Improving health and protecting human rights for individuals, communities, and society

Presenter:

Dasha Ocheret | dasha@harm-reduction.org

Reaching the un-reached: communities as generators of demand, and complementary deliverers of services at local level and to remote and key

populations

 Melbourne, July 25 2014

OST Program in Azerbaijan, 2013

Whom do we reach?

How often harm reduction services analyze who their clientsare and whom they do not reach?

‘Contacted’ = contacted once a year?once during the Global Fund programcycle? Contacted through secondaryneedle exchange?

Donor’s perspective

• EC-funded three year program in 6 countries of Eastern Europe

• Main objective: to enroll 4,000 women into harm reduction services

• Donor’s interest: high efficiency, low unit cost and clear reporting according to unified indicators

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How did we involve the community to improve harm reduction programs’ efficiency?

• 90ies: as unpaid workforce for rapid situation assessments

• Beginning of 2000s: secondary needle exchange (unpaid outreach workers)

• Mid-2000s: paid outreach workers, case managers and peer educators for ART

• Late 2000s: monitoring of access to HIV services• Since 2014: improving allocative and technical

efficiency of harm reduction programs6

Eurasian Network of People Using Drugs (ENPUD)

Eurasian Network of People Using Drugs (ENPUD)

Eurasian Network of People Using Drugs (ENPUD)

Eurasian Network of People Using Drugs (ENPUD)

Questions to be asked

• What services should be added on top of the standard WHO/UNAIDS/UNODC package to reach the unreached?

• What services should be removed?• How to reduce costs of service provision?

Operational management decisions (changing opening hours…), changing legislation framework (take-home methadone doses), negotiations with pharma (internazal naloxone), etc.

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Case of Tajikistan

• New Funding Model as ‘safe’ platform to pilot drug user involvement in funding allocation decision-making

• Status quo: community leaders are asked which service they want

• Naloxone, hepC treatment, legal support, expansion of methadone programs

• Budget decisions are taken behind close doors• As a result: expansion of methadone programs

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EHRN regional program

A. Community-based service monitoring: consultations with various sub-groups of PWID

B. Costing exercise: how much does it really cost?C. Prioritization exercise: consultations with the

community on D. Allocation exercise: explicit rationing of

resource allocation in E. Advocacy for better service management and

for supportive legal frameworks13