Making a difference: UNAIDS in Ukraine
08 January 2008
In the first of web special series focusing on the work of UNAIDS staff at country level, http://www.unaids.org/ talks to UNAIDS Country Coordinator in Ukraine, Dr Ana Shakarishvili, about the response in the country, her role and her motivations.
In the two years that Ana Shakarishvili has been the UNAIDS Country Coordinator in Ukraine, she has seen a lot of changes. The high profile of the epidemic in the country has led to a dramatic increase in attention from donors and other partners. “Our work entails a lot of coordination between UN agencies and very active support to the UN Theme Group and Joint Team on AIDS,” says Shakarishvili. “Dealing with different agencies with different mandates, and different personalities, is an inseparable part of our lives.”
In addition to typical UNAIDS work around advocacy, coordination of the AIDS response and monitoring and evaluation, the Ukraine office provides technical support in many areas. “In other words our daily lives are enormously busy. We work overtime, there’s no day that ends early,” says Shakarishvili. “But in terms of the daily work, the greatest thing we share is real teamwork. There is an amazing level of coordination and understanding between each partner and that is something we are proud of.”
Ukraine has the most severe epidemic in Europe, and despite the support of government and donor programmes, the epidemic continues to grow. “It is even more concerning that we now have an unprecedented high level of resources available in the country, including two grants from the Global Fund amounting to $243 million,” says Shakarishvili. It was this conundrum that led the government’s National Coordinating Council on AIDS to request an ambitious piece of research that will evaluate the national AIDS response so far. This external evaluation, which is being coordinated by UNAIDS, will look at the work of all partners in 130 programmatic areas.
“We will have a database on what is working and what needs to be done in the future,” says Shakarishvili. “Nothing at this kind of scale has ever been done in the world. And we are really proud of that. It does put us in a rather interesting position of being responsible for pulling together efforts for this evaluation that will inform further discussions at both national and sub-national levels about what should be done next.”
The importance of this evaluation cannot be overestimated: it will feed directly into the government’s new national AIDS plan which is to be developed in 2008. The UNAIDS office and the cosponsors will play a major role in this process, helping the government to revise its national AIDS programme, including national and sub-national access targets. “We are trying to help the government develop a totally new format for the national AIDS plan which will be well-costed with clear universal access and monitoring and evaluation targets and technical support requirements,” says Shakarishvili. “Up until now the national plans were vague and were more like a framework than a clear plan.” For the first time the government plan will also include contributions of all sectors of the government as well as civil society organisations, the private sector and the donor community.
Dr Shakarishvili notes that one of the biggest challenges of working in Ukraine is the political instability that the country has experienced in recent years. Frequent elections and changes in government affect the continuity of the work and the capacity and commitment of government to make sustainable progress. “The NGOs, and civil society organisations are very mobilised and very strong especially at the national level, compared with other countries that I have seen. There is a coalition of NGOs uniting over 70 NGOs providing HIV services. But there is still somehow a level of complacency in the governmental sector. We need to encourage more and greater leadership on the issue particularly from the governmental sector. The decree of President Yushchenko that was issued just after the World AIDS Day a few weeks ago, calls for urgent scaling up of response to AIDS and increased accountability. That gives all of us much hope,” she says.
Despite the challenges there has been progress. “We are really seeing some differences at the national level, which is a result of joint advocacy, including that from the UN.” Aspiration also comes from daily contact with the civil society organisations that provide many HIV services in the country. “We call ourselves one big family. We work pretty much together with the government, parliamentarians, NGOs, communities of people living with HIV, development partners and the private business. Its a huge sector.”
Shakarishvili joined UNAIDS after a long career in the Centers for Disease Control and Prevention in the US. “I love it here”, she says. “Despite the large work loads, what motivates me at the moment, is this momentum to do more in Ukraine, to really make a difference by changing the way the epidemic is going and preventing that from becoming generalized. There is enormous potential that this country has, a real belief that Ukraine should be able to slow down this epidemic and achieve universal access targets in a few years.”
“There are fantastic people and competent organizations here, and we hope and trust that people and communities can make a difference. If we don’t rapidly scale up efforts and make an impact in Ukraine, there is less hope for other countries in the region, especially Russia.” On the other hand, successes in Ukraine will bring hope for others. “Ukraine has managed to increase the number of people on treatment from 200 in 2004/5 to currently over 7000, reach the coverage level of prevention programmes of 35% of injecting drug users, and finally allow the importation of methadone for substitution maintenance treatment for injecting drug users – these are the messages to the rest of the world,” says Shakarishvili.
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