Liliana Caraulan: The National Coordination Council for TB/HIV is becoming a dictatorship that works in the interests of the NCC Chairperson, i.e. Minister of Health
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20 iulie, 2017, 14:47
Vizualizări: 2978
Every country that is in partnership with the Global Fund to Fight AIDS, Tuberculosis and Malaria has established a national structure with the mission to ensure the cooperation between all stakeholders interested in preventing and controlling the disease for which they get financial aid from the international organisation.
Author: Elena Cioina
Every country that is in partnership with the Global Fund to Fight AIDS, Tuberculosis and Malaria has established a national structure with the mission to ensure the cooperation between all stakeholders interested in preventing and controlling the disease for which they get financial aid from the international organisation. This institution consists of representatives from different public areas and sectors and is called the National Coordination Council (NCC). In Moldova we have the National Coordination Council (NCC) for TB/HIV Prevention and Control. What is the role of this national structure in setting the priorities for disease control supported financially by the Global Fund and what role does it play in negotiating the grants with the funder? Ms. Liliana Caraulan, Programme Coordinator of the Center for Health Policies and Studies (PAS Center) answered our questions.
Ms. Caraulan, the Republic of Moldova has benefited from financial support from the Global Fund since the country succeeded to establish a partnership with this international organisation. What was the financing application procedure until recently?
Moldova has benefited from the Global Fund support since 2003, when the donor started to provide financial support to countries for HIV, TB and malaria control. According to the requirements of the international organisation, the project proposals submitted to the donor were always developed in a participatory and inclusive manner, by involving all relevant governmental and non-governmental stakeholders.
This is how it was done in Round 1 of financing, Rounds 6, 8, 9, including when the new financing mechanism was established in 2014. The negotiations were heated every time because people who really cared discussed the matters. However, the negotiations were constructive, focused on common goals and the needs of affected and infected people. These discussions were evidence-based and guided by international good practice, considering the expertise and the potential of every party.
Many things have changed over the years. The HIV Service was moved from the management of one institution to another (from the AIDS Center within the National Scientific-Practical Centre of Preventive Medicine, today called NCPH, to the Hospital of Dermatology and Communicable Diseases); the HIV Programme Coordinators changed; the structure of Programme Coordination Unit changed; the monitoring and evaluation function migrated from one institution to another (from NCHM to HDCD). Even the antiretroviral treatment service (out-patient and in-patient) was a part of three institutions (the Republican Dermatological and Venereology Dispenser, Hospital for Infectious Diseases ‘Toma Ciorba’ and the Hospital of Dermatology and Communicable Diseases), but the participative and inclusive dialogue and decision-making process was the element that has not changed. It is stipulated by the NCC TB/HIV Regulation and ensured strictly by the NCC Secretariat, which team also changed during these years.
What was different about the negotiation process before the meeting of 29th of June?
First of all, by attempting to exclude and limit the participation of other stakeholders from the Working Group. Some were accepted in WG meeting only after insistent requests and with reference to the Program Continuation Request sent to the Global Fund on the 20th of March stipulating expressly the Principal Recipients and sub-recipients from governmental and non-governmental sectors.
Secondly, the quality of the dialogue and pressure from the National HIV Programme Coordination Unit. It is for the first time when the interventions and the budget were developed depending on the size of the envelope, i.e. resources granted by the Global Fund for the following years and not based on real needs of the country.
Also, for the first time, the service cost was imposed by the National HIV Programme Coordination Unit without prior appraisal, ignoring the arguments of the implementing institutions, previous service costs and recommendations of cost optimization exercises (OPTIMA) carried out by the UNAIDS. Finally, due to the non-transparency and favouritism of one non-governmental actor, which is also a member of the Administrative Council of the Hospital of Dermatology and Communicable Diseases (HDCD), which includes also the National HIV Programme Coordination Unit, interventions questioned by most civil society were kept, which in the opinion of the CSO have to be made pro-bono or from alternative sources. I am referring to the advocacy and social accountability activities that implemented by a non-governmental organization allied to HDCD and financed by the governmental Principal Recipient would reduce to zero leaving the key population vulnerable in front of the system.
Ms. Caraulan, why was it necessary to create an institution like NCCTB/AIDS? What is its role in the Moldova-Global Fund relationship?
National Coordination Councils are the cornerstones of the Global Fund architecture. The NCCs are established at the request of the Global Fund to ensure the cooperation of all interested stakeholders and participative and inclusive decision-making. These should include representatives of public and private sectors, including government representatives, multilateral and bilateral agencies, non-governmental organisations, academic institutions, private companies and persons living with diseases covered by the Global Fund.
Since the Global Fund does not have offices in the country, the organisation relies on the NCC, which has the obligation to govern efficiently the grants locally, as well as the Principal Recipients who assumed their implementation. As it was decided in the beginning, the NCC has to convoke all interested parties to identify jointly the country’s needs in national responses to targeted diseases to plan and determine the designs of the projects funded by the Global Fund and to oversee their implementation.
In Moldova’s case, the NCC activity is guided by the Government Decision No.825 of 3 August 2005, with further amendments, the NCC TB/SIDA Regulation stipulated by this Decision and the Operational Manual.
Considering that NCC members are representatives of different sectors and fields, who ensures the NCC activity and observance of the Regulation?
The NCC Secretariat is one of the main pillars of the NCC and has the goal to ensure good functioning and the decision-making process of the NCC, in accordance with the existing normative frame and the principles of the Global Fund. The NCC Secretariat is a team consisting of two persons paid by the Global Fund based on a grant with special destination.
Normally, besides the logistics in organising the meetings, drafting the agendas, minutes, information exchange, resolutions, etc., the NCC Secretariat acts like a gatekeeper in observing the NCC Regulation and ensuring the NCC processes in accordance with the Regulation.
Are you saying that the NCC Secretariat failed to fulfil its main task on the 29th of June?
Yes, the 29th of June meeting took place with severe infringements of the procedure, which were not even communicated to the NCC members and Chairperson: (I) unilateral interpretation of Conflict of Interests Policy in the interest of government structures; (II) voting on an item that was not included on the agenda; (III) making a decision with 10 votes out of 28 (contrary to the provisions of the Regulation that requires a consensus or 2/3 of votes). Further, distorted and unilateral description of the situation in the minutes of the meeting, on one hand. On the other hand, we are witnessing a complete lack of reaction from the NCC Secretariat addressed to the 4th of July by the NCC members representing civil society regarding the infringements committed in the meeting.
What does it mean and what consequences might entitle?
Actually, it means the beginning of the end of the NCC. Or, once being a participative and inclusive dialogue and decision-making platform, where all members enjoyed equal rights and common ground rules, irrespective of the sector represented, the NCC has become a dictatorship that works in the interests of the NCC Chairperson, i.e. Minister of Health, limiting the participation and excluding the inconvenient NGOs from the decision-making process. The representative of civil society who have functions of watchdog or social accountability, communities of affected and infected persons, service providers with more than 10 year experience in the field are excluded. The NCC Moldova that until recently was an example of good practice moved to the opposite league since June 29.
Ms. Caraulan, thank you for this interview.
Categoria: Interviuri
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