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Improving health and protecting human rights Improving health and protecting human rights for individuals, communities, and society Presenter: Dasha Ocheret | dasha@harm-reduction.org Reaching the un-reached: communities as generators of demand, and complementary deliverers of services at local level and to remote and key populations Reaching the un-reached: communities as generators of demand, and complementary deliverers of services at local level and to remote and key populations Melbourne, July 25 2014 Slide 2 Slide 3 OST Program in Azerbaijan, 2013 Slide 4 Whom do we reach? How often harm reduction services analyze who their clients are and whom they do not reach? Contacted = contacted once a year? once during the Global Fund program cycle? Contacted through secondary needle exchange? Slide 5 Donors perspective EC-funded three year program in 6 countries of Eastern Europe Main objective: to enroll 4,000 women into harm reduction services Donors interest: high efficiency, low unit cost and clear reporting according to unified indicators 5 Slide 6 How did we involve the community to improve harm reduction programs efficiency? 90ies: as unpaid workforce for rapid situation assessments Beginning of 2000s: secondary needle exchange (unpaid outreach workers) Mid-2000s: paid outreach workers, case managers and peer educators for ART Late 2000s: monitoring of access to HIV services Since 2014: improving allocative and technical efficiency of harm reduction programs 6 Slide 7 Eurasian Network of People Using Drugs (ENPUD) Slide 8 Slide 9 Slide 10 Slide 11 Questions to be asked What services should be added on top of the standard WHO/UNAIDS/UNODC package to reach the unreached? What services should be removed? How to reduce costs of service provision? Operational management decisions (changing opening hours), changing legislation framework (take-home methadone doses), negotiations with pharma (internazal naloxone), etc. 11 Slide 12 Case of Tajikistan New Funding Model as safe platform to pilot drug user involvement in funding allocation decision-making Status quo: community leaders are asked which service they want Naloxone, hepC treatment, legal support, expansion of methadone programs Budget decisions are taken behind close doors As a result: expansion of methadone programs 12 Slide 13 EHRN regional program A.Community-based service monitoring: consultations with various sub-groups of PWID B.Costing exercise: how much does it really cost? C.Prioritization exercise: consultations with the community on D.Allocation exercise: explicit rationing of resource allocation in E.Advocacy for better service management and for supportive legal frameworks 13