On 2-5 June 2014, Global Health Advocates visited Skopje, Macedonia, to assist local stakeholders in the preparation of a sustainability plan of national TB and HIV programmes. During the mission, Global Health Advocates met with several actors and facilitated a workshop on financial sustainability in order to facilitate successful transition from Global Fund (GF) to domestic financing in the country.
In spite of Macedonia being a low incidence country , a high number of cases are concentrated among the most vulnerable groups, such as injecting drug users, sex workers and Roma communities. With a 30% unemployment rate, a considerable part of the population left without health insurance and experience challenges in accessing health services. Most worryingly, the current financial crisis resulted in a reduction of domestic funding that has impacted the health system and especially the provision of prevention programmes by the Ministry of Health.
In this context, the GF has played a crucial role in supporting TB and HIV programmes since 2004. However, Macedonia now qualifies as a Middle Income Country and according to the GF’s New Funding Model is no longer eligible for funding. With around 95% of TB and HIV preventive activities still depending on GF financing, the country needs to urgently ensure continuation of essential services after 2016, once the GF phases out of the country.
The scope of Global Health Advocates’ visit was to gather main stakeholders, from affected communities and civil society organisations (CSOs) to the government and discuss how to achieve sustainability in the country. The first day of the workshop was therefore focused on gaining a common understanding of the Macedonian context, health system and TB and HIV programmes and identifying relevant challenges and opportunities. By presenting examples from other countries and different global initiatives, Global Health Advocates explained what sustainability is and the objectives and key elements of a sustainability plan, focusing especially on the importance of political advocacy and innovative financing. During the second day of the workshop, participants used the understanding gained on day one to openly discuss the content of a national sustainability plan and the process to define it.
During its visit, Global Health Advocates also met with representatives of the Ministry of Health, the Ministry of Justice, the private sector and the European Union (EU) Delegation in the country. With the latter, in particular, Global Health Advocates discussed the potential role of the European Commission within the transition process. Macedonia has been a candidate country to EU membership since 2005. Hence, the European Commission has a strong interest in ensuring that the country uses the next two years to advance towards the creation of a fully sustainable health system.
Finally, Global Health Advocates attended the launch of the Macedonian TB coalition. The first initiative of this kind in south-eastern Europe, the Macedonian TB coalition will play a crucial role in identifying essential services provided by CSOs which will need to be sustained after 2016 and will improve coordination of advocacy work in the country.
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