TB outreach in Bulgaria post Global Fund – a guessing game?

Update: On 5th of March, the Ministry of Health announced a public tender for TB services for the NGOs. Unfortunately, the call for tender covers only 4 cities – Vidin, Gabrovo, Sliven and Pernik and only for the 6 months, with the total amount of 9300 euro per city. The scope of services includes: First of all, 200 persons screened by inquiries; secondly, 100 persons screened by Mantoux skin tests and finally, only 10 people accompanied and assisted for treatment. Thus, although the initiative of the Ministry of Health is commendable, the actual amount allocated is minuscule and cannot be considered as sustainable long term solution. 

On 14th and 15th of February, TB Europe Coalition organised a two-day advocacy workshop for civil society organisations and activists from all around Bulgaria. The workshop aimed to build and strengthen coordination amongst tuberculosis (TB) interested civil society organisations and activists ahead of the withdrawal of the Global Fund to fight AIDS, TB and Malaria (Global Fund) from the country.

The country has been a recipient of donor support to their HIV/AIDS and TB programmes from the Global Fund since 2004 and 2008 respectively. Following Bulgaria’s accession to the EU and its continuously improving economic status, the Global Fund has been gradually withdrawing its support from national TB and HIV programmes, with HIV grant’s administrative closure taking place in May 2017 and TB grant’s closure to take place on 31st March 2019.

Throughout the years, Bulgaria has been praised as an example amongst other countries in the region for successful engagement of NGOs in service delivery and subsequent substantial decline in HIV and TB epidemics in the country. Unfortunately, civil society’s work had been exclusively financed by the Global Fund. Although Bulgarian government has foreseen budget for the new national TB and HIV programmes, adopted for period 2017-2020, there are very few funds to support NGO work, and what is more difficult – the access to these funds are further complicated by difficult public procurement mechanisms. Thus, following the end of HIV grant, the first call for proposals with regards to NGO engagement in service delivery received only a few applications from previously active and committed NGOs due to impossible indicators and financial restrictions. At the end of the call, only two contracts were signed, although the funding was foreseen for 13 civil society organisations. The second call for proposals, with the amended requirements, received a more positive response from civil society but is still considered relatively rigid and financially unviable in the long term.

Thus, the mood in the room despite it being St. Valentine’s Day was rather sombre. The civil society organisations discussed the importance of TB prevention, care, and outreach for their communities, reflected on what are the problems civil society organisations, working on TB, are currently facing and exchanged views on what will happen after 31st of March. Further, the civil society organisations then discussed a potential advocacy strategy and specific targets for this year that would allow better engagement for NGOs in TB service delivery.

The NGOs were helped there and then during the session to create an online listserve to exchange plans and views of developments within the country. This was important as providing a concrete tool for future action and for giving reality to their agreement to work as a common Forum of TB-interested NGOs.

The workshop was joined by E-DETECT TB partner from the Marius Nasta Institute in Romania, Dr. Dan Gainaru, who presented E-DETECT project and its activities in Romania and Bulgaria, specifically, development and use of the mobile TB screening unit, a modified truck. Furthermore, the Director of national TB and HIV programmes in Bulgaria, Dr. Tonka Varleva and her team attended one of the workshop sessions and discussed what can be expected following the end of the Global Fund grant in March 2019. Dr. Tonka Varleva reiterated the crucial role of NGOs in TB prevention, care and outreach and promised her support in continuing NGO engagement in service delivery. Finally, several experts from KPMG, commissioned by the Global Fund to review the sustainability of HIV and TB grants after the withdrawal in March 2019 also attended the workshop.

Although after two-days work the mood in the room shifted slightly, it is clear that a lot has yet to be done in order not to loose the decrease in TB and HIV incidence rates. Currently, TB case numbers in Bulgaria remain more than three times higher than the European Union average. Thus, there is still a lot of work to be done, especially in reaching out to key vulnerable populations, which can only be done by civil society organisations that are well liked and trusted by the community. In order not to loose what has already been achieved and continue to improve the TB incidence rate, Bulgarian civil society will have to work as one, be as inventive as it can possibly be and engage with various decision makers, from the Ministry of Health to national parliament members.

If you are interested to learn more about TBEC engagement in Bulgaria, please read: 1) TBEC country case study on transition and sustainability post Global Fund withdrawal, 2) TBEC country visit reports and 3) TBEC best practice example in Bulgaria, specifically, in TB outreach with vulnerable groups.

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TB outreach in Bulgaria post Global Fund – a guessing game?
TB outreach in Bulgaria post Global Fund – a guessing game?