Viorel Soltan: “I think that all NGOs would fully support for the State to take over the activities financed by the Global Fund. But the proposal does not correspond to the intentions”
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14 iulie, 2017, 21:04
Vizualizări: 2846
In the context of the recent events related to NGOs’ exclusion from negotiating the next grant for the country provided by the Global Fund, we would like to offer you an interview with the ex-Director of PAS Center, Viorel Soltan.
Author: Elena Cioina
In the context of the recent events related to NGOs’ exclusion from negotiating the next grant for the country provided by the Global Fund, we would like to offer you an interview with the ex-Director of PAS Center, Viorel Soltan. We have asked him, first of all, about the role of the civil society in the process of establishing a partnership between the Republic of Moldova and the Global Fund, what the nongovernmental organizations succeeded to obtain for HIV control in our country and how the decision of the National TB/HIV Coordinating Council to exclude NGOs from negotiating a new grant provided by the Global Fund for 2018-2020 is perceived.
Mister Soltan, when looking back and recalling how the partnership between the Republic of Moldova and Global Fund evolved, what was the role of the civil society in this process?
Moldova was among the first countries which benefited from the Global Fund’s support since 2003. Besides the purely medical activities (medicines, treatment, diagnosis, etc.), this project involved complex prevention programs in the vulnerable groups to HIV/AIDS. These activities were conceived, piloted and implemented by nongovernmental organizations. The active participation of the nongovernmental organizations was characteristic for all the countries, not only for Moldova. By definition, the nongovernmental organizations are the organizations which may work with the target population that usually does not access the health sector services (those who do not have a permanent place of residence, commercial sex workers, people who inject drug, and others). It is already for ten years, since when Moldova applies the so-called dual track financing system – a system in which projects are implemented minimum by two organizations – one from the state side and another one from the civil society side. This system is recommended by the Global Fund policies.
Why does the Global Fund recommend this system?
Because it is very important for the national programs to be implemented based on multi-sector collaboration, hence creating opportunities to increase access to primary level services and to cover a wider range of beneficiaries. In relation to the services for the target populations, WHO and UNAIDS recommend for these services to be provided by nongovernmental structures, because the public system does not have access to marginal and socially excluded groups. Thanks to the nongovernmental sector’s involvement, the services may be extended rapidly so as to cover a wider spectrum of beneficiaries, by also wider geographical regions. This approach contributes to long-term sustainability of interventions by building stakeholders’ capacities in this regard. Additionally, by using two implementers, the financial management is considered to be more transparent and with lower embezzlement risks.
These days there are more frequent talks about the fact that the Central Health Authority has finally decided to take over the implementer role in case of the project financed by the Global Fund and that the nongovernmental organizations are against it ...
I don’t see how the nongovernmental organizations would get opposed to this. On the contrary, I think that all the nongovernmental organizations would fully support this initiative. What I’ve noticed is that the proposal to take over these responsibilities does not fully correspond to intentions.
What do you mean?
I will explain it via an example. I would understand very well and I would support fully if from now on, the National Health Insurance Company (NHIC) will procure the services of prevention, treatment, and care from the NGO’s network active in the area. Actually, over the last four years, we were trying our best to obtain for at least two projects of the NGOs to be financed by the NHIC and we did not succeed. While now, without any wide discussion, all of the sudden, the proposal appears for the Health Project Coordination, Implementation and Monitoring Unit (PCIMU) to provide grants to NGOs. The solution for the State to take over the services of prevention, treatment, and care does not seem to be viable.
I do understand the concerns of my colleagues from the nongovernmental sector: how an organization which has never before dwelt with grants’ management for NGOs can suddenly be able to do it? Hence, legitimate questions appear, such as: Where is the de-facto taking over of activities by the State? How do we actually increase the State’s capacity to provide grants, which normally should have been administrated by the NHIC? And other.
What is the PCIMU’s role here?
PCIMU is a public, noncommercial, non-profit and self-managed institution, created based on the Government Decision for implementing projects in health area. This is a quasi-governmental organization established in the last century to facilitate the management of grants obtained from donors. In other words, certain barriers were avoided in relation to passing through the state treasury and other decision-making aspects. It was created especially to implement the World Bank projects, and initially it actually has been named as such. Afterwards, in 2009, the World Bank refused to finance its projects through the PCIMU due to a very clear reason – during the period of 15 years, no capacities were developed in case of the state institutions directly responsible for certain functions. For instance, the procurement of medicines or equipment was done through PCIMU and not through the Agency of Medicines and Medical Devices as it should be. Hence, the World Bank refused and transferred the project directly to the Ministry of Health. While the Global Fund Project remained under the PCIMU management, but mainly covering the centralized procurements of medicines, lab reagents, and other equipment.
What is the role of the nongovernmental recipient, PAS Center, in implementation of grants provided by the Global Fund to the Republic of Moldova?
The organization is responsible for the so-called soft activities, which imply service provision: preventing HIV spread in the vulnerable groups, by sub-contracting dozens of nongovernmental organizations, building the capacities in different areas, extending the coverage of care and support services, social protection, services of methadone substitution treatment for person using injectable drugs, advocacy and communication activities.
For instance, the activities meant to reduce the risks among the persons using injectable drugs have developed and got totally transformed over the 3 years since PAS Center became responsible for this segment. And now, under the pretext that the State must take over the activities of prevention, support and care, the National TB/HIV Coordination Council decided on June 29 that from now on the PCIMU will be responsible for all these activities.
The decision was contested. Why?
Several aspects were pointed out when the respective decision was adopted. The most important is the fact that the CCM Regulation approved via a Government Decision clearly provides that the CCM decisions should be taken with 2/3 of votes. The CCM decision from June 29 was taken only with 10 out of 28 cotes of the members attending the meeting. Any person with no legal education and without getting into details may see that this decision is illegal. I do not refer to the content but to the voting process. And if we talk about the substance of the voting, the questions appears how the State de-facto will take over the prevention, support and care activities, if it just moves these activities from one implementer to another?
I would understand if PAS Center transfers to the NHIC the prevention activities by sub-contracting NGOs, or if it transfers the support and care services to the Regional Centers of the Ministry of Labor, Social Protection and Family based on a concrete plan clearly setting the roles of all stakeholders. I think that the concerns of my colleagues from the nongovernmental sector are obvious in this case. They have suggested for a specific plan to be developed to transfer the activities financed by the Global Fund to the management of those who are directly responsible: the National Program Implementation Unit, the National Health Insurance Company, the Regional Social Protection Centers, etc. and not just a transfer with closed eyes to a quasi-governmental institution. As far as I have noticed, this concern was expressed a number of times, but it was not really heard.
Why did you accept this interview, if you are not the Director of the PAS Center anymore?
First of all, because I was present at the very beginning of all the activities that I have mentioned above and I know very well all the details. Secondly, in the new position that I have, I am responsible for assisting countries and involving communities and civil sector in implementation of national programs at the global level and this fits fully my portfolio within the Stop TB Partnership Secretariat. We develop special tools for a wider involvement of nongovernmental organizations in prevention, treatment, and support for target populations, but at the same time we make advocacy at the world level for involving communities in decision-making. It is obvious that Moldova should undertake bigger efforts to achieve the targets set in the regional and global policies for which it committed itself and I am sure that the international partners are ready to provide the necessary assistance.
Mister Soltan, thank you for this interview.
Categoria: Interviuri
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