The civic organizations HOPS – Healthy Options Project Skopje and HERA – Association for Health Education and Research from May 18th to 22nd organized a study visit to Croatia to gather information and knowledge about funding mechanisms of programs for HIV/AIDS prevention. The participants in the study visit were representatives from key institutions and ministries concerned with this issue in Macedonia: the Ministry of Health, Ministry of Labour and Social Policy, the City of Skopje, the Department for implementation of the Global Fund HIV/AIDS prevention project at the Ministry of Health, an MP from the Assembly, as well as representatives from HOPS, HERA and Stronger Together.
The trip included visits of the key institutions and ministries financing the programs for HIV/AIDS prevention and treatment in Croatia: the Ministry of Health, the Office for Combating Narcotic Drug Abuse of the Government of the Republic of Croatia, the City of Rijeka, as well as four civic associations that implement programs for HIV/AIDS prevention – the Red Cross of Croatia, HUHIV Zagreb, Iskorak Zagreb and Terra Rieka.
The Red Cross of Croatia hosted and coordinated the visit and the meetings in Zagreb.
Financing from the Budget of the Republic of Croatia
The Republic of Croatia was the recipient of one grant from the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria, from December 1st, 2003 to November 30th, 2006. Once the grant came to an end in 2006, the Ministry of Health took over the funding of the already implemented programs.
There are 10 needle exchange programs in Croatia. Four of them are implemented by the Red Cross of Croatia. We visited two of the programs – the Red Cross Program in Zagreb and the Terra Program in Rijeka. All programs are financed by the Ministry of Health of Croatia, with the possibility for additional funding from the local self-government units. The financing process is as follows: the Ministry organizes an open competition for civic organizations interested in the realization of health programs concerning the implementation of national strategies, plans and programs from the available funds of the state Budget and in part from revenues acquired from games of chance. Five priority activities, i.e. measures are financed with the competition.
Four of these measures refer to HIV, two of which are concerned with HIV prevention of people who use drugs: Measure 1: strictly designed for funding harm reduction programs, i.e. needle exchange programs and Measure 2: HIV prevention activities among the population with highest risk (drug users, people with high-risk sexual behaviour).
Measure 3 is HIV prevention among adolescents, while measure 5 refers to programs for psycho-social support of people who live with HIV, as well as activities for de-stigmatizing the homosexual population in the direction of HIV prevention. Measure 4 is not related to HIV and refers to funding the programs for psycho-social support of children with malign diseases.
Finances are allocated for each of these measures and civic organizations can apply for projects with a budget ranging from 100,000.00 HRK or 13,211.00 EUR, the lowest amount granted annually, or 1,000,000.00 HRK or 132,211.00 EUR, the highest amount granted annually, for 2013. An organization can apply for two programs the most, meaning 2,000,000.00 HRK or 264,422.00 EUR per year are granted for HIV prevention among people who use drugs. What is specific about the Croatian model is that the competition covers a three-year period, so civic organizations have the financial security to implement the programs continually for three years, relieved from the burden of constantly applying for projects and requesting funding, although technically they do sign an agreement every year.
The terms of the competition are:
- The civic organization must be registered pursuant the Law on Organizations of the Republic of Croatia;
- The civic organization must be registered in the Central Registry and have been actively implementing projects in the health field for at least 3 years;
- The civic organization must keep accurate and transparent records on its financial activities pursuant the Law on Accounting for Non-profit Organizations;
- The civic organization has fully complied with all undertaken responsibilities from previous funds granted from the Government’s Budget within the prescribed period.
On average, 90% of the Budget assigned to the competition is provided with finances from games of chance.
The competent authorities in the Ministry of Health pointed to partnership and mutual trust with the civic organizations, underlining that all issues regarding the programs’ realization are solved with a dialogue via the telephone, thus avoiding bureaucracy methods with official requests for meetings, scheduling etc.
The organizations we visited expressed reservations regarding the amount granted by the Ministry of Health, also pointing to a four or five-month delay in the payments as the main problem.
Still, despite the problems, the civic organizations also spoke of a good partnership relation with the Ministry of Health.
Funds from the local self-government units
The City of Rijeka proved to be an interesting example. The initiative for financing the Needle exchange program originated from the local self-government, not a foundation. Namely, in 2000, at the City’s initiative, the previously established Civic organization Terra opened the first Needle exchange program and HIV prevention among drug injecting individuals in Rijeka.
From then on, the local self-government has provided the funds for dependence programs within harm reduction programs, i.e. needle exchange.
The Program typically offers services other than needle exchange, such as fieldwork, psycho-social support and education.
The finances are provided with an open competition at the beginning of every year organized by the City of Rijeka. The competition specifies several fields, among them drug dependence. This year the City of Rijeka provided 120,000.00 HRK or around 16,000.00 EUR for the Harm reduction program implemented by Terra.
Due to problems with the managing of the City of Zagreb and a court procedure against the mayor and his associates, the Macedonian delegation was not able to meet with representatives from the City Of Zagreb to gather information about the financing of the HIV prevention programs.
Be that as it may, the organizations we visited mentioned there was a possibility to apply for HIV prevention projects with the City of Zagreb. Usually, the amount granted is notably smaller than the financial support offered by the Ministry of Health, however it is an opportunity to complement the existing activities.