Bakhrom Ibragimov, HIV Program Manager, EpiC Tajikistan
Marvorid, a civil society organization (CSO) working in Tajikistan since 2009, strives to prevent and reduce the spread of HIV and other infectious diseases and to provide harm reduction programming for key and priority populations. Like many other CSOs in Tajikistan, the organization has relied on funding from international donors, implementing programming with funds from the United States Agency for International Development (USAID) and the United Nations Population Fund (UNFPA). While this funding enables great work, the dependence on international funding can create instability when donors shift funding priorities or transition out of the country entirely. To ensure continuity of services in the future, Marvorid began looking into receiving funding from the national government in Tajikistan. This type of arrangement — where governments enter into an agreement to outsource public services, such as HIV services, to non-governmental entities — is called social contracting.
Previously, the Agency for Social Protection of the Population (Agency) under the Ministry of Health, and Social Protection of the Population of the Republic of Tajikistan (MoHSPP RT) only provided social contracting funding to organizations providing care and support services for disabled children and the elderly in difficult life situations. Organizations providing HIV services were unable to access these funds as the government did not have standards in place for HIV organizations to enter into social contracting agreements.
In August 2020, Marvorid started receiving funding from the Meeting Targets and Maintaining Epidemic Control (EpiC) project, funded by USAID and the U.S. President’s Emergency Plan for AIDS Relief, to continue to provide HIV prevention and testing services, pre-exposure prophylaxis (PrEP), and case management for people living with HIV (PLHIV). Together with CSOs in Tajikistan, the EpiC project worked with the National Coordination Committee, State Sanitary and Epidemiological services (SSES), and the Republican AIDS Center (RAC) to develop a report on the country’s HIV epidemiological situation. The report showed that increased funding and geographical coverage through state social contracting would enable expanded service delivery in support of achieving and sustaining epidemic control.
EpiC and CSO partners developed specifications and standards for CSOs to deliver HIV services. These were presented to a government-led technical working group on social contracting and in November 2022, they were approved by MoHSPP RT, creating a social contracting mechanism for the government of Tajikistan to fund CSOs to provide HIV services. Through this change in policy, CSOs in Tajikistan are now recognized as reliable and experienced partners to the national government in delivering community-based HIV services.
The following month, the MoHSPP RT released a call for tenders for CSOs to apply for state social contracting to provide HIV services. EpiС provided support and technical assistance to all interested CSOs in preparing a proposal, a budget, and other requested documents. Marovoid was one of two EpiC-funded organizations that was successful in receiving the funds.
Using state funding, Marvorid was able to expand their geographical coverage to other districts, including two new cities (Rogun and Faizabad), as well as to EpiC project sites (Vahdat, Hissor, Rudaki, Tursun-zade and Shahrinav). Through state social contracting, the organization now provides the following services:
- HIV counseling and screening using OraQuick HIV tests.
- Referral and accompaniment of those with a positive screening result to AIDS Centers for confirmatory HIV testing.
- Provision of case management services for PLHIV to ensure timely initiation or re-initiation and adherence to antiretroviral therapy (ART).
- Peer-to-peer counseling for timely initiation of and adherence to ART.
- Linkage to viral load testing for clients on ART for at least six months.
Public organizations and society play an important role in the fight against HIV, actively participating in the implementation of the national program to combat the HIV and AIDS epidemic. Reaching key and vulnerable populations, protecting human rights, ensuring transparent planning, implementation, evaluation, and resource mobilization with government funding makes our approach united, and unity is strength! When there is teamwork and cooperation, excellent results can be achieved.Rano Kaharova, Director of Marvorid
Between January 2023 and September 2023, Marvorid reached 1,345 people with HIV prevention and testing services under EpiC programming. In February 2023, Marvorid began outreach in the new geographical coverage areas made possible through social contracting. Between February 2023 and September 2023, Marvorid was able to reach an additional 99 people with HIV services in these new areas, representing around a seven percent increase in people reached.
This blog is part of a series highlighting EpiC’s local partner capacity strengthening work. Check back next Thursday for another story on capacity strengthening.
Featured image: Marvorid staff counseling client after HIV test (Photo credit: Marvorid).