Year 1 Work-Plan

Year 1 work-plan YEAR 1 WORK-PLAN HIV REFORM IN ACTION COOPERATIVE AGREEMENT- HEALTH SYSTEMS STRENGTHENING FOR A SUSTAINABLE HIV / AIDS RESPONSE IN UKRAINE (HSS SHARE)

QUARTER 3 REPORT April 1, 2018 – June 30, 2018

AWARD NUMBER: AID-121-A-13-00007 MODIFICATION NO. 08 DELOITTE CONSULTING, LLP

This report is made possible due to the funding provided by the U.S. President’s Emergency Plan for AIDS Relief through the United States Agency for International Development (USAID) under the terms of the HIV Reform in Action project, award number AID-121-A-13-00007. The content of this report is the sole responsibility of Deloitte Consulting LLP and its implementing partners and does not necessarily reflect the opinion of PEPFAR, USAID, or the United States Government.

Contents LIST OF ACRONYMS ...... 3 GENERAL PROJECT INFORMATION ...... 6 CURRENT AND CUMULATIVE PROGRESS ...... 7 EXECUTIVE SUMMARY ...... 8 OVERALL PROJECT PERFORMANCE ...... 12 SECTION 1. HIV REFORM SUPPORT ...... 12 Objective 1: Enhance national leadership and capacity for evidence-based and gender-sensitive HIV policy programming and implementation ...... 12 Sub-objective 1.1: Support national government institutions in AIDS policy development, programming, and implementation ...... 12 Sub-objective 1.2: Strengthen capacity of local government entities to implement regional AIDS programs with emphasis on key affected populations ...... 12 Sub-objective 1.3: Improve policy dialogue and ensure transparent policy development environment 13 Objective 2: Improve and optimize resource allocation and financing for the national and selected regional HIV/AIDS programs targeting key populations ...... 13 Sub-objective 2.1: Develop evidence pool to create support for funding decisions in HIV response at the national and regional level ...... 13 Sub-objective 2.2: Support the development of the HIV strategies and policies at the national and regional levels which reflect optimized resource allocation and lead to the most cost-efficient and effective implementation ...... 14 Sub-objective 2.3: Strengthen capacity of national and regional partners in finance planning, budget preparation, and execution to match the needs to optimized HIV/AIDS service-delivery operations ..... 15 Objective 3: Optimize and strengthen human resources for health (HRH) for the delivery and scale-up of gender-sensitive HIV/AIDS services targeting key populations ...... 15 Sub-objective 3.1: Strengthen evidence base for HIV workforce planning and development ...... 15 Sub-objective 3.2: Support the introduction of systemic and operational changes in HRH for the provision of sustainable and integrated HIV/AIDS services at the national and regional levels ...... 15 Sub-objective 3.3: Strengthen capacity of Ukrainian institutions in HRH policy, planning, and development. 1 6 Cross-cutting activities ...... 16 Grants Management ...... 16 Capacity Building ...... 19 Gender and Stigma Sensitization ...... 20 Communication and Knowledge Management ...... 20 SECTION 2. HEALTH SYSTEM FINANCING REFORM SUPPORT ...... 21 Objective 2: Optimize resource allocation and financing for the national and selected regional HIV/AIDS programs targeting key populations ...... 21 Sub-objective 2.4: Build the capacity of the national and selected regional/local GoU entities to design and establish a national purchasing agency ...... 21 Sub-objective 2.6: Support MOH and selected local authorities in the design and establishment of a performance-based payment system under ‘money-follows-the client’ approach ...... 21 Sub-objective 2.7: Support the National Purchasing Agency and MOH in developing and implementing effective IT solutions to launch, manage, and administer health system financing reforms ...... 25 Cross-cutting: Strategic Communication and Knowledge Management ...... 26 PROJECT MANAGEMENT ISSUES ...... 27 EVALUATION OF ACTIVITY WITH RESPECT TO ENVIRONMENTAL IMPACT ...... 28 PROJECT ACTIVITY MONITORING MATRIX ...... 29 Section 1. HIV REFORM SUPPORT ...... 29 Section 2. HEALTH SYSTEM FINANCING REFORM SUPPORT Under Objective 2...... 44

LIST OF ACRONYMS Acronym Description ACH Acute Care Hospital AIDS Acquired Immune Deficiency Syndrome AOR Agreement Officer's Representatives ART Antiretroviral Therapy BPMN Business Process Model and Notation CB Capacity building CD Capacity development CDC Centers for Disease Control and Prevention CEA Central Executive Agency CME Continuous Medical Education CMU Cabinet of Ministers of Ukraine COP Chief of Party CPD Continuing Professional Development CRH Central Rayon Hospital CSO Civil Society Organization CSSFCY Center of Social Services for Family, Children, and Youth CMU Cabinet of Ministers of Ukraine COP Chief of Party DCOP Deputy Chief of Party DRG Diagnostic-Related Groups ECOM Eurasian Coalition on Male Health ECOU The international charitable organization “East Europe and Central Asia Union of PLWH” ERs Expected Results FSWs Female Sex Workers FTCI Fast-Track Cities Initiative GARP Global AIDS Response Progress GF or GFATM Global Fund / Global Fund to Fight AIDS, Tuberculosis, and Malaria GoU Government of Ukraine HC Health Care HCF Health Care Facilities HIV Human Immunodeficiency Virus HIVRiA HIV Reform in Action HQ Headquarters HR Human Resources HRH Human Resources for Health HRIS Human Resource Information System HSS-SHARe Health System Strengthening for a Sustainable HIV/AIDS Response HTC HIV testing and counselling HTS HIV Testing Services IC Investment Case ICT Information and Communication Technology IS Information System

IT Information Technology IWG Inter-sectoral Working Group KAP Knowledge, Attitude, Practice/Key Affected Population KCSA Kyiv City State Administration KH Knowledge Hub KM Knowledge Management KMCS Knowledge Management and Communication Strategy KP Key Population KPIs Key Performance Indicators KSE Kyiv School of Economics LEA Legal Environment Assessment LGBT Lesbian, Gay, Bisexual, Transgender MARPs Most-at-risk Populations MAT Medication-assisted Treatment METIDA CDC-funded Project “M&E-related Technical Assistance and Improved Data Application in HIV” MIS Management Information System MMBT Maturity Model Benchmarking Tool MOF Ministry of Finance MOH Ministry of Health MOJ Ministry of Justice MOU Memorandum of Understanding MSM Men Who Have Sex with Men MSP Ministry of Social Policy MVP Minimal Viable Product M&E Monitoring and Evaluation NAP National AIDS Program NAPA National Academy of Public Administration under President of Ukraine NASA National AIDS Spending Assessment NGO Non-Governmental Organization NHS(U) National Health Service (of Ukraine) NMU National Medical University NPHC National Public Health Center Obj. Objective OHD Oblast Health Department OSA Oblast State Administration OST Opioid Substitution Therapy PBF Performance-Based Financing PEPFAR President's Emergency Plan for AIDS Relief PH Public Health PHC Primary Health Care PIP Performance Improvement Plan PLHIV or People Living with HIV/AIDS PLWH PM Project Management PMEP Performance Monitoring and Evaluation Plan 4

PPP Public-Private Partnership PReP Pre-exposure prophylaxis PWID People Who Inject Drugs QGIS Quantum Geographic Information System RAP Regional AIDS Program RCC Regional TB and HIV Coordination Council RESPECT USAID Project “Reducing HIV-related Stigma and Discrimination for Most-at-Risk Populations in Health Care Facilities in Ukraine” RESPOND USAID Project “Improving HIV/AIDS Services for Key Populations in Ukraine” RFA Request for Applications RSA or DSA Rayon State Administration or District State Administration SES State Epidemiology Service SOE State-owned Enterprise SOW Scope of Work SPH School of Public Health STI Sexually transmitted infection STTA Short-Term Technical Assistance TA Technical Assistance TB Tuberculosis TBD To Be Determined/To Be Done Test and WHO guided treat-all approach recommending ART for everyone living with HIV at START any CD4 cell count. START - Strategic Timing of Antiretroviral Treatment TI-Ukraine Transparency International Ukraine TOR Terms of Reference ToT Training of Trainers TWG Technical Working Group UCDC Ukrainian Center for Disease Control UCSF University of California, San Francisco U-LEAD Ukraine – Local Empowerment, Accountability and Development Programme UISR Ukrainian Institute for Social Research UNAIDS Joint United Nations Program on HIV/AIDS USAID United States Agency for International Development USG United States Government UTCFM Ukrainian Training Centre of Family Medicine VRU Verkhovna Rada of Ukraine WB World Bank WG Working Group WHO World Health Organization

GENERAL PROJECT INFORMATION

Country: Ukraine Project: HIV Reform in Action Regions/oblasts: Ternopil, Cherkasy, Short name: HIVRiA Dnipropetrovsk, Kherson, CoAg number: AID-121-A-13-00007 Mykolaiv, Odesa, Poltava regions and Kyiv City Implementer: Deloitte Consulting LLP Agreement Officer Start Date: October 1, 2013 Representative (AOR) Paola Pavlenko End Date: September 30, 2018

Alternate AOR Alina Yurova Latest modification Mod 8 signed June 21, 2018 Date of Report July 15, 2018 # and date: Submission: Period covered by the April 1 – June 30, 2018 report:

EXECUTIVE SUMMARY

In the 3rd quarter of its final Year 5, the HIV Reform in Action (HIVRiA) team continued to finalize the remaining key activities, disseminate Project’s best practices, experiences and lessons learned, and support the Government of Ukraine in health care reform. With the Ministry of Health of Ukraine regarding the project team as a leading and reliable partner, the Project kept playing a critical role in implementing ambitious HIV, public health and health financing system strengthening activities, informing national and local decision-making, and providing tools and solutions for effective programming. In the reporting period, the Project leadership also took part in the “National Conference to Mark the 4th Anniversary of the Local Self-Governance and Territorial Organization of Power in Ukraine”, chaired by the President and the Prime Minister of Ukraine. The HIVRiA Chief of Party joined the Deputy Minister of Health on a panel on Decentralization in Health Care, where health care reform implications at the regional and local levels were discussed, with a primary focus on strengthening governance for autonomous health care institutions. The Project shared with participants information on technical assistance tools (webinars, online materials and electronic instruments) available for local health care providers through the Project’s primary health care centers support initiative. Under Objective 1, the HIVRiA Project continued to support organizational development of the NPHC. Following up on the strategic and operational planning workshops, the project continued technical assistance in implementing priority tasks identified during the planning exercise. Specifically, the project completed the operational assessment focusing on internal policies, procedures and business processes and developed recommendations for improvement. The HIVRiA team also analyzed NPHC existing organizational structure and identified duplicated functions and inefficiencies. The project developed recommendations for the optimized organizational chart and the staffing structure and provided targeted support to improve human resource management capacity through developing new HR policies and procedures and the personnel grading system. The Project continued to participate and provide expert contributions in the stakeholder discussions related to the GOU endorsement of the draft Law “On Amendments to Some Legislative Acts of Ukraine on Optimization of the Central Executive Authorities in the Field of the Sanitary and Epidemiological Well- Being of the Population”. With support from HIVRiA, the Ministry of Health submitted the draft Law to other relevant Ministries for final concurrence prior to submission to the CMU. Following the ToT workshops on piloted best practices on sustainable model for HIV services provision conducted in Q2Y5, the HIVRiA’s pilot dissemination teams in all six target oblasts and Kyiv city focused their efforts on providing technical assistance to Regional State Administrations, local health administrations, and HCFs in building sustainable approach to HIV services. The technical assistance provided in Quarter 3 at selected dissemination sites included conducting trainings on building a sustainable HIV response; advocacy for local budgetary allocation to provide critical HIV services for KP’s; and integration of HIV services at all levels of care. In addition to this, to support a UNAIDS-initiated discussion on launching Dnipro Fast Track Initiative, HIVRiA co-organized stakeholder consultations and planning for official launch of this Initiative in August 2018. Under Objective 2, the HIV Reform in Action Project presented key findings from the Investment Case Phase II Study to national stakeholders, including the Ministry of Health’s Public Health Center, All- Ukrainian Network of People Living with HIV, and UNAIDS as key stakeholders. The study determined the most-cost effective mix of HIV programs to achieve the largest long-term impacts on HIV/AIDS for Ukraine and provided policy insights for evidence-based reform of HIV services in the country. The investigation estimated the savings that Ukraine can achieve by re-allocating its current HIV budget optimally and will guide evidence-based reform of HIV services in Ukraine. Thus, in Q3, the HIVRiA team updated the

electronic tool for conducting investment analysis and developed user guides based on workshops in Poltava and Mykolayiv regions. Investment Case-informed Action Plans for both regions are currently being finalized in partnerships with Oblast Health Departments and various HIV service providers. In the reporting period, the project team participated in the design of new algorithms for financing NPHC’s budget programs. Working with the NPHC, the project team prepared a list of legal documents needed in order to pilot the new public health financing mechanism. Based on the newly adopted health financing legislation, the HIVRiA team also developed an electronic tool for financial planning and presented it at the national forum for primary healthcare providers that was held in Kyiv in June 2018. Under Objective 3, the HIVRiA team developed and published regional quantifications of Test&START HRH estimates for the city of Kyiv. These analyses provided regional partners with empirical data on projected HRH requirements for implementing Test&START and enabled them to foresee gaps in projections and adopt informed decisions to close them. In partnership with NPHC, the HIVRiA team also designed rationalization options for Cherkasy and Mykolayiv oblasts, which included different scenarios for decentralization and task-shifting and recommended actions to improve sustainability of and access to key HIV services regarding the health workforce. The Project team co-organized a four-week postgraduate course with the National Medical University of Ukraine for medical professionals who will serve in National and Oblast Public Health Centers throughout Ukraine. With the course aiming to strengthen participants’ knowledge of and skills in public health methods and approaches and to increase the supply of competent and qualified medical professionals for the reformed public health system, the student cohort consisted of 26 participants from national level and various regions including Kyiv City, Cherkasy, Chernivtsi, Volyn, Donetsk, Zaporizhzhia, Odesa, Poltava, Lviv, and Zakarpattia oblasts. In order to boost public health reform and strengthening capacities of public health workforce, the Project meaningfully participated in the work of the National Working Group on Public Health Workforce development and provided critical inputs to the National Public Health Workforce Development Action Plan. The Project also made significant contribution to the introducing of the first Filed Epidemiology Training Program in Ukraine, fully supported by CDC. The Project team member provided technical assistance in developing curricula, training materials and teaching the course during May-June 2018. The HIVRiA team, MOH representatives, and e-Health partners continued to implement HRIS as an eHealth component. The HIVRiA team has endorsed the basic system concepts with SOE partners and submitted detailed software requirements specification to the MOH for approval. The team also designed and validated technical requirements specifications and Entity Relationship Diagram to upgrade the existent eHealth system. When implemented and institutionalized, the HRIS component of e-Health will provide planners and decision-makers with essential HRH data in a timely, consistent, accurate, and comprehensive manner. This effective IT solution will allow the Ministry of Health and regional authorities to adequately carry out vital functions of HR planning and development to meet the health needs of the people of Ukraine. Under the Health Reform Component, the Project continued to work with the MOH as a leading partner and provided technical assistance to the MOH in several critical health reform areas. Thus, the Project presented the Hospital District Strategic Planning Methodology for acute-care hospital planning, that was tested in Chortkiv Hospital district, to the Ministry of Health leadership. The methodology provides a simple and efficient approach as well as electronic tools for the assessment of local demographics, medical statistics, as well as facility level operational, resource and geographical coverage data. The results of the analysis are used for data-driven strategic decision-making, aimed at right-sizing the supply of secondary care facilities within a hospital district, in preparation for the launch of hospital sector reform in 2019-2020. The Ministry of Health endorsed the methodology and recommended for use in other regions, and following

the request from the Ternopil Oblast leadership, the HIVRiA team applied the methodology to three other hospital districts of Ternopil Oblast – Berezhanskiy, Kremenetskiy, and Ternopilskiy and initiated data collection and analysis. To assist GOU with reform of primary health care, in the reporting period, the MOH, National Health Service of Ukraine and HIVRiA co-organized the Health Reform Champions’ Forum, which assembled 149 healthcare facilities to recognize them for signing contracts with the NHS. Starting from July 1, 2018, these primary healthcare centers will receive funds under the new principle “Money follows the patient” while PHC physicians (family doctors, GPs, and pediatricians) will provide a clear, guaranteed list of health services to patients. This event became a valuable platform for open dialogue and better cooperation between local primary healthcare centers and national authorities. With support from HIVRiA Project, the Ministry of Health of Ukraine also published and distributed the Operational Manual for Primary Health Care (PHC) System management. This Manual provides practical guidelines to PHCs and was designed to standardize processes and explain the new health system principles in financing, service delivery, PHC system planning and human resources. This manual will help local authorities and health care providers in adopting and implementing health reforms at the local level. To reach wider audiences and scale-up dissemination of key tools, knowledge and best practices for PHCs, the HIVRiA team also conducted 21 webinars covering topics that ranged from legal aspects of transition to the municipal nonprofit enterprise, healthcare facility licensing, compliance with mandatory health commodities and equipment requirements, to initiating an information and communication campaign at the community level. To sustain the eHealth system and ensure its continuous development and implementation, the HIVRiA Project capitalized on its earlier successes in supporting MOH to establish state-owned enterprise (SOE) as the official governmental eHealth administrator. In Quarter 3, the project team finalized the elaboration of SOE business processes affecting external stakeholders such as the MOH, NHS, etc., and helped the SOE to draft departments’ functions, job descriptions, and competency maps for major positions. All documents were discussed with SOE leadership and finalized during a joint deep dive session. HIVRiA’s support for SOE organizational development resulted in rapid capacity building and operationalization according to the best practices of defined accountability lines, selection of decision centers, and control of responsibilities. During the reporting period, the Project also made significant progress in carrying out the 2019 Ukraine Capitation Rate Study. Thus, data collection and verification were completed, and final data set transferred to the analysts’ team. This data will serve to update the capitation rate model including utilization data by age groups, salary by staff type, distribution of services performed per visit, and relative cost of a home visit. The complete and verified results of the Capitation Rate 2019 Study will equip the MOH, NHS and other national stakeholders with evidence-based capitation rate estimations for the national budgeting process under the healthcare financing reform. As part of cross-cutting activities, the HIVRiA team launched its Knowledge Hub platform (http://www.hivreforminaction.org/u-health/), which hosts the Project’s intellectual products and serves as a key resource for information sharing. The KH platform provides access to stored technical expertise for partner organizations such as governments, self-governance bodies, their agencies at national and local levels, academic institutions, non-governmental organizations, and other institutions. The Project also continued the provision of targeted capacity building (CB) interventions, assisting the partner organizations in their institutional strengthening and provided TA based on their Performance Improvement Plans and identified needs. The Project team supported the LGBT community in preparation for the upcoming annual National LGBT Conference and hosted an organization committee meeting to elaborate agenda, concept, and open call for proposals for those who want to participate in the conference. The Project has also

started preparations for the Project Dissemination Conference to be held in July 2018. The Conference will contribute to sharing Project best practices and lessons learned with national, regional and local partners and key stakeholders. Finally, the HIVRiA team had as many as 10 abstracts accepted for presentation at the 22nd International AIDS Conference that is scheduled to take place in July 2018 in Amsterdam. With this Amsterdam’s AIDS 2018 Conference being specifically focused on key populations in Eastern Europe and Central Asia, the event presents a unique opportunity for the Project to reach international audiences and to share and disseminated key project results and best practices. These activities perfectly illustrate the diversity of the HIVRiA team’s initiatives undertaken in Q3Y5 to strengthen Ukraine’s health system overall and support effective and sustainable delivery of HIV services.

OVERALL PROJECT PERFORMANCE

SECTION 1. HIV REFORM SUPPORT

OBJECTIVE 1: ENHANCE NATIONAL LEADERSHIP AND CAPACITY FOR EVIDENCE- BASED AND GENDER-SENSITIVE HIV POLICY PROGRAMMING AND IMPLEMENTATION

Sub-objective 1.1: Support national government institutions in AIDS policy development, programming, and implementation During the reported period the HIVRiA Project continued to support organizational development of the NPHC. Following up on the strategic and operational planning workshops, the project continued technical assistance in implementing priority tasks identified during the planning exercise (Annex 1). Specifically, the project completed the operational assessment focusing on internal policies, procedures and business processes and developed recommendations for improvement. The HIVRiA team also analyzed NPHC existing organizational structure and identified duplicated functions and inefficiencies. The project developed recommendations for the optimized organizational chart and the staffing structure. The project also focused on improving human resource management capacity by supporting developing new HR policies and procedures and the personnel grading system. This assistance contributes to the goal to attract new qualified professionals and improve staff competitiveness at the center. The project continued to participate and provide expert contributions in the stakeholder discussions related to the GOU endorsement of the draft Law “On Amendments to Some Legislative Acts of Ukraine on Optimization of the Central Executive Authorities in the Field of the Sanitary and Epidemiological Well- Being of the Population”. The Ministry of Health submitted the draft Law to other relevant Ministries for final concurrence prior to submission to the CMU. The Project continued to provide technical assistance to the Technical Working Group on preparing changes to legislation in terms of designing regulations for HTS in Ukraine. On May 17, 2018 the Project team participated in TWG meeting to discuss the concept for the National HTS Strategy for Ukraine and presented the e-tool on HIV Rapid Tests needs forecasting to be incorporated into this strategy for the practical usage. The Project also finalized the operational IT-development of the AIDS Program Dashboard e-tool as a part of the National Strategic Information Portal for HIV/AIDS. Updating and uploading of data into the dashboard are scheduled for the beginning of the last quarter. But it is important to noticed that there is still a lack of NPHC’s leadership and staff in maintaining the full functionality of the National Strategic Information Portal for HIV/AIDS.

Sub-objective 1.2: Strengthen capacity of local government entities to implement regional AIDS programs with emphasis on key affected populations Following the ToT workshops on pilot best practices conducted in Q2Y5, the pilot dissemination teams in all seven oblasts focused on providing technical assistance to OSAs, local health administrations, and HCFs in building sustainable approach to HIV services. The technical assistance included analysis of the oblast HIV services system; conducting trainings on building a sustainable HIV response; advocacy for local budgetary allocation to provide HIV services for KP’s; and integration of HIV services at all levels of care. The TA teams helped analyze existing policy and financial barriers in service provision and implemented advocacy activities focusing on decentralization and integration of HIV testing services in primary health care, provision of ART (opening of new ART sites), opening new MAT sites and promotion of the patient scale up and OST prescription; advocating for resource allocation for HIV services through the social order mechanism and HTC training for health care providers at a local level.

Based on the piloting best practice results, the Project team developed the Social contracting guideline for planning, costing and managing the procedure of HIV services social contracting mechanism (Annex 2). The pilot teams also conducted intensified support for extension of HIV services in the cities of Kyiv, Odesa, and Dnipro. In Kyiv, supporting the Fast Track implementation, HIVRiA provided technical assistance to the City Health Department to re-evaluate budgetary needs for HIV funding allocations in the 2018 budget under the Kyiv city AIDS program. Further, the Kyiv city pilot team conducted training and dissemination support in five rayons of Kyiv city (Desnianskyi, Dniprovskyi, Sviatoshynskyi, Pecherskyi, and Holosiivskyi) to integrate HIV testing services at all PHC centers of Kyiv city, and the team trained district-level infection disease specialists to open new ART sites and increase communities’ access to ART services. In Odesa, the dissemination focused on training and organizational support in integration of HTS in all PHC centers of the city. The pilot team provided assistance to Health Department of Odesa City State Administration in drafting local orders, and assisted PHC facility administrations in developing patient pathways, local protocols, and estimating rapid testing needs, that resulted in all 9 PHC centers in Odesa offering HTS services in their communities starting from the end of June 2018. Finally, in Dnipro, the pilot implementer, the “Kryvyi Rih Branch of the Network of PLWH” signed a MOU with Dnipro city administration, partnering with the local health department to develop a sustainable HIV response. The municipal working groups were formed and have drafted local orders and protocols to support implementation. To support a UNAIDS-initiated discussion on launching Dnipro Fast Track Initiative, a HIVRiA technical advisor co-organized stakeholder consultations and planning for official launch this Initiative in August 2018.

Sub-objective 1.3: Improve policy dialogue and ensure transparent policy development environment In addition to training and dissemination tasks, HIVRiA regional pilot teams conducted advocacy activities at local and regional levels, focusing on getting buy-in of local and oblast-level authorities to build a sustainable HIV response and to ensure adequate financing and delivery of HIV services for KPs in their communities. As a result, in Cherkasy city, family doctors participated in HIV trainings for the first time, committing to integrate HIV-services for KP’s at a PHC level. Poltava and Cherkasy oblast administrations drafted local HIV pathway protocols and orders for decentralization and integration of HIV testing in PHCs, opening new ART and OST sites, and promoting scale-up of patients served and OST prescription. Similarly, in Kyiv, advocacy focused on decentralization of treatment to improve access to ART. Advocating for resource allocation for HIV services resulted in decisions regarding procurement of rapid tests in Kherson oblasts. Dnipro city and oblast-level advocacy initiatives, including media briefings and round tables with local hromadas, resulted in rapid extension of Kryvyi Rih pilot strategies in Dnipro city.

OBJECTIVE 2: IMPROVE AND OPTIMIZE RESOURCE ALLOCATION AND FINANCING FOR THE NATIONAL AND SELECTED REGIONAL HIV/AIDS PROGRAMS TARGETING KEY POPULATIONS

Sub-objective 2.1: Develop evidence pool to create support for funding decisions in HIV response at the national and regional level In the reporting period, the HIVRiA team presented key findings from the Investment Case Phase II Study (Annex 3) to national stakeholders, including key stakeholders like the Ministry of Health’s Public Health Center, All-Ukrainian Network of People Living with HIV, and UNAIDS. The study determined the most- cost effective mix of HIV programs to achieve the largest, long-term impacts on HIV/AIDS for Ukraine and provided policy insights for evidence-based reform of HIV services in the country. The investigation also

estimated the savings that Ukraine can achieve by reallocating its current HIV budget optimally to achieve the UNAIDS 90-90-90 targets by 2020 and maintain them at lower cost. The HIVRiA Project is now working with national partners to ensure that the study findings are used to inform the development of Ukraine’s National AIDS Program 2019-2023. In Q3Y5, the Project team finalized the electronic tool for investment analyses at the facility level based on Investment Case Phase Study II and the results of workshops conducted in Q2Y5 in Poltava and Mykolayiv regions. The HIVRiA team also prepared user guidelines for the tool (Annex 4-5). The tool is intended for HIV-services providers and will equip them with a practical instrument for better, more cost- effective financial planning. Now the project team is working on preparing Action plans for Poltava and Mykolayiv regions. The Action Plans are aimed at the allocation of resources for optimal mix of services to achieve the biggest long-term impact on the local HIV epidemic in Poltava and Mykolayiv regions. These Action Plans will be presented for the representatives of HC Departments and HIV service providers in Q4Y5.

Sub-objective 2.2: Support the development of the HIV strategies and policies at the national and regional levels which reflect optimized resource allocation and lead to the most cost-efficient and effective implementation During Q3Y5, HIVRiA team continued close work with the NPHC’s representatives (were identified in February 2018), using the updated NASA Electronic Tool in the current reporting period. As the result, by the end of April 2018, the tool has been finalized and ready for transfer to NPHC, including all proposals and technical specifications requested by the NPHC (the tool is available at http://hiv.phc.org.ua/finreports/req/). At the end of May 2018, a new Deputy Head of the NPHC was tasked with NASA institutionalization. The HIVRiA team held a meeting on June 8, 2018 with the NPHC to discuss the current situation, progress, and additional work. Complementing administrative capacity, new technical staff at the NPHC should be defined. Once institutionalized, the tool will help optimize time and resources for annual data collection and reporting, thus enhancing transparency, accountability, and quality of national AIDS expenditure data and reporting to improve data-driven decision making. The challenge in the process is the staff turnover in the NPHC. During the reporting period, the Project team also continued working on Test&START Strategy costing following the feedback received through the national stakeholder consultations. The Project verified and updated the calculations of the alternative scenarios costs for Test and START Strategy implementation in Ukraine with data available in the 2nd quarter of 2018. Furthermore, updated results are planned to be presented during the Project Final Conference to be held in July 2018. Also, during the public discussion on the new NAP Concept for 2019-2023 the Project is providing the feedback to the Concept based on recalculated evidence-based results. The Project continues to provide technical assistance to the NPHC and MOH in developing new PH financing mechanisms. Working with the NPHC, the project team prepared a list of legal documents needed in order to pilot the new public health financing mechanism (Annex 6). This work aimed at strengthening the national decision makers in implementing new financial approaches. Also, the Project’s expert participated in WHO Conference regarding the development of new financing mechanisms for TB services on regional and local levels (June 26-27, Lviv). The HIVRiA team prepared a presentation on the new health care financing mechanisms based on the newly adopted legislation and the results of workshops in Poltava and Mykolaiv. That was presented during several regional events including Medical Forum on April 17, 2018 (Lviv), Medical Scientific Conference on April 26, 2018 (Dnipro), Workshop for PHC Providers on June 7, 2018 (Kyiv) (Annex 7-8). As well, the

Project’s expert presented the health care financing reform during meeting with regional PHC providers and local authorities (June 22 and 26, Kyiv) and participated in relevant discussions.

Sub-objective 2.3: Strengthen capacity of national and regional partners in finance planning, budget preparation, and execution to match the needs to optimized HIV/AIDS service-delivery operations During the reporting period, the HIVRiA team agreed to respond to the National Health Service’s need to train its new employees and equip them with knowledge of modern developments and concepts in health finance. Thus, the Project team designed a three-day training course to fill existing knowledge gaps, involving faculty from the KSE and national experts to strengthen the training team. Mr. Oleh Petrenko, Head of the NHS, agreed that HIVRiA should conduct this training in September 2018; therefore, this activity is shifted to Q4Y5. OBJECTIVE 3: OPTIMIZE AND STRENGTHEN HUMAN RESOURCES FOR HEALTH (HRH) FOR THE DELIVERY AND SCALE-UP OF GENDER-SENSITIVE HIV/AIDS SERVICES TARGETING KEY POPULATIONS

Sub-objective 3.1: Strengthen evidence base for HIV workforce planning and development In Q3Y5, the HIVRiA team finalized and published regional analytical notes with Test and START HRH estimates for the city of Kyiv. To facilitate region-specific HRH for HIV planning, decision-making, and developing optimization and decentralization options, the HIVRiA team used Google Maps to develop interactive maps with geospatial information related to network of HCFs, Trust Cabinets, ART and MAT sites, projected service coverage targets, and estimated gaps in HRH for HIV (Annex 9). By designing those tools and developing quantifications, HIVRiA equipped national and regional partners with critical data on human resource needs for TEST and START implementation and enabled data-driven HRH planning to achieve UNAIDS’ 90-90-90 targets.

Sub-objective 3.2: Support the introduction of systemic and operational changes in HRH for the provision of sustainable and integrated HIV/AIDS services at the national and regional levels In Q3Y5, in line with the concept for HRH for HIV rationalization options with different scenarios for decentralization and task-shifting developed jointly by the MOH, NPHC, and HIVRiA during the previous reporting period, the Project has conducted two workshops with the NPHC and finalized such options for Cherkasy and Mykolayiv regions (Annex 10). The options address six potential scenarios and provide recommendations for closing forecasted gaps in health workforce, thus improving sustainability of and access to HIV services. The Project also finalized the design of financial and non-financial incentive schemes based on an earlier study on motivators and incentives for HIV service provision (Annex 11). Based on the analysis of health workforce and the HIV regulatory framework for financial and non-financial incentives, the schemes offer specific HIV-related performance targets and an array of options for motivating and incentivizing staff to achieve those targets. Adoption of these financial and non-financial incentive schemes by regional health authorities and facility managers will increase involvement of primary health care facilities in the provision of HIV services. In addition, these incentives will contribute to improving coverage with HIV services at specialized facilities, thus helping the national and regional authorities to control the HIV epidemic. The HIVRiA and ELEKS grantee team, MOH, and SOE representatives continued to work in partnership on the implementation of HRIS as the eHealth component. In Q3Y5, the HIVRiA team developed the initial product vision, and completed a review of relevant Ukrainian human resources legislative and regulatory framework pertaining to medical, nursing, and other health personnel (Annex 12). The HIVRiA team has endorsed the basic system concepts with SOE partners, and technical requirements specifications and

Entity Relationship Diagram were developed by ELEKS and validated to design the existent eHealth system. The software architecture satisfies WHO minimum requirements for health workforce registries and is suitable for input into the development process. Terms for transfer of intellectual property rights with developers were also agreed and signed, and copies provided to HIVRIA’s team. A detailed software requirements specification was developed and submitted to the MOH and SOE for approval. This effective IT solution will allow standardization of data values and enabling health workforce data interoperability within national and sub-national contexts. It will also enable the Ministry of Health and regional authorities to adequately plan industry resources and making strategic decisions on the training, equitable distribution, accessibility and retention of health workers in Ukraine.

Sub-objective 3.3: Strengthen capacity of Ukrainian institutions in HRH policy, planning, and development. Under this activity, the HIVRiA Project implemented a four-week public health certificate course on the Modern Aspects of Public Health that took place April-June 2018. This four-module course has equipped the 4th cohort of 26 health care professionals from across the country (Annex 13). The course was conducted in close partnership with the MOH’s National Public Health Center and the Ukrainian Training Center for Family Medicine (UTCFM) of the O.O. Bohomolets National Medical University. The National Public Health Center provided supervisory input and is planning to institutionalize the course under its training component to develop a highly qualified public health and epidemiology workforce in Ukraine, addressing the existing competencies and qualifications shortages in the reformed national and regional public health systems. Finally, in Q3Y5, HIVRiA facilitated a meeting of the Intersectoral Working Group on HRH for HIV, to review the implementation of 2018 HRH for HIV Operational Plan, update stakeholders on HRIS implementation progress, and validate the Project’s tools and guidelines for further dissemination (Annex 14). In order to boost public health reform and strengthening capacities of public health workforce, the Project meaningfully participated in the work of the National Working Group on Public Health Workforce development and provided critical inputs to the National Public Health Workforce Development Action Plan. The Project also made significant contribution to the introducing of the first Filed Epidemiology Training Program in Ukraine, fully supported by CDC. The Project team member provided technical assistance in developing curricula, training materials and teaching the course during May-June 2018.

CROSS-CUTTING ACTIVITIES

Grants Management The grant management activities help to develop organizational capabilities of a pool of national organizations and local partners (NGOs and other partners) that will be able to serve as national resource organizations and TA providers. LIST OF SUB-GRANTS OPERATED DURING THE REPORTING PERIOD Grant No Sub-grantee Title of project Period of STATUS name performance

11 CO “All- Creating the Conditions August 1, 2016 – Close-out process Advocacy/ Ukrainian for a Sustainable March 31, 2017

August 1, Network of Response to the HIV Mod 2: 2016 PLWHA” Epidemic August 1, 2016 –

June 30, 2017

Mod 3: July 1, 2017 – September 30, 2017 Mod 4 October 1, 2017 – December 31, 2017 13 Region- Charity Pilot a Sustainable Model April 1, 2016 – Close-out process 02/April 1, Organization for the Provision of September 30,

2016 Mykolaiv's Critical Services to Key 2017 Regional Fund Populations and People Mod 2: "Healthy Nation" Living with HIV at the Rayon Level in Mykolayiv October 1, 2017 – Oblast December 20, 2017

14 Region- Kherson NGO Pilot a Sustainable Model April 1, 2016 – Close-out process 03/April 1, “Association XXI for the Provision of September 30, 2016 Stolittya” Critical Services to Key 2017 Populations and People Mod 2: Living with HIV at the Rayon Level in Kherson October 1, 2017 – Oblast December 10, 2017 15 Region- Odesa Charity Pilot a Sustainable Model April 1 2016 – Administration of on- 04/April 1, Fund “Way to for the Provision of September 30 2017 going grant project 2016 Home” Critical Services to Key Mod 3: Populations and People Preparation for Living with HIV at the October 1, 2017, - close-out process Rayon Level in Odesa December 20, 2017

Oblast Mod 4:

December 21, 2017 – June 30, 2018 16 Region- The Cherkasy Pilot a Sustainable Model April 1 2016 – Close-out process 05/April 1, NGO for PLWHA for the Provision of September 30 2017 2016 “Heart to Heart” Critical Services to Key Mod 2: Populations and People Living with HIV at the October 1, 2017, - Rayon Level in Cherkasy December 25, 2017 Oblast 17 Region- Kyiv city Branch Pilot a Sustainable Model May 16, 2016 – Close-out process 06/May 16, of the Network of for the Provision of September 30, 2016 PLWH Critical Services to Key 2017 Populations and People Mod 2: Living with HIV at the Rayon Level in Kyiv City May 16, 2016 – December 31, 2017 Mod 3: January 1, 2018 – March 31, 2018

18/1 HF National Adaptation and June 19, 2017 – Close-out process 02/ June Academy for Institutionalization of the December 25, 2017 19, 2017 Public Health Finance and Mod 1: Administration Economics Curriculum

(NAPA) under December 26, 2017 the President of – March 31, 2018 Ukraine 18/2 HF 02 Kyiv Institute of Adaptation and June 27, 2017 – Close-out process Economics Institutionalization of the December 25, 2017

Health Finance and Mod 1: Economics Curriculum December 26, 2017 – March 31, 2018 RFA 2017- Kyiv School of Data Collection for July 13, 2017 – Close-out process 20 Economics Capitation Rate September 30, (KSE) Development 2017 Mod 1: December 31, 2017 RFA 2017 CO “All- Supporting the Ministry June 25, 2017 – Close-out process – 21 Ukrainian of Health (MoH) in July 28, 2017 Network of Developing and Mod 3: PLWHA” Implementing Effective IT Solutions (e-Health) August 31, 2107 Mod 4: September 30, 2017 RFA 2017 Supporting the Ministry September 18, Close-out process – 22 of Health (MoH) in 2017 –December Developing and 15, 2017 Implementing Effective IT Solutions (e-Health) – 2nd stage RFA 2017 Ukrainian Informal Payment Study March 26, 2018 – On-going grant – 24 Institute for for Capitation Rate June 30, 2018 administration Social Research Development Mod 1: (UISR) Mod #1 approved by August 31, 2018 USAID RFA 2018- ELEKS Ltd. Supporting the MoH in Planned: April 2, Award approved and 23 Developing and 2018 – August 15 signed Implementing Effective IT 2018

Solutions (HRIS) Grant launched

On-going grant administration RFA 2018- CO Healthy Dissemination of the March 12, 2018 – On-going grant 25 Nation, Successful Experience of August 31, 2018 administration Pervomaisk the HIV Services

Sustainability Pilot in the Mykolaiv Oblast RFA 2018- NGO XXI Dissemination of the March 12, 2018 – On-going grant 26 Century Successful Experience of August 31, 2018 administration Association, the HIV Services Kherson Sustainability Pilot in Kherson Oblast RFA 2018- CO Heart to Dissemination of the March 14, 2018 – On-going grant 27 Heart, Cherkasy Successful Experience of August 31, 2018 administration the HIV Services Sustainability Pilot in Cherkasy Oblast RFA 2018- CO Light of Dissemination of the March 14, 2018 – On-going grant 28 Hope, Poltava Successful Experience of August 31, 2018 administration the HIV Services Sustainability Pilot in Poltava Oblast RFA 2018- CO Kryvy Rih Dissemination of the Planned: April 5, Award approved and 29 City Branch of Successful Experience of 2018 – August 31, signed Network of the HIV Services 2018 Grant launched People Leaving Sustainability Pilot in with HIV (PLWH) Dnipropetrovsk Oblast On-going grant administrating RFA 2018- CO 100% of Dissemination and March 14, 2018 – On-going grant 30 Life. Kyiv Region Scale-Up of the August 31, 2018 administrating. (former Kyiv City Successful Experience of Branch of the Pilot Project Network of Sustainability of HIV PLWH) Services in the Kyiv Region RFA 2018- Kyiv School of Additional Data March 12, 2018 – On-going grant 31 Economics Collection for Capitation June 30, 2018 administrating. (KSE) Rate Development

Capacity Building During the Q3Y5, the HIVRiA Project has continued provision of targeted capacity building (CB) interventions, assisting the partner organizations in their institutional strengthening and providing TA based on their Performance Improvement Plans or identified needs. Thus, as part of the capacity building support, the project’s CB Specialist has worked with the NGO 100% of Life Kyiv Region by conducting performance evaluation for the organization’s staff and providing recommendations for further improvements, which have been identified. Reassessment of progress made in implementing the Performance Improvement Plan and revision of its strategic and operational planning, conducted with Project grantee organization Club Eney (Kyiv), has motivated the organization to schedule a session on operational plan development and finalization of strategies being developed over the last year. These CB events contribute to strengthening institutional capacity of partner organizations, enabling them to be better equipped to further replicate Project pilot achievements in Kyiv or serve as a strong community organization serving the needs of key populations.

The Knowledge Hub (http://www.hivreforminaction.org/u-health/) has been launched (currently in testing), and new products are added on a regular basis. The KH platform provides access to stored technical expertise for partner organizations such as governments, self-governance bodies, their agencies at national and local levels, academic institutions, non-governmental organizations, and other institutions.

Gender and Stigma Sensitization In Q3Y5, the project team supported the LGBT community in preparation for the XI National LGBT Conference (October 18-20, 2018) and conducted an organization committee meeting on June 25, 2018 to elaborate agenda, concept, and open call for proposals for those who want to participate in the conference and to deliver oral presentations. Participants will discuss health issues and cases of human rights abuse of the LGBT community in order to elaborate recommendations and a road map for national and regional partners. (Annex 15).

Communication and Knowledge Management In Q3Y5, HIVRiA prepared 9 daily impact bullets and published 27 news articles for the project’s website, www.hivreforminaction.org. At the end of the reporting period, the website had attracted 1,457 unique visitors for Q3Y5: 448 in April, 644 in May, and 460 in June. On the March 13, the HIVRiA Project launched a new website, www.healthreform.in.ua, to support local primary health care centers’ teams in preparation for transition to a new financing system and implementation of health reform at the primary care level. At the end of the reporting period, this website had attracted 9,748 unique visitors for Q3Y5: 3131 in April, 4135 in May, and 4192 in June. The project’s Facebook page (facebook.com/HIVReformUA) is dedicated to the HIV reform in Ukraine and HIVRiA’s activities. At the end of the reporting period, the project’s Facebook page gained 52 new followers. This shows a 6.5% growth in the number of followers since the beginning of the reporting period (852 followers at the end of the reporting period vs. 800 followers at the beginning of Q3Y5). The project produced 82 Facebook posts, 75% of which were unique Project news and announcements. In Q3Y5, the HIVRiA Project issued 2 editions of newsletter #16 and#17 (available in electronic and printed formats) in both English and Ukrainian on www.hivreforminaction.org. Seven project publications were designed and distributed. Preparation has started for the Project Dissemination Conference to be held in July 2018. The Conference will contribute to sharing Project best practices and lessons learned with national/regional partners and key stakeholders.

SECTION 2. HEALTH SYSTEM FINANCING REFORM SUPPORT

OBJECTIVE 2: OPTIMIZE RESOURCE ALLOCATION AND FINANCING FOR THE NATIONAL AND SELECTED REGIONAL HIV/AIDS PROGRAMS TARGETING KEY POPULATIONS

Sub-objective 2.4: Build the capacity of the national and selected regional/local GoU entities to design and establish a national purchasing agency HIVRiA has demonstrated regulatory impact by preparing MOH draft order amendments to Order #360 which HIVRiA had also developed, and by facilitating the MOJ’s endorsement of orders. The project’s activities resulted in adoption and state registration in May of the MOH's order, which introduced e- prescription in Ukraine for the first time (MOH order dated 18.04.2018 # 735) and allowed doctors to issue prescriptions as private entrepreneurs. Adopted regulatory changes will support transparency in medicine prescription, logistics, and use, as well as increase convenience for patients. It also will decrease the use of personal data of patients when unnecessary for their treatment. After MOH's order #735 was officially published, HIVRiA provided legal support for its implementation, based on piloted state registry of patients needing insulin therapy, and developed a draft order for the MOH (Annex 16). The project has developed the regulatory framework for efficient management of health care facilities with legal support setting new occupational qualifications for heads of hospitals in the MOH draft order "On Amendments to the Reference Book of Occupational Qualifications. Release #78 "Health Care” on modifying qualifications for healthcare facility top managers, agreed by departments of the MOH, will be signed by the Minister within days. New occupational qualifications will set a requirement for education in management to become a hospital director. As a next step, MOH requested legal support on drafting amendments to the MOH Order No. 385, approving the list of doctors' positions in healthcare facilities (Annex 17). These amendments will clarify the list of doctors' positions in healthcare facilities, as now it will include positions of hospital heads who will not require medical education once amendments to Release 78 "Health Care" take effect. During the reported period, the project team drafted the eHealth agreement between the SOE and MIS developer (Annex 18). Agreement is crucial for the SOE to set the rules as eHealth Administrator (as defined in GOU Resolution of April 25 # 411) for cooperation with medical information systems as a part of the eHealth eco-system. Agreement sets SOE-MIS rights and responsibilities and stimulates both a public- (eHealth central component) and private-sector function (IT development of MIS). In Q3Y5, the project’s team also provided input on an SOE eHealth by-law regulating technical procedures and testing functionality of contracts signed between the NHS and PHCs.

Sub-objective 2.6: Support MOH and selected local authorities in the design and establishment of a performance-based payment system under ‘money-follows-the client’ approach 2.6.1. Support for Capitation Rate Development Considering the results of Capitation Rate 2018 Study, the HIVRiA Project initiated the Capitation Rate 2019 Study. This quarter, the Kyiv School of Economics as selected grantee conducted data collection among identified PHC facilities (Annex 19). The data verified by HIVRiA team have been transferred to the Deloitte US team. HIVRiA and the Deloitte US team are using the data to update the capitation rate model including utilization data by 5-year age groups, salary by staff type, distribution of services performed per visit, and relative cost of the home visit. The results of the Capitation Rate 2018 Study and current progress on Capitation Rate 2019 development was presented and discussed with the USAID

representative on June 13, 2018. The complete and verified results of the Capitation Rate 2019 Study will equip the MOH/NHS and national stakeholders with evidence-based capitation rate estimations for the national budgeting process under the healthcare financing reform. HIVRiA initiated the Informal Payment Survey to assess the magnitude of informal payments for incorporation in the Capitation Rate 2019 calculations to create incentives to curtail informal payments in the health system. The implementer, the Ukrainian Institute of Social Research, conducted the Informal Payment Survey during March-April 2018 in all oblasts of Ukraine, including 4020 interviews with the patients and 25 interviews with medical staff (Annex 20-23). HIVRiA verified the results of the Informal Payment Survey, now being incorporated into the Capitation Rate 2019 calculations together with the Deloitte US team. These will create incentives to reduce the level of informal payments and corruption in the Ukrainian health system.

2.6.2. Primary Healthcare Provider Autonomy During the Q3Y5 reporting period, the project continued the technical support of 100+ PHC centers and stored webinars videos, electronic tools, latest legal acts, and other comprehensive information about primary healthcare reform at http://healthreform.in.ua/. There were conducted 22 webinars which covered the most important topics in primary healthcare reform, such as: • legal process of transition to the municipal nonprofit enterprise • the license for medical practice gaining process • starting and maintaining the information campaign of choosing the family doctors in the community • mapping available and capable PHC center’s networks • the new financing system in of the health care • compliance with a table of health commodities and equipment • the procedure for composing, approving, and changing the financial plan • webinars dedicated to the MOH requirements to sign a contract with NHSU • webinars of electronic tools presentations, discussion of the most common questions and mistakes of its usage • the set of 10 training sessions on building the management capacity of local PHC reform teams (including strategic planning of the organization, service, HR optimization and recruitment, operational and financial management, and communication tools and initiatives) In overall, since March 2018, 28 webinars with 13 speakers were held, and four video-manuals on applying e-tools were typed and presented. The graph below shows the rate of the of webinars attendance (Figure 1).

Figure 1. The rate of the of webinars attendance Generally, the rate of the on-line webinars attendance had a slight tendency to decrease, which was expected as the records of webinars are available at the HIVRiA web-site and YouTube channel (https://www.youtube.com/channel/UCl6lq99PNvBhO64kuoha78g/videos). There were three dates when we observed a dramatic fall in webinar attendance. The first (April 6) and second (May 14) fell close to national holidays and weekends (Easter and WW II Memorial Day). On the date of the third sharp decline, May 29, the webinar, dedicated to the discussion of the NHSU contract request submission, was not open to all PHC centers, but only those that had already become municipal nonprofit enterprises and could meet other needed requirements, such as introducing medical information system which integrated with eHealth, to receive electronic access keys for each family doctor, meet standard service criteria etc. Further, as promised, a set of electronic tools were developed and presented to the PHC centers: 1. The electronic tool for generating the package of documents to submit for change of legal status into autonomous municipal nonprofit enterprises. The tool was used 241 times. 2. Mapping of the current and capable networks of PHC facilities. Based on Google Maps, there were 118 maps developed for PHC centers. (Annex 24). 3. Financial plan calculator. The tool was also available on the official MOH website. The video- instructions on how to use it gained more than 2,000 views on YouTube. (Annex 25) 4. Local PHC center commodity and equipment assessment tool. The 60 PHC centers that sent the filled-up tool to the project received personal feedback and recommendations on their procurement plan. (Annex 26). 5. Tool for forecasting HIV testing programmatic and financial needs. (Annex 27). All these electronic tools aimed to help PHC center teams with the management process by gathering data on and analyzing the current operational and financial situation to highlight strengths and weaknesses, prioritize needs, and create development plans for their respective centers.

As HIVRiA proceeded with technical support, providing the webinars and e-tools, 15 new PHC centers requested to receive the methodology support and guidance. So now 129 PHC centers receive methodological support. Moreover, the project provided technical support in contract request submission to all PHC centers that expressed the wish to contract with the NHSU in the first contracting wave. During the short preparational period of contract request submission (PHC centers had only 5 days for the submission), technical support assistance was provided to PHC centers in large cities as Kyiv, Kryvyi Rih, Vinnytsia, Poltava, Cherkasy as well as a number of rayons and small hromadas all over Ukraine. As a result, 149 PHC centers signed contracts with the NHSU, while only 60 contracts were expected. On June 14, 2018, in Kyiv the HIVRiA Project, in cooperation with the MOH, hosted a Health Reform Champions’ Forum for the first 149 PHC centers that signed a contract with NHSU. More than 200 participants from national and local levels had the opportunity to discuss the first results of the PHC reform and celebrate these 149 contractors’ participation in health reform. NHSU and MOH representatives highlighted the special aspects of contracting with the NHSU. The PHC centers presented best practices on reform communication in the community. At the forum, legal and financial questions that needed to be clarified were raised. This event became a valuable platform for open dialog and better cooperation between the local PHC centers and national authorities. (Annex 28). The PHC operational manual was updated according to the legal acts accepted during March-April 2018, with nearly 1,200 copies printed. Printed versions of the updated manual were disseminated among forum participants. All remaining copies were distributed to PHC centers all over Ukraine in June 2018. (Annex 29). On April and May 2018, HIVRiA provided technical support to organize and host family health fairs for the Balta and Tsarychanka communities. While the fair in Balta took place in the renovated Balta PHC center, the Tsarychanka fair was organized in the park. The fairs were primarily meant to raise people’s awareness of the primary health care reform, services that PHC centers provide, and the necessity to choose a family doctor. So, at the health fairs doctors played the most important roles, giving speeches describing the most common health issues and prevention strategies. At both events, visitors had the opportunity to get a consultation and of course to sign the declaration with the chosen family doctor. The experience of these fairs as one of the communicational tools was presented at the forum as an example of best practices.

2.6.3. Hospital Districts In Q3Y5, the continued strategic planning pilot with Chortkiv Hospital District (Ternopil Oblast) and finalized the hospital district strategic planning methodology and e-tools for future dissemination throughout all regions of Ukraine. The project team developed a data-driven strategic planning methodology that asses each hospital’s preparedness to serve as an Acute Care Hospital (ACH) and to select the priority hospitals that could serve as a basis for creating ACHs (Annex 30). The results of applied methodology for Chortkiv hospital district were presented at a workshop in Ternopil Oblast on April 24, 2018 for Ternopil oblast State Administration leadership (Deputy Head and Head of HC Department) and HCF managers. During the event, participants presented and discussed the following materials (Annex 31): 1) an overview of the Chortkiv hospital district, including a demographic overview of population served by hospital district and the current supply of both physical and healthcare personnel assets; 2) results of the rapid assessment of healthcare facilities’ capacity to serve as acute care hospitals (ACHs) in the hospital district; 3) scenario planning in order to identify the optimal combination of facilities to be transformed into ACHs based on assessment criteria, drive time, and draft MOH criteria for ACH-I and ACH-II designations; and 4) a legal

summary for Chortkiv Hospital District that could be disseminated to other HCFs to prepare for legal steps that hospitals should take in transformation period. As a result, Ternopil Oblast leadership asked the project to apply the methodology to three other hospital districts of Ternopil Oblast – Berezhanskiy, Kremenetskiy, and Ternopilskiy and to start data collection for this purpose. Thus, the project conducted analysis for three more hospital districts that allowed to double- check results and assumptions and to refine methodology and e-tools (Annex 32-33). As a key aspect of Health Care Reform is changing the finance mechanism, it is crucial for health care facilities to perform their cost accounting to prepare for DRG payment implementation. So, the project, in cooperation with USAID Health Finance & Governance Project, conducted training for 6 HCFs ‘Cost accounting in Health Care Facilities’ (April 4, 2018) and then experts from USAID Health Finance & Governance Project provided support in implementing JLN methodology for cost accounting, (approved by Cabinet of Ministers of Ukraine on December 27, 2017) during April-June 2018. The results of cost accounting were presented during a workshop in Kyiv (June 26, 2018) (Annex 34). HIVRiA developed a methodology for acute-care hospital planning within hospital districts and presented e-tools to the MOH, USAID (April 6, 2018), and key national stakeholders that work with hospital districts – MOH, World Bank, Vidrodzennya, GIZ (May 2, 2018). The Ministry of Health endorsed the methodology and recommended it for use in other regions. The methodology provides a simple and efficient approach and electronic instruments for the assessment of local demographics, medical statistics, as well as facility level operational, resource and geographical coverage data. The results of the analysis are used for data-driven strategic decision-making, aimed at right-sizing the supply of secondary care facilities within a hospital district, in preparation for the launch of hospital sector reform in 2019-2020.

Sub-objective 2.7: Support the National Purchasing Agency and MOH in developing and implementing effective IT solutions to launch, manage, and administer health system financing reforms After selection of the SOE Director General, rounds of meetings took place beginning April 2, 2018. The main areas of support focused on SOE operationalization and included organizational development, legal and technical support, and day-to-day processes to help the SOE core team to become officially appointed and follow all necessary formal procedures. Finally, the SOE core team was appointed in May and took leadership of the eHealth system further development, fund-raising, stakeholders mapping, and mid-term planning.

During the reporting quarter, HIVRIA helped newly appointed SOE leaders to define core business processes such as ‘Certification of a New MIS’, ‘Re-Certification of an Existing MIS’, ‘Supporting Core Component Code’, and ‘Procurement: Plan, Tender, and Small’. Project experts drafted BPMN diagrams and had extensive discussions with SOE how to best define accountability lines, decision centers, and control responsibilities.

Defining the business process was also the prerequisite for proper assessment of workload per SOE functional units and estimation of required personnel. This process helped the SOE to design its organizational chart and structure with the MOH, which approved them in May.

HIVRIA finalized other SOE business processes (those affecting external stakeholders such as the MOH, NHS, etc.) and helped the SOE draft departments functions, job descriptions, and competency maps for major positions. All documents were discussed with SOE leadership during a deep dive session that took place on June 19, 2018 and finalized considering their input.

As a part of legal support, HIVRiA defined and provided the SOE with a list of legislative acts related to the main activities of SOE in order to realize the general Ukrainian legal framework and organize necessary legal steps for SOE organizational development.

Supporting SOE organizational development resulted in rapid capacity building and operationalization according to the best practices of defined accountability lines, selection of decision centers, and control of responsibilities (Annex 35).

Cross-cutting: Strategic Communication and Knowledge Management Communication During the reporting quarter, HIVRiA continues to support Health Reform Digests targeted to raise awareness of health reform issues among the professional community. The MOH, with HIVRiA’s support, issued three digests, with the following topics: #6 The Launch of a Doctor for Every Family Campaign; #7 The Start of the National Health Service of Ukraine; #8 Available Drugs Campaign (Annex 36). 2,555 health care facilities subscribed to the Health Reform Digest, half of which are primary health care facilities. The topic of each issue is developed based on current streamlining of the MOH Communication Action Plan and information requests from medical professionals. On April 15-16, 2018 HIVRiA conducted Information Design and Visual Communications Training for 10 representatives of the MOH Communications Department (Annex 37). This training improved the capacity of MOH Communication Department staff in health reform content development and visualization. The participants received skills in directing complicated messages simply and quickly. They developed capacity in management of health reform messaging and design tools. On April 21, 2018 and May 18, 2018 HIVRiA supported organization and conducting of family health fairs in Balta (Odesa Oblast) and Tsarychanka (Dnipropetrovsk Oblast) for local hromadas (Annex 38). The events aimed to motivate residents to select and sign-up with a primary care doctor. As a result of the family health fairs, 136 residents signed-up with primary care doctors in Balta and 154 – in Tsarychanka during the events; over 3,600 residents signed-up with primary care doctors in response to the event advertisement campaign in Balta and over 2,775 – in Tsarychanka. During the fairs, primary care doctors’ presentations about disease prevention were part of entertainment with possibility of face-to-face meeting with patients. HIVRiA developed the Internal Communications Best Tools and Approaches Guide for the MOH targeting improved internal communication among MOH staff (Annex 39). This guide will improve the capacity of the MOH Communications Department during the administration of ongoing MOH reform. It will help to build a sustainable internal communication system for the MOH and create high-quality internal communication tools. Visually engaging communication is critical for public health initiatives and promotion. The project developed a brandbook (Annex 40) for the Kyiv Public Health Center with all the essential tools and components. It will make all Kyiv PH Center external communications recognizable, understandable, and accessible. During reporting period HIVRiA team participated at 5th “Health Care Systems Transformation: Eastern Europe” Summer School, organized by School of Public Health of Kyiv-Mohyla Academy, Swiss TPH, UNICEF (June 17-22, 2018 Chernihiv, Ukraine). HIVRiA experts delivered presentation regarding financial planning for PHC providers considering new healthcare financing mechanisms (Annex 41) and a methodology for acute-care hospital planning within hospital districts. These capacity-building efforts aim to increase knowledge and promote understanding of the new health system financing mechanisms among regional-level change agents.

PROJECT MANAGEMENT ISSUES Q3Y5 was one of the busiest and most challenging periods for the HIVRiA team due to the stage of Ukraine’s health reform, HIVRiA project nearing completion, and changes in project leadership. With only 3 months remaining in the HIVRiA Project, the team is working diligently to ensure all previously started activities are completed and that new or on-going activities have clear and attainable timelines targeting no later than the Project end date of September 30, 2018. In Q3Y5, the HIVRiA team was faced with tight deadlines and a significant workload to support PHC facilities to enter into contractual relationships with the National Health Service in Ukraine so that they would be eligible for capitation payments under the new healthcare system. HIVRiA provided surge support to the NHS and several HIVRiA staff were temporarily reassigned from their usual positions and relocated to a temporary workspace at the NHS to support this effort full-time. This often included working beyond normal business hours, on weekends, and even on local holidays to ensure that all required activities were completed by the deadline. Ultimately, the HIVRiA surge support worked and the NHS was able to review and finalize all PHC applications submitted in this period. This work was recognized and USAID and the HIVRiA project received significant praise and recognition from the MOH, NHC, and several PHC facilities. As the HIVRiA nears completion, there was significant pressure on HIVRiA technical teams, local subcontractors, and grantees to ensure that all workplan activities were either completed or on track for completion by the expected project end date of September 30, 2018. During this quarter the M&E team worked closely with all project staff to make sure everything was on-track and the Grants Manager had numerous meetings with subgrantees to discuss milestone statuses and to work on closing ongoing grants. Overall, we expect all workplan activities to be completed by the Agreement estimated completion date. During this period demobilization activities started and a formal demobilization/transition plan was developed, which is in the process of being implemented. In Q3Y5 HIVRiA had Key Personnel and project leadership changes. Due to the award of the new USAID Health Reform Support contract, the HIVRiA Chief of Party (Nata Avaliani) departed HIVRiA as Key Personnel/COP and Deputy Chief of Party (Alex Iaremenko) was promoted to Chief of Party. Despite a major change in leadership, the HIVRiA has been able to stay on track and achieve results. Overall, the HIVRiA Management team has been able to effectively mitigate all project management risk, issues, and challenges; has made progress on the Y5 work plan; and has raised all concerns to USAID AOR.

EVALUATION OF ACTIVITY WITH RESPECT TO ENVIRONMENTAL IMPACT Regarding Initial Environmental Examination (IEE) conditions 3.1.5, 3.1.6 of the Cooperative Agreement, project activities for the reporting period did not have adverse impacts on human health. Certain activities, linked to IEE 4.1.2, 4.1.4, were continued (TA to Public Health Department of MOH and KCSA to establish and develop Kyiv City Public Health Center and implement Kyiv City Fast Track HIV/AIDS Program), and the project expects a positive impact on the health of the target population (PLHIV, KPs) in the long term. HIVRiA successfully conducted activities on Kyiv City RAP development conducted in Y3-Y4 (IEE 4.1.5) and thus anticipates positive impact on the health of the target population (PLWH, KPs).

PROJECT ACTIVITY MONITORING MATRIX

SECTION 1. HIV REFORM SUPPORT This report illustrates progress by symbols in color code: • Dark green: Completed, • Light green: Ongoing, • Yellow: Delayed, • Orange: Cancelled • Red: Not completed. In Q3Y5, of total 60 tasks: • 25 tasks were completed, • 32 tasks are ongoing, • 0 tasks were not initiated, • 0 tasks were delayed, • 3 tasks were canceled. Q3Y5 Tasks completeness ratio – 41.7 % Year 5 Expected result/ outcome Activity Sub - Activity Key milestone Indicators (output) Status Comments Target Objective 1: Enhance national leadership and capacity for evidence-based and gender-sensitive HIV policy programming and implementation Sub-objective 1.1: Support national government institutions in AIDS policy development, programming and implementation Key PH system entities 1.1.1. Provide legal Provide legal support to Amendments to # of Completed in Q2 (PH department of support to MOH in MOH in developing public regulatory framework recommended MOH, NPHC) staff are public health reform health Legislation made regulatory equipped with implementation changes prepared 1 Completed knowledge and skills in PH

1.1.2. Support Conduct strategic session Capacity of MOH and # strategic work Completed in Q2 development and for NPHC PHC in national public plan for NPHC capacity building of the health policy making, prepared 1 Completed MOH Department of including HIV/AIDS Public Health, National programming 29

Year 5 Expected result/ outcome Activity Sub - Activity Key milestone Indicators (output) Status Comments Target Public Health Center, Develop and implement strengthened # of NPHC’s staff selected regional PH strategic work plan for trained in PH centers to address NPHC developed programming, 10 Completed HIV, TB, and other financing and public health organizational challenges development 2018 GoU state budget 1.1.3. Support and Provide expert and Concept of new NAP # of the concepts Participation in the allocate funds to critical facilitate optimization organizational support to prepared and for a new NAP NAP working group HIV services of resource planning the inter-sectoral working discussed with key prepared and and allocation using 3 group at MoH that will stakeholders agreed funding sources: GoU/ develop a new National 1 Ongoing central and local AIDS Program for 2019 - budgets, new GF HIV- 2023 TB grant for 2018- 2020, and PEPFAR. HIV legislation in 1.1.4. TA and support Support finalizing Changes to HIV # of legal acts of In April and May, Ukraine updated to the MOH in amendments in some legislation adopted HIV legislation 2018 according UNAIDS preparing legislations legal acts of Ukraine in prepared and communication with recommendations changes based in the field of HIV-associated adopted Ministry of Finance Legal environmental diseases response and and State assessment results further institutional Regulatory Service approve and submitting 1 Ongoing on endorsement for Verkhovna Rada the draft of law is in consideration process. In June our efforts resulted in vising the draft law by the State Regulatory Service. Comprehensive HIV TA and support to the Comprehensive HIV # of regulations to Participation in the management guideline MOH TWG to develop management guideline implement 90-90- WG and legislation changes and implement and legislation 90 strategy to implement 90-90-90 comprehensive HIV changes to implement developed and strategy approved. management guidelines 90-90-90 strategy endorsed by and prepare legislation approved MOH/NPHC. 1 Ongoing changes, including the design of regulations for partner notification/ index testing of sexual partners of KP and self-testing for hard-to-reach KP 30

Year 5 Expected result/ outcome Activity Sub - Activity Key milestone Indicators (output) Status Comments Target National and regional Support functionality of Continue supporting AIDS Program # of functional e- Administrator Stakeholders (MOH, the AIDS Program functionality of the AIDS Dashboard is tools manual and NPHC, oblast Dashboard Program Dashboard operational and templates for data administrations, health (updating/upgrading updated with the latest collection/uploading care providers, NGOs functionality, when available (2017) data are finalized and 1 Ongoing and patients) are necessary; supporting Administrator’s ready for equipped with the visual data collection and data functions transferred to transfering to evidence-based data on uploading to the e-tool) NPHC NPHC M&E Unit NAP implementation and key results. Sub-objective 1.2: Strengthen capacity of local government entities in implementing regional AIDS programs with emphasis on key affected population PHCs established in five 1.2.1. Support OSA in Conduct trainings for OSA Standard TOR for # of regional-level regions with political will RPHC developments. in regional PH system RPHCs developed and Public Health Capacity building of development with MOH approved by MOH Centers 5 newly established and PHC established Completed selected RPHC to (cumulative address HIV, TB, and Y4&5) other diseases # of PHC staff 20 trained Completed Basic HIV, TB, MAT, 1.2.2. Share and Analyze regional pilots Planning, costing and # of guideline and STI services disseminate regional results and prepare management tool-kits prepared and integrated and pilots results on Guidelines (tool-kit) on for sustainable model disseminated sustainably provided, building a sustainable developing sustainable implementation for including at the primary model for the provision provision of HIV services local administrations, 1 Ongoing health care level, in 7 of of critical services to and an adequate system disseminate at the PEPFAR-supported key populations and of funding of critical regional level and regions people living with HIV services for KPs and nationally at the local level PLWH. TA to the 7 oblast Lessons learned from # of planning, administrations and MOH/ planning, costing and costing and NPHC to change/ develop organization of ARV organizational regulations for planning, dispensing in primary tools for ARV costing and organization HC and community- dispensing at of ARV dispensing based settings primary HC and in 1 Ongoing through primary health documented and community-based centers and in disseminated at the settings designed, community-based setting local/regional level and tested and (NGOs) nationally for scale-up endorsed by local GOU/ MOH

Year 5 Expected result/ outcome Activity Sub - Activity Key milestone Indicators (output) Status Comments Target Trainings on scaling up Lessons learned from # of local Completed in Q2 PITC at primary and planning, costing and administrations specialized HCF including organization of ARV that introduced planning, costing and dispensing in primary PITC in primary management issues HC and community- care and 7 Completed conducted based settings specialized (TB, documented and STI, narcology) disseminated at the clinics. local/regional level and nationally for scale-up Training the regional and Pilots results shared # of staff in local local administration staff with local GoU state and local NGOs to plan administrations and administrations and cost MAT and rayons/sites on and rayons/sites prevention services building a sustainable trained 200 Ongoing through local budgeting model for the provision process and advocating sustainable services, its approval by the local including PITC, ART, councils. MAT planning, costing and provision Analyze the results of Co-payment MAT # of MAT co-funding models models scaled-up in 3 regions/districts and provide options to the more PEPFAR- going to local health supported regions (up implement or 3 Ongoing administrations for to 7) based on the pilot implementing revising the local MAT results MAT co-funding provision models HIV social services 1.2.3. Analyze and Based on the pilot results, Social contracting # of guidelines integrated in public share results of social develop and provide guidelines, based on prepared health and promoted at contracting toolkits for planning, pilot results, the local level implementation of HIV costing and managing the implemented in 14 service at local level. social contracts for HIV district state 1 Completed services by NGOs for administrations in 7 dissemination and scale regions up at the regional level and nationally. Provide capacity Local government # of people developments to local administrations trained 140 Completed administration in 6 regions implement social contracting or other 32

Year 5 Expected result/ outcome Activity Sub - Activity Key milestone Indicators (output) Status Comments Target to implement social order mechanisms for mechanism funding community- based HIV services TB/HIV social services 1.2.4. Promotion of the Jointly with CCM of Conduct capacity of # of As agreed by MOH, integrated in public joint order of the Ukraine, conduct one key stakeholders at representatives of NPHC and CCM health and promoted at Ministry of Health of training on the the oblast level on Departments of secretary the local level Ukraine and the Sustainability Strategy TB/HIV social services Health and Ministry of Social implementation (p.29) for integration in public Departments of Policy of Ukraine on Departments of Health health at the local level Social Policy 20 Cancelled Approval of the and Departments of trained guidelines for Social Policy collaborating implementing of HIV in the field of TB/HIV and TB social services social services integrated at the local level in public health Conduct trainings on # of rayon and Completed in Q2 practical application of city authorities’ Guidelines for the representatives 20 Completed integration of HIV and TB trained social Planning, costing and 1.2.5. Document and Develop TA to local GoU # of planning, Will be developed organization models for legalize the planning, recommendations for authorities in costing and with line 1.2.2. - case management for costing and dissemination and roll-out introducing case organization Guideline PLHIV documented, organization PLHIV case management management models mechanisms for endorsed by MOH/ mechanisms for PLHIV provided PLHIV case 1 Ongoing NPHC and disseminated case management by management at the regional level and the local developed nationally administrations in local budgeting process Objective 2: Improve and optimize resource allocation and financing for the national and selected regional HIV/AIDS programs targeting key populations Sub-objective 2.1: Develop evidence pool to create support for funding decisions in HIV response at the national and regional level Recommendations 2.1.1. Provide support Develop a tool for Electronic tool for # of tool prepared Completed in Q2 developed for national to MOH/NPHC to conducting investment conducting investment partners on most cost- develop and analysis on regional level analysis on regional 1 Completed effective interventions implement action plans based on IC-II Study level based on IC II and modes of HIV of optimized allocation results Study developed service provision. for HIV at national and Workshop with # of people Completed in Q2 Action plan developed regional level based regional trained for optimized allocation on Investment Case II representatives held 20 Completed of resources for HIV results and piloted new for presenting services in a pilot region funding mechanisms electronic tool for 33

Year 5 Expected result/ outcome Activity Sub - Activity Key milestone Indicators (output) Status Comments Target (provider PBF, social conducting investment contracting, clients co- analysis on regional financing and PPP) level Identify & present a set of Action plans for # of action plans The electronic tool (most cost-effective) Poltava and Mykolayiv developed for investment services for financing at regions allocation of analyses at the the regional level (based resources for optimal facility level based on the region’s HIV mix of services to 2 Ongoing on Investment epidemiological profile). achieve the biggest Case Phase Study long-term impact on II and including the the local HIV epidemic results of

developed workshops Activities of the action # of action plans conducted in Q2Y5 plan for Poltava and costed in Poltava and Mykolayiv regions Mykolayiv regions costed finalized as well as Guidelines on how- to-use the e-tool. 2 Ongoing It is planned to present Action Plans for Poltava and Mykolayiv regions during July 2018. Sub-objective 2.2: Support the development of HIV strategies and policies at the national and regional level which reflect optimized resource allocation and lead to the most cost-efficient and effective. HIV expenditure 2.2.1. Build capacity Provide TA to develop, NASA electronic tool # of electronic tool During Q3 HIVRiA monitoring (NASA) is within GoU for data pilot e-tool and analyze developed and tested developed provided expert fully institutionalized at and analysis (NASA NASA results for AIDS support for the national and regional institutionalization) program review and levels adjustments technical representatives of NPHC on how-to- 1 Ongoing use the electronic tool. By the end of April the NASA electronic tool has been fully finalized including all

Year 5 Expected result/ outcome Activity Sub - Activity Key milestone Indicators (output) Status Comments Target proposals and technical specifications requested by the NPHC. Develop combined Guidelines developed # of guidelines Developed guidelines for reporting and submitted for developed previously the about HIV expenditures approval by technical guidelines based on adapted NASA UCDC/MOH. on NASA e-tool and using NASA online usage for reporting tool 1 Ongoing about HIV expenditures are updating due to the results of testing and national level training. Support to institutionalize NASA electronic tool # of electronic tool NASA electronic tool for transferred to the transferred 1 Ongoing national use MOH/ NPHC PBF framework 2.2.2. Support reforms Develop and discuss with HIV-related KPIs for # of PEPFAR- mechanisms for PHC of PHC provider PHC representatives PHC payment system supported regions payment system, payment system (to innovative financing and developed and with HIV-related including HIV-related include HIV in the budgeting mechanisms to discussed in 2 KPIs for primary 2 Ongoing services provision, performance variable) improve allocative and selected PEPFAR- HC payment designed, and in the two focal technical efficiencies in supported regions system developed introduced to key regions, in HIV programs and presented stakeholders collaboration with the Develop Recommendations for # of meetings MOH and other donors recommendations and implementing PBF conducted disseminate them among mechanism in PHC 1 Ongoing key stakeholders developed and presented to the key stakeholders National partners are 2.2.3. Provide TA to Cost key Test&START An account developed # of reports Results to be equipped with evidence- MOH to cost intervention (services) of costed Test&START prepared presented for the based financial data for Test&START Strategy and project the financial interventions, stakeholders during annual budgeting and project the needs to implement specifying direct, 1 Ongoing Project Final process based on financial needs Test&START Strategy in indirect/overhead cost Conference and Test&START approach. Ukraine (by 2020) and estimated report disseminated uncertainty 35

Year 5 Expected result/ outcome Activity Sub - Activity Key milestone Indicators (output) Status Comments Target among stakeholders Conduct working group Test&START # of meetings Policy paper will be meeting with key approach costing conducted prepared and stakeholders to inform results shared with key 1 Ongoing disseminated bythe them about Test&START stakeholders end of August costing results Legal/legislative 2.2.4. Build capacity Coordinate with MOH Develop public health # of legislative environment for within GoU for public Health financing and financing scenarios recommendations introducing public health health financing and Public Health teams to under the new health prepared financing mechanism budgeting, including develop budget code financing model 2 introduced HIV programs amendments and other Completed legislative amendments for financing public health services, including HIV Regional state 2.2.5. Build capacity Present new health care Trainings on new HC # of people Completed in Q2 authorities provided with within regional state financing mechanisms to financing mechanisms trained skills and knowledge for authorities for health regional authorities provided for regional financing and budgeting care system financing authorities 30 Completed health care programs and budgeting, including HIV programs Sub-objective 2.3: Strengthen capacity of national and regional partners in finance planning, budget preparation and execution to match the needs to optimized HIV/AIDS service-delivery operations Capacity of national and 2.3.1. Implement Grant implementation on Distance learning # of curricula Completed in Q2 regional health health system and Harvard course course organized as implemented and specialists/ economists health financing adaptation and part of NAPA and\or supervised in in health systems/health training course(s) institutionalization in KSE curricula national higher 1 financing is improved national educational educational Completed institutions (NAPA and institutions KSE) by incorporating it into existing curricula Harvard course # of curricula Completed in Q2 adopted and adopted institutionalize in 2 NAPA and KSE post- Completed graduate (M.A.) updated Curricular

Year 5 Expected result/ outcome Activity Sub - Activity Key milestone Indicators (output) Status Comments Target Conduct health Training course on # of people It is planned to systems/health financing health system/health trained conduct the course training course for financing conducted in collaboration with national and regional 25 Ongoing MoH and KSE for specialists National Health Service of Ukraine, NPHC, etc. Objective 3: Optimize and strengthen human resources for health (HRH) for the delivery and scale-up of gender-sensitive HIV/AIDS services targeting key populations Sub-objective 3.1: Strengthen evidence base for HIV workforce planning and development National partners are 3.1.1. Based on Estimate human Empirical data analysis # of analytical Completed in Q2 equipped with data on estimates of HRH resources requirements conducted and reports notes on Test and human resource needs needs for Test and for Test and START for 4 with HRH START HRH required for TEST and START in 3 regions, additional regions based requirements for Test regional START approach support other focal on the Model developed and START with projections implementation regions in and applied in previous recommendations for prepared 4 Completed quantification of HRH year HRH rationalization for HIV in 2019 and options developed 2020, using HRH requirements projection model Sub-objective 3.2: Support the introduction of systemic and operational changes in HRH for provision of sustainable and integrated HIV/AIDS services at the national and regional levels Regional authorities 3.2.1. Support 7 focal Conduct HRH Region-specific # of receive region-specific regions in planning of consultations with recommendations for recommendations recommendations and HRH for HIV using technical staff, chief HRH planning and with HRH support in HRH for HIV task- shifting models. physicians and regional rationalization rationalization 4 Completed planning decision makers and developed and options developed health authorities in 4 disseminated and disseminated additional regions Conduct 1 cross-regional Priority HRH # of HRH for HIV HRH consultation for key optimization actions priority action stakeholders from developed based on plans developed Mykolayiv, Odesa and region-specific 3 Completed Poltava regions recommendations received in previous year Incentive schemes for 3.2.2. Collaborate with Develop financial and Incentive schemes for # of documents Pre-final draft was health staff, providing and provide support to non-financial incentive health staff designed with incentives completed and 1 Ongoing critical HIV services for regional health schemes for health staff and disseminated schemes for translated into key populations, are authorities and facility to provide critical HIV among regional health health staff Ukrainian 37

Year 5 Expected result/ outcome Activity Sub - Activity Key milestone Indicators (output) Status Comments Target designed and managers to adopt services, based on health authorities for roll-out developed and disseminated financial and non- workforce motivators and at health facility level adopted by health financial incentives incentives study, and facilities schemes to ensure recommendations from increased involvement regional HRH of primary healthcare- consultations level facilities in the provision of HIV services Human Resource 3.2.3. Finalize and In line with WHO HRIS institutionalized # of HRIS The initial product Information System is institutionalize HRIS requirements for health by means of E-health modules vision was developed, piloted, workforce registries, developed and developed, and the endorsed nationally and develop and incorporate integrated into E- software business operational HRIS module into the e- Health requirements were Health system of the updated through MOH the review of 1 Ongoing relevant legislation of Ukraine on the management issues of medical, nursing and other health personnel of healthcare facilities. Legislation passed that 3.2.4. Provide TA to Develop the draft Legislation changes on # of legislation In April and May, allows for task shifting of MOH, National PHC to guidelines/legislation task shifting of HIV changes prepared 2018 HTS and referrals to develop legislation for allowing for task- shifting testing and referral and adopted communication with non-physicians task-shifting of HTS, of HTS and referrals to services to non- Ministry of Finance referrals to non- non-physicians and physicians prepared and State physicians provide for public and adopted by MOH Regulatory Service discussion 1 Ongoing on endorsement the draft of law is in process. In June our efforts resulted in vising the draft law by the State Regulatory Service Sub-objective 3.3: Strengthen capacity of Ukrainian institutions in HRH policy, planning and development Increased capacity, 3.3.1. Provide TA to Provide technical and HRH for HIV IWG # of HRH for HIV HRH for HIV IWG ownership and MOH and National secretarial support to quarterly meetings IWG meetings 4 Ongoing #4 conducted accountability for HRH PHC in coordinating MOH and NPHC to organized to convened 38

Year 5 Expected result/ outcome Activity Sub - Activity Key milestone Indicators (output) Status Comments Target policy development and and planning HRH for streamline and coordinate HRH for implementation within HIV activities and consolidate national HRH HIV activities and GOU addressing priority for HIV coordination, support national multi- areas for planning and sectoral HRH for HIV strengthening HIV implementation efforts. planning and workforce prioritization processes HRH for HIV # of HRH for HIV Completed in Q2 Operational Plan for operational plans 2018 that incorporates developed activities of national and international 1 stakeholders prepared Completed and adopted by the HRH for HIV Inter- sectoral Working Group Local educational 3.3.2. Public health Conduct faculty and Faculty and curriculum # of people This activity was institution(s) improve(s) training course curriculum development development training (faculty members) modified into capacity to develop adopted into post- training for faculty conducted trained supporting the Public Health workforce graduate educational members of educational Conference, in in areas of public health system with broad institutions order to discuss policy, HIV surveillance, involvement of national 25 Completed integration and programming and and regional institutionalization monitoring stakeholders of the Public Health course into the national educational system Training curricular # of raining It was discussed developed and curricular with the new Head institutionalized into developed and of National PH educational system of institutionalized Center that Center post-graduate into educational has a different institution system strategy for PH 1 Cancelled curricular development, thus funds from this line were allocated to another PH training for regional and national 39

Year 5 Expected result/ outcome Activity Sub - Activity Key milestone Indicators (output) Status Comments Target representatives of the PH centers. Conduct trainings for National and regional # of people PH training Course national and regional level PH Centers staff trained #5 has been 50 Completed public health specialists trained conducted in Q3.

Cross-Cutting Capacity Building Capacity building CB1. Strengthening of Provide TA to PHC MOH TA provided according # of CB This activity is support to governmental PHC MOH based on action plan of to Action Plan; PHC interventions conducted in partners at national level YR 4 (strategic session) MOH institutional conducted coordination with provided in order to capacity strengthened the NPHC identify policies, organizational financing, and strategic development staffing for delivering 2 Ongoing support under Sub- optimal HIV services to Objective 1.1. The KP and PLWH NPHC operational assessment will be completed and CB support will be continued in Q3. Capacity of non- CB2. Capacity building Conduct second Assessment # (and %) of Reassessment with governmental support to NGOs – assessment using conducted, and self- organizations with Club Eney has organizations future TA providers CYPRESS methodology assessment scoring improved scoring been completed in strengthened to enable (implementers of pilot with partner organizations received June them supporting projects and grantees) which have completed 2 Completed regional administrations performance improvement (NA) in further replication of plans in YR 4: pilot concepts and - Kherson (Q2) providing expertise on - Pervomaysk (Q1) selected focus areas - Club Eney (Q2-3) after the Project Provide necessary Targeted capacity # of pilot Provided TA to to completion targeted CB interventions building interventions organizations Kyiv NGO 100% of based on performance provided which received Life- PLWH improvement plans/action capacity building Network, conducted 3 plans of YR 4 (including: interventions Ongoing staff performance - 100% of Life, Kyiv evaluation - Svitlo nadii, Poltava - 21 Century,Kherson

Year 5 Expected result/ outcome Activity Sub - Activity Key milestone Indicators (output) Status Comments Target - Zdorovaya natsiya, Pervomaysk Conduct trainings to Trainings conducted # of people prepare for future role of trained TA providers and better equip organizations with relevant skills: 30 Completed - Direct funding from USAID - TA provision - Framing and Productization Project intellectual CB3. Design and Develop and launch KH KH platform created # of platforms products shared with support the functioning platform and operative created key stakeholders and of Knowledge and TA partners to improve Hub in support of collaboration and health reform 1 coordination in implementation Completed HIV/AIDS response and health care reform implementation.

Provide TA through KH KH platform utilized for # of TA provided Platform will be platform TA requests and TA dedicated to provision # of displaying Project organizations\ products for sharing institutions and dissemination. received TA N/A Cancelled TA provision was through KH cancelled, because other platforms are used instead (http://healthreform. in.ua ) Gender and Stigma Sensitization Joint activities with other GS1. Support activities Support the participation Set of # of sets of Completed in Q1 partner projects at the through Policy, Health of regional recommendations on recommendations national level Financing and HRH representatives from pilot responding to gender- presented at the 1 coordinated and Objectives that will regions in the MSM and sensitive problems and LGBT Conference Completed streamlined to address have impact on KP LGBT X National needs of KPs KP needs communities Conference to discuss elaborated 41

Year 5 Expected result/ outcome Activity Sub - Activity Key milestone Indicators (output) Status Comments Target KP’s problems in accessing to health, and develop recommendations for both NGO and GOU and HCFs GS2. Organize LGBT Convene and facilitate Events conducted, and # of meetings Organization stakeholders’ meetings LGBT stakeholder recommendations conducted Committee meeting and\or capacity meetings or any other disseminated among on June 25, 2018. building trainings with events relevant stakeholders the aim to coordinate advocacy and programmatic activities to ensure 4 Ongoing complementarity of donor support in the field of stigma and discrimination-free service provision to KPs at the national level Communication and Knowledge Management Accountability and CM1. Maintain the Project news posted # of unique news transparency through Project's website and on the website on the website communication with provide information to and/or FB 170 Ongoing HIV/AIDS stakeholders national and regional supported stakeholders CM2. Publish media Media hits and # of media hits hits and interviews interviews on and interviews with leading health HIV/AIDS reform 40 Ongoing experts on HIV/AIDS published reform CM3. Provide routine Newsletter is # of newsletters Newsletter #16 and information through published per year #17 was prepared 6 Project Newsletters Ongoing for release (Ukr/Eng) Core Health Care CM4. Maintain Provide information on Facebook page is # of FB followers Reform topics, including Facebook page HIV reform in Ukraine maintained and public health and HIV number of followers is 850 Ongoing visualized through social increased media 42

Year 5 Expected result/ outcome Activity Sub - Activity Key milestone Indicators (output) Status Comments Target Evidence-based best CM5. Develop Policy Policy briefs on Policy, # of Policy briefs practices in public briefs/memoranda/leafl Finance and HR published health/HIV disseminated ets) on priority public published for decision for decision makers, health/HIV topics makers, health care health care providers, providers, donors to donors to advocate for advocate for HIV 5 Ongoing HIV services services sustainability sustainability in the in the regions: regions investment case, pilots best practices, PBF, case management, test and start Develop success Success stories are # of success stories shared with stories 6 Ongoing stakeholders to

SECTION 2. HEALTH SYSTEM FINANCING REFORM SUPPORT UNDER OBJECTIVE 2. This report illustrates progress by symbols in color code: • Dark green: Completed, • Light green: Ongoing, • Yellow: Delayed, • Orange: Cancelled • Red: Not completed. In Q3Y5, of total 42 tasks: • 25 tasks were completed, • 13 tasks are ongoing, • 0 tasks were not initiated, • 0 tasks were delayed, • 4 tasks were canceled. Q3Y5 Tasks completeness ratio – 59.5% Expected result/ Indicators Year 5 Activity Sub - Activity Key milestone Status Comments outcome (output) Target Objective 2: Improve and optimize resource allocation and financing for the national and selected regional HIV/AIDS programs targeting key populations Sub-objective 2.4: Build the capacity of the national and selected regional/local GoU entities to design and establish a national purchasing agency Streamlined guidance 2.4.1. Provide legal Support the MOH with Amendments to # of regulatory Replaced with new for governance of MOH, support to MOH in organizational design, regulatory framework changes legal support capacity straightened health reform development and capacity made developed activities at MOH TBD Cancelled implementation building in terms of public request administration reform and NHS launching Trainings designed # of trainings Replaced with new and provided provided legal support activities at MOH 2 Cancelled request

Provide legal support in Assessment of current # of Replaced with new 1 Cancelled assessing medical status made assessments activity has changed: 44

Expected result/ Indicators Year 5 Activity Sub - Activity Key milestone Status Comments outcome (output) Target workforce certification and aligned with 1. ePrescription order licensing process, study reform agenda (approved), 2. Draft best practices provided order on insulin 3. Draft order on order 385 Provide legal support in Assessment of current # of Replaced with new assessing НС facilities status made assessments activity: 1. input to licensing and aligned with 1 Cancelled eHealth bylaw, 2. accreditation process, reform agenda SOE- MIS agreement study best practices provided Provide legal support in Amendments to # of regulatory Completed in Q2 defining new qualification regulatory framework changes 3 Completed requirements for HC made developed facilities management Develop draft legal Regulatory framework # of regulatory framework for reviewing developed changes 3 Completed the list of healthcare developed facilities Provide legal support Regulatory framework # of regulatory Completed in Q2 related to the developed for the Law changes implementation of the Law on health care provider developed 2 Completed “On Health Care Provider autonomy developed Autonomy”.

2.4.2. Provide Provide technical Technical assistance # of regulatory Participation in WG technical assistance to assistance to MOH in reform action plan changes meetings MOH to successfully working groups provided developed 3 Ongoing implement critical health reforms Sub-objective 2.5: Support the Ministry of Health (MoH) and relevant Parliamentary Committees to define, develop, implement and update a basic benefits package of service, in consultation with civil society and patient organizations Coordination with 2.5.1. Provide Provide input to the draft Recommendations on # of Completed in Q2 stakeholders provided feedback to the draft of primary care benefit draft BBP are recommendatio 1 Completed basic benefit package package developed and n documents provided to MOH developed Sub-objective 2.6. Support MoH and selected oblast/ local authorities in the design and establishment of a performance-based payment system under ‘money- follows-the client’ approach 2.6.1. Support for Capitation Rate Development

Expected result/ Indicators Year 5 Activity Sub - Activity Key milestone Status Comments outcome (output) Target CY2019 Capitation 2.6.1.1. Expand the Support data collection Data collection tools in # of tools Completed in Q2 Rates Finalized and Utilization and Cost and analysis to inform Excel developed developed Approved data collection tools Utilization and Unit Cost and templates of services for 2017 and developed as part of 2018 to be used as base 1 Completed Y4 for Primary Health line data to develop Centers (PHC) to Capitation rates for 2019 collect data and obtain feedback from facilities 2.6.1.2. Select a Select additional 100 Sample of 200 PHC’s A set of PHCs Completed in Q2 representative sample PHCs in addition to the from various Urban sample is of primary care centers 100 PHCs selected in and Rural areas is prepared Year 4 as a selected representative sample of Yes Completed primary care centers in Ukraine to improve data collection and predictability 2.6.1.3. Collect data Collect data to inform Data is collected from Data is collected The translated on utilization of Utilization and Unit Cost sample PHC’s on and verified databases provided primary health care of Primary Care services utilization of primary to the international data for CY2017 and care and cost of STTA to be used for CY2018 services new capitation 2019 Yes Ongoing rate model. Undergoing discussions with international STTA about the data and approaches. Tool for measuring 2.6.1.5. Conduct Select and survey a Assess magnitude of Data Collected The draft Analytical informal payments for Informal Payment sample population to informal payments report is now under basic PHC services Study prior to assess the baseline level internal review. package designed and Capitation payment of informal payments prior Databases translated tested implementation in to the implementation of 1 Ongoing and provided to the CY2018 Capitation rates international STTA to be used for new capitation 2019 rate model. 2.6.2. Healthcare Provider Autonomy

Expected result/ Indicators Year 5 Activity Sub - Activity Key milestone Status Comments outcome (output) Target Hromadas and selected 2.6.2.1. Provide TA for two local PHC to Pilot on operational # of hromadas primary healthcare technical assistance to operate as autonomous management under receive TA in providers strengthened two selected organizations for health capitation model Healthcare in developing of hromadas (Balta and care providers initiated in 2 PHC sites Provider provision of primary care Tsarichanka) in • Operational and completed Autonomy at the local level development local financial management PHC system under capitation model 2 Completed • Conduct HR needs assessment and address needs • Support PHC to implement the local MIS under E-health system 2.6.2.2. Support MOH in Develop implementation Operation manual # of operation preparing Operation guidelines to operate as prepared manual manual on autonomous prepared Development of the organizations for health 1 Completed system of provision of care providers primary care at the local level 2.6.2.3. Supporting Capacity development to Hromadas trained in # of people Support 129 PHC hromadas in up to 15 primary care providers to implementation best trained oblasts in development learn skills that will be practices in provider of the system of essential for success autonomy 100 Completed provision of primary under the new system management under care at the local level capitation model managed Conduct ToT for Best practices on # of people Completed in Q2 hromadas teams to serve capitation trained as regional resource for implementation 20 disseminating the assessed and Completed implementation guideline provided to MOH and national stakeholders 2.6.3. Hospital districts Capacity of regional 2.6.3.1. Proceeding in Conduct cluster Workshops on # of workshops Completed in Q2 administrations conducting technical workshops presenting the presenting the tool and conducted strengthened in hospital assistance in tool and a roadmap to a roadmap to conduct 4 district strategic developing strategic conduct a hospital district a hospital district Completed planning plans for hospital strategic planning strategic planning held districts 47

Expected result/ Indicators Year 5 Activity Sub - Activity Key milestone Status Comments outcome (output) Target 2.6.3.2. Support Initiate strategic planning Site is selected, initial # of site Completed in Q1 selected pilot hospital process in selected capacity built selected 1 Completed district in strategic plan hospital district, build development capacity Conduct Personnel and Assessment is # of Completed in Q2 Asset inventory conducted assessments 1 Completed conducted Conduct needs Needs assessment is # of Completed in Q2 assessment and analysis conducted assessments 1 Completed conducted Develop Recommendations # of recommendations for provided recommendatio 1 Completed optimization ns provided Conduct consultations Events are conducted # of events with local and oblasts stakeholders to discuss 3 Completed hospital district clinic services design Communication activities Public events are # of public conducted events 1 Completed conducted Conduct training on Training is conducted # of events strategic plan conducted 2 Ongoing implementation Sub-objective 2.7. Support the MoH in developing and implementing effective IT solutions to launch, manage and administer health system financing reforms. Completed MVP and 2.7.1. Develop a Review sprints with the Review sprints with the Review sprints Physician Profile schedule for development team, MOH development team, with the product development (sprint and stakeholders MOH and stakeholders development 2 schedule); Identify risks and develop Identify risks and team, MOH and prod Ongoing contingency plan develop contingency stakeholders ucts plan Identify risks and develop contingency plan 2.7.2. Manage risks Review sprints with the Review sprints with the Review sprints development team, MOH development team, with the 2 and stakeholders MOH and stakeholders development prod Ongoing Identify risks and develop Identify risks and team, MOH and ucts contingency plan develop contingency stakeholders plan Identify risks and

Expected result/ Indicators Year 5 Activity Sub - Activity Key milestone Status Comments outcome (output) Target develop contingency plan Completed MVP and 2.7.3. Develop Develop documentation Drafts developed and # of artifacts 2 Completed in Q2 Physician Profile technical for MVP finalized sets technical documentation documentation Develop documentations of for Physician Profile techn Completed ical docu ment ation Completed short- and 2.7.4. Consolidate and Analyze outputs from Roadmaps renewed # of roadmaps long-term E-health analyze information strategic sessions strategy roadmap in collected during Renew a short-term e- 2 Ongoing collaboration with MOH strategic sessions Health strategy and e-Health Renew a long-term e- stakeholders Health strategy Supported and 2.7.5. Design and Suggest topics for deep Scheduled sessions # of sessions facilitated strategic support targeted dive strategy sessions delivered planning sessions held strategic sessions to Design data collections 4 Ongoing for MOH stakeholders to solidify e-Health tools for the sessions coordinate e-health strategy and roadmaps Develop a facilitation activities guide for each session Provide legal framework 2.7.6. Provide legal Develop business model Business model # of legislative for establishment of support for all activities Develop guidance for developed documents SOE and MVP transfer related to structure and operations Legal framework to SOE establishment and Develop guidance for drafted TBD Ongoing SOE operations cybersecurity and MVP Develop organizational registration and transfer and governance structure for SOE Cross-cutting: Communication and Knowledge Management Health Reform Implementation Planning Health reform Support MOH in Organize and facilitate Health reform # of roadmaps Completed in Q1 implementation road designing and meetings of teams of roadmaps developed developed map with tangible facilitating teams of SMEs and stakeholders for key health reform 6 Completed outcomes developed subject matter experts topics and progress and stakeholders monitored by MOH

# of stakeholder meetings 4 Ongoing conducted 49

Expected result/ Indicators Year 5 Activity Sub - Activity Key milestone Status Comments outcome (output) Target Communication MOH Communication CM1. Support MOH in Provide support for 6-months # of action plans Action Plans are shared development of development of 6-months communication action developed 2 Ongoing with key internal Communication Action communication action plans developed stakeholders Plans plans Presentation of 6- # of meeting months conducted 2 Ongoing communication action plans conducted Capacity of new MOH CM2. Support MOH in Design capacity building MOH Communication # of people Communication capacity building in trainings in project Department Key staff trained Department is improved communications management and website trained on project 10 Completed content development for management and Communication website content Department staff development CM3. Support MOH to Update draft of tool-kit, Tool-kits and # of tool-set / develop internal guidelines and guidelines updated guideline communication system Communication on- and presented to MOH developed boarding tool-kit for 2 Completed Internal Communications according to results of administration reform of MOH Regional professional CM4. Support MOH in of Develop and conduct Health reform events # of events Event #4 is cancelled community is informed line information campaig Health Reform events in conducted conducted 4 Completed about health reform for regional PHC staff an the regions advantages health departments of locOperation manual Operation manual for # of documents administrations about Development of the health management developed health reform system of provision of and family doctors 1 Completed improvements primary care at the local prepared level Support development of Health Reform Digests # of digests Health Reform Digest for developed developed 24 Ongoing the regions Health Reform CM5. Support MOH in Design Health Reform Health Reform Forum # of Forums Replaced with 100 implementation lessons, conducting Health Forum Agenda conducted conducted PHC kick-off meeting 1 Completed achievements and plans Reform Forum Support organization of are shared Health Reform Forum

Expected result/ Indicators Year 5 Activity Sub - Activity Key milestone Status Comments outcome (output) Target with national and CM6. Support MOH in Design of information Health Reform # of information Completed in Q2 regional stakeholders design of regional campaign in the regional information campaign campaigns 1 Completed media campaign media designed designed