, from the public institutions and representatives involved in the budget process. Harm reduction advocates can benefit from the budget advocacy and can use the budget advocacy to:

§ Increase the share of the overall budget for harm reduction in comparison to other government spending and prioritize harm reduction programs within the allocations for health;

§ Increase the efficiency in use of the resources for harm reduction; § Learn how the decision making system works and how to make interventions in the policy and

budget development and enactment process: policy and budget enactment; policy and budget implementation; and policy and budget oversight;

§ Improve transparency and accountability; § Intensify/Increase the voices of the people who use drugs who are not heard; § Raise issues that would otherwise be neglected, and draw the attention of the media and others in

civil society; § Confront unequal power dynamics that affect the distribution of public resources; § Pressure governance institutions to treat drug users with dignity; § Create new public spaces for people’s participation; § Gain the skills needed to effectively participate in public argument; § Produce alternative budgets; § Simplify budgets; § Expand the debate around budget policies and decisions.

“In the U.S., major changes have taken place in fewer than 20 years. A small number of highly skilled budget analysts have emerged to work on the national and state levels. Premier among the national organizations is the Center for Budget and Policy Priorities. Born out of crisis during the Reagan Administration’s severe cutbacks to social programs, the Center has played a significant role in showing how the U.S. budget affects low-income families, the poor, and the near poor – including millions of people who work for a living and yet remain poor.”3

Budgets are extensive and quite complex documents, recognized by the activists as technical and

highly skilled economist work. But in reality this work can be done by everyone through using basic arithmetical formulas on the publicly available information. Based on the findings, activists can talk in more powerful ways about how harm reduction is funded in the county. If the activists are not confident to conduct the analysis, then they can make alliance and request for help from other organization that work on budgets. “We are analysts, and our business is calculating numbers. And you (community organizations), you are the stars, and your task is reaching policy makers and making them feel what those numbers actually mean and how they can hurt,”4

3 People Powers and Participation Guideline, http://www.advocate-for-children.org/advocacy/budget_advocacy/start 4 Budget Advocacy Lessons for Moldova, http://www.harm-reduction.org/news/budget-advocacy-lessons-moldova

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III. WHAT ARE THE KEY PHASES IN THE HIV POLICY AND BUDGET PROCESSES ON NATIONAL AND LOCAL LEVEL IN EECA? We cannot divide the policy process from the budget process. These processes are parallel processes. The graphs presented below are developed just for the purpose of simplification and visualization of the stages in both processes and presenting the points of connection between them. The policy and budget processes on different levels of the government (local, regional, national etc.) are conducted independently from the governmental structures present on those levels, based on the country general priorities and priorities of the other levels of government. The local and the regional level government in the policy and budget processes put prime focus on the priorities developed by the national level governments; the regional and local interests are mostly on a second place. Ex. If the national government decide that the main priority of the country for certain year will be infrastructural development, than the policy and the budget process will be primarily based on this issue. The health care and harm reduction programs needs will be satisfied with the left over’s. The policy and the budget processes are composed of four main phases: formulation, adoption, implementation and oversight or monitoring and evaluation. In the first phase of the policy process the governmental institutions, including the health institutions, develop the policy content and conduct costing of the activities planned to be implemented with those policies. In the second phase of this process, the developed policies are submitted for approval to the respective governmental institutions (ex. The HIV strategies and programs for HIV protection are developed by the Ministry of Health in the first phase and submitted for approval from the Government and adoption form the Parliament in the second phase). It is important to know that the development of the certain policies and there adoption sometimes takes more than one calendar year and their development and adoption sometimes is not followed by budgeting and funds allocations in the public budgets. In theory, after the approval/adoption of the policies they have to be taken as a base for funds allocation in the budget process. If the policy is budgeted and the government allocated certain amount of resources then that policy should be implemented (third phase of the policy process) at the level of the budget allocation and the effectiveness of the implementation should be assessed (fourth phases of the policy process). The third and the fourth phase from the policy process are conducted parallel with the third and the fourth phase of the budget process. If the policy, as it is developed, does not satisfy the needs of the citizens, then that policy should be amended. The first phase of the budget process (formulation of the budget) is based on the deliverables from the second phase of the policy process (adoption of the policies). All the policies adopted, are starting bases for budget formulation and development, but not all are priority for the governmental institutions (if the programs for harm reduction are not priority of the government then the allocations to those programs will be minimal or they will not exist at all). After the budget formulation, the budget is approved by the responsible persons in each of the institutions and from the government, and in the second phase adopted by the responsible public institutions on higher level (ex. Parliament, Councils, etc.). Once the budget is adopted, budget execution (third phase) and audit (fourth phase) follows.

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Graph 1 – Policy and Budget process in the area of harm reduction local, regional and national level

Monitoring

andevaluationThe effectiveness of the policies is subject of assessment

Formulation

The government and the health institutions draft the HIV policies and make costing of the policies

Policy process in harm reduction

Implementation

The policies are executed

Adoption

The relevant governmental bodies approve the policies

Monitoring

and evaluation The effectiveness of the expenditures are assessed assessment

Formulation

The government and the health institutions draft their budget and make the expenditures priorities

Adoption

The government priorities and expenditures are approved by responsible bodies (ex. parliament…)

The approved expenditures and policies are executed

December January

September

January August

Implementation

Budget process in harm reduction

December January

December

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IV. HOW EHRN SEE BUDGET ADVOCACY APPROACH IN HARM REDUCTION? EHRN main goal from the engagement in the budget process5: community of civil society organizations to influence public allocation in a desirable fashion. EHRN specific objectives from the engagement in the budget process6: 1. Formulation phase: - Stage I: Policy Priority Setting: Harm reduction is stated as a priority; - Stage II: Programmatic and Budget Planning: Harm reduction is included in the public allocation plan (budget). 2. Adoption phase: - Stage I: Enacting the budget (government): Allocated funds for harm reduction in the budget to be approved by the government; - Stage II: Enacting the budget (parliament): Allocated and approved funds for harm reduction in the budget to be adopted by the parliament. 3. Implementation phase: Enhance the budget expenditures outcomes. 4. Monitoring and evaluation phase: Enhance the quality, availability, cost-effectiveness of the HR programs and services.

5 All the information presented under this topic are taken from the EHRN Budget Advocacy meeting minutes and are developed by the EHRN. 6 All the information presented under this topic are taken from the EHRN Budget Advocacy meeting minutes and are developed by the EHRN.

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Budget phase Aim for EHRN

engagement in the stage

National Placeholders and Stakeholders Barriers Facilitators Tool and cases available Tools and cases to be developed

I. FORMULATION PHASE

Stage I: Policy Priority Setting

Harm reduction is stated as a priority

National Placeholders: - Policies & Legislation: drug policy, etc - National Strategies: EU association agreement, etc - Sectoral Strategies: Transition Plan, Health sector Strategy, etc. - Disease-specific Strategies: HIV national action plan, etc. - Programs: National Healthcare Program, National AIDS Program, etc. - Others: Clinical guidelines and protocols Informal promises.

- Lack of democracy and transparency; - Corruption; - Lack of influence; - Lack of awareness among public agencies; - Limited capacities and capabilities of CSOs to influence and deal with those processes.

- Key decision makers declare their readiness to support harm reduction (president, MPs, Cabinet of Ministers, MoH, media, influential individuals); - Global Fund; - Transition process approaching; - Donors; - Creditors (IMF, WB); - Country Coordination mechanism; - “Supporters” in government agencies; - Working with media; - Networking/partnerships; - EC/EU integration; - Public Health concerns (e.g. HIV epidemics)

- International “best practice” examples; - Communities having access to number of working groups with the government;

- Partnership with CSOs working on public budget and monitoring issues (or other relevant CSOs); - Mapping of power and means of influence; - Mapping of interests and powers; - Methods and tools to be used by the communities for conduct legal review, mapping and advocacy activities; - “Horrors” – cases of countries where transition process has failed; - Check-list for national placeholders should be developed and we should analyze, which one is “the best” placeholder to prioritize Harm Reduction.

Stage II: Programmatic and Budget Planning

Harm reduction is included in the public allocation plan (budget)

National Placeholders: - National Action Plans; - Drug policy related programs; - Annual budget and multi-year prognosis; - Standards of services and costing; - Procurement regulations; - Budget law (to understand budget cycle and especially, at central and local levels.) Stake holders: - CCM, MoH, MoF; - Parliamentary Committees for health and budgets

- Lack of standards and mechanisms/Limitation of the current standards; - There are not standards in some countries; - The standards do not address the needs of the citizens.

No facilitators determinate.

No tools and cases available

- Guidelines for good HR service standards; - Standards for HR services accreditation; - Social contracting mechanisms; - EHRN will collect examples from other standards and analyze the risks for the implementation This process should include analysis of all related risks (e.g. if the standards are too strict, implementation might be a problem, etc.). - Guidelines for fiscal strategy analysis; - Guidelines for analysis of the budget guidelines, budget requests and budget proposals and engagement in these activities; - Partnerships created to help HR NGOs in this process.

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II. ADOPTION PHASE Stage I: Enacting the budget (government)

Allocated funds for harm reduction in the budget to be approved by the government

National Placeholders: - Budget proposal Stake holders: - MoH, MoF; - Government - Parliamentary Committees for health and budgets

No barriers determinate.



- Tools and cases on how to influence and engage in this process. Stage II: Enacting

the budget (parliament)

Allocated and approved funds for harm reduction in the budget to be adopted by the parliament

National Placeholders: - Budget proposal Stake holders: - Parliamentary Committees for health and budgets - Parliamentarians




III. IMPLEMENTATION PHASE

Implementation

Enhance the budget expenditures outcomes

National Placeholders: - Enacted budget/Amended budgets - Law on public procurement; - Annual public procurement plans; - Documents developed through during the implementation of the public procurement procedures. Stake holders: - All budget users responsible for implementation of the HR programs; - Primary recipient of the Global Fund Grant; - Public Procurement Agencies.




- Tools public procurement monitoring and analysis; - Guides for public procurement process on country level; - Methodology for community assessment of the public procurements and the quality of the good/services procured.

III. MONITORING AND EVALUATION PHASE

Monitoring and evaluation

Enhance the quality, availability, cost-effectiveness of the HR programs and services

National Placeholders: - Budget execution reports; - Transition Plan; - National HIV/AIDS Plan. Stake holders: - All budget users responsible for implementation of the HR programs;




- Tools for monitoring and evaluation of the budget execution outcomes; - Tools for engagement in this budgets phase.

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V. RECOMMENDATIONS FOR CIVIL SOCIETY ORGANIZATIONS, COMMUNITIES AND EHRN FOR ENGAGEMENT IN THE POLICY AND BUDGET PROCESS The prime focus of the civil society organizations when engaging in the policy process is to demand and make changes in the existing policies or to demand new policies and regulations. Also, civil society organizations have important role in this process, by demanding proper costing of the policy planned activities or propose possible costing scenarios. The engagement in the policy process does not means that the organizations have to be completely outside the budget process. The engagement in the policy process and the budget process can be parallel, even though lack of policy regulations limits the possibilities for involvement in the budget process. Important guidelines for the policy process: If the existing policies are restrictive or the county lack key policies, then civil society organizations should engaged in both the policy process and the budget process. In this process civil society organization should do broader policy analysis, targeting also the policies outside harm reduction area, such as fiscal and other sectors policies. Without elimination of the existing policy barriers, civil society organizations won’t be able to achieve full national funding of the HR programs. Until the legal barriers are eliminated, civil organizations can monitor and analyze the implementation of the budget process in two directions: first, to identify possible sources of funds in the country budgets which could be used for financing the HR and secondly, track the expenditures for implementation of the existing HR policies and assess their quality and effectiveness (for engagement in the budget process, preparatory activities are needed, see the text in the next paragraph).

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Advocacy Goal Current Situation Role of the CSOs and the

communities in the policy process Role of the CSOs and the communities in the budget process

Role of EHRN in supporting the national processes related to the achievement of the

advocacy goal

Create conductive legal environment to

ensure smooth implementation of

HIV and TB national responses and achieve greater

engagement of civil society organizations

through public funding

The existing policies are restrictive and represent a barrier for achievement of full national funding of the HR programs

- Policy mapping; - Policy assessment; - Development of simplified version of the policies to increase policies and policy barriers understanding; - Implementation of advocacy campaigns for changes.

- Monitoring and analysis of current revenues and expenditures (implementation phase); - Monitoring and evaluation of the current expenditures (oversight/monitoring and evaluation phase); - Implementation of advocacy campaigns to increase the efficiency in the implementation of the policies and enhance the quality in the current level of services provided to the people who use drugs (implementation phase).

- To provide technical assistance and support to the network members on how to use human rights for strategic organizational development and situation analysis; - To help network members obtain recognition of the issues from other civil society organizations, governments and international community; - To develop guidelines and standards; - To conduct training and capacity building; - To help network members to demand remedy governments that violates national human rights laws; - To encourage network members to file complains on national, regional and international level; - To form alliances with other interested groups and organizations and to develop networks; - To encourage and assists network members in conducting necessary law reforms.

Country lack key policies to insure full national funding of the HR programs

- Policy research in other countries; - Development of draft policy models; - Implementation of advocacy campaigns for adoption of the key policies.

- Monitoring and analysis of current revenues and expenditures (implementation phase); - Monitoring and evaluation of the current expenditures (monitoring and evaluation phase); - Implementation of advocacy campaigns to increase the efficiency in the implementation of the policies and enhance the quality in the current level of services provided to the people who use drugs (implementation phase).

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The prime focus of the civil society organizations when engaging in the budget process is to demand and make changes in the budgets, concentrating on the financial implementation of the existing policies. The engagement in the budget process does not means that the organizations have to be completely outside the policy process. The engagement in the policy process and the budget process can be parallel, but when all the policies needed are in power then the engagement in the budget process could be extensive. Important guidelines for the budget process: The role of the civil society organizations and the communities in the budget process can be different and mostly depends on the current situation in the country. The activities and the strategies that civil society organizations and the communities can undertake are different in different country contexts. Before starting with the engagement in the budget process, civil society organization and communities should have detailed information regarding the county specific budget processes in general and harm reduction specific, information regarding functioning and financing of the health system in general and harm reduction specific are essential and information about the need of the communities. The organization and the communities might have direct involvement in the budget process after eliminating the policy barriers and conducting the preparatory activities.

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Advocacy Goal Current Situation Role of the CSOs and the communities in the policy process

Role of the CSOs and the communities in the budget process

Role of EHRN in supporting the national processes related to the achievement of the

advocacy goal

Full national funding of the HR programs

Country does not allocate any funds in the budget for implementation of the HR programs.

- Monitoring the policy implementation; - Assessing the outcomes from the existing policies; - Initiate changes in the existing policies if they are still obstacle for providing full national funding of the HR programs.

- Monitoring and analysis of current budget revenues and expenditures (implementation phase); - Monitoring and evaluation of the current expenditures (oversight/monitoring and evaluation phase); - Direct engagement in the formulation and adoption phase in order to advocate for insuring that HR programs are taken in consideration when developing the county budgets, HR programs become budget priority and the budget for HR is approved by the responsible institutions; - Tracking the revenue allocations and the expenditures made for implementation of the approved budget for HR programs (implementation phase); - Assessing the impact of the allocated funds on the communities.

- To provide technical assistance and support to the network members on how to use human rights for strategic organizational development and situation analysis; - To help network members obtain recognition of the issues from other civil society organizations, governments and international community; - To develop guidelines and standards; - To conduct training and capacity building; - To help network members to demand remedy governments that violates national human rights laws; - To encourage network members to file complains on national, regional and international level; - To form alliances with other interested groups and organizations and to develop networks; - To encourage and assists network members in conducting necessary law reforms.

Country allocates insufficient funds in the budget for implementation of the HR programs.

- Monitoring the policy implementation; - Assessing the outcomes from the existing policies; - Initiate changes in the existing policies if they are still obstacle for providing full national funding of the HR programs. - Advocate for enhancement of the policy realization and outcomes, even the funds are not enough for realization of the HR programs.

- Monitoring and analysis of current budget revenues and expenditures for harm reduction (implementation phase); - Monitoring and evaluation of the current expenditures for harm reduction (oversight/monitoring and evaluation phase); - Direct engagement in the formulation and adoption phase in order to advocate for increasing the funds in the HR programs and insuring that the increased budget for HR is approved by the responsible institutions; - Tracking the revenue allocations and the expenditures made for implementation of the approved budget for HR programs

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(implementation phase); - Assessing the impact of the allocated funds on the communities.

Country allocates enough funds from country budget for implementation of the harm reduction programs.

- Monitoring the policy implementation; - Assessing the outcomes from the existing policies; - Advocate for enhancement of the policy realization and outcomes.

- Tracking the revenue allocations and the expenditures made for implementation of the approved budget for HR programs (implementation phase); - Assessing the impact of the allocated funds on the communities. - Direct engagement in the formulation and adoption phase in order to advocate for increasing that HR programs are still priority of the government and the allocated funds satisfy the need of the people who use drugs.

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VI. ANALYSIS AND DATA DEVELOPED BY THE EHRN WHICH CAN BE USED IMMEDIATELY IN THE ENGAGEMENT IN BUDGET PROCESS

All the materials listed below provide essential information which can be used for civil society organizations and community engagement in all the stages from the budget process.

Material title Link to the material In which budget phase you can use the material

Situation analysis of sustainability planning and redress for responsible transition of harm reduction programs from global fund support to national funding in EECA

http://www.harm-reduction.org/sites/default/files/pdf/ehrn_report_on_responsible_transition_in_eeca_eng_0.pdf

- Formulation phase; - Adoption phase; - Implementation phase, - Monitoring and evaluation phase.

Regional High Level Dialogue on Successful Transition to Domestic Funding of HIV and TB Response in Eastern Europe and Central Asia countries “ROAD TO SUCCESS”

http://www.harm-reduction.org/sites/default/files/pdf/resolution_eng_final.pdf


Road to Success: Towards Sustainable Harm Reduction Financing Regional Report First year of the Regional Program “Harm Reduction Works – Fund It!”

http://www.harm-reduction.org/sites/default/files/inline/files/Regional_report_210x297%2B3mm.pdf


Seeking Alternatives for Regressive Drug Policies http://www.harm-reduction.org/sites/default/files/pdf/reports/kiev_meeting_report_april_25-26_english.pdf


Access of women who use drugs to harm reduction services in Eastern Europe

http://www.harm-reduction.org/sites/default/files/pdf/reports/access_of_women_who_use_drugs_to_harm_reduction_services_in_eastern_europe.pdf


HIV, Drug Use and The Global Fund, International HIV/AIDS Alliance, 2012

http://www.harm-reduction.org/sites/default/files/pdf/HIV%2C%20drug%20use%20and%20the%20global%20fund%2C%202012.pdf


Transition and sustainability of HIV and TB responses in Eastern Europe and Central Asia

http://www.harm-reduction.org/sites/default/files/pdf/regional_consultation_report_for_gfs_eng.pdf


TB Strategic Investment Information Note http://www.harm-reduction.org/sites/default/files/pdf/Core_TB_StrategicGuidance_Infonote_en%20%282%29.pdf

- Formulation phase; - Adoption phase; - Implementation phase, - Monitoring and evaluation phase..

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Transition Readiness Assessment Tool (TRAT) http://www.harm-reduction.org/library/transition-readiness-assessment-tool-trat

- Monitoring and evaluation; - Formulation phase; - Implementation phase.

Methodology to Assess Harm Reduction Funding http://www.harm-reduction.org/library/methodology-assess-harm-reduction-funding


Methodology to Assess and Monitor Access to Harm Reduction Services

http://www.harm-reduction.org/library/methodology-assess-and-monitor-access-harm-reduction-services


Training module "Community Led Budget Advocacy in Harm Reduction"

http://www.harm-reduction.org/library/training-module-community-led-budget-advocacy-field-harm-reduction


http://www.harm-reduction.org/library/carhap-quality-management-toolkit-qmt-hoppenbrouwer-j-2011


Evaluation of national programmes on viral hepatitis C in EECA countries

http://www.harm-reduction.org/sites/default/files/pdf/hep_c_national_programmes_evaluation_instrument_0.pdf


Situation assessment: hepatitis C treatment costs in EECA countries

http://www.harm-reduction.org/sites/default/files/pdf/hep_c_treatment_cost_instrument_0.pdf


Evaluation of protocols for chronic hepatitis C treatment in EECA countries

hhttp://www.harm-reduction.org/sites/default/files/pdf/evaluation_of_hep_c_treatment_protocols_instrument_0.pdf


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REFERENCES

1. Progress report: Budget advocacy for improved women’s and children’s health: experiences from national civil society coalitions; The Partnership for Maternal, Newborn and Child Health;

2. Influencing Government Health Budgets in Uganda, Guide for Civil Society Organizations; USAID Advocacy for Better Health Project;

3. Health Sector Budget Advocacy, a guide for civil society organizations; Save the Children; 4. Health Budget Advocacy: A Guide for Civil Society in Malawi; Health Policy Project; 5. Seeing from our perspectives: youth budget advocacy in Ghana; Charllotte Bani – Afudego, George

Cobbinah Yorke and Anastasie Ablavi Koudoh 6. A Budget Guide for Civil Society Organisations Working in Education; The Commonwealth

Education Fund (CEF); 7. Budget advocacy orientation, understanding, tools, strategies, tactics and opportunities,

International Budget Partnership; 8. Budgeting for Human Rights: The use of Maximum Available Resources, International Budget

Partnership; 9. Budgeting for Human Rights: Progressive Realization, International Budget Partnership; 10. Budgeting for Human Rights: Non-discrimination, International Budget Partnership; 11. Strategy for the period 2015 – 2019, EHRN.