In recent years the EECA can finally recognize some success in advocating the transition to public funding. Procurement of medicines and prevention services are partially covered by the state, and we should welcome it, because it’s good and necessary.
But why we cannot be happy, and recently, more and mode discontent is heard from the PWID community? Because, as a result of the transition, both the quality of the procured medicines and the quality of the services deteriorated.
Let me provide a specific example.
An example with opioid substitution therapy (OST) in Ukraine is illustrative in many aspects. And in general, it would seem that if the benefits of OST programs are clear to everyone and the injecting route of HIV transmission is no longer prevalent, then the state should take every effort to promote and sustain these programs.
But in fact we see a very different story: the officials unanimously refuse to allocate budget money to the OST programs, and if they do so under the pressure of international structures and donors, they do not care about the program performance, therefore, the procured medicines are of the lowest quality, and the staff of OST sites is still remunerated under the same residual principle.
It is curious that at the same time, the same officials are willing to talk and do a lot to develop the services of the paid OST program on the basis of private clinics, this options seem far more interesting to them for some reason. They even include this in the official reports statistics, pretending to develop the program.
And that’s what we face today: it seems that the government held the tender for OST medicines procurement in compliance with all necessary procedures, and the cheapest offer, a domestically manufactured drug, was procured. But at the same time lots of OST patients in Ukraine complain about it, and the majority of complaints are related even to the extremely uncomfortable condition after taking the medicine, but to numerous and painful side effects.
That is why activists of the VOLNA (national network of the Ukrainian PWID) are now collecting complaints about the state-procured OST drug manufactured in Kharkov, hoping that the voice of the community will be heard and the abundant negative feedback of patients will affect the situation.
The conclusion here is simple: when switching to public financing, one should never forget about the quality that patients are used to in the Global Fund programs, and which by default should be a priority when it comes to people’s health.
We need to create efficient feedback mechanisms on the quality and accessibility of the services and medicines provided – the community must have tools to influence the situation.