Presenting author: Yuliya Georgieva
Issue and setting
During the last 20 years Bulgaria experienced encouraging successes in HIV prevention. The Global Fund provided almost $80 million between 2004-2017 to support HIV and TB prevention in the country, while the Bulgarian Ministry of Health (MoH) covered ART and OST. However, as a result of the Global Fund withdrawal, the needle exchange, HIV testing and case management stopped completely in July 2017 and the Government has not stepped in to close the gap. Civil society is worried that the lack of action can lead to increase in HIV and Hepatitis C infections among key population.
The Centre for Humane Policy research from 2017 found that the MoH is not ready to implement Government-led harm reduction response. The research argues that while the civil society has relevant experience in delivery of successful HIV prevention, the MoH has not developed yet a funding procedure that guarantees high quality, efficient, sustainable and evidence-based services. In 2017 the MoH launched a public tender to invest €144,000 in harm reduction services for key populations. Many civil society organizations found the tender conditions, required by the Healthcare Law, challenging (high indicators for low cost; bank guarantee before getting funds etc.) and decided against applying. Despite continues advocacy, MoH has not changed their approach, putting at risk Bulgaria’s earlier HIV prevention successes.
Outcomes and implications
Due to a current Healthcare Law, the MoH is allowed only to invest resources using a very rigid and inefficient public tender procedure. A small change to the Law can enable the MoH to directly fund organizations that are most experienced in providing effective and evidence-based services for key populations.