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The Impact of the Global Fund Programmes on Hiv Prevention Policy and Services in Ukraine in 2003-2012

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The Impact of the Global Fund Programmes on Hiv Prevention Policy and Services in Ukraine in 2003-2012 THE IMPACT OF THE GLOBAL FUND PROGRAMMES ON HIV PREVENTION POLICY AND SERVICES IN UKRAINE IN 2003-2012 SVETLANA MCGILL A thesis submitted in partial fulfilment of the requirements for the degree of Doctor of Philosophy QUEEN MARGARET UNIVERSITY 2014 i Abstract Ukraine is home to one of the world‘s fastest growing HIV epidemic and has received significant amounts of foreign aid to help it tackle the crisis. This study is an enquiry into the implementation of the Global Fund against AIDS, Tuberculosis and Malaria (GFATM) programmes in Ukraine, during the second decade of this country‘s post-Soviet economic and political transition. The discussion is positioned within a broader debate on aid effectiveness. By looking at the GFATM as an aid institution whose establishment was purported to improve the aid delivery process, the thesis offers a critical insight on the GFATM aid delivery model in the context of Ukraine. The thesis investigates the conduct and practice of INGO and national NGOs in their role as Principal Recipients of GFATM grants targeting HIV prevention in Ukraine. Based on ethnographical enquiry conducted in three oblasts in Ukraine, and in capital Kyiv, the thesis aims to understand how NGOs have implemented HIV prevention services in context of state-owned health care system and to determine the perceived effects of the GF programmes on the ground. The thesis situates analysis of NGOs into a broader socio-political context of post-Soviet Ukraine and questions their role as central actors in delivering essential HIV programmes in parallel with or instead of the state, as well as the consequences for sustainability of such programmes. Using the particular experience in Ukraine, the thesis shows the influence of global funding institutions on relationships between state and civil society and altering of civil society‘s roles in aid programmes. The thesis includes a comprehensive literature analysis about the Global Fund and other donor programmes working in Ukraine in the area of HIV/AIDS. Key words: Ukraine, the Global Fund, aid effectiveness, HIV prevention, HIV services, NGOs. ii Acknowledgements The research presented herein has been conducted at the Institute for International Health and Development at Queen Margaret University. I am deeply indebted to this institution and its collective for outstanding academic environment and truly international spirit that surrounded and supported me throughout my whole stay at QMU and made this research happen. I want to commend the Institute‘s former director, Professor Barbara McPake who has also been my supervisor, for her remarkable leadership and support that enabled me to get a profound understanding of the parameters of academic debate on international health. The knowledge I gained at the Institute‘s seminars, global lecture series, and other venues allowed me to develop and expand my research skills and will be indispensable in my future work. I am grateful to Oonagh O‘Brien, the Director of Studies, who spent time over my text at different stages of its development, led me through the pathways of methodology, data collection and analysis, and assisted me until the final stages of my PhD endeavour. I am also grateful to the colleagues at the Institute who inspired me with ideas and understanding, especially to Suzanne Fustukian, Carola Eiber, Karina Kielmann and others. Special thanks go to the Institute‘s support staff, especially to Kyoko Jardine and Janice Burr, for their invaluable assistance on all matters possible during my stay at QMU. I am also grateful to the Centre for Academic Practice (CAP) for being an important venue that enhanced my learning and teaching experiences at QMU and impacted my research. Special thanks to Professor Roni Bamber, Iddo Oberski, Susi Peacock, and Lindesay Irvine. I am grateful to the staff at Research Degrees for leading me through the whole process and for responding promptly to all my requests. Great thanks to Sheila Williams, our reference librarian, and other staff at the QMU library. Kudos to RILO staff for the assistance they provided to me as an international student, to IT support services, and all other student services at QMU. I am grateful to Professor Diane DeBell for her advice at earlier stages of my research. And, finally, to my research participants, in Ukraine and internationally, who took hours of their invaluable time and busy schedules to sit down with me and share their qualified opinions and thoughts in interviews that mainly shaped my research. Thank you for confiding and sharing your thoughts with me, your responses were a major source of inspiration and empowerment for me as a social scientist. In my earlier academic endeavors, I am very grateful and profoundly indebted to Professor Ruth Pearson who opened the world of international development studies to me, first as a course supervisor at the University of East Anglia in Norwich in 1992, and later as my Master‘s dissertation supervisor at the University of Leeds iii in 2001-2002, whose personal and professional support gave me an impetus to learn and develop, and shaped my thinking. And last but not least, thanks go to my beloved son Tikhon and husband Olin, who deserve a special praise for their true endurance, sparkling joy and warmest care and love they surrounded me with during my busy times of writing a thesis and elsewhere. And I can never thank enough my parents, Vladimir and Valentina, whose love brought me into this world, and who have always been there for me, whom I greatly missed when doing research in Scotland. Big thanks for encouragement and care to my sister Ira and her family. My prayers and best wishes go to my compatriots, the people of Ukraine, who now are going through a very difficult time in their history. To them, and to the future of their children, I dedicate this work. iv List of terms and abbreviations1 Activities - services the intervention provides to accomplish its objectives. Activities can be delivered through outreach, materials distribution, counselling sessions, workshops,etc. Affected Communities, or Communities – communities of people living with or affected by HIV/AIDS, tuberculosis or malaria. AIDS - Acquired immunodeficiency syndrome AP- Associated Press ART - Antiretroviral therapy or treatment ARV - Antiretroviral drug Bilateral Donor– the term used to describe a developed-country government (or its specialised agency) that provides official development assistance. CCM - Country Coordinating Mechanism. A country-level partnership that includes representatives from government, multilateral and bilateral development partners, nongovernmental and faith-based organizations, affected communities, academic institutions and the private sector. Coverage - The percentage of persons reached by activities/services. CSO - civil society organisation. Associations of citizens (outside their families, friends and businesses) entered into voluntarily to advance their interests, ideas and ideologies. DFID - Department for International Development (United Kingdom) Disbursement – a periodic payment of grant funds to a Principal Recipient. Donor– government, private business, foundation, or individual that makes contributions to the Global Fund. DOTS - Directly Observed Treatment Short-Course (for tuberculosis) EU – the European Union Evaluation – a systematic collection of information about the activities, characteristics, and outcomes of programmes to make judgments about the programme, improve programme effectiveness, and/or inform decisions about future programming. 1Based on definitions provided by ICASO (n.d.), and some other sources v Framework Document – the founding document of the Global Fund, developed by the Transitional Working Group that worked to design the Global Fund in late 2000. The document codifies the organization‘s purpose, principles, scope and key processes. FYE - Five-Year Evaluation of the Global Fund FSU – Former Soviet Union countries – usually refers to all former Soviet republics minus the Baltic states, and includes Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Republic of Moldova, Russian Federation, Tajikistan, Turkmenistan, Ukraine, and Uzbekistan GFATM - the Global Fund to Fight AIDS, Tuberculosis and Malaria GF – same as above GAVI - Global Alliance for Vaccines and Immunization GNP+ - Global Network of People Living with HIV Grant/grant agreement – a written agreement between the Global Fund and a PR that outlines the terms and conditions of Global Fund financing and the targets to be achieved. In most cases, the initial term lasts for two years (Phase 1), which can be extended for up to a further three years if the Board decides to commit additional resources for Phase 2. HIV - Human immunodeficiency virus HR – Harm reduction HSS - Health systems strengthening ICASO – International Council of AIDS Service Organisations IEG - Independent Evaluation Group (at the World Bank) Intervention - a specific set of activities implemented by a project or providers and can be focused at various levels such as the individual, small or large group, community or societal levels. INGO – International nongovernmental organisation IOM – International Organisation of Migration LFA – the Local Fund Agent of the GF.A local, independent body contracted by the Global Fund to provide oversight of a PR on behalf of the GF. MAP – Multi-country AIDS Program (World Bank) MARPs – Most-at-Risk-Populations vi MDGs – Millennium Development Goals M&E – Monitoring and Evaluation MOH – the Ministry
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