Report of the Independent

Evaluation of the HIV/AIDS

Programme in Bosnia and
Herzegovina
Final Report !anuar" #$%&
A'(no)ledgements
This report was prepared by the AIDS Projects Management Group. It was written
by a team of independent consultants Da!e "urrows# Arlette $ampbell %hite#
&ou Mc$allum# Aram Manuyan and Anna Shapo!al# who carried out all aspects of
the e!aluation with logistical and interpreter support from the 'I()AIDS
Programme Management *nit of the *nited +ations De!elopment Programme in
"osnia and 'er,ego!ina.
The authors than- the following organisations for their assistance with this report
.a/ the Ministry of $i!il A0airs "i' .M1$A/2 .b/ 3ederation of "osnia and
'er,ego!ina the 3ederal Ministry of 'ealth .3M1'/# AP1'A# Association 45# the
Institute for Alcoholism and Substance Abuse of Saraje!o $anton# the 6oma 'I(
$entre in 7a-anj# Margina# Partnerships in 'ealth# Public 'ealth Institute of 3"i'#
*G P61I# 3aculty of Medicine Saraje!o# the Department of Psychiatry Tu,la2 and
the Infectious Disease $linic Saraje!o and Tu,la2 .b/ in the 6epublic of Srps-a
the Ministry of 'ealth and Social %elfare .M1'S%/# Action Against AIDS# the
Department of Psychiatry of the General 'ospital in Doboj# Poenta# Public 'ealth
Institute 6S# the State 'ospital of St. &u-a in Doboj# Infectious Disease $linic
"anja &u-a2 and (i-torija2 and .c/ in the district of "r8-o the Public 'ealth
Institute. &i-ewise# than-s are e9tended to the International organisation for
Migration .I1M/ and %orld (ision.
Although too many to mention here
:
# we would li-e to than- e!eryone who ga!e
up their !aluable time to meet with the ;!aluation Team and share their insights
concerning the Programme<s performance and their e9pectations and !ision for
the future. In particular# we would also li-e to than- the sta0 from the !arious
public !oluntary counselling and testing and antiretro!iral therapy clinics and
opioid substitution therapy .1ST/ centres that we !isited# as well as the truc-
dri!ers and the police.
%e would also li-e to than- representati!es from the =oint *nited +ations
Programme on 'I()AIDS# *+DP 6egional 1>ces# the *nited +ations Population
3und# the *nited +ations $hildren<s 3und and the %orld 'ealth 1rganisation# as
well as the &ocal 3und Agent from the *nited +ations 1>ce of Project Ser!ices.
The following indi!iduals were of particular help to the authors D?anela "abi@
.*+DP/# Arijana Drini@ .*+DP/2 Dr Aerifa Godinja-# $$M $hairman2 SaBa Pote?ica
.*+DP/ and# last but by no means least# Dr +eBad Aeremet# Programme Director#
Global 3und 'I()AIDS Programme# *+DP.
3inally# we would li-e to than- the bra!e men and women from the !arious focus
groups put together from -ey a0ected populations who were willing to tal- to us
about their e9periences# their dreams and their hopes for the future. This report
is about you# and for you and we hope that we ha!e reCected your honesty and
willingness to help us ma-e your ser!ices e!en better suited to your needs.
:
The names of people met are listed in Anne9 A.
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina D
*+,-E,-S
Abbre!iations E
;4;$*TI(; S*MMA65 F
:. I+T61D*$TI1+ :G
Geopolitical# Go!ernance and Socioeconomic "ac-ground :G
Geography..................................................................................................... :G
Political 'istory.............................................................................................. :G
Go!ernance.................................................................................................... :H
Socioeconomic Situation................................................................................ :E
Population...................................................................................................... :E
The 'ealth System :E
The PreI%ar 'ealth $are System...................................................................:J
1rganisation and Management of 'ealth $are after the :KKDI:KKE $i!il %ar
....................................................................................................................... :J
'ealth $are 6eform and 3inancing.................................................................:F
The Status of the 'I( ;pidemic in "i' :K
'I( Pre!alence............................................................................................... :K
Population Si,e ;stimation .PS;/....................................................................DL
"i'<s 6esponse to 'I( and AIDS D:
Strategic *nity in Pre!enting and $ombating 'I()AIDS.................................D:
D. G&1"A& 3*+D S*PP16T T1 "i' DG
'I( Programme 6ound E .DLLJIDL::/ DG
1bjecti!e :..................................................................................................... DG
1bjecti!es D and E......................................................................................... DG
1bjecti!e G..................................................................................................... DH
1bjecti!e H..................................................................................................... DH
1bjecti!e J..................................................................................................... DE
1bjecti!e F..................................................................................................... DE
'I( Programme 6ound K .DL::IDL:E/ DJ
Phase I........................................................................................................... DM
Phase II.......................................................................................................... GL
1bjecti!e : Ma9imise the $o!erage of ;0ecti!e 'I( Pre!ention and $are
among MostIatIris- Populations.....................................................................GL
1bjecti!e D ;nsure appropriate pre!ention# treatment# care and support for
people li!ing with 'I( and AIDS.....................................................................GK
1bjecti!e G Strengthen the ;nabling ;n!ironment for Scaling up 'I(
Pre!ention and $are....................................................................................... HD
1bjecti!e H Strengthen $oordinating and Implementing Agencies< $apacity
to 6espond to 'I()AIDS.................................................................................. HG
G. P61G6AMM; ;(A&*ATI1+ S$1P;# 1"=;$TI(;S A+D M;T'1DS HF
;!aluation Goals and 1bjecti!es HF
;!aluation Approach HF
%or- Plan HM
Phase : Inception.......................................................................................... HM
Phase D Intensi!e Data $ollection.................................................................HM
Phase G Analysis and 6eporting....................................................................HM
H. ;(A&*ATI1+ 3I+DI+GS HK
Social# ;conomic and Political 3actors HK
Target Groups EL
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina G
5outh.............................................................................................................. EL
6oma Population............................................................................................ EL
1ther Minority Populations.............................................................................EG
'I( Programme Ser!ice Deli!ery EG
($T and A6T Pro!ision EE
Stigma and Discrimination EJ
Sta>ng and Training EM
E. 6;$1MM;+DATI1+S EK
Social# ;conomic and Political EK
Target Groups EK
5outh.............................................................................................................. EK
6oma Population............................................................................................ JL
1ther Minority Populations.............................................................................JL
'I( Programme Ser!ice Deli!ery JL
($T and A6T Pro!ision J:
Stigma and Discrimination JD
Sta>ng and Training JD
Anne.es
Anne9 : ;!aluation Matri9
Anne9 D &ist of 6eferences
Anne9 G Mission Schedule
Anne9 H The $onceptual 3ramewor- for the ;!aluation
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina H
A//reviations
AAA Action Against AIDS
AI Appreciati!e InNuiry
APMG AIDS Project Management Group
A6T Antiretro!iral treatment
A6( Antiretro!iral .medicines/
""S "ioIbeha!ioural sur!ey
"i' "osnia and 'er,ego!ina
"SS "eha!ioural sentinel sur!eillance
$"1 $ommunityIbased organisation
$$M $ountry $oordinating Mechanism
$1; $ouncil of ;urope
$S1 $i!il society organisation
DI$ DropIin centre
D1TS Directly obser!ed treatment# short course tuberculosis
;$D$ ;uropean $entre for Disease Pre!ention and $ontrol
;* ;uropean *nion
3"i' 3ederation of "osnia and 'er,ego!ina
3"1 3aithIbased organisation
3P 3amily planning
3S% 3emale se9 wor-er
G"( GenderIbased !iolence
GDP Gross domestic product
G3 Global 3und for AIDS# Tuberculosis and Malaria
G+P Gross national product
'AA6T 'ighly acti!e antiIretro!iral therapy
'"()'$( 'epatitis " and $ !iruses
IDP Internally displaced persons
I&1 International &abour 1rganisation
I1M International 1rganisation for Migration
IPT$S Integrated Pre!ention# Treatment# $are and Support
7APs 7ey a0ected populations
7APS" 7nowledge# attitude# practices and beha!iour
MO; Monitoring and ;!aluation
M'66 Ministry for 'uman 6ights and 6efugees
M13 Ministry of 3inance
M1' Ministry of 'ealth
M1'S% 6S Ministry of 'ealth and Social %elfare of the 6epublic of
Srps-a
MSM Men who ha!e se9 with men
MT$T Mother to child transmission
M'$ Municipal 'ealth $ouncil
+;P +eedle and syringe e9change
+G1 +onIgo!ernmental organisation
1SD( 1nISite Data (eriPcation
16 1perational research
1ST 1pioid substitution therapy
P'$ Primary health care
P'I Public 'ealth Institute
PI$T Pro!iderIinitiated counselling and testing
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina E
P&'I( Persons li!ing with 'I(
PMT$T Pre!ention of motherItoIchild transmission
PM* Programme Management *nit
PP3 Programme Performance 3ramewor-
P6 Principal 6ecipient
PS; Population si,e estimate
P%ID People who inject drugs
6"A 6ightsIbased approach
6DS 6espondentIdri!en sur!ey
6S 6epublic of Srps-a
6SQA 6apid ser!ice Nuality assessment
SDA Ser!ice deli!ery area
S1P Standard operating procedures
S6 SubIrecipient
SS6 SubIsubIrecipient
S% Se9 wor-er
T16 Terms of 6eference
T6P Technical and 6e!iew Panel
*+ *nited +ations
*+AIDS =oint *nited +ations Programme on 'I()AIDS
*+DP *nited +ations De!elopment Programme
*+3PA *nited +ations Population 3und
*+I$;3 *nited +ations $hildren<s 3und
*+1PS *nited +ations 1>ce of Project Ser!ices
*+TG *nited +ations Thematic Group on 'I()AIDS
($T (oluntary counselling and testing
%'1 %orld 'ealth 1rganisation
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina J
E0E*1-IVE S122AR3
"osnia and 'er,ego!ina ."i'/ has a comple9 political and administrati!e
structure. The Dayton Peace Agreement signed in :KKE retained "i'Rs
international boundaries and created a joint multiIethnic and democratic
go!ernment .the $ouncil of Ministers/ charged with conducting foreign#
diplomatic# and Pscal policy. Also recognised was a second tier of go!ernment
comprised of two ;ntities roughly eNual in si,e the 3ederation of "osnia and
'er,ego!ina .3"i'/ with cantons# and the 6epublic of Srps-a .6S/ each ;ntity
has its own parliament. In DLLL# "r8-o District became a separate administrati!e
unit under the so!ereignty of "i' that remains under international super!ision. In
total "I'# between the two ;ntities and "r8-o District# has three presidents and
:MG ministries.
The country has a lowIle!el 'I( epidemic. 'I( pre!alence has not e9ceeded E S
in any dePned -ey a0ected population .7APS/ and the pre!alence in the general
population is below : S. Since the Prst registered 'I( case in :KMJ until the end
of DL:D there were DDD 'I( registered cases out of which :DL persons de!eloped
AIDS. The main mode of transmission for the period :KMJ to DL:: is reported as
heterose9ual .EJ.: S/# followed by men who ha!e se9 with men .MSM/ at D:.K S
and people who inject drugs .P%ID/ at :L.F S. 6ecent data show increasing
incidence in the MSM population# with :H out of :F .MD.E S cases registered for
antiretro!iral therapy .A6T/ in the Prst three Nuarters of DL:D occurring in the
MSM population.
There is a mechanism at the national le!el that o!ersees and ad!ises on the
'I()AIDS programme in the country. The +ational Ad!isory "oard for $ombating
'I()AIDS in "osnia and 'er,ego!ina .+A"/ is chaired by the Ministry of $i!il
A0airs .M1$A/ and was established in early DLLD with the tas- of de!eloping a
strategy to pre!ent and combat 'I()AIDS and further de!elop the planning and
implementation processes in the Peld. It is comprised of representati!es from
di0erent Ministries# ci!il society and international organisations. ;ach of the two
;ntities and the District of "r8-o has 'I( and AIDS +ational $oordinators to
facilitate and coordinate the tas-s underta-en by the +A".
The Global 3und to 3ight AIDS# Tuberculosis and Malaria .G3ATM/ has been
pro!iding a signiPcant le!el of funding to the 'I( response since awarding the
country its Prst grant in DLLE. This grant focused particularly on scaling up 'I(
pre!ention among those populations most a0ected by 'I(. This wor- continued
through a second grant awarded under 6ound K. Phase I has been completed2
Phase II was awarded in DL:D and is currently being implemented.
The *nited +ations De!elopment Programme .*+DP/ was nominated Principal
6ecipient .P6/ by the $ountry $oordination Mechanism .$$M/. %hile *+DP is the
implementing agent and responsible for the management of the 'I( Programme#
the o!erall ownership of the implementation of Global 3und grants rests with the
Go!ernment of "i' and the $$M# where the M1$A is the -ey counterpart for
*+DP at the national le!el together with the 3ederal Ministry of 'ealth .3M1'/
and the Ministry of 'ealth and Social %elfare of the 6epublic of Srps-a .M1'S%
6S/# as the two "i' ;ntity le!el ministries in charge of health issues.
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina F
ToIdate there has ne!er been an e!aluation of the national 'I( programme in
"i'. A 6apid Ser!ice Quality Assessment .6SQA/ was conducted for the 'I()AIDS
Global 3und grant in DL:D and a number of issues related to Nuality were
identiPed. These issues and suggestions were in the areas of guidelines and
protocols# pro!ider practices and recording and reporting2 and ha!e been
addressed.
;!en though the national programme is ma-ing progress towards proposal goals#
"i' is in need of an independent e9ternal e!aluation of the national 'I( and
Global 3und grant programme because it needs to assess progress in order to
ensure that the proposed inter!entions are achie!ing high impact in the most
costIe0ecti!e manner. Accordingly# in +o!ember and December DL:G# a team
from the Aids Project Management Group .APMG/ conducted an e!aluation of the
programme since its inception. This in!ol!ed re!iewing documents# inter!iewing
-ey informants both indi!idually and through focus groups# and !isiting
Programme acti!ities in "anja &u-a# "ihach# "jeljina# "r8-o# Doboj# 7a-anj#
Mostar# Saraje!o# Tu,la and Ti!inice.
In order for a country to respond e0ecti!ely to its 'I( epidemic# it is essential
that it understands what dri!es the epidemic and who and where the -ey
populations at ris- are. *nder the 6ound K proposal# "i' has dePned its target
groups as the general population and -ey populations at increased ris- of 'I(
infection2 the -ey a0ected populations .7APs/ are MSM# P%ID# S% and their
clients# asylum see-ers# refugees# prisoners# internally displaced persons .IDP/#
the transient population# young people and persons who li!e on or below the
po!erty line. Populations which are !ulnerable to 'I( also included persons
e9posed to 'I( in a professional capacity2 for e9ample# healthcare wor-ers who
come into contact with bodily Cuids as well as other professionals such as
policemen# soldiers# correctional o>cers# Pre Pghters# rescue ser!ice o>cers and
members of associations and foundations that pro!ide harm reduction ser!ices.
In addition# there is consensus that signiPcant attention should be paid to the
6oma population due to their marginalisation and youth I particularly adolescents
and primary school pupils in rural areas.
'owe!er# one of the -ey challenges of de!eloping an 'I( programme that is
targeted towards 7APS in "i' has been the di>culty in assessing the si,e of
these populations2 without a !alidated population si,e estimate it is di>cult to
assess if the co!erage of 7APs has been su>cient. In order to calculate this# in
DL:D a Population Si,e ;stimate .PS;/ sur!ey was organised and implemented by
a team of national specialists and international consultants. The monitoring and
e!aluation .MO;/ units of the country<s two public health institutes in 3"i' and
6S# as well as national nonIgo!ernment organisations .+G1s/# were in!ol!ed in
the sur!ey implementation process. 'owe!er# the data obtained did not pro!ide
a national le!el estimate as reNuired by the G3# hence it could not be !alidated
by +A".
Accordingly the APMG ;!aluation Team# concurrently while conducting the
e!aluation# also undertoo- a data !eriPcation e9ercise to re!iew the results of the
former PS; and present its Pndings to both $$M and +A" meetings held on :H
+o!ember DL:G. +ational sta-eholders re!iewed the PS; 6eport and consensus
was reached on the si,e of 7APs.
Su''esses
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina M
"ased on the a!ailability of su>cient epidemiological e!idence in "i'# it can be
seen that the 'I( situation in "i' has not mo!ed from one of low pre!alence to a
concentrated epidemic. Gi!en the ris- factors that e9ist and will continue to
e9ist# it is logical to place the reason for this on the e9istence of a strong national
response to 'I( and AIDS. The country has begun to introduce e0ecti!e 'I(
pre!ention measures among -ey populations at ris-# in particular# MSM# P%ID#
S%# truc-ers and mobile populations# prison inmates# and the 6oma. These
include pro!ision of sterile injecting eNuipment and opioid substitution therapy
.1ST/ through a networ- of go!ernment centres# drop in clinics .DI$/ and
outreach wor-2 the pro!ision of condoms and other ser!ices# including diagnosis
of se9ually transmitted infections .STI/ and 'epatitis " and $ and referral for
treatment2 and the pro!ision of A6T through Go!ernment A6T centres. Ser!ices
are deli!ered through a combination of Go!ernment ser!ices wor-ing in tandem
with se!eral +G1s.
The 'I( Programme has became an unprecedented case of consensus building#
bringing together and promoting collaboration among Go!ernment and ci!il
society from across all three highly segregated political di!isions .the 3"i'# the
6S and "r8-o District/ !ia the platform of +A" and the $$M. 'I( is the only stateI
wide programme with its own Strategy .e9cluding T"/ and one which pro!ides a
forum to bring together di!erse sta-eholders representing di0erent sectors and
interests.
If one were to e!aluate the Programme from a pure U!alueIforImoney<
perspecti!e# the per capita cost would be e9pensi!e. 'owe!er# it was designed
when the country was still reco!ering from the e0ects of a war and within a
broader framewor- of health system strengthening2 as such# the 'I( Programme
has had crucial nonIhealth e0ects# including political# peaceIma-ing and socioI
economic .incomeIgenerating/ impacts that cannot be easily measured V if at all.
The 'I( Programme has pro!ided a uniNue opportunity to create a system of
anonymous and freeIofIcharge ser!ices bridging most hidden 7APs with the
public health system. The engagement of 6oma and MSM are seen as special
successes since both groups are e9tremely stigmatised and ignored in society2
the 'I( Programme is the only inter!ention so far co!ering both populations.
Stigma and discrimination towards most at ris- populations is being addressed
and attitudes are !ery slowly beginning to change.
The past se!en to eight years of acti!ities ha!e seen changing attitudes towards#
and an increase in# safer beha!iour among targeted 7APs# especially P%ID and
6oma# and in particular as a result of harm reduction inter!entions. This higher
le!el of awareness is also illustrated by the low number of 'I( cases among 7APs.
Success in implementing the country<s 'I( response is largely attributed to the
wise selection# culti!ation# and acti!ism of indi!idual agents of change V such as
speciPc Go!ernment sta0# the *+DP P6 and its leadership# and +G1 leaders# who
ha!e e0ecti!ely promoted all inter!entions .including Nuic-ly introduced and
inclusi!e acti!ities such as needle syringe e9change programmes .+;P/# 1ST#
!oluntary and conPdential testing .($T/ and antiretro!iral .A6(/ treatment/.
The country has de!eloped a cohort of wellIeducated# openIminded and
e9perienced practitioners as a result of comprehensi!e training and education
e0orts within both 6ound E and 6ound K grants in both state and +G1 sectors
who will continue using their -nowledge and s-ills after the completion of G3ATM
project funding2 and this is seen as part of the process of sustainability.
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina K
3inally# the establishment of a national MO; database and the engagement of all
sta-eholders# including +G1s# in research and analysis# pro!ide opportunities for
increasing the e0ecti!eness of the Programme.
*hallenges
In spite of the successes of the Programme# a number of challenges remain.
Perhaps one of the biggest obstacles to the future of the Programme is the
pre!ailing and !ery strong stigma and discrimination against 7APS# particularly
MSM and S%# by the general public and health care wor-ers which is also fuelled
by religious beliefs and leaders as well as the somewhat conser!ati!e and
patriarchal nature of society in "i'.
The o!erall comple9ity of the administrati!e system in "i'# including
considerable di0erences among the three political di!isions and the impact this
has on health ser!ice deli!ery# is a challenge to ser!ice deli!ery in terms of
standardising guidelines and protocols and ensuring the sustainability of the
Programme. The freNuent turno!er of Go!ernment o>cials negati!ely a0ects the
consistency and stability of ser!ice pro!ision. Moreo!er# the !ariation in the
regulatory framewor- between the two ;ntities is an e9ample of this. The
criminalisation of drug possession and Upoliticisation< of 1ST .1ST was legalised
as a medicine but there is no political commitment to support it after G3ATM
funding ends because of lac- of funds as well as because di0erent politicians play
the 1ST card as Ulegalisation of illegal drugs<# Uthreatening citi,ensR wellIbeing<#
and so on/. "oth se9 between men# and se9 wor-# are illegal# although they
clearly e9ist. This results in these groups feeling e!en more isolated and
Uhidden<# and hence unwilling to access Go!ernment ser!ices run by sta0 who
they may feel are judgemental and discriminatory.
There appears to be insu>cient of coordination and collaboration among di0erent
sta-eholders# including the subIrecipients .S6/ V for e9ample# there is no cohesi!e
S6Iwide training strategy or plan2 hence there are lost opportunities to combine
and ma9imise training e0orts. 'owe!er# at the same time there ha!e been
sudden sta0 cuts resulting in the number of sta0 of the P6<s Programme
Management *nit .PM*/ being cut in half. Gi!en the huge amount of wor-
in!ol!ed in the intensi!e programme grant management of a large number .:D/
of S6# the time of the P6 sta0 is spread !ery thinly with barely enough time for
monitoring and super!isory acti!ities. This has resulted in underIresourced
programmatic e9pertise at the P6 le!el along with an underIresourced
coordinating role for programmatic acti!ities.
JE S of the 'I( Programme is funded by the "i' Go!ernment# largely through
ser!ice deli!ery .DD ($T centres and three A6T clinics/ and the purchase of A6(.
The remaining GE S of the Programme is supported by the Global 3und .($T
clinic sta0# +G1 wor- with 7APS including the DI$ and outreach wor- that is so
critical in reaching these populations with much needed ser!ices. 'owe!er# there
ha!e been changes in the G3ATM<s funding modalities and priorities since 6ound
K was appro!ed. In today<s economic climate which has also a0ected the Global
3und# it is hard to see how the 3und can continue to support a high middle
income country with a low pre!alence rate. It is clearly undesirable and
unsustainable for the country to be solely reliant on one e9ternal funder.
+onetheless# there does not appear to ha!e been much dialogue on programme
sustainability at any le!el# while Go!ernment commitment remains wea- to
absorbing sta0 costs or supporting +G1s.
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina :L
There is low co!erage of ($T sites in terms of numbers and !ulnerable
populations !isiting such sites2 since 'I( testing is only a!ailable through medical
sta0# and lac- of rapid testing through +G1s .DI$ and outreach wor-ers/# means
that not enough 7APs are being tested.
3ollowing the closure of the youthIfriendly clinics at the commencement of Phase
II and the inability of the Go!ernment to absorb their acti!ities into either the
formal or nonIformal education sector# there appears to be an absence of any
primary pre!ention among youth.
There is a lac- of gender sensiti!ity in both ser!ice design and pro!ision. All
ser!ices are tailored to men e9cept for the most recent DI$ for female S% .as of
=une DL:G/. There are wea- lin-ages with se9ual and reproducti!e health .S6'/
ser!ices# including family planning .3P/. There appear to be no ser!ices for
pregnant women .some of whom do not e!en recei!e prenatal care/# children of
female clients# !iolence pre!ention and protection2 all of which lead to women<s
increased !ulnerability. %hile Phase II clearly states that it is intended to
Ufeminise< ser!ices# integrate S6' and address genderIbased !iolence .G"(/ while
tailoring ser!ices to the needs of female clients and addressing pre!ention of
motherItoIchild transmission .PMT$T/ through pro!iderIinitiated counselling and
testing .PI$T/# so far this has been slow to happen.
Although opinion di0ers# many inter!iewees cited the apparently poor a!ailability
of health insurance# especially among 7APs# along with the o!erall complicated
nature of the health insurance system and societal ignorance about its
reNuirements# resulting in limited medical co!erage# especially when coupled
with the poor capacity of people to understand and use the system.
A 'epatitis $ epidemic is clearly on the rise with large number of cases detected
but limited access to treatment. It is li-ely that 'epatitis "# closely lin-ed with
'I( and 'epatitis $# is also on the rise but there is a lac- of 'ep " testing -its.
%ith regard to the $$M# there are no thematic %or-ing Groups to address
programmatic concerns# MO;# sustainability and other speciPc issues in more
depth. There is a need for wider representation of some target groups such as
P&'I(.
Sustaina/ilit"
%hile the location of ($T and 1ST sites within state public health care facilities
could be seen as a wea-ness that pre!ents the Programme from reaching out to
more 7APs# it is also a strong element of longIterm sustainability of ser!ices.
Procurement of rapid tests systems# howe!er# is the wea-ness here as it is
completely co!ered by the G3ATM. The same relates to procurement of 1ST
medication. A -ey aspect relating to the sustainability of the 'I( Programme will
be the willingness of the two entities and district go!ernments to commit to
procuring both rapid tests and 1ST medicines.
Prior to the e!aluation# there had been no formal comprehensi!e discussion of
sustainability of the 'I( Programme and related ser!ices either at the country or
local le!el# neither among Go!ernment nor ci!il society partners. 'owe!er# some
+G1s .e.g. Margina/ ha!e been proacti!e in their sustainability planning and see
potential in de!eloping such options as WlocalisationX of ser!ices !ia social
contracting .funding/ by the local go!ernment and social entrepreneurship. 5et
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina ::
the legal framewor- and mechanisms to facilitate this and other possible
inno!ations are still to be de!eloped. There is an ob!ious need to build ad!ocacy
s-ills among +G1 sta-eholders and support them in collaboration with local and
di!ision .3"i'# 6S and "r8-o District/ go!ernments.
The Pnancial power of political di!isions .3"i'# 6S and "r8-o District/ !aries#
hence a !ariety of approaches to Programme sustainability should be de!eloped#
o0ered to sta-eholders and integrated. +o single scheme will wor-.
The $$M should be used as a platform for sustainability dialogues and transition
planning.
There is a big ris- of losing the positi!e impact of the Programme on 6oma and
MSM communities as both groups are highly discriminated and without e9ternal
.G3ATM/ funding they will be left behind. The 'I( Programme has opened some
real opportunities for wor-ing with these communities and careful followIup is
needed.
Re'ommendations
Global 3und support to "i' has resulted in the country -eeping its le!el of 'I(
infection low# and the elements are in place to continue this. 'owe!er# the
danger of relying solely on an e9ternal funding source and the li-elihood that
Global 3und support may not be forthcoming in the longIterm means that the
!aluable gains of the past se!en years may be lost if action is not ta-en now to
ensure programme sustainability.
The ;!aluation Team<s o!erarching recommendation# therefore# is that the
country should de!elop a Transition Strategy with an accompanying costed
1perational)Implementation Plan that sees the withdrawal of G3 support o!er a
P!eIyear period and the introduction of a sustainable Pnancing e0ort.
The ;!aluation Team<s :D main recommendations are presented in "o9 : below.
%hile many of the following recommendations can be implemented regardless of
whether or not a Transition Strategy is prepared# it is recommended that these
proposals are addressed within the conte9t of the Transition Strategy.
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina :D
Bo. % 2ain Evaluation Re'ommendations
%4 Ensure sustaina/ilit" through the de!elopment of a Transition Strategy
with an accompanying 1perational)Implementation Plan# with costing# that
sees the withdrawal of G3 support o!er a P!eIyear period and the
introduction of a sustainable Pnancing e0ort. Initiate a crossIcountry .crossI
;ntity/ dialogue on sustainability and ownership of the Programme at the
state.s/ le!el through de!eloping and promoting the $$M as an e0ecti!e
platform for such dialogue .including creation of thematic %or-ing Groups as
necessary/. This means employing a conte9tIsensiti!e approach and the
de!elopment of multiple sustainability solutions)models for di0erent political
di!isions# and identiPcation of di0erent options to wor- with di!erse groups of
7APS.
#4 Strengthen the fo'us of the Programme5s a'tivities on those areas
)here it 'an ma(e the most di6eren'e7 viz4 promoting HIV
prevention among (e" populations and in parti'ular s'aling up )or(
)ith 2S2 and Roma. This will result in changing some acti!ities# e.g.
Partnership in 'ealth to begin to analyse the collected data to feed results
bac- into the system and inform ser!ice de!elopment and deli!ery.
84 Strengthen HIV prevention a'tivities among (e" populations /"
e.panding servi'es in )a"s identi9ed /" 'lients and servi'e
providers# such as opening more DI$s and mobile ser!ices# further
strengthening the numbers of gate-eepers and outreach wor-ers# and
pro!iding them with the capacity to deli!er e9panded ser!ices .rapid testing#
S6' ser!ices and so on/.
&4 Redu'e late HIV diagnosis and en'ourage more upta(e of HIV testing
among (e" populations through introdu'ing rapid testing through
+G1s# DI$# mobile ser!ices where possible# gate-eepers and outreach
wor-ers.
:4 Strengthen the national 2;E data/ase through development of a
national strateg"# establishing a wor-ing group at subI$$M)+A" le!el#
re!iewing the e9isting research base and any gaps in -nowledge# de!eloping
a programme of operational research to create a solid e!idence base to be
used to inform the de!elopment of targeted inter!entions2 including an
assessment of e9isting data collection and how data are analysed and fed
bac- into the system and to ser!ice pro!iders.
<4 *ondu't another Population Size Estimate =PSE> in #$%&/#$%:# aided
and informed by the DL:G $ensus results and the PS; Manual pro!ided by
APMG.
?4 Implement a *apa'it" Building Revie) and ,eeds Assessment7 as the
basis for de!eloping a comprehensi!e $apacity De!elopment Strategy with
accompanying plan and timetable.
@4 Assess past research on 7APS# stigma and discrimination# and other related
issues to inform the development of a strateg" and implementation
plan in Behaviour *hange and *ommuni'ation =B**>4
A4 Invest in the advo'a'" and fundraising s(ills of lo'al ,B+s7 as )ell
as 'ommunit" mo/ilisation7 to ensure future sustaina/ilit"4 This
Programme has had some real successes and there are se!eral e9amples of
best practice and lessons to be learned that could be applied elsewhere.
"est practices should be written up and disseminated through publications#
websites or other mechanisms.
%$4 Advo'ate for the introdu'tion of 'hanges in legislation )ith
regard to harm redu'tion7 se. )or(7 standardisation/'erti9'ation of
so'ial servi'es for CAPS and so'ial 'ontra'ting =state funding>7 to
encourage use of regular ser!ices by 7APS and encourage the de!elopment
%4 I,-R+D1*-I+,
Beopoliti'al7 Bovernan'e and So'ioe'onomi' Ba'(ground
Beograph"
1.1 "osnia and 'er,ego!ina ."i'/# one of the so!ereign republics that
constituted the former 5ugosla!ia# is located in the western part of the "al-an
Peninsula and co!ers an area of E:#:DK sN. -m. It shares international borders
with $roatia to the north# south and west# and with Serbia and Montenegro to the
east. "i' has a DHI-m stretch of Dalmatian coast# which includes the tourist
town of +eum. The eastern and central regions of the country ha!e a subI
continental climate with cold winters followed by hot summers# and the southI
west coastal hinterland has a Mediterranean climate. Three Nuarters of "osnia
and 'er,ego!ina belongs to the "lac- Sea "asin# a system of ri!ers feeding the
"lac- Sea# which lies on the eastern side of the peninsula. The ri!ers of the
remaining Nuarter of the country Cow to the Adriatic Sea Y$ain# =. et al# DLLDZ. It
is a mountainous country with some hard to reach places.
Politi'al Histor"
1.2 In :KKL# the Prst democratic# multiparty elections were held and in early
:KKD "i' became an independent country. At that time# it had a multiparty
democratic system and a DHLImember parliament located in Saraje!o. In April
:KKD# "osnia became a member of the *nited +ations .*+/ and a member of the
%orld 'ealth 1rganisation .%'1/. The planned transition from a socialist system
to a mar-et economy was interrupted by the war that commenced in April :KKD
and continued until the signing of the General Framework Agreement for Peace
in Bosnia and Herzegovina# also -nown as the Dayton Agreement in :KKE YIidZ.
1.! It is di>cult to appreciate the comple9 organisation of the health system in
"i' without Prst understanding the impact of the war which shaped the country<s
socioeconomic situation and which# by e9tension# a0ects the present conte9t in
which health ser!ices V including 'I( and AIDS ser!ices V are deli!ered. The war
lasted from :KKD to :KKE and its profound conseNuences are mar-ed by the large
number of !ictims and an increased pre!alence of pre!iously uncommon diseases
and disorders. The e0ects of the war on the health status of the entire
population was reCected through many negati!e demographic trends# the
increasing pre!alence of chronic diseases and the spread of a number of
unhealthy beha!ioural patterns# together with a signiPcant amount of migration.
1." The current constitution of "i' forms an integral part of the Dayton
Agreement. It established two ;ntities# the 3ederation of "osnia and 'er,ego!ina
.3"i'/ and the 6epublic of Srps-a .6S/. *nder this constitutional construction "i'
is a so!ereign state with a decentralised political and administrati!e structure. In
addition# the area of "r8-o# in the northIeast corner of the country# had already
been settled through international arbitration when "r8-o District was established
in March DLLL# with powers largely similar to those of the two ;ntities. "r8-o
District was not allocated to either ;ntity under the Dayton agreement and
remains a separate# third authority within "i'. The state of "i' is the central
authority but has only limited and speciPc powers whereas the two ;ntities and
"r8-o District are politically# administrati!ely and legally Pscally autonomous to a
large degree. The entities ha!e their own respecti!e constitutions and hold all
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina :G
responsibility not e9pressly assigned to the State by the "i' constitution. As a
result# the country has three presidents and :MG ministries spread between the
two ;ntities and "r8-o District.
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina :H
Figure % Politi'al and Administrative 2ap of Bosnia and Herzegovina
Bovernan'e
1.# Today# "i' is a state with a highly comple9 and multiIlayered political
organisation. $onstitutionally# four le!els of administration# including health
system go!ernance# ha!e been recognised .3igure D below/ as follows
.i/ State le!el2
.ii/ SubIstate le!el# consisting of two ;ntities# the 3ederation of "I' .3"I'/
and 6S# and one independent administrati!e district# "r8-o District2
.iii/SubIentity le!el# consisting of ten formal administrati!e
jurisdictions)cantons in 3"I' and P!e geographical regions in 6S2 and
.i!/The community le!el# represented by o!er :HL municipalities
throughout "I'.
Figure # BiH5s Administrative +rganisation
$o%rce& Personal 'omm%nication wit( )H* 'o%ntry *+ce, $ara-evo, 1# .ovemer 2/1!
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina :E
1.0 "osnia and 'er,ego!ina has close to GL political parties# some with a
strong ethnic identity YIidZ.
So'ioe'onomi' Situation
1.1 "osnia and 'er,ego!ina is an upper middleIincome country which has
accomplished a great deal since the midI:KKLs. Today "i' is a ;uropean *nion
.;*/ potential candidate country mo!ing toward alignment with ;* reNuirements.
"etween :KKM and DLLM "i' e9perienced strong growth# with gross national
product .G+P/ per capita nearly Nuadrupling and a reduction in the po!erty le!el
from nearly DL S to around :H S.
1.2 'owe!er# despite this strong economic performance# the onset of the
global Pnancial crisis in late DLLM had a negati!e impact on "i'<s economy# and
is still a0ecting the country today. Despite the lac- of recent data# there are
indications that the progress in po!erty reduction e9perienced up to DLLF has
been stalled by the recent crisis. Po!erty in DLLF was estimated at :: S .*S[E
per day/# with e9treme po!erty at :.E S .*S[D.EL per day/. %hile more recent
po!erty estimates from the DL:: ;9tended 'ousehold "udget Sur!ey are not yet
a!ailable# other indicators# such as unemployment# suggest a deterioration in
li!ing standards due to the crisis and# as e9pected# a re!ersal in po!erty
reduction. More than EL S of the population report recei!ing reduced
remittances# and almost HL S lower wages.
1.3 The main performance indicators of the social assistance system in "i' are
poor by the standards of middleIincome countries in ;urope. Targeting accuracy
is low# while the lea-age of resources to the richest DL S of the population is
signiPcant. 1nly a small proportion of the poor recei!e social benePts# and their
po!erty reduction impact is negligible. The 2/1/ )orld Bank Poverty 4e5ort
found that if these transfers were to be eliminated# the po!erty headcount would
increase by only :.D S. In contrast# the po!erty impact of pensions is much
higher2 without these transfers# po!erty would increase to DE.M S of the
population
D
.
Population
1.1/ According to the preliminary results of the DL:G $ensus the total number
of enumerated persons is G#FK:#JDD with the majority li!ing in the 3ederation
.D#GF:#JLG/# followed by the 6S .:#GDJ#KK:/ and in "r8-o District KG#LDM YAgency
for Statistics of "i'# DL:GZ
G
.
1.11 ;thnically# the composition of "i' society includes "osnians .HM S/# Serbs
.GF S/# and $roats .:F S/. 6eligions practiced in "i' include =udaism# Islam .HL
S/# 1rthodo9 .G: S/ and 6oman $atholic .:E S/. The se9 ratio in the country is
estimated at :.LD females per male Y%'1# DLLJZ.
1.12 1>cial unemployment stands at about :L S. *no>cially# though# the
Pgure could be as much as HL S.
-he Health S"stem
D
http))www.worldban-.org)en)country)bosniaandher,ego!ina)o!er!iew2 and %orld "an- Group
"osnia and 'er,ego!ina Partnership $ountry Program Snapshot# 1ctober DL:G.
G
It should be noted that the census results are only preliminary and may be subject to change.
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina :J
1.1! The comple9 administrati!e structure of the country# as described in
section :.H abo!e# has ad!erse implications for the e>cient organisation of the
health system.
-he PreDEar Health *are S"stem
1.1" Prior to the :KKD war# "i' was a member of the former 3ederal Socialist
6epublic of 5ugosla!ia# had a wellIde!eloped health care system comprising a
large networ- of hospitals# public health facilities and a networ- of primary health
care .P'$/ centres # doctors< o>ces for ambulatory P'$ ser!ices# and Prst aid
and emergency ser!ice units. The country<s population health indicators were
comparable to other countries in ;urope Y6ifat A. et al., DLLFZ.
1.1# Although the health systems in former 5ugosla!ia shared similarities with
those in the former So!iet *nion countries .publicly Pnanced and pro!ided by
salaried public employees# with free health care at the point of deli!ery/#
di0erences e9isted. The So!iet Semash-o model of health was centrally
managed with a large networ- of secondary care institutions and a fragmented
P'$ le!el \ comprising a tripartite system of adult# children and women<s
polyclinics# and specialised dispensaries. In contrast# former 5ugosla! states had
substantial autonomy in the organisation of their respecti!e health systems \
with a strong P'$ le!el and the in!ol!ement of local go!ernment YIidZ.
+rganisation and 2anagement of Health *are after the %AA#D%AA: Ear
1.10 The war caused widespread physical damage and had a de!astating e0ect
on the country. 1!er :L S of the population was -illed or wounded and o!er two
million people \ nearly half the preIwar population \ were forced from or chose
to lea!e their homes and became refugees# either abroad or displaced internally
within "i'. As a result of these population mo!ements# communityI and familyI
based social networ-s were seriously disrupted. TwoIthirds of homes were
damaged# with oneIPfth totally destroyed. An estimated GLVHL S of hospitals
and FL S of schools were destroyed or se!erely damaged# and GL S of health
care professionals and a similar share of teachers were lost to death or
emigration. The economic situation deteriorated rapidly during the war2 the
economy collapsed and the per capita gross domestic product .GDP/ fell P!eIfold#
from *S[D#HDK in :KKL to *S[HEJ in :KKE YIidZ.
1.11 The :KKE Dayton Agreement ac-nowledged the bitter ethnic di!ides that
had led to war by establishing a go!ernment structure with a wea- central state
in which the ethnically based Uentities< retained political# military and economic
authority as described in the pre!ious section.
1.12 As a result# health care Pnance# management# organisation and pro!ision
in "i' are the responsibility of each ;ntity# while "r8-o District runs a health care
system o!er which neither ;ntity has authority. "osnia and 'er,ego!ina#
therefore# has :G ministries of health and :G health systems for its G.F million
people2 one for the 6S# one for "r8-o District# one for the 3ederation le!el and ten
cantonal ministries in the 3ederation of "osnia and 'er,ego!ina .one for each
canton/. In "i' there is no national or countryIle!el mandate for health care
Pnancing and pro!ision. Y$ain# =. et al., o5. cit.Z.
1.13 There are signiPcant di0erences in the organisation of health care in the
di0erent political areas. In the 6S# authority o!er the health system is
centralised# with planning# regulation and management functions held by the
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina :F
M1'S% 6S in "anja &u-a. 'owe!er# in the 3"i'# health system administration is
decentralised# with each of the ten cantonal administrations ha!ing responsibility
for the pro!ision of primary and secondary health care through its own ministry.
The 3"i'<s central 3M1'# located in Saraje!o# coordinates cantonal health
administration at the 3ederation le!el. This feature has ob!ious functional
repercussions in terms of transaction costs# the coordination of decisionIma-ing
at the ;ntity le!el# and other matters which are not faced by the 6S.
1.2/ The district of "r8-o pro!ides primary and secondary care to its citi,ens.
"ecause of the small si,e of its population# the abo!eImentioned Agreement on
"r8-o states that each ;ntity is obliged to pay health care contributions for
pensioners# war !eterans# in!alids# displaced persons and others not otherwise
insured in the "r8-o District2 and that entities will also co!er unemployed citi,ens
of the "r8-o District until unemployment bureaus are created by the District itself.
Health *are Reform and Finan'ing
1.21 %ith the end to the war in :KKE# the "i' Go!ernment# with support from
international organisations and multilateral agencies such as the %orld "an-#
began a health reform programme to restructure its health system and to
de!elop a basic health programme comprising .i/ P'$ based on the concept of
family medicine2 .ii/ a shift from the preIwar emphasis on large hospitals and
polyclinics towards a more e>cient use of outpatient facilities and homeIbased
care2 and .iii/ a greater emphasis on costIe0ecti!e public health# disease
pre!ention and control Y6ifat A. et al., o5. cit.Z.
1.22 In the 3"i'# the 'ealth $are &aw .DL:L/ and the 'ealth Insurance &aw
.:KKF/# along with related byIlaws and regulations# di!ided the responsibilities of
the 3ederation and cantonal le!els. The 3ederation le!el was gi!en the authority
to formulate policy and pass laws# and the cantonal le!el the authority to prepare
local policies# implement laws# and be responsible for the Pnancing and pro!ision
of health ser!ices. The Strategic 'ealth $are Plan for the De!elopment of the
'ealth Sector in 3"i' DLLMIDL:M .DLLM/ articulated the objecti!es for health
system reform YIidZ.
1.2! In the 6S# the Strategic Plan for 'ealth System 6eform and 6econstruction#
:KKFVDLLL identiPed -ey structural problems within the 6S health system and
articulated the need for health reforms whose objecti!es were stated in the
Healt( Policy 6argets and 7eas%res in 4e5%lic of $r5ska y t(e 8ear 2/2/# with
corresponding actions identiPed in the 9aw on Healt( 'are :1333; YIidZ.
1.2" $ollecti!ely# these reforms aimed to .:/ de!elop a sustainable and
a0ordable health system2 .D/ introduce uni!ersal co!erage for a Ubasic pac-age<
of ser!ices to achie!e eNuity and solidarity2 .G/ impro!e e>ciency by better use
of a!ailable resources and allocation of these to priorities through e0ecti!e
management2 .H/ increase the satisfaction of users and health professionals
.higher Nuality health care with transparency and accountability/2 and .E/ create
pluralism and ownership by introducing a public)pri!ate mi9 YIidZ.
1.2# Special attention was paid to a new model of P'$ centred on family
medicine. In DLL:# a new type of P'$ was piloted in both ;ntities .3"i' and 6S/
and simultaneously introduced changes in parts of the health systems# namely
organisational structure and stewardship# Pnancing# pro!ider payment systems#
ser!ice pro!ision and resource generation. $hanges to the stewardship function
and organisational structures included the creation of a 3M1' with the
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina :M
decentralisation of health ser!ices to ;ntity .in the case of the 6S/ and canton
le!els .with a Minister of 'ealth for each of the ten cantons in 3"i'/. At the
operational le!el# family medicine was established as a medical specialty and
introduced into municipality health centres to pro!ide P'$ ser!ices. Autonomous
family medicine teams .comprising a family physician and one or two family
medicine nurses/ were created. These could contract directly with the
municipality health centres or through them with the newly created health
insurance organisations .one in 6S and one in each of the ten 3"i' cantons/ to
pro!ide health care ser!ices a shift from state funded and fully sta0ed health
care facilities. At P'$ le!el# users were gi!en the right to choose their family
physicians YIidZ.
1.20 Direct budget funding was replaced with a mi9ed Pnancing system through
the introduction of health insurance to complement budget transfers from the
state and local go!ernment. Pro!ider payment systems for P'$ changed from
budgets to simple per capita YIidZ.
1.21 $hanges in ser!ice pro!ision were dri!en by the introduction of ser!ice
contracts between health insurance organisations and P'$ pro!iders# which
dePned the scope of ser!ices deli!ered and speciPed the use of e!idenceIbased
guidelines .de!eloped locally with international technical assistance and adopted
in law/. These set the standards for Nuality and were used for the accreditation
of P'$ pro!iders2 they also set out the list of essential eNuipment to be used to
deli!er ser!ices. The family medicine model e9tended the scope of ser!ices
deli!ered in the P'$ setting by family physicians and family medicine nurses to
include health education# promotion# disease pre!ention inter!entions# e9panded
diagnostic and curati!e ser!ices# enabling the family medicine team to act as a
gate -eeper while pro!iding more comprehensi!e and continuous health care
ser!ices to its registered population YIidZ.
1.22 Despite a !ery challenging postIwar conte9t# resource constraints and
professional resistance# within four years P'$ reforms had some success and as a
result were scaled up to co!er DE S of the population in 3"i' YIbidZ. "y law# most
citi,ens should be entitled to health care and ha!e compulsory health insurance
co!erage. In reality# many are not. A large number of the population in "i' is
not co!ered by health insurance and cannot e9ercise their right to health care.
3or e9ample# in DLLK DM S of people in the 6S and :E S of those 3"i' did not
ha!e an insurance card. The largest number of uninsured people in the 6S is
company wor-ers whose employers do not pay contributions to the health
insurance fund. In 3"i' there is an additional problem whereby unemployed
persons who miss the deadline of GL to KL days for applying to the
*nemployment 1>ce lose their right to health insurance through the
unemployment bureaus Y;*# DL::Z.
1.23 'ealth care Pnancing is seriously complicated by the administrati!e
structure of the country# as described below Y%'1# DLLJZ
.a/ In the 3"i'
The cantonal health insurance funds Pnance health ser!ices# and the
3ederal 'ealth Insurance and 6einsurance 3und .Solidarity 3und/#
founded in =anuary DLLD# addresses the problems of the highly
decentralised system and surmounts the di>culties caused by
disparate and uneNual inCows of re!enues in the form of the health
insurance contributions of the cantonal funds .the di0erences
between richer and poorer health insurance funds in the 3"i'/2
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina :K
The collection of funds is low and the mo!ement of funds and
patients is obstructed2
The scope for redistribution of resources to those in need is greatly
limited2 and
In DLLJ# the a!erage contribution rate of :M S of salary was split
between the employee .:G S/ and the employer .P!e S/ YIid2 $1;#
DL:LZ2
.b/ In the 6S
The system is relati!ely centralised and e9ists at the ;ntityIwide
le!el# whereas the 'ealth Insurance 3und is comprised of eight
branch o>ces ."anja &u-a# "ijeljina# Doboj# ;ast Saraje!o# Prijedor#
Srbinje# Trebinje and ]!orni-/2
Around FL S of the population contributes to the 'ealth Insurance
3und .with rates for di0erent groups/ through the compulsory social
health insurance system2 and
There is no option for !oluntary insurance but supplementary
.e9tended/ insurance is allowed for some e9tra benePts YIidZ2
.c/ "r8-o District has its own 'ealth Insurance 3und which co!ers the
whole district Y$1;# DL:L# o5. cit.Z.
1.!/ 'ealth insurance fund re!enues fall signiPcantly short of co!ering all
legislated entitlements and# as a result# the funds ha!e little control o!er budgetI
item spending or its impact on the Nuality and scope of ser!ices. The main
shortcomings of the health Pnancing system are
The low ta9 base and high ta9 burden# particularly in the 3ederation2
&ow ta9 collection rates2
The ine0ecti!e inclusion of the selfIemployed and farmers as
contributors to the funds2
The large number of benePciaries e9cluded from ma-ing personal
contributions# and the widespread failure of intended contributors
.e9tra budgetary funds and go!ernment budget/ to do so2
The increasingly large share of people who are not co!ered#
especially among the unemployed whose numbers are growing and
who do not o>cially register as such2 and children# young people
and 6oma who fall out of the system as a result of low
awareness)poor -nowledge of e9isting procedures and contradictory
regulations2
Their highly s-ewed ability to generate re!enues across cantons2
and
Small ris- pools and their inability to e9ploit economies of scale
Y%'1# DLLJ# o5. cit.2 $1;# DL:L# o5. cit.Z
-he Status of the HIV Epidemi' in BiH
1.!1 "osnia and 'er,ego!ina is a low 'I( pre!alence country with an estimated
'I( pre!alence of ^L.: S. "y the end of DL:D# "i' had reported a cumulati!e
total of DDG 'I( cases to the %'1 6egional 1>ce for ;urope and the ;uropean
$entre for Disease Pre!ention and $ontrol .;$D$/# including :DL people who had
de!eloped AIDS. M: S of the newly reported 'I( infections in DL:D: were among
men. At the end of DL:D a cumulati!e total of two motherItoIchildItransmission
.MT$T/ case had been reported .and this was in DLLJ/ Y*+AIDS# DL:D2 %'1#
DL:GZ. $hanges in the number of registered 'I( cases# especially the last two
years# show an upward trend. According to data from routine statistics and
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina DL
sur!eys# the most common cause of infection is ris-y se9ual beha!iour .FMS of
all registered/. The highest number of infections is among people between DL
and HK years of age# with the a!erage age at infection being G:. The
predominant mode of transmission in DL:D is heterose9ual at ED S .DL:: EJ S2
DL:L EJ.E S/2 homose9ual) bise9ual DM.E S .DL:: DD S2 DL:L :M.K S/# and
people who inject drugs K.ES .DL:: :: S2 DL:L :D.H S/ Y*+AIDS# DL:D2 %'1#
DL:GZ.
1.!2 During DL:G# "i' reported a cumulati!e total of DHE 'I( positi!e cases of
which :DJ ha!e de!eloped into AIDS. A total of DD new 'I( cases ha!e been
registered .:J men and si9 women/# from which si9 de!eloped AIDS. As of
+o!ember DL:G# K: people are on A6T in "i' and two more are being treated in
neighbouring countries
H.
HIV Prevalen'e
1.!! In DL:L the ($T centres reported :E 'I( positi!e cases out of total of
F#:KJ tests underta-en. 'owe!er# only J#GJE of this total were informed of their
'I( test results. In DL::# the ($T centres reported GD 'I( positi!e cases out of
total of J#L:: tests. 3rom this total# E#HKF were informed of their 'I( test results.
Gi!en the ratio of populations tested in ($T and 'I( positi!e cases# and gi!en the
o!erIrepresentation of -ey populations at ris- undergoing testing in ($T centres#
this puts the li-ely pre!alence rate of those tested at ($T centres between L.:
and L.ES Y*+AIDS# DL:D# o5. cit.Z.
1.!" As of DL:L# H: facilities in "i' were o0ering 'I( testing2 in DL:L# :K#MKF
people o!er the age of :E were tested for 'I(. Systematic 'I( testing was
carried out on blood donors and 'I( testing was promoted on a !oluntary basis
for pregnant women. 'I( testing is free and nonImandatory .e9cept for patients
reNuiring transfusion or organ transplantation/. PreItesting and postItesting
counselling in "i' was established in DLLE through the ($T centres. In DL:G
there are DG ($T centres of which DD are established and functional. ($T centres
ha!e increased the number of people coming in for tests2 this is important since
the increased a!ailability and use of 'I( testing is a necessary preIreNuisite for
diagnosing and pro!iding appropriate treatment and care to people li!ing with
'I( .P&'I(/.
1.!# In "i'# treatment and care are pro!ided free of charge to P&'I(. It is
interesting to note that of the HM people on A6T in DL:L# GK .M: S/ were male.
Three health facilities based in "anja &u-a# Saraje!o and Tu,la pro!ide A6T Y%'1#
DL:G# o5. cit.Z.
1.!0 According to "i' reporting to ;$D$# the number of AIDS cases in "I' has
stabilised since DLLD. %ith the introduction of highly acti!e antiIretro!iral
therapy .'AA6T/# the number of AIDS cases and deaths from AIDS seems to ha!e
slowed down# while the number of 'I( positi!e cases has increased.
1.!1 In the past few years# therefore# 'I( infection has been -ept under control
in "i'. The goal of the $trategy to 4es5ond to HI< and AID$ in Bosnia and
Herzegovina 2/11=2/10 is to -eep the 'I( rate at less than one S within the
general population and less than P!e S in any of the 7APS2 and these rates are
being successfully maintained largely due to the G3ATM 'I(Isupported
programme being implemented in "i'. 'owe!er# there are a number of factors
that can stimulate the emergence and spread of the epidemic at any time V the
H
Personal communication with *+DP team# +o!ember DL:G.
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina D:
disruption of the war2 postItraumatic stress syndrome among those who fought in
the %ar and their relati!es# leading to greater !iolence to women and increased
drug use2 a conser!ati!e and largely religious society whose traditional !iews
gi!e rise to prejudice against 7APS2 !ulnerable populations who remain Uhidden<
and are frightened to use ser!ices due to fear of being stigmatised or
discriminated against2 a large number of migrants and refugees from other
countries in conCict# as well as many people tra!elling through "i' to get to other
countries in the region2 and so on.
1.!2 Gi!en the country<s low 'I( pre!alence# inter!entions are predominantly
focused on the promotion of pre!enti!e beha!iour in -ey populations at ris-. The
6ound K Global 3und proposal described these as including the general
population# -ey populations at increased ris- of 'I( infection .MSM# P%ID# S%
and their clients# asylum see-ers# refugees# prisoners# IDP# the transient
population# young people and persons who li!e on or below the po!erty line/. 'I(
!ulnerable populations also included persons e9posed to 'I( in a professional
capacity2 for e9ample# healthcare wor-ers who come into contact with bodily
Cuids as well as other professionals such as policemen# soldiers# correctional
o>cers# Pre Pghters# rescue ser!ice o>cers and members of associations and
foundations that pro!ide harm reduction ser!ices. In addition# there is consensus
that signiPcant attention should be paid to the 6oma population due to their
marginalisation and youth I particularly adolescents and primary school pupils in
rural areas Y*+AIDS# DL:DZ.
Population Size Estimation =PSE>
1.!3 1ne of the -ey challenges of de!eloping an 'I( programme that is
targeted towards 7APS in "i' has been the di>culty in assessing the si,e of
these populations. In order to calculate this# in DL:D a PS; sur!ey was organised
and implemented by a team of national specialists and international consultants.
The MO; units of the country<s two public health institutes in 3"i' and the 6S# as
well as national +G1s# were in!ol!ed in the sur!ey implementation process. The
national e9perts< wor-ing group agreed on a dePnition of 7APS subgroups as MSM
being men who had se9 with a male partner# both donor and recipient# in the past
si9 months2 P%ID being people who ha!e injected drugs at least once in the past
month2 and female se9 wor-ers .3S%/ I women who were paid money in
e9change for se9 in the past year.
1."/ The sur!ey was implemented in =anuary DL:D in the cities of "anja &u-a#
"iha@# "ijelina# "r8-o# Mostar# Saraje!o# Tu,la and ]enica. The +G1s co!ered the
following 7APS MSM Y+G1s Action Against Aids .AAA/ in the 6S# and Association
45 .3"i'/Z2 P%ID +G1s *G P61I and Margina .3"i'/# and (i-torija and Poenta
.6S/2 and S% +G1s AAA .6S/ and *G P61I .3"i'/.
1."1 At the same time as the APMG team e!aluated the 'I()AIDS Programme# a
PS; 6eport was also prepared and disseminated for discussion at a $$M meeting
held on :H +o!ember DL:G# in!ol!ing the +ational ;9perts Team# together with
+A" members and other -ey sta-eholders.
1."2 The 6eport made the following recommendations
E
:. The $$M should de!elop and recommend a uniPed approach to
estimation .called a 7APS si,e estimation protocol/ in order to .i/
dePne the freNuency of the process .for e9ample# biennially/2 .ii/
E
The detailed PS; 6eport is a!ailable separately.
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina DD
facilitate close collaboration between Go!ernment# +G1s and
international organisations2 .iii/ strengthen partnerships through
establishing a +ational $onsensus Team2 and .i!/ facilitate the support
of local administration .the local health coordinating bodies/ in the
estimation process.
D. $oordinating bodies and implementers should follow a seNuence of
acti!ities laid out by the 7APS si,e estimation protocol .for e9ample#
creation of a +ational 3ield Team# capacity building# de!eloping and
testing of national guidelines# data collection and analysis# follow up
and dissemination of results/.
G. $oordinating bodies and implementers should ensure the participation
of the communities< at all the stages of the estimation process.
H. "efore starting the estimation process# both the +ational $onsensus
and 3ield Teams should perform preparatory wor- on an indi!idual le!el
among S% and MSM in order to build consensus and ownership# and
ensure these groups understanding of the process.
E. The timeframe for the national estimate of 7APS subIpopulation si,e
should be su>cient to ensure that representati!e results are obtained.
J. %hile de!eloping national guidelines for subseNuent estimates of 7APS
si,e# the foregoing should be ta-en into consideration.
F. De!elop and implement a plan for necessary data collection on the
national le!el to be used for !arious estimation methodologies.
M. $onsider opportunities to use respondentIdri!en sur!ey .6DS/
sampling methodology during the ne9t round of si,e estimation.
K. "ear in mind the possibility of including PS; sur!ey Nuestions in bioI
beha!ioural sur!ey .""S/ Nuestionnaires and the synchronisation of
these processes to signiPcantly reduce the costs of estimation
processes.
:L.$onsider using U*niNue 1bject);!ent< and U+etwor- scale up<
methodologies during the ne9t round of si,e estimation.
+dgovor BiH na HIV i AIDS
StrateF(o Gedinstvo u preven'iGi i /or/i protiv HIV/AIDS
1."! "e, ob,ira na nis-u pre!alencu 'I(Ia# -lju8ne interesne grupe u "I'#
u-lju8uju@i *+AIDS# !jeruju da postoji !eli-i broj fa-tora -oji mogu pota@i daljnju
poja!u i Birenje epidemije 'I(Ia u bilo -oje !rijeme. 7rata- sa?eta- fa-tora ri,i-a
-oji mogu do!esti do Birenja epidemije !e@ su obra_eni u prethodnom odjelj-u
:.GF.
1."" * DLLD. godini# -ao odgo!or na epidemiju 'I()AIDS na globalnom ni!ou i
*+ De-laraciju o oba!e,ama u !e,i sa 'I()AIDSIom i drugim me_unarodnim
do-umentima# (ije@e ministara# u, tehni8-u podrB-u *+ Temats-e grupe ,a 'I( i
AIDS .*+TG/# usposta!ilo je Dr?a!ni sa!jetoda!ni odbor ,a borbu proti! 'I()AIDSI
a .+A"/ -ojim predsjeda!a Ministarst!o ,a ljuds-a pra!a i i,bjeglice i 8iji je
,adata- i,rada strategije ,a sprje8a!anje i borbu proti! 'I()AIDSIa te ra,ra_i!anje
procesa planiranja ,a njenu pro!edbu. Dr?a!ni sa!jetoda!ni odbor ,a borbu proti!
'I()AIDSIa 8ine predsta!nici ra,li8itih ministarsta!a i me_unarodnih organi,acija.
1ba entiteta i "r8-o distri-t imeno!ali su entitets-e 'I()AIDS -oordinatore -a-o bi
se ola-Bali i -oordinirali ,adaci -oje je preu,eo Dr?a!ni sa!jetoda!ni odbor.
Godine DLLG# usposta!ljen je Dr?a!ni -oordinacijs-i mehani,am .$$M/# -ojeg 8ine
GG 8lana institucija !lade# organi,acija ci!ilnog druBt!a i *+TG2 Dr?a!ni
-oordinacijs-i mehani,am inicirao je pripremu i a-ti!no doprinio i,radi s!ih
prijedloga upu@enih G3ATM. Pored o!og -lju8nog ,adat-a# Dr?a!ni -oordinacijs-i
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina DG
mehani,am imao je -lju8nu ulogu u ja8anju -apaciteta organi,acija ci!ilnog
druBt!a# mobili,acije ,ajednice i u-lju8i!anja P&'I(# saradnji sa drugim
donatorima i podi,anju s!ijesti u ra,li8itim rele!antnim se-torima# posebno -od
onih -oji su ,adu?eni ,a i,radu politi-a. `lano!i Dr?a!nog -oordinacijs-og
mehani,ma i procedure ,a njiho!o formalno imeno!anje pro!odi Dr?a!ni
sa!jetoda!ni odbor ,a borbu proti! 'I()AIDS. Dr?a!ni sa!jetoda!ni odbor ta-o_er
nadgleda rad Dr?a!nog -oordinacijs-og mehani,ma# i !ladinih institucija#
ne!ladinih organi,acija i *+ agencija u oblasti 'I(Is i AIDSIs Y*+AIDS# DL:D# o5.
cit.Z.
1."# Pr!a $trategi-a za odgovor na HI< i AID$ % Bosni i Hercegovini ,a period
DLLHIDLLK. us!ojena je u februaru DLLH. Strategija je ut!rdila o-!ir ,a !ladu i
organi,acije ci!ilnog druBt!a u smislu planiranja i pro!edbe programa -ao
odgo!ora na cilje!e ,emlje Y*+AIDS# DL:DZ. "i' je primatelj G3ATM podrB-e od E.
7ruga DLLJ. godine# Bto je omogu@ilo ,emlji da pro!ede s!eobuh!atan odgo!or
na 'I( .-a-o je detaljnije objaBnjeno u dolje na!edenim odjeljcima/.
1."0 Inten,i!nije a-ti!nosti ,a pro!edbu no!e $trategi-e za odgovor na HI< i
AID$ za 5eriod 2/11>2/10. ,apo8ete su sredinom DL:L. godine# -ada se od
Dr?a!nog sa!jetoda!nog odbora ,a borbu proti! 'I()AIDSIa tra?ilo da i,radi no!u
strategiju. I,radu Strategije -oordiniralo je Ministarst!o ci!ilnih poslo!a# ,ajedno
sa tri entitets-a 'I( -oordinatora i *+TG. ]na8ajan doprinos dali su imeno!ani
predsta!nici 3ederalnog ministarst!a ,dra!st!a# Ministarst!a ,dra!lja i socijalne
,aBtite 6S# i 1djela ,a ,dra!st!o "r8-o distri-ta# ,a!oda ,a ja!no ,dra!st!o u
3ederaciji i 6epublici Srps-oj# -lini-a ,a infe-ti!ne bolesti u "anja &uci# Saraje!u i
Tu,li# predsta!nici ci!ilnog druBt!a i me_unarodnih organi,acija -oji rade sa
osobama -oje ?i!e sa 'I(Iom P&'I( YIbidZ.
1."1 7lju8ni cilj Strategije DL::IDL:J. je postepeno smanjenje broja
no!o,ara?enih osoba i st!aranje o-ru?enja -oje @e osigurati dugoro8an# -!alitetan
i ,dra! ?i!ot ,a s!e osobe -oje ?i!e sa 'I(Iom. S!eobuh!atni cilj Strategije je
odr?ati stopu pre!alence 'I(Ia ispod ni!oa od L#L: S. Postoji Best speciP8nih
cilje!a YIidZ
:. *ni!er,alni pristup prema pre!enciji# lije8enju# nje,i i socijalnoj podBci2
D. =a8anje nad,ora nad 'I()AIDSIom2
G. =a8anje me_use-tors-e i !iBese-tors-e saradnje2
H. =a8anje i i,gradnja -apaciteta s!ih interesnih grupa ,a borbu proti!
'I()AIDSIa2
E. *naprje_enje pra!nog o-!ira ,a promociju# poBti!anje i ,aBtitu ljuds-ih
pra!a2 i
J. Smanjenje stigmati,acije i dis-riminacije.
1."2 Smjernice ,a dobro!oljno sa!jeto!anje i testiranje ,abranjuju prisilno
testiranje2 s!a-o testiranje se mora pro!esti u, pristana- -lijenta ,asno!an na
odgo!araju@im informacijama ,ajedno sa potpisom sa!jetni-a. Me_utim# u
]a-onu o radu se na!odi da posloda!ac mo?e# u-oli-o smatra neophodnim# tra?iti
,dra!st!eni pregled ,aposleni-a# te ,aposleni- ima oba!e,u informirati
posloda!ca o s!om ,dra!st!enom stanju# u-oli-o ta-!o stanje utje8e na radnu
sposobnost.
1."3 Strategije ,a smanjenje Btete# -ao Bto je ,amjena Bprica i igala# je teB-o
pro!esti# s ob,irom da je inje-cijs-o -oriBtenje droga nelegalno u "i'. Me_utim#
od DLLJ. godine# (lada je odobrila ,amjene Bprica i igala na osno!i -oja o!isi od
slu8aja do slu8aja ,a programe smanjenja Btete. +e-oli-o ne!ladinih organi,acija
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina DH
u!elo je podjelu igala)Bprica i pri-upljanje -oriBtenih igala)Bprica u -lini-ama ,a
infe-ti!ne bolesti u 6S# u, posti,anje odre_enog uspjeha. Godine DLLM# 3ond
*jedinjenih naroda ,a djecu .*+I$;3/ podr?ao je i,radu dr?a!ne strategije -ojom
se osigura!a pra!ni o-!ir ,a pro!edbu a-ti!nosti ,a smanjenje Btete u "i'. 1!a
Strategija us!ojena je u martu DLLK. godine.
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina DE
#4 P+DRHCA BI+BAI,+B F+,DA BIH
Crug : HIV programa =#$$<D#$%%4>
2.1 Imaju@i u !idu slo?enu upra!u i pra!ni o-!ir u "i'# decentrali,iran
,dra!st!eni se-tor .be, ministarst!a ,dra!st!a na dr?a!nom ni!ou/ i ni,a-
apsorpcijs-i -apacitet# DLLJ. godine Dr?a!ni -oordinacijs-i mehani,am je odabrao
*+DP -ao primarnog primatelja ,a E. 7rug G3ATM 'I( granta. Program je
pro!eden u saradnji sa 3ederalnim ministarst!om ,dra!st!a# Ministarst!om
,dra!lja i socijalne ,aBtite 6S i ci!ilnim druBt!om. +a,i! granta je -oordinirani
dr?a!ni odgo!or na 'I()AIDS i tuber-ulo,u u ratom ra,orenom i !iso-o
stigmati,iranom o-ru?enju# i uspjeBno je pro!eden u d!ije fa,e 3a,a I# no!embar
DLLJ V o-tobar DLLM2 i 3a,a II# no!embar DLLM V o-tobar DL::. $jelo-upan cilj
programa bio je ,adr?ati ni,a- ni!o pre!alence 'I(Ia u "i' -ro, po!e@an pristup
!iso-o-!alitetnim uslugama te smanjenje stigmati,acije i dis-riminacije u pogledu
'I(IAIDSIa. Pro!edba o!og Programa doprinijela je posti,anju o!og cilja putem
osiguranja rane dijagno,e 'I(Ia i u-lju8i!anja u programe lije8enja. S!eu-upno
!lasniBt!o nad Programom ostalo je na (ladi "i' i Dr?a!nom -oordinacijs-om
mehani,mu# do- je *+DP -ao imeno!ani primarni primatelj bio odgo!oran ,a
cjelo-upno upra!ljanje Programom. $jelo-upan bud?et granta i,nosio je
:L.MFL.KDM *SD.
2.2 Programs-i cilje!i 7ruga E su
:. Po!e@ati informiranje# edu-aciju# -omuni-aciju)promjenu ponaBanja#
informiranje .I;$)"$$/ i edu-aciju o pre!enciji -od mladih2
D. Po!e@ati I;$)"$$ u grupama stano!niBt!a sa po!e@anim ri,i-om2
G. *naprijediti pristup i -!alitet dobro!oljnog sa!jeto!anja i testiranja2
H. 1dgo!or na suinfe-ciju 'I()AIDSIom i tuber-ulo,om .T"/2
E. *naprijediti usluge ,a smanjenje Btete2
J. *!esti pre!enciju 'I(Ia u roms-e ,ajednice i ,a ranije raseljene osobe2 i
F. 1sigurati uni!er,alan besplatan pristup antiretro!irusnoj terapiji ,a
osobe -oje ?i!e sa 'I(Iom# lije8enje oportunisti8-ih infe-cija#
hospitali,aciju# psihosocijalno sa!jeto!anje i palijati!nu njegu.
2.! Gla!ni partneri u pro!edbi proje-ta su Ministarst!o ci!ilnih poslo!a#
3ederalno ministarst!o ,dra!st!a# Ministarst!o ,dra!lja i socijalne ,aBtite u 6S#
3ederalni ,a!od ,a ja!no ,dra!st!o# ]a!od ,a ja!no ,dra!st!o u 6S i ne!ladine
organi,acije Asocijacija 45# *G P61I# AAA# *dru?enje (i-torija# Partnerst!o ,a
,dra!lje "i'# Margina# Poenta i %orld (ision "i'. 7lju8ni re,ultati Programa# prema
cilju# sa?eto su na!edeni u dolje na!edenim sta!o!ima D.HID.:F.
*ilG %
2." 7ao re,ultat Programa# !iBe od JJ.LLL mladih u dobi od :H do :K godina u
osno!nim i srednjim B-olama proBlo je -ro, !rBnja8-u edu-aciju# do- je dodatnih
:HF.KFF mladih ljudi
J
dobilo informacije ili je imalo pristup informacijama u
neformalnom o-ru?enju. ;du-acija o ,dra!om na8inu ?i!ota u!edena je u
formalno obra,o!anje u B-ole. 1ba entiteta .3"I' i 6S/ us!ojila su us-la_ene
strategije !e,ane ,a mlade i ,dra!lje. $trategi-a za %na5r-e?en-e seks%alnog i
re5rod%ktivnog zdravl-a i 5rava % FBiH 2/1/>2/13. us!ojena je DL:L. godine# a
6epubli-a Srps-a je trenutno u procesu us!ajanja sli8ne strategije. 1sno!an je
J
7a-o je pot!rdio &3A# o-tobar DL::.
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina DJ
d!adeset i jedan ,dra!st!eni informati!ni centar ,a pru?anje usluga prilago_enih
mladima u cijeloj ,emlji Y*+DP)G3ATM# DL:DZ.
*ilGevi # i :
2.# I,!rBene su i,mjene i dopune ,na8ajnog broja ,a-ons-ih propisa -oji se
odnose na pitanja smanjenja Btete. * martu DLLK# (ije@e ministara us!ojilo je
Dr@avn% strategi-% za 5raAen-e, 5revenci-% i eliminiran-e zlo%5otree droga % BiH
2//3>2/1!. 6epubli-a Srps-a je ranije us!ojila sli8nu strategiju YIidZ.
2.0 1sno!ano je sedam centara ,a opijatnu supstitucijs-u terapiju -oji rade sa
solucijom metadona i -oji su pru?ili usluge ,a JHD inje-cijs-a -orisni-a droga.
Subo9on je u!eden u ,emlju i ne-i od pacijenata centara ,a supstitucijs-u terapiju
su preBli na Subo9on. Pro!edene su inten,i!ne -ampanje# i,!rBen rad na terenu te
organi,irane edu-acije ,a ,dra!st!ene radni-e# a s!e je to omogu@ilo
distribuciju),amjenu Bprica i igala te i,radu odnosnih smjernica. 7ao re,ultat toga#
do augusta DL::. godine# D.FLE osoba obuh!a@eno je programom ,amjene igala i
Bprica YIidZ.
2.1 7a-o bi se i,mjerio ni!o postignutih pra-ti8nih re,ultata# pro!edene su
d!ije studije ponaBanja u, 'I( i 'epatitis " i $ testiranje. Studije su pro!edene u
d!ogodiBnjim inter!alima DLLF. i DLLK. godine. Primije@ene su ,na8ajne ra,li-e u
smislu osoba -oje nisu ,ajedno -oristile inje-cijs-u opremu to-om prote-lom
mjeseca V FKS DLLK. godine# u pore_enju sa procentom od samo DFS DLLF.
godine. Ta-o_er se po!e@ao procijenjen broj inje-cijs-ih -orisni-a droga -oji su
upo,nati sa organi,acijom -oja radi na pre!enciji 'I(Ia u njiho!om gradu. Samo
:ES njih ,nalo je ,a ta-!u organi,aciju DLLF# u pore_enju sa procentom od HGS
DLLK. godine. * tom smislu# procenat osoba -oje su primile sterilnu inje-cijs-u
opremu od ne!ladine organi,acije po!e@ao se sa jedan S DLLF. godine na :H S
DLLK. godine. Pored toga# broj osoba -oje su na!ele da im je +(1 -lju8ni i,!or
inje-cijs-e opreme po!e@ao se sa nula S DLLF. na 8etiri S DLLK. godine. Gruba
procjena inje-cijs-ih -orisni-a droga po-a,uje da ih ima F.ELL .i,me_u J.LLL i
:L.LLL/. * pogledu poja!e# prenoBenje 'I(Ia -od inje-cijs-ih -orisni-a droga palo
je na tre@e mjesto YIidZ.
2.2 1!o istra?i!anje je ta-o_er po-a,alo da je 'epatitis $ i dalje naj!e@i
problem -od inje-cijs-ih -orisni-a droga sa procentom od DLS osoba u ]enici
-oje imaju 'epatitis $ i ELS u "anja &uci i Saraje!u YIidZ.
2.3 Godine DLLE# HMG muB-arca u-lju8ena u su u program pre!encije 'I(Ia2 do
-raja o-tobra DL::. godine# o!aj broj se po!e@ao na G.JGK. Pored toga# DLLE.
godine obuh!a@eno je samo D:L se-sualnih radni-a# a do -raja o!og Programa
broj se po!e@ao na :.LGH
F
. +ajbolji re,ultati uo8eni su -od ,at!oreni-a# jer u
pore_enju sa brojem od :LL ,at!oreni-a u-lju8enih u Program na po8et-u# do
-raja Programa obuh!a@eno je :.:GM osoba u ,at!orima. S!i indi-atori ut!r_eni ,a
DLLE. godinu su ili postignuti ili premaBeni YIidZ.
*ilG 8
2.1/ I,ra_en je ,ajedni8-i proto-ol ,a sa!jeto!anje i testiranje# do- su postoje@e
smjernice ,a dijagnosti-u i lije8enje -oriBtene -ao pola,na osno!a ,a i,radu no!og
proto-ola. I,ra_eni su priru8nici ,a edu-aciju# organi,irana edu-acija te su
obu8eni uposlenici centara ,a dobro!oljno sa!jeto!anje i testiranje. * isto
F
Iid.
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina DF
!rijeme# pro!edene su i medijs-e -ampanje o dobro!oljnom sa!jeto!anju i
testiranju YIidZ.
2.11 Do -raja Programa# osno!ano je u-upno :K centara ,a dobro!oljno
sa!jeto!anje i testiranje# i no!i centri su bili u procesu ot!aranja. Di,ajn usluga
dobro!oljnog sa!jeto!anja i testiranja ,asno!an je na principu decentrali,acije i s
ciljem da centri ,a dobro!oljno sa!jeto!anje i testiranje budu bli?e -orisnicima.
7ao re,ultat toga# do -raja o-tobra DL::. godine# broj od DM.:FM osoba dobio je
usluge sa!jeto!anja i testiranja putem centara ,a dobro!oljno sa!jeto!anje i
testiranje# do- je# u DL:L. godini# samo M.LEH obuh!a@eno uslugama -oje pru?aju
o!i centri. Pored toga# dodatna :DD ,dra!st!ena radni-a obu8ena su -ao
sa!jetnici ,a dobro!oljno sa!jeto!anje i testiranje YIidZ.
*ilG &
2.12 Tuber-ulo,a i 'epatitis ." i $/ i dalje su naju8estalije -oIinfe-cije u "i' i
stope pre!alence ,a tuber-ulo,u dosti?u 8a- ELS -od osoba -oje ?i!e sa 'I(Iom.
"i' je potpuno s!jesna da tuber-ulo,a predsta!lja naj!e@u prijetnju ,a ja!no
,dra!lje u ,emlji# u,imaju@i u ob,ir !iso-o prisust!o u "i' u pore_enju sa drugim
e!rops-im ,emljama# posebna pa?nja u o-!iru 'I( programa usmjerena je na
tuber-ulo,u .-oja je obuh!a@ena i -ro, drugi G3ATM -oji se dire-tno odnosi na
tuber-ulo,u u o-!iru J. 7ruga/. Promo!irana je !e@a saradnja i,me_u -lini-a ,a
infe-ti!ne i plu@ne bolesti# a unaprije_eni su i sistemi upu@i!anja pacijenata
i,me_u o!ih institucija. I,!rBene je pregled s!ih osoba -oje ?i!e sa 'I(Iom u !e,i
sa tuber-ulo,om i podijeljeni su lije-o!i ,a pre!enciju tuber-ulo,e. I,ra_en je
priru8ni- ,a dijagnosti-u i lije8enje i odobrili su ga ministarst!a ,dra!st!a oba
entiteta i ,dra!st!ene !lasti u "r8-o distri-tu. 1rgani,irano je jedanaest
jednodne!nih radionica na temu -oIinfe-cije 'I()tuber-ulo,a ,a ,aposleni-e -oji
rade u bolnicama ,a plu@ne bolesti# a deset edu-acijs-ih radionica organi,irano je
,a uposleni-e $r!enog -ri?a YIidZ.
*ilG <
2.1! Postoje ,na8ajne ra,li-e u smislu procjena roms-og stano!niBt!a i prema
jednoj procjeni taj broj bi mogao i,nositi 8a- do ML.LLL osoba. * roms-im
,ajednicama# odre_eni i,bori na8ina ?i!ota# tradicija i obi8aji po!e@a!aju ri,i-
prijenosa 'I(Ia i spolno prenosi!ih bolesti. Stoga je odlu8eno da se u o-!iru o!og
cilja# speciP8na pa?nja usmjeri na s!eobuh!atni program informiranja# edu-acije i
-omuni-acije sa roms-im ,ajednicama. YIidZ.
2.1" Ministarst!o ,a ljuds-a pra!a i i,bjeglice .M'66/ i,radilo je A-cioni plan ,a
rjeBa!anje problema 6oma u oblasti ,apoBlja!anja# stano!anja i ,dra!st!ene
,aBtite .Saraje!o# DLLK/. Putem 'I( programa# +(1 %orld (ision u8est!o!ala je u
i,radi A-cionog plana. 6ade@i sa Ministarst!om ,a ljuds-a pra!a i i,bjeglice# %orld
(ision i =edinica ,a upra!ljanje programom uspjeli su osigurati da d!a prioritetna
programa u o-!iru o!og A-cionog plana se odnose na 'I( i druge spolno
prenosi!e bolesti# -ao i pre!enciju tuber-ulo,e. 6adnici na terenu obuh!atili su
K.MFG 6om-inje u o-!iru o!og programa pre!encije u "anja &uci# "iha@u# GradiBci#
7a-nju# Prnja!oru# Srebrenici# Saraje!u# Tu,li# (iso-om# (ite,u i ]enici YIbidZ.
*ilG ?
2.1# `a- i prije po8et-a pro!edbe Programa# postojale su d!ije organi,acije u
"i' -oje su radile sa osobama -oje ?i!e sa 'I(Iom i njiho!im porodicama2 .i/
Asocijacija ,a podrB-u osobama oboljelim od 'I(Ia)AIDSIaIAP1'A/# registrirana
na dr?a!nom ni!ou ali -oja primarno radi u 3"i' i "r8-o distri-tu2 i .ii/ Action
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina DM
Against AIDS ili AAA# -oja radi u 6S. 1!e ne!ladine organi,acije pru?ale su psihoI
socijalnu podrB-u u o-!iru Programa ,a osobe -oje ?i!e sa 'I(Iom. Pored toga#
prije po8et-a E. 7ruga Programa# 'AA6T . (iso-o a-ti!na antiretro!irusna
terapija/ je osiguran u cijeloj "i' i po-ri!en -ro, ,a!ode ,a ,dra!st!eno
osiguranje na entitets-om ni!ou YIidZ.
2.10 +a po8et-u Programa# :H osoba -oje ?i!e sa 'I(Iom -oristile su 'AA6T. Do
-raja DL:L. godine# od JJ osoba -oje ?i!e sa 'I(Iom# HM osoba bile su
antiretro!irusnoj terapiji# a :M su pra@ene na -ontinuiranoj osno!i ali joB u!ije-
nisu doBli do fa,e u -ojoj im je potreban 'AA6T. Do -raja Programa# J: osoba je
primala 'AA6T. +a po8et-u# s!e osobe su dobile antiretro!irusnu terapiju jer im je
dijagno,a usposta!ljena u u,napredo!anom stadiju bolesti i !e@ su bili prisutni
simptomi2 me_utim# pri -raju Programa# !eli-i broj asimptomati8nih osoba -oje
?i!e sa 'I(Iom identiPciran je u ranoj fa,i infe-cije. +a po8et-u Programa# samo
mali broj pacijenata bi pro?i!io godinu od ot-ri!anja infe-cije# a do -raja
Programa# broj osoba -oje su pre?i!jele pr!u godinu i,nosio je KGS od u-upnog
broja inPciranih osoba. Smjernice ,a lije8enje su i,mijenjene i dopunjene u s-ladu
sa najno!ijim smjernicama S!jets-e ,dra!st!ene organi,acije. Program je ta-o_er
opremio s!e tri -lini-e na -ojima se lije8e pacijenti -oji boluju od AIDSIa# -a-o bi
se moglo pratiti $DH @elije YIidZ.
2.11 1stala s!eobuh!atna postignu@a Programa E. 7ruga u-lju8uju YIidZ
Dobro planiranje i usmjerena odgo!araju@a pa?nja na 1-!ir rada2
Suosje@ajan i po,iti!an odgo!or i speciP8na robna pomo@ osobama -oje
?i!e sa 'I(Iom . sympathetic and positi!e response and inI-ind support
to P&'I( .dr!a# -oriBtena IT oprema# i ta-o dalje/2
1d :E obuh!a@enih po-a,atelja# deset je postignuto sa pre-o :LLS# do-
su tri indi-atora premaBila KL S# jedan je premaBio ML S i posljednji FL
S pro!edbe2
*sposta!ljena je dobra ra!note?a i,me_u -apaciteta i cilje!a2 i
Dobro su us-la_eni 'I( Program E. 7ruga i Program tuber-ulo,e J.
7ruga# ia-o nije odabran podprimatelj ,a $ilj H# aSmanjenje -oinfe-cije
'I()AIDS i tuber-ulo,eW.
HIV Program A4 Crug =de'em/ar #$%$Dnovem/ar #$%:4>
2.12 Pored postoje@ih proje-ata -oje podr?a!aju druge me_unarodne
organi,acije# DLLK. i DL:L. godine# *+DP je pru?io podrB-u "i' dr?a!nim
institucijama# stru8njacima i predsta!nicima ne!ladinih organi,acija# te je putem
dr?a!nog -oordinacijs-og mehani,ma pripremio d!ije uspjeBne G3ATM apli-acije
,a K. 7rug programa pre!encije i lije8enja 'I(Ia i tuber-ulo,e.
2.13 7ao Bto je slu8aj i sa prethodnim G3ATM 'I( grantom u o-!iru E. 7ruga#
odobreni G3ATM 'I()AIDS Program u K. 7rugu ,a "i' ,asno!an je na na8elu
smanjenja Btete# u-lju8uju@i i rad u ,ajednici# !rBnja8-u edu-aciju# ra,noli-e
usluge lije8enja lije-o!ima# promo!iranje i distribucija pre,er!ati!a# rjeBa!anje
problema stigmati,acije i dis-riminacije i pru?anje psihoIsocijalne podrB-e
osobama -oje ?i!e sa 'I(Iom. 7ro, pro!edbu o!ih a-ti!nosti# *+DP# Ministarst!o
,dra!lja i socijalne ,aBtite 6S# 3ederalno ministarst!o ,dra!st!a i lo-alne
organi,acije ci!ilnog druBt!a# ,ajedno sa *+ partnerima -ao Bto su ]ajedni8-i
program *jedinjenih naroda ,a 'I()AIDS .*+AIDS/# *+DP# *+I$;3 i S!jets-a
,dra!st!ena organi,acija# nastoje oja8ati i po!e@ati ni!o postoje@ih usluga# -a-o
bi se osigurao obuh!at u cijeloj ,emlji eP-asnim ,dra!st!enim uslugama i pru?ila
podrB-a usposta!i dr?a!nog sistema ,a pra@enje i e!aluaciju. * to-u i,!jeBtajnog
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina DK
perioda# ,na8ajno je unaprije_ena !iBese-tors-a saradnja# Bto je do!elo do !e@eg
ni!oa u-lju8enosti ci!ilnog druBt!a u proces i,rade politi-a putem po!e@ane
,astupljenosti predsta!ni-a ci!ilnog druBt!a u dr?a!nom -oordinacijs-om
mehani,mu i dr?a!nom sa!jetoda!nom odboru.
2.2/ Pro!edba Programa podijeljena je u d!ije fa,e sa sljede@im !remens-im
o-!irima i bud?etima
M

De!eti -rug fa,e I decembar DL:L I no!embar DL:D .*S [

:H#KJE#FFM#MG/
De!eti -rug fa,e II decembar DL:D I no!embar DL:E .*S [
:J#DHK#E:K#MK/
2.21 Prijedlog ,a K. -rug bilo je pono!no podnoBenje "i' 'I( prijedloga#
podnesenog u o-!iru M. -ruga. *,eti su u ob,ir -omentari 7omisije ,a tehni8-o
ra,matranje i pregled i nja njih se odgo!orilo -ro, dodatne informacije i a-ti!nosti
u o-!iru prijedloga ,a K. -rug. S!eobuh!atni cilj# speciP8ni cilje!i i !e@ina
inter!encija i ?eljenih re,ultata ostala je ista# ali u, !e@i naglasa- na i,gradnju
-apaciteta# pra@enje i e!aluaciju i -lju8ne populacije i,lo?ene ri,i-u# -ao Bto su
6omi# i,bjeglice po!ratnici i migrant.
2.22 Program se nadogra_uje na postignu@a dosadaBnjih 'I( programa#
u-lju8uju@i ona -oja su re,ultat G3ATM Programa# Pnanciranog u o-!iru E. -ruga#
-ao i a-ti!nosti -oje je podr?ala (lada. *t!r_eno je pet cilje!a
:. Do ma(simuma poveJati o/uhvat e9(anom preven'iGom HIVDa i
nGege meKu naGriziLniGim popula'iGama promo!iraju@i prijela, sa
podi,anja s!ijesti o 'I(Iu -od op@e populacije -a s!eobuh!atnom pristupu
podr?a!anja -ontinuirane pre!encije 'I(Ia u o-ru?enjima# gdje su osobe
-oje su naj!iBe i,lo?ene ri,i-u od 'I(Ia. ;P-asno lije8enje 'I(Ia i njega
osoba -oje ?i!e sa 'I(Iom i, marginali,iranih grupa stano!niBt!a
predsta!lja -lju8nu strategiju pre!encije.
Program nastoji pomo@i inje-cionim -orisnicima droga putem po!e@anja
pristupa dobro!oljnom sa!jeto!anju i testiranju i primarnoj ,aBtiti# te
po!e@anjem speciP8nih a-ti!nosti smanjenja Btete do E. godine# -a-o bi se
osiguralo .i/ 1pijatna supstitucijs-a terapija ,a :.HEL inje-cionih -orisni-a
droga i .ii/ pristup informiranju# edu-aciji i -omuni-aciji i ,amjeni igala i
Bprica ,a J.MGK inje-cionih -orisni-a droga .u-lju8uju@i i one -oji -oriste
1pijatnu supstitucijs-u terapiju/. Posebna pa?nja @e se usmjeriti na
smanjenje prepre-a ,a ost!arenje pristupa ?enama -orisnicama droga.
]a se-sualne radni-e# Program @e po!e@ati a-ti!nosti do pete godine# -a-o
bi .i/ usmjerio se na o-ru?enje u -ojem se-sualni radnici rade# u-lju8uju@i
!lasni-e baro!a# no@nih -lubo!a# motela)hotela i sli8nih obje-ata# -ao i
-lijente se-sualnih radni-a2 .ii/ u-loniti prepre-e ,a ost!ari!anje pristupa
dijagno,i i lije8enju spolno prenosi!ih bolesti# dobro!oljnom sa!jeto!anju i
testiranju# ,aBtiti ,dra!lja maj-e i djece i primarnoj ,aBtiti2 i .iii/ osigurati
redo!an pristup informati!nim# edu-acijs-im i -omuni-acijs-im
materijalima i pre,er!ati!ima ,a D.:DF se-sualnih radni-a.
Airo- spe-tar pristupa ,asno!anih na ponaBanju su -oriBteni ,a rad sa
muB-arcima -oji imaju spolne odnose sa muB-arcima .MSM/. Pru?it @e se
podrB-a no!onastalim organi,acijama na ni!ou ,ajednice# -a-o bi pru?ali
usluge WDrop InX centra# rad na terenu u pogledu informiranja# edu-acije i
-omuni-acije i podjele pre,er!ati!a i lubri-anata ,a MSM. MSM @e ta-o_er
biti obuh!a@en i putem usluga -oje se odnose na spolno prenosi!e infe-cije
M
1sobna -omuni-acija sa *+DP P6 timom# no!embar DL:G.
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina GL
i rad usmjeren na se9 sites .internet i -lubo!i i ostalo/. 1!e inter!encije @e
obuh!atiti H.GDJ muB-araca -oji imaju spolne odnose sa muB-arcima do
-raja E. godine.
* pogledu ,at!oreni-a# prosje8ne ,at!ors-e -a,ne su -rat-e u "i'# Bto
,na8i da se o!a populacija -ontinuirano i,mjenjuje. 7ro, postoje@e
a-ti!nosti pru?a se edu-acija i ograni8en pristup pre!enciji u ,at!orima.
Prema o!om prijedlogu# o!e a-ti!nosti @e se po!e@ati i institucionali,irati u
o-!iru Ministarst!a pra!de# te @e se obuh!atiti dodatnih D.:LL ,at!oreni-a
-ro, !ije- trajanja proje-ta. Pro!est @e se istra?i!anja o speciP8nim
a-ti!nostima ,a pre!enciju 'I(Ia# usmjeren na potrebe -orisni-a droga i
drugih osoba -oje su u naj!e@em ri,i-u od 'I(Ia. Programi prije i na-on
odslu?enja ,at!oes-e -a,ne bit @e usposta!ljeni I integrirani sa
a-ti!nostima pre!encije 'I(Ia injege ,at!orima .posebno terapija
lje-o!ima/.
Program je ta-o_er usmjeren na ugro?ene mlade osobe# posebno one -oje
pripadaju najri,i8nijoj populaciji# sa uslugama ,a spolno i reprodu-ti!no
,dra!lje prilago_enim mladim osobama i socijalnim uslugama# te
institucionali,iranoj edu-aciji ?i!otnih !jeBtina ,a mlade osobe -oje
poha_aju B-ole
K
.
+a -raju# a-ti!nosti ,a roms-u populaciju# i,bjeglice po!ratni-e i migrante
@e se po!e@ati i usmjeriti na ?ens-e 8lano!e o!ih ,ajednica# -ro,
promo!iranje dobro!oljnog sa!jeto!anja i testiranja i u-lanjanje prepre-a
,a prostup 'i! pre!enciji i nje,i.
D. +sigurati odgovaraGuJu preven'iGu7 liGeLenGe7 nGegu i podrF(u za
oso/e (oGe Mive sa HIVDom Grupama osoba -oje ?i!e sa 'I(Iom pru?it
@e se pomo@ u smislu da!anja informacija i podrB-e njihio!im ,ajednicama
-a-o bi se po!e@ala njiho!a u-lju8enost -ao odgo!or na 'I(. Slu?be ,a
,dra!lje maj-i i djece dobit @e pomo@ -a-o bi integrirali procjenu ri,i-a ,a
'I( i dobro!oljno sa!jeto!anje i testiranje u antinatalnu ,aBtitu. I,rada
-lini8-ih smjernica# -oja je trenutno u to-u# predsta!ljat @e osno!u ,a
unaprije_enje -lini8-ih usluga i i,gradnju -apaciteta# -a-o bi se st!orila
mogu@nost ,a pre!enciju 'I(Ia# lije8enje i ,aBtitu radne snage -ro,
proBirene usluge edu-acije ,a medicins-e sestre i lije8ni-e u oblasti 'I(Ia.
(e,e sa postoje@im programima# posebno sa programom -oji se odnosi na
tuber-ulo,u# programom ,a ,dra!lje maj-i i djece# terapije lije-o!ima i
centrima ,a socijalni rad# unaprijedit @e se# te @e se dodatna pa?nja
usmjeriti na dijagnosti-u i lije8enje -oinfe-cije hepatitisom $.
G. 1napriGeKenGe povolGnog o(ruMenGa za poveJanGe preven'iGe i
zaFtite od HIVDa Proveden Ge formalni pregled postoje@ih ,a-ons-ih
propisa i pru?it @e se tehni8-a pomo@ -a-o bi se podr?alo prilago_a!anje
postoje@ih politi-a i)ili i,rada no!ih politi-a i )ili ,a-ons-ih propisa -ojima bi
se eliminirali nedostaci i neslaganja i,me_u politi-a. * pr!oj fa,i# granto!i
religijs-im organi,acijama u ,ajednici i !jers-im !o_ama dati su -a-o bi se
pro!eli programi ,a smanjenje stigmati,acije u njiho!im ,ajednicama. * :.
godini odr?an je sastana- programa -a-o bi se i,radile strategije ,a
podrB-u !jers-im organi,acijama i !o_ama u smislu smanjenja
stigmati,acije.
H. 1napriGeKenGe (apa'iteta za odgovor na HIV/AIDS Agen'iGa za
(oordina'iGu i proved/u G3ATM 'I( grant u o-!iru E. -ruga po-a,ao je
i,ra?enu potrebu ,a dugoro8nim programom i,gradnje -apaciteta -a-o bi
K
Prema fa,i II ,ahtje! ,a obno!u2 me_utim# o!e a-ti!nosti su na-nadno is-lju8ene# -ao
Bto je to -asnije opisano u o!om i,!jeBtaju.
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina G:
se pru?ila podrB-a !ladinim i ne!ladinim agencijama. To u-lju8uje
mentorst!o i rjeBa!anje st!arnih problema# -a-o bi se na eP-asan i odr?i!
na8in prenijele !jeBtine i usposta!io dr?a!ni sistem -oji je potreban ,a
podrB-u odgo!oru na 'I(. Sa ,dra!st!enim slu?bama radilo se na ,na8ajnoj
i,gradnji -apaciteta -a-o bi se osigurao najri,i8nijoj populaciji pristup
uslugama integrirane pre!encije# lije8enja# ,aBtite i podrB-e. * entitetima
@e se usposta!iti centri ,a i,gradnju -apaciteta -a-o bi se podr?ale
osno!ane i no!e organi,acije u ,ajednici# u smislu po!e@anja a-ti!nosti
pre!encije i ,aBtite najri,i8nije populacije. Tehni8-i -!alitet i dosljednost
odgo!ora na 'I( u "i' unaprije_en je -ro, osni!anje 8etiri tehni8-a
sa!jetoda!na odbora ,a sljede@e oblasti .i/ st!aranje po!oljnog o-ru?enja
,a pre!enciju i ,aBtitu bod 'I(Ia2 .ii/ smanjenje ugro?enosti najri,i8nijih
populacija2 .iii/ 'I( lije8enje# ,aBtita i njega2 i .i!/ pra@enje i e!aluacija.
Program @e unaprijediti -apacitete pru?atelja usluga ,a pri-upljanje i
anali,u informacija# -ro, osiguranje godiBnjih programa edu-acije o nad,or
druge generacije# i,radi indi-atora i pra@enju i e!aluaciji.
E. +/ez/iGediti sigurnost (rvi Pro!edena je edu-acija ,a ,dra!st!ene i
medicins-e radnij-e o sigurnosti -r!i# naba!ci ,dra!st!enih roba ,a
programe sigurnosti -r!i i a-ti!nosti podi,anja s!ijesti ja!nosti. 7lju8ni
obje-ti su dobili opremu ,a unaprije_enje sigurnosti -r!i. Program radi na
usposta!i tri referentne laboratorije# odnosno jedne -lju8ne laboratorije u
s!a-oj od administrati!nih jedinica.
Faza I
2.2! 3a,a : Programa .DL:L.IDL:D./ pomogla je ja8anju institucionalnih i
tehni8-ih -apaciteta na dr?a!nom ni!ou .posebno -lju8nih !ladinih agencija i
+(1Ia/# unaprije_enju strateB-og planiranja i -oordinacije# poboljBanju sistema
upra!ljanja informacijama i ,ago!aranju ,a po!oljne ,a-onoda!ne o-!ire i o-!ire
politi-a. *+DP je nasta!io djelo!ati -ao primarni primatelj# sara_uju,@i sa ne-oli-o
!ladinih tijela i osam ne!ladinih organi,acija .AAA# Asocijacija 45# Margina#
Partnerst!o u ,dra!lju# Poenta# *G P61I# (i-torija i %orld (ision/# d!ije
me_unarodne organi,acije# Me_unarodnom organi,acijom rada .I&1/ i
Me_unarodnom organi,acijom ,a migracije .I1M/# i jednom a-adems-om
institucijom .Medicins-i fa-ultet/# -ao podprimateljima# te jednom +(1 -ao
podpodprimateljem .AP1'A/. +a,i!i organi,acija i -lju8ne ciljane grupe su
na!edene u Tabeli : na narednoj stranici.
2.2" S!eu-upan u8ina- u o-!iru Programa to-om perioda i,!jeBtaja o napret-u
bio je i,!anredan i top deset indi-atora imaju ocijenu UA:< .::ES/ a prosje@na
ocjena u8in-a ,a s!e indi-atore je UA:< .::HS/. 1!o predsta!lja poboljBanje u
odnosu na prethodni i,!jeBtajni period -ada su Top deset indi-atora ocjenjeni sa
UAD< .KJS prosje8na stopa u8in-a/ i prosje8na ocjena u8in-a ,a s!e indi-atore je
bila UAD< .:LLS prosje8an u8ina- ,a s!e indi-atore/. 6e,ultati su postignuti ,a
s!ih :H indi-atora# od -ojih :D imaju naj!iBu ocjenu# a niti jedan indi-ator nema
ocjenu na ni!ou U"D< ili U$<. $ilje!i ,a :D indi-atora su u suBtini premaBeni
:L.
2.2# D!a indi-atora# ,a -oje nije postignut odgo!araju@i u8ina- u prethodnom
i,!jeBtajnom periodu su se ,na8ajno poboljBala# Bto je re,ultat i,ra?enih
inter!encija primarnog primatelja# usmjeren na rjeBa!anje slabosti. "roj -lju8nih
populacija .adolescenti# muB-arci -oji imaju spolne odnose sa muB-arcima#
,at!orenici# inje-cioni -orisnici droga i se-sualni radnici/ obuh!a@eni 'I(
pre!encijom# ,na8ajno se po!e@ao sa HS .prosje-/ u to-u prethodnog i,!jeBtajnog
:L
"i' $$M ]ahtje! ,a obno!u 'I( granta# 3a,a II K. -rug# no!embar DL:D.
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina GD
perioda na o-o :DLS u to-u druge polo!ine DL::. godine. (e@i broj 6oma#
migranata i i,bjeglica obuh!a@eni su a-ti!nostima usmjerenim na pre!enciju 'I(I
a i tri 'I( informati!na centra su postala potpuno fun-cionalna. * to-u
i,!jeBtajnog perioda# %orld (ision .jedan od podprimatelja / ot!orio je tri 'I(
centra ,a roms-u populaciju i obuh!atio je D.GF: osobu. S!e osobe -ojima je
potrebna antiretro!irusna terapija prima o!u terapiju. Ae,desettri osobe su dobile
A6( terapiju u odnosu na EL planiranih# ,ah!aljuju@i !eli-om obuh!atu sa
uslugama dobro!oljnog sa!jeto!anja i testiranja. * to-u posljednje pro!jere
podata-a na terenu# -oja je obuh!atila period od decembra DL:L. do juna DL::.#
&ocal 3und Agent .&3A/ pot!rdio je tri indi-atora na pet lo-acija i ocijenio s!e
indi-atore sa ocjenom UA<.
2.20 S!eu-upna ocjena instrumenta ,a ocjenu granta bila je UA:<# ali usljed
odre_enih slabosti u Pnancijs-om i,!jeBta!anju# isplate su dobile ocjenu UAD<
::.
2.21 * o-!iru fa,e I# no!i centri ,a dobro!oljno sa!jeto!anje i testiranje aDrop
InW centri i centri ,a deto-si-aciju obno!ljeni su i opremljeni sa najpotrenijim
namjeBtajem i informati8-om opremom# Bto je omogu@ilo 8lano!ima da !rBe s!oje
a-ti!nosti na -!alitetniji na8in i be, tehni8-ih prepre-a. 1!i centri se ugla!nom
nala,e u o-!iru ,a!oda ,a ja!no ,dra!st!o# Bto osigura!a odr?i!ost usposta!ljenih
usluga. S!i 8lano!i -oji pru?aju usluge -lijentima proBli su edu-aciju u pogledu
njiho!e uloge i a-ti!nosti -oje trebaju !rBiti. +aj!a?nija 8injenica je da s!i
pru?atelji ja!nih usluga# -oji pru?aju usluge -lju8nijim populacijama ra,umiju
!a?nost s!ojih uloga i potrebu da redo!no# na mjese8noj osno!i# !rBe
i,!jeBta!anje. A-ti!nosti u DL::. i DL:D. godini do!ele su do poboljBane -!alitete
rada# -ao i unaprije_ene -!alitete i,!jeBtajnih podata-a. S!e a-ti!nosti do!ele su#
ne samo do ta8nijih podata-a o 'I( i AIDS pacijenata# nego i do podata-a o
po!e@anom broju ot-ri!enih 'I( po,iti!nih slu8aje!a u "i' u pore_enju sa DL:L.
godinom
:D
.
-a/ela % Popis podprimatelGa i 'ilGane popula'iGe
Federa'iGa BiH
,aziv organiza'iGe *ilGana popula'iGa Faza I *ilGana popula'iGa Faza II
AP1'A 1sobe -oje ?i!e sa 'I(Iom
.psihosocijalna podrB-a#
osiguranje osno!nih
potrepBtina/
7ao 3a,a I
Asocijacija 45 MSM
]at!orenici
Mladi
MSM
]at!orenici
]a!od ,a ja!no
,dra!st!o 3ederacije
"i'
1perati!no istra?i!anje .16/#
""S# 1pijatna supstitucijs-a
terapija .1ST/ i pra@enje 1ST
centara# pra@enje i e!aluacija
i i,!jeBta!anje#
7ao 3a,a I
I&1 I,rada politi-a Donositelji politi-a i inspe-cije
rada .samo 3a,a I/
I1M Migranti
Mobilne populacije
7ao 3a,a I
Margina Inje-cioni -orisnici droga Inje-cioni -orisnici droga
Inje-cioni -orisnici droga u
::
Iid.
:D
Iid.
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina GG
,at!orima
Se-sualni radnici
Mladi .3a,a I/
Partnerst!o ,a ,dra!lje 1sobe -oje ?i!e sa 'I(Iom
.edu-acija ,a ,dra!st!o V
gine-olo,i# medicins-e sestre
V i ne,dra!st!eni se-tor V
socijalni radnici V pru?atelji
usluga# u-lju8uju@i i,lo?enost
na radu2 pono!na edu-acija2
osiguranje osno!nih
potrepBtina .!itamini# dr!o#
itd./2 PMT$T# dobro!oljno
sa!jeto!anje i testiranje#
u-lju8uju@i edu-aciju ,a
obno!u ,nanja ,a sa!jetni-e
7ao 3a,a I
*G P61I Inje-cioni -orisnici droga
Se-sualni radnici
7ao 3a,a I
%orld (ision 6eligijs-e organi,acije
6omi
7ao 3a,a I
Repu/li(a Srps(a
Action against AIDSI MSM
1sobe -oje ?i!e sa 'I(Iom
.psihosocijalna podrB-a#
osiguranje osno!nih
potrepBtina .!itamini# hrana#
dr!a# itd./
Se-sualni radnici
7ao 3a,a I
Poenta Inje-cioni -orisnici droga 7ao 3a,a I
]a!od ,a ja!no
,dra!st!o 6S
16# ""S# 1ST terapija# i
pra@enje 1ST centara#
pra@enje# e!aluacija i
i,!jeBta!anje
7ao 3a,a I
(i-torija ]at!orenici
Inje-cioni -orisnici droga
7ao 3a,a I
Izvor& 1sobna -omuni-acija sa *+DP timom# no!embar DL:G.
2.22 Paralelno# !ladinim podprimateljima pru?ena je podrB-a ,a pro!edbu
a-ti!nosti -oje se odnose na i,radu situacijs-ih anali,a i istra?i!anja i organi,aciju
edu-acije. Mnogo !remena i napora ulo?eno je u ,a!od ,a ja!no ,dra!st!o i no!e
podprimatelje# s ciljem da im se omogu@i nesmetana pro!edba programs-ih
a-ti!nosti. Primarni primatelj u8est!o!ao je u sastancima timo!a ,a upra!ljanje
proje-tima podprimatelja# gdje su se da!ale sugestije ,a pro!edbu i upra!ljanje
proje-tom. Pored toga# Pnancijs-o i programs-o pra@enje s!ih podprimatelja .-ro,
pro!jeru s!ih rashoda i ra8una/ pro!odi se na redo!noj osno!i# mjese8no i
-!artalno i o!a pra-sa @e se nasta!iti i u o-!iru 3a,e II
:G
.
2.23 Primarni primatelj uspio je ,a!rBiti goto!o s!e programs-e a-ti!nosti
planirane ,a o!aj period. ]bog 8injenice da su -!antitati!ni indi-atori postignuti#
primarni primatelj radio je na unaprije_enju -!aliteta rada i usluga -oje se nude
-lijentima# -ao Bto su ,aBtita i podrB-a osobama -oje ?i!e 'I(Iom. +a primjer# u
o-!iru $ilja D# 'I( program ta-o_er nudi poticaje .podrB-a u ?i!otnim
potrepBtinama# Bto u-lju8uje podrB-u u obli-u !itamina# ogrije!nog dr!eta# hrane#
:G
Iid.
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina GH
lije-o!a i odje@e/ osobama -oje ?i!e sa 'I(Iom# -oje ispune -riterije -oje su
ut!rdili Dr?a!ni 'I( i AIDS -oordinatori
:H.
2.!/ 7a-o bi se usmjerilo programiranje# nedostaci u pogledu strateB-ih
informacija o -lju8nijim populacijama rjeBeni su u 3a,i I# -ro, ni, -!alitati!nih i
-!antitati!nih istra?i!a8-ih inicijati!a. Pro!edena istra?i!anja do!ela su do ta8nije
procjene o brojnom stanju ,a -lju8ne populacije# te su anali,irane prepre-e ,a
ost!ari!anje pristupa 'I( pre!enciji i ,aBtiti. A-ti!nosti u DL:D.# pos!e@ene su
daljnjem unaprije_enju rada sa -lju8nim populacijama# s ciljem osiguranja
-!alitete
:E
.
Faza II
2.!1 1pis prioriteta programa u o-!iru 3a,e II# -oji se dolje nala,i# na!eden je i,
"i' $$M ,ahtje!a ,a obno!u K. 7ruga 'I( granta i, no!embra DL:D. godine i
ostao je# ugla!nom# nepromjenjen sa odre_enim manjim i,mjenama
*ilG % +stvariti ma(simalni o/uhvat e9(asnom HIV preven'iGom i
zaFtitom naGriziLniGih popula'iGa
Injekcioni korisnici droga
2.!2 `etiri +(1Ia osigurali su ,mjenu igala i Bprica ,a inje-cione -orisni-e droga
u 3a,i I. D!ije su radile u 3"i' .Margina i *G Proi/# do- su ,amjenu igala i Bprica u
6S pro!odile Poenta i (i-torija.
2.!! 7ro, njiho!e a-ti!nosti# radnici na terenu i se-undarni medijatori
.gate-eepers i !rBnja8-i edu-atori/ !rBili su distribuciju sterilnog inje-cionog
materijala i -ondoma# i pru?ali sa!jetoda!ne usluge# edu-aciju na terenu#
promo!iranje 'I( testiranja i testiranja na ostale se-sualno prenosi!e bolesti.
aDrop In centriW ,a inje-cione -orisni-e droga# osno!an u 3a,i I# nasta!it @e sa
radom i u 3a,i II "iha@# "r8-o# Mostar# Saraje!o# Tu,la i ]enica u 3"i'2 i "anja
&u-a# "ijeljina# Doboj# Prijedor i Trebinje .-oji @e se obno!iti u periodu produ?enja/
u 6S.
2.!" * 3a,i II# program @e se usmjeriti na pre!enciju parenteralnog i spolnog
prenoBenja 'I(Ia -od inje-cionih -orisni-a droga putem sljede@ih a-ti!nosti
:. Po!e@an obuh!at programima smanjenje je Btete ,a inje-cione
-orisni-e droga u geografs-om smislu i u o-!iru ,ajednica u -ojima
bora!e inje-cioni -orisnici droga2
D. ProBirenje sadr?aja i obima usluga -oje se pru?aju2
G. *naprije_enje usluga i ja8anje -ontrole -!alitete2
H. 1la-Ba!anje integracije usluga -oje se pru?aju na ni!ou ,ajednice u
usluge -oje se pru?aju u medicins-im ustano!ama2
E. ]ago!aranje ,a reformu politi-e o ja!nom ,dra!lju i lije-o!ima# -a-o bi
se rjeBila postoje@a ograni8enja u po!e@anju obima smanjenja Btete ,a
inje-cione -orisni-e droga2 i
J. ;P-asna pre!encija daljnjeg prenoBenja 'I(Ia spolnim putem# -ro,
pru?anje usluga pre!encije 'I(Ia ,a spolne partnere inje-cionih
-orisni-a droga.
2.!# Paralelno sa po!e@anjem dostupnosti i -!alitete usluga pre!encije ,a
inje-cione -orisni-e droga# Bto je planirano u 3a,i D# ta-o_er @e se po!e@ati i
ciljani broj no!ih inje-cionih -orisni-a droga# -oji @e se obuh!atiti programom.
:H
Iid.
:E
Iid.
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina GE
Po!e@anje obuh!ata i ra,noli-osti usluga podra,umije!a proporcijalno po!e@anje
u broju uposleni-a# u smislu radni-a na terenu i gate-eepers# -oji su dire-tno
odgo!orni ,a pro!edbu a-ti!nosti na terenu. * ne-im grado!ima# postoji !iBe od
jedne +(1# -oja radi na istoj geografs-oj lo-aciji2 Mostar# na primjer# je grad
podjeljen na d!a dijela i s!a-i dio ima dupliciranu stru-turu i institucije# -ao Bto su
bolnice# B-ole# i ta-o dalje.
2.!0 6ad na terenu proBirit @e se na no!e geografs-e lo-acije# -a-o bi se
obuh!atili inje-cioni -orisnici droga# -oji ni-ada prije nisu imali pristup uslugama#
posebno u ruralnim podru8jima i malim grado!ima. Pru?anje usluga# -a-o bi se
odgo!orilo na osno!ne potrebe -lijenata i ola-Bao im prustup# osigurat @e se -ro,
rad na terenu i aDro5 In centreW. Pru?anje o!og proBirenog pa-eta usluga u-lju8it
@e i ,amjenu igala i Bprica i pre!enciju -ro, rad na terenu i aDrop In centreW2
podjelu -ondoma2 pru?anje specijali,irane pomo@i i usluga sa!jeto!anja# -ro, rad
psihologa# socijalnih radni-a i pra!ni-a2 !rBnja8-o sa!jeto!anje i edu-acija2
moti!acijs-o sa!jeto!anje2 radionice o sigurnom ponaBanju2 participatorni ra,!oj2
podjela informati!nih# edu-acijs-ih i -omuni-acijs-ih materijala2 upra!ljanje
predmetima2 upu@i!anje na dobro!oljno sa!jeto!anje i testiranje2 i druge
,dra!st!ene usluge.
2.!1 S ciljem po!e@anja i odr?a!anja -ontinuiteta u pristupu uslugama# program
@e pru?ati usluge prilago_ene ra,li8itim podgrupama inje-cionih -orisni-a droga#
u, poseban fo-us na usluge prilago_ene spolo!ima i mladima# pru?aju@i usluge ,a
?ens-u populaciju i mlade inje-cione -orisni-e droga. ]a ?ene inje-cione -orisnice
droga# inter!encije @e dodatno u-lju8iti i speciP8ne usluge usmjerene na spolno i
reprodu-ti!no ,dra!lje# u-lju8juju@i planiranje porodice. Posebna pa?nja @e se
usmjeriti na rjeBa!anje problema !e,anih ,a rodno ,asno!ano nasilje.
2.!2 +ajmanje :LL apote-a bit @e u-lju8ene u pru?anje usluga smanjenja Btete.
+o!i model inter!encija# -oje !ode pripadnici istih grupa# pomo@i @e da se
obuh!ate no!e podgrupe inje-cionih -orisni-a droga# -ao Bto su mladi i)ili ?ene
inje-cioni -orisnici droga# i -orisnici stimulanata. Procjena programa je da# u
o-!iru 3a,e II# -ao re,ultat o!ih a-ti!nosti# bi se obuh!at -lijenata inje-cionih
-orisni-a droga trebao po!e@ati najmanje ,a i,me_u :LS do :ES.
2.!3 6ad na terenu pro!odit @e terens-i radnici# !rBnja8-i edu-atori i
gate-eepers# -oji su upo,nati sa pod-ulturom -orisni-a droga# bilo putem
njiho!og stru8nog is-ust!a u radu sa o!om populacijom# ili putem osobnog
is-ust!a -oriBtenja droga .osobno is-ust!o ili is-ust!o 8lana porodice/. (jeruje se
da pru?atelji usluga -oji# ,aista# dola,e i, o!ih grupa# mogu usposta!iti bolji
-onta-at sa -lijentima# pre!a,i@i barijere i nedostata- po!jerenja# te utjecati na
promjenu ponaBanja. Posebice gate-eepers# -ro, njiho!o !lastito prih!atanje i
-oriBtenje sigurnijih modela ponaBanja# bit @e u mogu@nosti pru?iti pomo@
radnicima na terenu -a-o bi doBli do s-ri!enih populacija o!isni-a i la-Be
usposta!ili pr!i -onta-t.
2."/ 3a,a II se ne@e odnositi samo na proBirenje obuh!ata a-ti!nostima
pre!encije2 Program @e nastojati osigurati odr?i!o Pnanciranje putem daljnjeg
ja8anja me_use-tors-e i !iBese-tors-e saradnje. (lasniBt!o nad 'I( programom
dr?a!e ne@e doprinjeti samo dugoro8noj !ladinoj podrBci programu# nego @e
ta-o_er pomo@i entitetima i Distri-tu "r8-o da promijene sta!o!e i ponaBanje
op@e populacije prema inje-cionim -orisnicima droga. Pored toga# s ob,irom da
@e ta-!a saradnja u-lju8i!ati ra,li8ite institucije# organi,acije i !ladine odjele u
programs-e a-ti!nosti# usposta!it @e se i bolje i po!oljnije o-ru?enje ,a inje-cione
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina GJ
-orisni-e droga V o-ru?enje -oje u-lju8uje njiho!a ljuds-a pra!a# medicins-u
njegu i budu@u odr?i!ost usluga. Inter!encije u o!om smislu u-lju8uju
I,radu do-umenta politi-a ,a smanjenje Btete2
Standardi,aciju pa-eta usluga ,a aDro5 In centreW i rad na terenu2
A-reditacija usluga i pr?atelja usluga2
Anali,a e-onomi8nosti usluga ,a smanjenje Btete2
*sposta!a procesa prego!aranja sa ra,li8itim ni!oima !lade2
I,rada instrumenata i metodologija ,a proces prenosa nadle?nosti
programa -ao modela ,a odr?i!o pru?anje usluga2 i
1rgani,acija temats-ih sastana-a -a-o bi se i,gradili -apaciteti !ladinih
i ne!ladinih pru?atelja usluga i -renulo u pra!cu primarnog primatelja
-oji nije dio *+Ia# te bolje opremila ministarst!a ,a osiguranje odr?i!osti
-!alitete usluga.
2."1 +a godiBnjoj osno!i u o-!iru 3a,e II# DL !rBnja8-ih edu-atora odabrat @e se
od grupe inje-cionih -orisni-a droga u 3"i' i educirat @e ih +(1 Margina# sa
ciljem da se po!e@a pristup inje-cionim -orisnicima droga do -ojih je teB-o do@i.
;du-acija @e obuh!atiti teme -oje se odnose na 'I( i AIDS# hepatitis# se-sualnost#
-oriBtenje droga# -a-o pristupiti -lijentima i moti!irati ih da promijene s!oje
ponaBanje# metode a-ti!nog sluBanja# neosu_uju@a -omuni-acija sa -lijentima#
pitanja po!jerlji!osti i daljnjeg upu@i!anja -lijenata u situacijama -ada !rBnja8-i
edu-ator nije u stanju da rijeBi probleme.
2."2 1!i educirani !rBnja8-i edu-atori predsta!ljat @e s!oje -lijente inje-cione
-orisni-e droga i -asnije @e preu,eti gate-eeper. +a o!aj na8in# broj osoba
obuh!a@enih uslugama @e se po!e@ati# te @e se ost!ariti !e,a sa !e@im brojem
postoje@ih mre?a u o-!iru grupe inje-cionih -orisni-a droga. *8esnici @e dola,iti i,
ra,li8itih podru8ja "i'# te @e se na taj na8in osigurati !e@i geografs-i obuh!at. *
radu sa ugro?enim i marginali,iranim grupama stano!niBt!a !a?no je naglasiti da#
pored njiho!e ugro?enosti i 8estog pre-lapanja sa drugim# grani8nim
populacijama .-ao Bto su# naprimjer# se-sualni radnici/# inje-cioni -orisnici droga
su pod !eli-im ri,i-om od 'I(Ia i# stoga# je -ontinuirana !rBnja8-a edu-acija od
i,u,etno !eli-og ,na8aja.
Seksualni radnici
2."! * 3a,i I# usluge su pru?ane se-sualnim radnicima putem d!ije ne!ladine
organi,acije .AAA u 6S# *G Proi u 3"i'/. * to-u perioda pro!edbe 3a,e I# potrebe
se-sualnih radni-a rjeBa!ane su putem a-ti!nosti na terenu i informacionih#
edu-acijs-ih i -omuni-acijs-ih materijala# !au8era ,a besplatno 'I( testiranje i
-ondoma -a-o bi se sprije8ilo prenoBenje 'I(Ia. 6a,li8iti a,aba!ni obje-tiW i
njih!oi !lasnici su bili ciljane grupe# -ao i gate-eepers i -lijenti se-sualnih
radni-a# sa ciljem da se u-lone barijere ,a ost!ari!anje pristupa dijagnostici i
lije8enju spolno prenosi!ih bolesti2 informiranje o uslugama dobro!oljnog
sa!jeto!anja i testiranja osigurano je putem !rBnja8-ih edu-atora .-oji su dijelili
!au8ere ,a besplatne usluge dobro!oljnog sa!jeto!anja i testiranja/# usluge -oje
se odnose na ,dra!lje maj-e i djece# -ao i usluge primarne ,aBtite.
2."" * 3a,i II# pored a-ti!nosti -oje pro!ode AAA i *G Proi# inter!encije
usmjerene na se-sualne radni-e pro!odit @e i Margina2 te @e tri +(1 po-ri!ati
ra,li8ite lo-acije u cijeloj ,emlji.
2."# Da bi se ost!ario !e@i utjecaj u 3a,i II program @e
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina GF
Po!e@ati obuh!at a-ti!nostima usmjerenim na pre!enciju 'I(Ia putem rada
u ,ajednici i programa pru?anja usluga se-sualnim radnicima# -a-o u
geografs-om smislu ta-o i u smislu po!e@anja podgrupa se-sualnih
radni-a2
Po!e@ati sadr?aj i obim usluga -oje se pru?aju2
*naprijediti -!alitet usluga i pro!esti -ontrolu -!alitete2
1mogu@iti integraciju usluga na ni!ou ,ajednice sa uslugama -oje se
pru?aju u medicins-im ustano!ama2
6jeBa!ati problem stigmati,acije i dis-riminacije -od pru?atelja
,dra!st!enih usluga -a-o bi se pota-li se-sualni radnici da ost!are bolji
pristup op@im ,dra!st!enim i drugim uslugama2 i
Sprije8iti daljnje prenoBenje 'I(Ia putem pro!edbe -!alitetnih usluga
pre!encije 'I(Ia ,a -lijente se-sualnih radni-a.
2."0 $ilj programa je odr?a!anje i po!e@anje rada na ni!ou ,ajednice i obima
usluga ,a se-sualne radni-e putem !rBnja8-ih edu-atora)radni-a na terenu i
gate-eepers# -oji su u stanju da ost!are pristup# st!ore po!jerenje# i,grade !e,e i
pru?e e-onomi8ne usluge najri,i8nijim s-upinama ?ena. 1!oj populaciji @e se
pristupiti putem -oriBtenja no!ih tehni-a i strategija rada na terenu# sa ciljem
sprje8a!anja prijenosa se-sualnim putem i parenteralnog puta prijenosa. 1sno!ni
pa-et usluga .informati!ni materijal# lubri-anti# -ondomi i sa!jeto!anje sa
radni-om na terenu/ bit @e unaprije_eno putem osni!anja d!a aDrop In centraW ,a
se-sualne radni-e u 3"i' .Saraje!o i ]enica/ i jednog u 6S ."anja &u-a/2
testiranja ,a ot-ri!anje trudno@e2 speciP8nijih a-ti!nosti informiranja# edu-acije i
-omuni-acije# ra,!ijenih putem participatornog u-lju8i!anja se-sualnih radni-a2
socijalnih# pra!nih usluga# i usluga stru8nog usa!rBa!anja i samopodrB-e2
upu@i!anja na 'I( testiranje i terapiju lije-o!ima2 usluge !e,ane ,a spolno i
reprodu-ti!no ,dra!lje i planiranje porodice2 te pru,?anje sa!jeta o pitanjima -oja
se odnose na nasilje. 1!e usluge oja8at @e pre!enciju i smanjiti stopu smrtnosti.
2."1 aDrop In centarW pru?at @e ?enama 8ita! ni, besplatnih usluga u ,ajednici#
u-lju8uju@i i psihosocijalnu podrB-u i sa!jeto!anje# informacije o 'I(Iu i AIDSIu i
,loupotrebi droga# te pristup ,aBtiti spolnog ,dra!lja i primarnoj ,dra!st!enoj
,aBtiti. Poseban fo-us bit @e na pre!enciji nasilja nad se-sualnim radnicima.
*sluge @e u-lju8iti i podrB-u ,a ?rt!e nasilja .pra!na# medicins-a# psiholoB-a/2
upu@i!anje u s-loniBta ,a ?ene# posebice -ada su u pitanju ?rt!e nasilja u
porodici2 besplatan pristup psihosocijalnom sa!jeto!anju ,a paro!e .se-sualni
radnici i njiho!i partneri/2 edu-ati!ne programe o sprje8a!anju i rjeBa!anju
su-oba# te edu-aciju o !jeBtinama -omuni-acije ,a se-sualne radni-e i
,losta!ljane ?ene.
2."2 * o-!iru 3a,e II# u-upan broj od JL !rBnja8-ih edu-atora odabrat @e se i,
grupe se-sualnih radni-a i udru?enje AAA @e ih educirati# -a-o bi se po!e@ale
usluge na terenu -oje se pru?aju se-sualnim radnicima. Teme -oje @e se
obuh!atiti u o-!iru edu-acije u-lju8uju 'I( i AIDS# se-sualnost# -oriBtenje droga#
hepatitis# spolno prenosi!e bolesti# dobro!oljno sa!jeto!anje i testiranje# -a-o
ost!ariti pristup -lijentima i moti!irati ih da promijene s!oje ponaBanje# metode
a-ti!nog sluBanja# neosu_uju@a -omuni-acija sa -lijentima# po!jerlji!ost i daljnje
upu@i!aje -lijenata u situacijama -oje ne mogu rijeBiti !rBnja8-i edu-atori.
2."3 (rBnja8-i edu-atori -oji budu poha_ali o!e edu-acije# predsta!ljat @e
populaciju se-sualnih radni-a i -asnije @e preu,eti ulogu gate-eeper# sli8no -a-o
je to opisano i pred!i_eno u radu sa inje-cionim -orisnicima droga V obuh!at
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina GM
!e@eg broja osoba# u!e,i!anje sa !e@im brojem postoje@ih mre?a# proBiri!anje
geografs-og obuh!ata i odgo!aranje na potrebe grani8nih populacija.
2.#/ +a -raju# pro!odit @e se -ampanja ,ago!aranja -a-o bi se omogu@ilo
st!aranje po!oljnog o-ru?enja u -ojem pre!encija 'I(Ia i AIDSIa# lije8enje# njega i
usluge podrB-e ,a -lju8ne populacije i osobe -oje ?i!e sa 'I(Iom# se mo?e
eP-asno pro!esti. ]ago!aranje @e se !rBiti na sljede@e teme
De-riminali,acija -oriBtenja droga i dobro!oljni se-sualni rad2
*-lanjanje administrati!nih -a,ni sa -ojima se trenutno suo8a!aju
osobe -oje su proglaBene -ri!im ,a pru?anje se-sualnih usluga ,a
no!ac2
"esplatan pristup se-sualnim radnicima lije8enju spolno prenosi!ih
bolesti2
Pristup metodama sprije8a!anja prenoBenja 'I(Ia .lubri-anti sa
mi-robicidima/2 i
1siguranje s!eobuh!atne usluge ,a smanjenje Btete# posebno ,amjene
igala i Bprica# podjela lubri-anata# i ta-o dalje.
Mukarci koji imaju spolne odnose sa mukarcima
2.#1 * 3a,i :# muB-arci -oji imaju spolne odnose sa muB-arcima obuh!a@eni su
pre!enti!nim a-ti!nostima -oje su pro!odile +(1 Asocijacija 45 u 3"i' i AAA u
6S. 1!e a-ti!nosti sastojale su se od rada na terenu# !o_enja aDrop In centaraW# i
rada putem interneta .t,!. acyberW rad/# -ao i pro!o_enje ra,li8itih organi,acija
-oje se odnose na 'I( i AIDS. 6ad na terenu pro!odio se u "anja &uci# "iha@u#
"r8-om# Doboju# Mostaru# Prijedoru# Saraje!u# Tu,li i ]enici i sastojao se od
pru?anja informacija o uslugama -oje se odnose na spolno ,dra!lje# u, poseban
naglasa- na 'I( i AIDS i druge spolno prenosi!e bolesti. other STI. A-ti!nosti
aDrop In centraW Asocijacije 45 u-lju8i!ale su sa!jeto!anje i upu@i!anje uju
Association<s DI$a testiranje na hepatitis " i $# 'I( i siPlis.
2.#2 * to-u 3a,e I postoji samo jedan aDrop In centarW u 3"i' -oji je pru?ao
usluge ,a muB-arce -oji imaju spolne odnose sa muB-arcima2 u to-u 3a,e II# o!aj
ograni8eni pristup proBirit @e se putem ot!aranja dodatna tri aDrop In centraW u
3"i' i jednog u 6S# Bto @e omogu@iti mnogo !e@i obuh!at muB-araca -oji imaju
spolne odnose sa muB-arcima. Sli8no tome# u 3a,i II geografs-i obuh!at @e se
proBiriti u DL:G.# -a-o bi se u-lju8ile d!ije no!e proje-tne lo-acije# `apljina i
Tra!ni-# u 3"i'.
2.#! Pristup rada na terenu je speciP8na metoda# 8iji cilj je obuh!atiti -lju8nu
populaciju -oja nema ?elju ili nije u mogu@nosti da -oristi usluge tradicionalnih
slu?bi# -ao Bto su -lini-e ,a spolno prenosi!e bolesti i druge !rste usluga# -oje se
pru?aju putem ,dra!st!enih institucija# te promo!iranje pristupa o!im uslugama.
1!aj metod omogu@a!a promociju ,dra!lja putm
Po!e@anog ni!oa s!ijesti o ri,i8nom ponaBanju2
Poticanja smanjenja ri,i8nog ponaBanja2 i
Pru?anja pre!enti!nih usluga prilago_enih pojedina8nim potrebama.
6ad na terenu u "i'# -ao i u !e@ini ,emalja sa -oncentriranim epidemijama ili
jasnim grupama -lju8nih populacija# pru?a se putem mre?a organi,acija ci!ilnog
druBt!a.
2.#" ]a poru-e usmjerena na promjenu ponaBanja# rad naterenu se naj8eB@e
pro!odi putem dire-tnih ra,go!ora .licem u lice/ ili grupnih edu-acijs-ih
sastana-a u aDrop In centruW ili radnom o-ru?enju# na neformalnim
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina GK
o-upljaliBtima# ili odre_enim mjestima u lo-alnoj ,ajednici. A-ti!nosti tima ,a rad
na terenu u-lju8uju ra,go!or o pre!enciji 'I(Ia# podjeli -ondoma i !au8era ,a
besplatno testiranje na 'I( u lo-alnim -lini-ama ,a dobro!oljno sa!jeto!anje i
testiranje ili testiranje u aDrop In centrimaW na terenu. *sluge dobro!oljnog
sa!jeto!anja i testiranja i promocija upotrebe i podjela -ondoma nasta!it @e se
pro!oditi u aDrop In centrimaW smjeBtenim bli,u popularnih o-upljaliBta
muB-araca -oji imaju se-sualne odnose sa muB-arcima u gore na!edenim
grado!ima.
2.## aDrop In centriW nude informati!ne# edu-ati!ne i -omuni-acisj-e sastan-e2
edu-acije i radionice2 pre,entacije !rBnja8-e edu-acije2 psiholoB-o sa!jeto!anje
od strane psihologa2 osno!no pru?anje sa!jeta -oje pru?aju obu8eni sa!jetnici ,a
muB-arce -oji imaju se-sualne odnose sa muB-arcima2 telefons-a linija ,a pomo@2
rad putem interneta u s!rhu da!anja informacija i upu@i!anja u Asocijaciju 45 i
druge slu?be2 cyber rad na terenu .Planet 6omeo# popularna internet stranica ,a
homose-sualce/2 upu@i!anje na dobro!oljno sa!jeto!anje i testiranje2 i podjela
edu-ati!nih materijala# -ondoma i lubri-anata. Pored toga# dermatolog posje@uje
aDropIin centarW# -a-o bi pru?io usluge u pogledu spolno prenosi!ih bolesti.
Po!e@anje obima rada aDropIin centraW u o-!iru 3a,e II predts!aljeno je -ro,
po!e@ane cilje!e.
2.#0 * to-u pro!edbe 3a,e II# plan je odrediti :LL !rBnja8-ih edu-atora i,
populacije muB-araca -oji imaju se-sualne odnose sa muB-arcima u oba ;ntiteta#
te ih obu8iti putem AAA i Asocijacije 45. Association. Pored toga# GD muB-araca
-oji imaju spolne odnose sa muB-arcima bit @e educirani na temu ,ago!aranja2
u8esnici @e dobiti mogu@nost da u8est!uju u radionici o ,ago!aranju# sa ciljem da
se pomogne lo-alnoj !ladi da osigura odr?i!ost programa pre!encije 'I(Ia u
,ajednicama muB-araca -oji imaju spolne odnose sa muB-arcima. ;du-acija @e
po!e@ati ni!o ,nanja i !jeBtina)instrumenata ,a ,ago!aranje -od u8esni-a i,
grupe muB-araca -oji imaju spolne odnose sa muB-arcima. `etrdesetosam
socijalnih radni-a pro@i @e edu-aciju o pitanjima -oji se odnosi na muB-arce -oji
imaju spolne odnose sa muB-arcima i GD muB-araca -oji imaju spolne odnose sa
muB-arcima educirat @e se -ao sa!jetnici# -a-o bi pomogli u8esnicima da
unaprjede s!oje !jeBtine -omuniciranja# te identiPciraju ri,i8no ponaBanje i
ola-Baju -omuni-aciju sa -lijentima.
2.#1 1stale a-ti!nosti -oje @e pro!oditi o!e +(1 u-lju8uju edu-aciju ,a
sa!jetni-e ,a muB-arce -oji imaju spolne odnose sa muB-arcima i i,radu
smjernica ,a njiho! rad# ,ago!aranje i seta instrumenata ,a 'I(2 namjera je
osigurati odr?i!ost proje-tnih a-ti!nosti# ta-o Bto @e muB-arci -oji imaju spolne
odnose sa muB-arcima ste@i !jeBtine i ,nanje potrebno da ,astupaju interese
populacije muB-araca -oji imaju spolne odnose sa muB-arcima.
2.#2 6adionice ,a pru?atelje usluga socijalne ,aBtite osigurat @e u8esnicima
mogu@nost da se usposta!i minimalan pa-et usluga ,a pre!enciju 'I(Ia -od
muB-araca -oji imaju spolne odnose sa muB-arcima2 pono!no# to je a-ti!nost -oja
@e doprinjeti odr?i!osti a-ti!nosti u ,ajednici# a -oje se odnose na ciljane
populacije.
Zatvorenici
2.#3 A-ti!nosti pre!encije 'I(Ia me_u ,at!orenicima u 3a,i I pro!odile su d!ije
+(1# (i-torija u 6S i Asocijacija 45 u 3"i'. A-ti!nosti pre!encije ,asno!ane su na
edu-aciji pripadni-a iste populacije2 ,at!orenici su educirani da pro!ode
proje-tne a-ti!nosti u ,at!orima# te informiraju i educiraju pripadni-e iste
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina HL
populacije o 'I(Iu# spolno prenosi!im bolestima i infe-cijama -oje se prenose
putem -r!i. ]at!orenici su ta-o_er imali pristup -ondomima# lubri-antima# i
Btampanim edu-ati!nim materijalima.
2.0/ * o-!iru 3a,e II# joB jedna +(1# Margina# pro!odit @e a-ti!nosti ,a
inje-cione -orisni-e droga u ,at!orima i s!e tri +(1 nasta!it @e raditi na
a-ti!nostima pre!encije 'I(Ia u ,at!orima u oba ;ntiteta. A-ti!nosti pre!encije
,asni!at @e se na edu-aciji od strane pripadni-a iste populacije
:J
i mobilnih
timo!a -oji @e omogu@iti ,at!orenicima testiranje na 'I(.
2.01 Sedamdeset educiranih edu-atora i, populacije ,at!oreni-a i K: stru8ni
uposleni- ,at!ora# pro@i @e edu-aciju i biti u mogu@nosti organi,irati mjese8ne
edu-ati!ne sastan-e sa drugim pripadnicima iste populacije. Module @e i,raditi# i
prema njima !rBiti edu-aciju# sami edu-atori pripadnici date populacije i isti @e
biti u-lju8eni u priru8ni- ,a edu-atore# -ao i edu-ati!ni posteri -oji @e se -oristiti
-ao instrumenti ,a prijenos ,nanja ostalima# a bit @e prilago_eni u!jetima u -ojim
,at!orenici ?i!e# te ,a upotrebu u ,at!orenim i ot!orenim prostorima.
2.02 * 3a,i II# Asocijacija 45 po8et @e sa pro!o_enjem a-ti!nosti edu-acije od
strane pripadni-a iste populacije u jedinom ?ens-om ,at!oru# smjeBtenom u Tu,li.
A-ti!nosti @e ta-o_er biti usmjerene na edu-aciju uposleni-a ,at!ora# o
smanjenju ri,i-a -od uposleni-a# -a-o bi programi pre!encije bili eP-asniji i
odr?i!iji# te -a-o bi se ri,i8nost ,at!oreni-a po!e,ala sa ni!oom ri,i-a unutar
,at!ora. I,rada 'I( proto-ola)smjernica ,a ,at!ore bit @e integrirana u s!e
pristupe -oji @e se -oristiti sa ,at!orenicima ,ara?enih 'I(Iom# smanjenje
stigmati,acije i dis-riminacije prema 'I( po,iti!nim ,at!orenicima# objaBnjenje
ri,i-a -oji se odnose na -onta-t sa ,at!orenicima -oji su potencijalni infocirani
'I(Iom ili bilo -ojom drugom spolno prenosi!om boleB@u# op@enito podi,anje
s!ijesti o 'I(Iu# -a-o bi se smanjio ri,i- infe-cije me_u ,at!orenicima i
uposlenicima.
2.0! I,ra_i!at @e se 8asopisi ,a ,at!oreni-e# -ao !a?an -omuni-acijs-i
instrument gdje @e ,at!orenici mo@i obja!lji!ati s!oje 8lan-e i ra,mjenji!ati
is-ust!a# ,nanje i ra,miBljanja -oja se odnose na program pre!encije 'I(Ia.
2.0" Dodatna a-ti!nost u 3a,i II bit @e pra@enje inje-cionih -orisni-a droga u
,at!orima i na-on otpusta i, ,at!ora# putem Margine i (i-torije. 1!aj mehani,am
smanjuje mogu@nost agubit-aW -lijenta u ,ajednici na-on puBtanja i, ,at!ora.
7oristi se sistem umre?a!anja sa institucijama i ne!ladinim organi,acijama -a-o
bi se unaprijedilo pra@enje -lijenata i njiho!ih potreba. Sli8no tome# podu,et @e se
napori -a-o bi se oja8ala uloga i -apacitet centara ,a socijalni rad u ,aBtiti na-on
odslu?enja -a,ne i u!e,i!anju i,me_u o!ih cenatara# +(1 i -a,neno popra!nih
institucija. =oB jedanput# o!e a-ti!nosti @e doprinjeti odr?i!osti programa na-on
,a!rBet-a 3a,e II.
Mladi
2.0# 7lju8ni dio a-ti!nosti 3a,e I bile su inter!encije usmjerene na mlade u B-oli
i !an B-ols-og sistema. Pola,na osno!a je 8injenica da su adolescenti suo8eni sa
najtubulentnijim periodom s!oga ?i!ota# -ada su ,apra!o najranji!iji2 naprimjer#
:J
(rBnja8-a edu-acija)edu-acija od strane pripadni-a iste populacije je pristup u edu-ciji I
pre!enciji 'I(Ia# -oji preporu8uje !eli-i broj e-sperata I organi,acija -oje rade na 'I( edu-aciji u
,at!orima. Istra?i!anja po-a,uju da edu-atori# -oji dola,e i, ,at!ors-e populacije# su jedna-o
eP-asni u s!om radu -ao I profesionalni 'I( edu-atori# jedina je ra,li-a u tome da ,at!orenici
preferiraju o!a-!e edu-atore# jer su pripadnici iste populacije.
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina H:
mnogi od njih imaju nesuglasice sa roditeljima i, ra,li8itih ra,loga. Mladi -oji ?i!e
u students-im domo!ima ili centrima ,a smjeBtaj odrastaju u posebno teB-im
u!jetima -oji utje8u na njiho!o priholoB-o i mentalno ,dra!lje2 odrastanje i,!an
porodice mo?e biti traumati8no# u !e@ini slu8aje!a# be, ob,ira da li je ra,log smrt
roditelja# da li dola,e i, disfun-cionalnih porodica# da li su od!ojeni od porodica
,bog napuBtanja od strane porodice# ,losta!ljanja# ,anemari!anja ili siromaBt!a.
Pored toga# mladi u centrima ,a -ole-ti!ni smjeBtaj suo8eni su sa stigmati,acijom
i dis-riminacijom od strane !rBnja-a -oji se prema njima odnose na druga8iji
na8in.
2.00 Adolescenti su pod naj!e@im !rBnja8-im pritis-om# te su ,bog toga
posebno pod ri,i-om2 posebice# jer# u isto !rijeme# po8inju sa -on,umiranjem
al-ohola i droga i po8inju da stupaju u spolne odnose. Mladi -oji odtrastaju u
hostelima ili centrima ,a ,brinja!anje# 8esto su i,lo?eni teB-im u!jetima i njiho!
pristup -!alitetnim informacijama je ,na8ajno ograni8en. +jiho!o socijalno
o-ru?enje ne daje im do!ojno podrB-u ,a ,dra! ra,!oj# te 8esto nemaju
s!a-odne!nu njegu i podrB-u -oja im je potrebna -a-o bi donijeli obje-ti!ne
odlu-e# te su# stoga# pod po!e@anim ri,i-om od 'I( infe-cije. ]apra!o# re,ultati
studije o ponaBanju
:F
# pro!edene u institucijama ,a -ole-ti!ni smjeBtaj u "i'#
po-a,uju da mladi u o!im institucijama imaju ograni8eno ,nanje o 'I(Iu .samo
DK#:S je ta8no odgo!orilo na pitanje o 'I(Iu/ i uslugama !e,anim ,a 'I( .samo
jedna osoba od GKD ispitani-a je testirana na 'I(/.
2.01 1rphans# street children and other young people li!ing in collecti!e
accommodation were identiPed as a 7APs in "osnia<s second $trategy to
4es5ond to HI< and AID$ in Bosnia and Herzegovina for t(e 5eriod 2/11>2/10.
&i-ewise# at the same time a majority of these youth are li!ing below the po!erty
line which is also a target group dePned by the Strategy as a -ey population at
ris-.
2.02 *nder Phase I# youth acti!ities were implemented by Association 45.
Acti!ities targeted !ulnerable youth in both school .age range :LIDH/ and outIof
school .age range :HIDH/ settings. Acti!ities were based on life s-ills education
with a focus on assisting S6' and social ser!ices to become more genderI
appropriate and youthIfriendly. %ith Global 3und support# DJ youthIfriendly
health centres were established and operational# pro!iding
educational)promotional acti!ities and medical ser!ices.
2.03 Information centres were established within local +G1s and were
responsible for educational and promotional acti!ities such as regular peer
educational presentations in elementary and secondary schools2 educational
acti!ities at uni!ersity faculties2 educational acti!ities with parents and school
sta02 outIofIschool acti!ities with !ulnerable groups2 !arious e!ents for youth
.concerts# street acti!ities# etc./2 the ongoing distribution of condoms and
educational materials2 and all conducted with a youthIfriendly approach.
2.1/ The medical centres comprised teams of NualiPed health wor-ers wor-ing
within local health institutions. They were in charge of pro!iding medical ser!ices
such as networ-ing and collaboration between medical centres and +G1s at the
project locations2 gynaecological and counselling ser!ices to young people2
referral to other institutions# especially ($T centres# for testing for 'I( and
hepatitis.
:F
*+I$;3 "i' .DLLM/ "eha!ioural research conducted among adolescents in collecti!e
accommodation in "osnia and 'er,ego!ina in DLLM# funded by the G3ATM.
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina HD
2.11 The youthIfriendly health centres were set up to pro!ide high Nuality
health ser!ices tailored to the speciPc needs of young people# especially
!ulnerable groups. These centres are also in charge of promoting healthy
lifestyles as well as protecting the S6' and rights of young people# including
pre!ention of 'I( and other STI. 'owe!er# under Phase II these acti!ities were
dropped at the reNuest of the G3 who did not consider youth to be a priority
group to 7APS. Another reason for dropping this acti!ity was that it was e9pected
that 'I( education would be assumed into the regular school curriculum.
Roma
2.12 During Phase I %orld (ision "i'# in cooperation with the 6oma $ouncil and
6oma +etwor-# established three 6oma 'I( Information $entres# which pro!ed to
be an essential partnership in the successful implementation of project
objecti!es. In addition# DL outreach wor-ers from the 6oma communities were
trained to wor- in 6oma communities# ranging from regular outreach wor- .group
and indi!idual information sharing# educational and counselling sessions/ to peer
education using specially designed educational boards. The project has countryI
wide co!erage with particular emphasis on remote 6oma communities which#
prior to this project# had no access to any information related to 'I( and AIDS.
2.1! The outreach wor-ers reached more than H#LLL 6oma community
members with information on 'I( pre!ention and ($T. 1f this number# DEF 6oma
ha!e used ($T ser!ices and ha!e been tested for 'I( and hepatitis $. 1!er
HL#LLL condoms were distributed# along with appro9imately :E#LLL I;$
materials. In addition# se!en round tables and :L public e!ents and awareness
raising sessions were conducted for 6oma community members# ensuring project
!isibility and pro!iding rele!ant information to the 6oma population. 1!er ML
health and social wor-ers were sensitised to wor- with 6oma communities in
order to better respond to 6oma health needs.
2.1" In Phase II# the Programme will continue to e9pand acti!ities through the
full participation of the 6oma 'I( Information $entres# partners# !olunteers and
other sta-eholders. The 6oma project will pro!ide continuous support to the
three 6oma 'I( information centres# support the Peld acti!ities of DE 6oma
outreach wor-ers co!ering DM 6oma communities# e9pand outreach by trained
6oma outreach wor-ers to P!e new communities and eNuip the P!e new outreach
wor-ers with the -nowledge and s-ills reNuired to launch outreach acti!ities in
new communities. 3inally# the project will sensitise and mobilise 6oma
community leaders and opinion ma-ers
2.1# It is e9pected that# by the end of Phase II# J#LLL 6oma benePciaries will be
reached through Peld acti!ities and JL#LLL condoms will be distributed# together
with I;$ materials.
2.10 The 6oma 'I( pre!ention programme was designed based on the .ational
Action Plan for 4oma Healt( Protection2 this project is the direct implementation
of 1bjecti!e G# Pro!ision and Implementation of Pre!enti!e Measures Aimed at
Impro!ing the 'ealth Status of 6oma +ational Minority Measure :.:.D. Se9ually
transmittable diseases with emphasis on 'I()AIDS. The Action Plan also
en!isages the use of 6oma mediators to gain better access to 6oma communities
and to impro!e the general health of this !ulnerable population. It is e9pected
that "i' health institutions will continue to use the e9perience# capacities and
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina HG
s-ills of 6oma outreach wor-ers as mediators in the future# following the end of
Phase II.
Migrants and Mobile Populations
2.11 In Phase I this acti!ity was implemented by the International 1rganisation
on Migration .I1M/.
2.12 Due to their geographical mobility and long periods of separation from
their se9ual partners# migrants and mobile populations are at high ris- of STI#
including 'I(# regardless of their beha!iour in their homes of origin. 6is-s are
embedded in the transient nature of migrants< li!es the longer the time spent
and the freNuency of tra!el away from home# the higher the probability of
engaging in ris-y se9ual beha!iour. 1ther factors# such as the characteristics of
lifestyle and wor- en!ironment related to speciPc profession such as longI
distance truc- dri!ing# may increase the odds of infection. The Phase II I1M
inter!entions focus e9clusi!ely on migrants and mobile populations# which ha!e
been identiPed as among the most at ris- in "i'.
2.13 Three important lessons ha!e been learned from the Prst phase of
implementation.
3irst# it is important to collect baseline information on the -nowledge#
attitudes and practices of target populations in order to design appropriate
outreach and pre!ention acti!ities and to measure change and impact o!er
time. Though this information was unfortunately not a!ailable for the Prst
phase# I1M will use the results of a sur!ey of truc- dri!ers currently being
implemented by the ;ntity Public 'ealth Institutes and conduct a similar
sur!ey amongst labour migrants .no speciPc research regarding 'I()AIDS
-nowledge# awareness and beha!iour has pre!iously been conducted with
this group in "i'/ for this purpose.
Secondly# though I1M successfully built an informal networ- for
communication and information sharing by and between partners including
+G1s# media representati!es and the public health sector# the networ- has
been somewhat wea-ened by the absence of migrant representati!es and
representati!es of crucial go!ernmental institutions that wor- on a daily
basis with migrants and mobile populations. Gi!en that 'I()AIDS and
mobility is a comple9#
#
e!ol!ing# and multiIfaceted Peld# reNuiring the
in!ol!ement of a wide !ariety of sectors and subIgroups# I1M intends to
carry forward and enhance the role of the 'ealth and Mobility +etwor-
while also pro!iding professionals and decisionIma-ers in the !arious
sectors with practical tools to pro!ide ser!ices that address the needs of
migrants and mobile populations in the Peld of 'I()AIDS ris- reduction and
pre!ention.
3inally# unless the successful approaches to tac-ling 'I( and AIDS and
mobility are embedded in the current and future strategic documents of
"i'# the sustainability and longe!ity of successful best practices will be
lost. As such# I1M will wor- with rele!ant sta-eholders and partners to
de!elop a detailed action plan for implementing inter!entions that will
pre!ent 'I()AIDS among mobile populations from becoming a high social
and economic cost in the future.
2.2/ The o!erall goal of the second phase is to pro!ide pre!ention and
treatment ser!ices that e0ecti!ely and appropriately address the needs of
migrants and mobile populations# while ensuring that these ser!ices in the health
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina HH
care and nonIhealth care sectors will continue to support migrants in the long
run.
2.21 1utreach wor-ers will continue to disseminate information through one to
one and group discussions# pro!ision of written information and condoms to
migrant sub groups including transport wor-ers# labour migrants# immigrants#
and armed forces personnel. ($T for transport wor-ers will be augmented and
made sustainable through cooperation with the Ser!ice for Indirect Ta9ation# the
($T centres and +G1s. Transport wor-ers often face di>cult wor-ing conditions
which raise their health ris- and leads to disad!antages in terms of access to
health care. I1M will establish two pilot $ounselling and Information Points at
customs terminals which ha!e the highest !olume of transit. The $ounselling and
Information Points will ma-e a!ailable low cost)free preIpac-aged STI information
-its. I1M will wor- in cooperation with the ;ntity P'I# the ($T centres in "anja
&u-a and Saraje!o# AAA in "anja &u-a and Partnerships in 'ealth in Saraje!o to
organise information dissemination# counselling and testing. All counselling
acti!ities carried out by +G1s will be organised in close cooperation with the
;ntity P'I in order to pro!ide them with the four indicators that they are reNuired
to collect .including counselling pre and post test# number of tests# number of
indi!iduals that return for results/.
2.22 I1M will design tool -its for institutions and organisations in healthcare and
nonIhealthcare to pro!ide support and ser!ices to migrants and mobile
populations in the long run.
2.2! A practical and user friendly guideboo- will be de!eloped on 'ealth and
Mobility that will pro!ide stepIbyIstep Whow toX for wor-ing with mobile
populations# pro!iding counselling and safeguarding human rights. ;ach
wor-shop underta-en as part of the project will be based on The 'ealth and
Mobility Guideboo- and the guideboo- will be widely promoted. It will pro!ide
guidance not only to all participants of the programme and at wor-shops# but
also to all future sta-eholders in the !arious institutions and organisations that
wor- with migrants and mobile populations.
2.2" InIdepth interacti!e 'I()AIDS and Mobility wor-shops will be organised and
tailored to the needs of participants within healthcare and nonIhealth care
institutions and businesses. Institutional benePciaries of these wor-shops will
include 'I()AIDS &ocal $oordinators2 communityIle!el healthcare wor-ers2
professionals in ministries addressing border security# immigration# asylum#
counterItra>c-ing# and customs2 counsellors in employment institutions and the
State Agency for &abour and ;mployment2 and pri!ate sector companies with a
focus on transport and construction.
2.2# Gi!en that 'I()AIDS and mobility is a comple9# e!ol!ing# and multiIfaceted
Peld# reNuiring the in!ol!ement of a wide !ariety of sectors and subIgroups# I1M
intends to carry forward and enhance the role of the 'ealth and Mobility +etwor-.
I1M proposes to augment its membership to include .i/ Prst and foremost
representati!es of migrants and migrant communities2 .ii/ localIle!el health care
sector participants2 .iii/ representati!es of go!ernmental institutions that are not
in the health care system .such as the State $oordinator against Tra>c-ing in
'uman "eings# the Ministries of Security# 3oreign A0airs# and 'uman 6ights and
6efugees# ;mployment Institutes and the Agency for &abour and ;mployment/2
and .i!/ representati!es of the pri!ate sector such as transport and construction
companies that employ migrants.
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina HE
2.20 In order to ensure that migrant !oices are heard and that migrants< needs
are speciPcally included in strategy de!elopment# I1M will wor- o!er the course
of the three years with the 'ealth and Mobility +etwor- to identify gaps in
national policy as they relate to 'I()AIDS and mobility. These e0orts will
culminate in the third year of the project when the 'ealth and Mobility +etwor-
will participate in wor-shops designed speciPcally to de!elop recommendations
and a concrete and detailed action plan for the mainstreaming of speciPc
measures addressing migrants and mobile population in 'I( and AIDS national
strategies. Gi!en that migrants ha!e been identiPed as one of the most atIris-
groups in "i'# and yet ha!e only earned a passing mention in the e9isting
strategy# it is of utmost importance that !ery speciPc recommendations V i.e. a
detailed and practical action plan V e9ist to address the particular ris-s arising
through mobility.
+/Ge'tive # Ensure appropriate prevention7 treatment7 'are and
support for people living )ith HIV and AIDS
Integrated Prevention, Treatment, Care and Support (IPTCS !or P"#I$
2.21 In Phase : acti!ities relating to P&'I( were deli!ered by one S6 and two
subIsub recipients .SS6/ in regard to the pro!ision of li!ing support to P&'I(
Partnerships in 'ealth# and AP1'A and AAA. &i!ing support included the
pro!ision of !itamins# wood# food# drugs and clothes# and V through AAA and
AP1'A I the formation of psychosocial assistance through support groups.
2.22 In Phase II the two +G1s which were formerly SS6s ha!e now become S6s.
The main reason for this is that it pro!ides the P6 with easier access to and direct
o!ersight)coordination of rele!ant P&'I( acti!ities.
2.23 "ased on the positi!e results of the li!ing support acti!ity under Phase I#
the pro!ision of the !itamins# drugs# food# hygiene products and other items to
P&'I( will be continued. P&'I( needs are identiPed in collaboration with the
clinicians and on the basis of their social status# i.e. if employed or not# and so
on. To ensure transparency and coordination with the Infecti!e Diseases $linics#
consultations with these professionals ta-e place twice yearly. Medications are
stored within the Infecti!e Diseases $linics# while the inI-ind goods are pro!ided
directly to the benePciaries. A mechanism for control that will pre!ent
o!erlapping and duplication will be established in cooperation with the +ational
$oordinators# Infectious Disease $linics# AAA and AP1'A.
2.3/ This component also aims to boost pre!ention e0orts among P&'I(
including# but not limited to# pro!ision of social support to P&'I(# therapy for 1I#
as well as monitoring of therapy and drug resistance. Since the number of new
'I( infections signiPcantly increased during DL:D# strengthening of those e0orts
in DL:G and beyond is of -ey importance. Those actions are supported by other
acti!ities such as study tours for health pro!iders treating 'I( and AIDS across
the country# their capacity building# and so on.
2.31 In order to fully address issues pertaining to treatment and care#
Partnerships in 'ealth has de!eloped a training methodology which contains an
obligatory module to address stigma and discrimination towards P&'I( as well as
7APs.
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina HJ
2.32 AAA and AP1'A pro!ide support to empower P&'I( which to de!elop
relationships with the 'I(Ipositi!e community# with their close social circles and
within the larger community. P&'I( who ha!e gone through all the empowerment
steps are able to participate in all acti!ities conducted by AAA and AP1'A#
especially peer consultancies. 'a!ing reached a certain le!el of empowerment#
P&'I( will be encouraged to become members# employees# and e!en board
members# of AAA and AP1'A. As both organisations become stronger through
P&'I( empowerment# the organisations themsel!es will be able to participate in
international 'I( networ-s.
2.3! Psychosocial counsellors and P&'I( deli!er outreach wor-# which includes
!isiting their homes# !isits during hospitalisation# and in other situations as
needed. This acti!ity is implemented by AP1'A.
2.3" Moreo!er# plans are underway to de!elop P&'I( leadership and ad!ocacy
to increase P&'I( participation in the country<s response to 'I(. P&'I( groups will
be assisted to pro!ide information and support to P&'I(. Small grants will be
pro!ided to P&'I( groups for operational support and establishing local projects
aimed at stigma reduction# positi!e pre!ention and ad!ocacy. +ew models of
negati!e impact mitigation will be established in Phase II# notably Sustainable
&i!ing De!elopment# which includes !ocational training# pro!ision of tools and
materials related to sustainable li!ing# and networ-ing. This will enable lowI
income P&'I( .dePned through the e!aluation of social status conducted by the
P'I/ to create a sustainable en!ironment for themsel!es by employing newly
acNuired s-ills and -nowledge.
2.3# A 6egional $ase 6egistry will be de!eloped# lin-ing "i'<s clinical centres
with the entire country through the three di0erent health systems .regions#
cantons and "r8-o District/. This acti!ity could play an important role in caring
for P&'I(# reinforcing and maintaining their adherence to Nuality therapy# and the
management of data related to A6T. If properly implemented# the 6egional $ase
6egistry will demonstrate that it is possible to prescribe A6( using a mentorship
system for prescribers when needed2 patients may be referred# as appropriate# to
specialist .e9amination# biological tests and radiological e9aminations#
hospitalisation/ and palliati!e care. +etwor-ing care facilities and de!eloping
partnerships are critical to strengthening the care continuum for P&'I(.
2.30 All P&'I( trainings# wor-shops# trainers# institutions and curriculum for
social wor-ers and employees of the social ser!ices sector will be secured with
the permission of the +ational $oordinators on 'I( and AIDS. M1' will prioritise
the health facilities for participation. "ased on the turnout# training sessions may
be repeated whene!er necessary in order to meet the rele!ant indicator.
2.31 *nder Phase II the sustainability of the P&'I( social support component will
be addressed throughout the in!ol!ement of the social welfare and social ser!ice
pro!iders. This decision has been made on the basis that the majority of P&'I(
belong to marginalised and poor population groups2 hence continuation of the
li!ing support is of !ital importance. The Programme will ma-e e!ery e0ort to
ensure the sustainability of this component after the end of Phase II through
wor-ing in close collaboration with Ministries of Social %elfare# who ha!e already
been consulted and are supporti!e of the component.
PMTCT
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina HF
2.32 As a recognised highIimpact inter!ention# the PMT$T component remains
one of critical importance to the Programme. This component addresses the
upta-e of ($T within the health care system2 encouraging pregnant women who
might be at ris- to choose ($T while at the same time discouraging mandatory
'I( testing of pregnant women.
2.33 1ne -ey inter!ention relates to the elimination of new 'I( infections in
children. The PMT$T component will build on e9panding its e0orts with
gynaecologists# obstetricians# midwi!es and pregnant women. 'ealth care
pro!iders will initiate 'I( testing and counselling for pregnant women identiPed
as being at higher ris- of 'I( e9posure according to national guidelines .pro!iderI
initiated counselling and testing# or PI$T/. In all cases# information about MT$T
and 'I( testing will be gi!en to all pregnant women during antenatal information
sessions. Another acti!ity under this component is a Uschool< for pregnant
women# who will be taught about healthy lifeIstyles and 'I( pre!ention by
gynaecologists and midwi!es. The UPMT$T schools< should result in an e!en
stronger in!ol!ement of the pregnant women in their pregnancy# with greater
attention paid to ris-y beha!iour and PMT$T2 Pnally# it should increase number of
pregnant women going for 'I( tests.
$CT
2.1// *nder Phase II# wor-shops on inIser!ice training in ($T as part of antenatal
care for gynaecologists and midwi!es will be conducted as a continuation of
Phase I acti!ities.
2.1/1 The ($T networ- is composed of DG ($T centres .of which DD are
operational/# pro!iding counselling and testing ser!ices across the country. *ntil
now# ($T ser!ices ha!e only been pro!ided within public health care facilities. To
impro!e outreach towards 7APS the ($T centres# in collaboration with $S1
wor-ing with 7APS# will impro!e ser!ice Nuality through introducing onIsite
testing for 7APS in the P%ID DI$# MSM centres# 6oma communities# prisons and
other sites as appropriate. These acti!ities will be coordinated with ci!il society#
who will mobilise their clients to attend the selected locations.
2.1/2 The ($T clients to date ha!e largely comprised MSM# P%ID and S%# as well
as the general population. It is not always easy to -now when someone
reNuesting an 'I( test is a member of one of the 7APs because# although the
+G1 pro!ides the client with a !oucher for free and anonymous testing at a ($T
centre# many 7APs do not present the !oucher for fear of stigma and
discrimination. Since one of the Programme<s targets is number of !ouchers
gi!en out by +G1 rather than numbers of clients presenting !ouchers at the ($T
clinics# it is impossible to obtain an accurate Pgure for 7APS who ha!e been
tested at a ($T centre. 'owe!er# the Programme does collect data regarding the
number of !ouchers presented by migrants# MSM# P%ID# 6oma# S% and youth.
2.1/! In order to increase the ser!ice<s reach to 7APS# the ($T networ- will
introduce a new ser!ice 'epatitis " !accination for 7APS. $urrently 'epatitis "
!accination is pro!ided for newborn infants and for some professionals at high
ris- of e9posure# but it is not pro!ided for 7APS. It is e9pected that this new
!accination programme will incenti!ise 7APS to use ($T ser!ices. (accination
will be pro!ided for an estimated KLL clients per year. Additionally# ($T
counsellors and health ser!ice pro!iders will recei!e a further training on the
principles of harm reduction which will enable them to pro!ide more e0ecti!e
counselling ser!ices to P%ID2 and a mobile ($T unit will be set up to compliment
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina HM
the e9isting static ($T ser!ices and increase 7APS 'I( and 'epatitis " and $
testing.
2.1/" 3ollowing the end of Phase II# the public health care system will continue to
pro!ide ($T ser!ices# including !accinations for 7APS# to ensure the sustainability
of this component. $ontinuity of treatment and a!ailability of drugs# !accines
and medical products will further build the procurement and supply capacity that
is being pro!ided through this Programme.
2.1/# $ertiPcation of the ($T centres will be initiated in Phase II. This process
includes de!elopment of the standard operating procedures .S1P/ for the
centres# and strongly supports ongoing e0orts with regard to Nuality assurance.
The S1P will be de!eloped by Partnership in 'ealth# as well as a schedule for
more freNuent monitoring and super!ision !isits. A number of training#
wor-shops and stu0y tours for !arious medical and nonImedical sta0# as well as
de!elopment oif curricula# brochures and guidelines are en!isaged under Phase
II. If these e0orts do not result in su>cient and measurable impro!ement#
Partnerships in 'ealth will reNuest the respecti!e M1' to consider other
geographical locations for ($T centres and)or to appoint di0erent ($T
counsellors.
2.1/0 The Fth 6egional $onference on 'I( and AIDS will be organised in
collaboration with the *+# including *+AIDS# academic# public and ci!il sector
.P'I# Infecti!e Diseases $linics# and Partnerships in 'ealth/ largely coIfunded by
the *+# ci!il society and pri!ate sector. The pre!ious si9 regional conferences
ha!e ser!ed as a platform for the e9change of -nowledge# e9periences and
de!elopment of new initiati!es largely aimed at 7APS. The $onference fulPls
other important functions. It pro!ides a uniNue opportunity for 7APS to share
their in!aluable e9periences and pro!ide feedbac- on how ser!ice deli!ery can
meet their needs. 7APS still remain largely hidden from the public eye# which
presents a formidable obstacle in project implementation as the e9act si,e and
dynamics of the populations are un-nown.
2.1/1 The 6egional $onference also pro!ides a platform for the e9change of
-nowledge and ideas for indi!idual practitioners# sta-eholders and organisations
from the %estern "al-ans region. It is an e9cellent basis for the further
e9pansion of the e9isting networ- of organisations# not only for practitioners to
learn from others how to wor- more e>ciently but to Pght for the sustainability of
the country and regional response to 'I(.
+/Ge'tive 8 Strengthen the Ena/ling Environment for S'aling up HIV
Prevention and *are
2.1/2 In Phase I ad!ocacy acti!ities were implemented by the International
labour 1rganisation .I&1/ and stigma acti!ities by %orld (ision. *nder the second
Phase# howe!er# wor-place acti!ities were not appro!ed by the G3 and hence the
%orld (ision programme remains the sole implementing agency under this
objecti!e.
%ork &it' ()*s
2.1/3 %orld (ision# in cooperation with the InterI6eligious $ouncil# has completed
a stigma assessment on the attitudes of the $atholic# =ewish# Muslim and
1rthodo9 faiths towards P&'I(. This assessment clearly demonstrates the
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina HK
e9istence of inCe9ible and intolerant attitudes# prejudices# and signiPcant social
distance e9hibited by all religious groups towards 'I(Ipositi!e people. According
to the assessment Pndings# DL S agree with the statement that P&'I( should not
be allowed to raise children2 and o!er JL S agree that no education or treatment
should be wasted on 'I( positi!e people as their life span is short. Systematic
ongoing awareness programmes for representati!es of religious communities and
churches were recommended in order to foster greater inclusion# support and
dignity for P&'I(.
2.11/ During Phase I %orld (ision succeeded in sensitising and mobilising faith
leaders by utilising the $hannels of 'ope methodology .targeted faith response
to 'I( and AIDS/# adapted and conte9tualised to di0erent religious !iews and
moral teachings# and appro!ed by the leadership of all four religious communities
and churches. This methodology# accompanied by specially designed stigma
reduction wor-shops and acti!e collaboration with the InterIreligious $ouncil#
prepared a common ground for the initiation of adeNuate faithIbased responses
to 'I( and AIDS on a national le!el and opened a discussion on the importance of
the acti!e in!ol!ement of religious leaders in 'I( pre!ention and stigma
reduction acti!ities.
2.111 A signiPcant e0ort towards building the capacities of faith wor-ers and
changing the attitudes of religious belie!ers and 3"1 representati!es has been
made. 1!er HL faith wor-ers and faith teachers were sensitised to ensure that
themes such as 'I( pre!ention and stigma reduction were included in religious
ceremonies in all four faith communities# including regular faith education in
primary and secondary schools.
2.112 3urthermore# as a result of the Stigma 6eduction component# four pilot
projects on 'I(Irelated stigma reduction in faith communities ha!e been
prepared# funded and implemented by targeted 3"1 in communities all o!er "i'.
Project data show that o!er HL.LLL representati!es of faith communities and
churches were introduced to the faithIbased response to 'I()AIDS and related
stigma# and were reminded about moral teachings that pre!ent faith belie!ers
from stigmatising and discriminating against P&'I(. 1!er :#:LL faith wor-ers#
3"1 representati!es# and belie!ers were trained on areas of 'I( pre!ention in
stigma reduction# in faith conte9t.
2.11! In the second phase of implementation# %orld (ision is e9panding project
outreach acti!ities and co!erage through direct engagement with the four 3"1
identiPed and recommended by the Inter 6eligious $ouncil. &eaders of the four
3"1 ha!e strong relationships and wideIspread faith networ-s in their
communities# which is necessary for the e0ecti!e continuation and wider
geographical co!erage of the project.
2.11" 1!erall# further mobilisation of 3"1# faith communities and churches will
in!ol!e training# mentoring# other forms of technical assistance and# abo!e all#
awareness rising# to strengthen the common understanding and approaches in
'I( pre!ention. This is essential for increased utilisation of Nuality pre!ention
ser!ices within the e9isting health care system and creation of an enabling
en!ironment to impro!e the faith communities< in!ol!ement in responding to
these issues. The focus of Phase II# therefore# is again one of sensitisation and
mobilisation of 3"1s# using the $hannels of 'ope methodology for a targeted 'I(
response.
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina EL
+/Ge'tive & Strengthen *oordinating and Implementing Agen'ies5
*apa'it" to Respond to HIV/AIDS
2.11# *nder Phase I# acti!ities to support this objecti!e were implemented by the
Public 'ealth Institutes in 3"i' and 6S.
Supervision o! *ST Centres
2.110 The Prst case of methadone treatment was recorded in :KMK in Saraje!o
but the 1ST programme was suspended during the war. Today in 3"i' there are
si9 1ST centres that deal with deto9iPcation and pro!ide replacement therapy
with methadone and Subo9one ."ugojno# Mostar# Sans-i Most# Saraje!o# Tu,la
and ]enica#/# and two in the 6S ."anja &u-a and Doboj/. ;ach day JM: persons
recei!e methadone substitution and DHJ recei!e Subo9one substitution# through
:E sta0 at the 1ST centres.
2.111 1ST centres are !ery important not only for weaning P%ID o0 injecting
drugs# but also for the local community in terms of the impro!ement in beha!iour
.theft# !iolence/# of P%ID.
2.112 P'I employees perform Nuarterly monitoring !isits to super!ise record
-eeping# reporting on the consumption of alternati!e and substitution therapies#
their storage and management# client registration and outreach acti!ities#
including prison !isits. The introduction of 1ST in prisons is planned for the whole
of the country under Phase II.
+evelopment o! *ST ,uidelines
2.113 The current 1ST programme lac-s a standardised national 1ST protocol#
needed to ensure harmonisation of e9isting local 1ST guidelines and e>cient
implementation at all le!els. *nder Phase II plans are in place to establish a
multidisciplinary team to de!elop comprehensi!e national 1ST guidelines based
on practices which ensure e>cient treatment# ways of preparation#
recommended dosages and monitoring. This will ensure strict control# better
monitoring and management of opioid substances and 1ST reser!es# as well as a
more realistic estimate of needs. The guidelines will also recommend and ensure
the application of updated standards of the -nowledge and s-ills reNuired for the
e>cient implementation of 1ST in all centres.
Municipal CS* #ealt' Councils
2.12/ In accordance with the 1bjecti!e D of Phase I .Strengthening the
$ooperation of Public 'ealth Institutes with &ocal $ommunities/# the 3"i' P'I
established two Municipal 'ealth $ouncils .M'$/# each composed of eight
members from Go!ernment and +G1# whose acti!ities were mainly related to the
organisation of wor-ing meetings# round tables# etc. %ith the aim of better and
more e>cient coordination of the parties in!ol!ed in the implementation of
'I()AIDSIrelated acti!ities# the current membership of the established M'$s will
be reduced to two members .a Municipal $oordinator and Assistant/ and the
same approach will be used to set up four more M'$. The M'$ team will
de!elop local action plans with the aim of stronger ad!ocacy and inCuence on
local decision ma-ers# mobilising resources# while at the same time they will be
functionally lin-ed to other organisations# such as ser!ice deli!ery points in local
communities .($T# methadone centres# +G1# 6esource $entres and so on/.
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina E:
2.121 *nder Phase I in 6S# two Municipal 'ealth $ouncils were established in 6S#
composed of P!e members from Go!ernment and +G1.
M - .
2.122 *nder Phase II it was been planned to further strengthen the capacity of
the ;ntity MO; *nits which# in Phase I# were established at the P'I.
2.12! %hile the wor- of the MO; *nits in the Prst Phase is mainly based on the
monitoring of acti!ities implemented with G3ATM support# in the second Phase it
is e9pected that the MO; *nits ta-e o!er the monitoring of the Action Plan for the
implementation of "i'<s national 'I()AIDS Strategy for DL::IDL:J. The MO;
units will prepare the annual MO; plan# identify the resources needed to
implement the plan# and identify potential problems in the implementation of the
plan. The P'I will pro!ide the technical and logistical support needed for the
functioning of the MO; *nits# lin-ing the MO; *nits with other parties deli!ering
'I( inter!entions.
2.12" The P'I will also con!ene meetings of the MO; *nits in order to impro!e
the reliability of data reNuired for an e0ecti!e 'I( response# and pro!ide
technical support for the establishment of scientiPc and methodological
guidelines.
Researc'
2.12# In a country with a low pre!alence of 'I( infection# sur!eillance of the
population at ris- is crucial for monitoring the epidemic and pro!iding the
e!idence base which informs the de!elopment of targeted and tailored
inter!entions. Sur!ey data allow comparison with other countries# monitoring the
achie!ement of the Millennium De!elopment Goals# and the design of national
'I( programmes. Sur!ey data are -ey tools for a timely and e0ecti!e response
to the epidemic. *nder the Programme<s second phase# therefore# three ""S and
one 16 are planned.
))S among Roma Population as a Population at Risk
2.120 According to estimates by the "i' M'66# between GL#LLL and HL#LLL
6oma currently reside in the country# although this number is !ery di>cult to
determine because of the mobility of the population. As well as being !ery
mobile# the 6oma population has speciPc traditional cultural# social and economic
characteristics. There are many indicators that point to the e9istence of high ris-
practices among this population group# such as early debut of se9ual contact#
early marriage# multiple partners and so on. To date in "i'# no research has been
underta-en related to se9ual beha!iour among the 6oma which would conPrm
the abo!e assumptions and allow a better response to STI and 'I( for this
population. The P'I plans to conduct a ""S on a sample of G to E S of the 6oma
population aged between :E and HK years of age2 appro9imately ELL 6oma.
)e'avioural sentinel surveillance ()SS among P%I+
2.121 The P'I plays a signiPcant role in planning and conducting research#
strengthening second generation sur!eillance through the implementation of "SS
co!ering the three -ey target 7APs .MSM# P%ID and S%/. In the second Phase#
two studies will be underta-en whose results will allow the monitoring of trends in
ris- beha!iour and pro!ide a seroIepidemiological proPle of 'I( in "i'. Data from
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina ED
two "SS conducted in DLLF and DLLK among P%ID in three cities# and the third
"SS in DL:D co!ering P!e cities# show the constant ris- of 'epatitis $ and 'I(
pre!alence among P%ID2 although the data show some growth# Pgures are still
low among this population. Data trends show progress in 'I( pre!ention among
P%ID in "i' .a noticeable increase in the use of harm reduction ser!ices#
although pharmacies still represent the major source of sterile injecting
eNuipment for P%ID/.
2.122 The high pre!alence of 'epatitis $ suggests the need for better co!erage
of 'epatitis $ testing. There has been progress in reducing ris-y practices
relating to injecting drug use# but not in terms of reducing ris-y se9ual beha!iour
.decrease in the use of condoms# decrease in -nowledge of those who -now the
ways for 'I( transmission/.
2.123 Due to multiple ris- factors# subseNuent research is needed to enable the
design of targeted programmes to reach this !ulnerable population# utilising a
gender and ageIsensiti!e approach .to date# o!er ME S of respondents were older
than DE years and male/ and proacti!e outreach strategies.
2.1!/ In the second stage of Phase II implementation .DL:E/# a ""S has been
planned for P%ID# which will allow the collection of data about a population at
high ris- of STI and 'I(# and comparison of these data with data obtained in
pre!ious research# to analyse beha!iour trends among P%ID and the
de!elopment of a timely response to these trends. The research will be
conducted in P!e cities ."anja &u-a# "ijeljina# Mostar# Saraje!o and ]enica/# and
will co!er appro9imately :#LLL P%ID.
))S among MSM and S%
2.1!1 Participation of homose9ual modes of 'I( transmission in relation to all
modes of 'I( transmission has increased in the past few years# indicating the
need for closer obser!ation of this population group. The MSM population is
highly stigmatised in "osnia and for this reason also hard to access2 howe!er# two
""S were underta-en in DLLM and DL:L# funded by the G3 and implemented by
*+I$;3.
2.1!2 "SS conducted among MSM populations generally show a relati!ely good
-nowledge of routes of 'I( transmission and increased protecti!e se9ual
beha!iour .higher condom at last anal se9 with men# an increase in the use of
lubricants# an increase in those tested in the last :D months who -now the test
result# a growth in the rates of those who are reducing the number of se9ual
partners and random partners# a reduction in se9ual acti!ity while under the
inCuence of drugs# and so on/. It is e!ident of beha!ioural change# but still
insu>cient2 o!er MD S of condoms are supplied through +G1s# but their clientele
still demonstrate ris-Ita-ing beha!iour .se9ual intercourse under the inCuence of
alcohol# unprotected se9 with a woman# and so on/.
2.1!! 6esearch on S%# another group which is hard to access and at high ris- for
'I( infection and other STI# will be underta-en at the same time. This will enable
the monitoring of 'I( and STI trends# and allow more timely and e0ecti!e
o!ersight. So far# in all three studies among S% populations# the a!erage age of
patients was DF years2 urban S% are relati!ely well educated# mostly
unemployed .E:.M S/# with :L S being students. There is an increase in the age
of se9ual debut .:K years/# but a decrease in the age of Prst paid se9ual
intercourse .D: years/.
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina EG
2.1!" All three "SS show relati!e progress in 'I( pre!ention among S%
increased condom use at last !aginal intercourse .MF.F S/# but not for oral .eight
S/ and anal .JJ.: S/. There is a rising trend of image of low self ris- of 'I(
infection .:: S/. Almost JL S of S% ha!e ne!er been tested for 'I(# and all
three studies indicate low rates of those tested in the pre!ious :D months who
-new their 'I( test result. 3or the ne9t research# 6DS methodology is planned2
howe!er# its application will pose challenges due to the lac- of S% social
networ-s. SigniPcantly# in the future to be able to identify the factors that
contribute to ris-y beha!iour among MSM and S%# the Programme will e9pand its
partnerships with +G1s and the de!elopment of e0ecti!e inter!entions such as
early detection and 'I( pre!ention through ($T# and new s-ills in outreach
acti!ities .rapidItesting# mobile teams# and others mechanisms/.
Surve/ o! #I$ Stigma and +iscrimination
2.1!# In DL:L# the P'I in 3"i' conducted a study of stigma and discrimination
among health care wor-ers in the pri!ate and public health sector# which
conPrmed a high le!el of stigma towards P&'I(. SubseNuently# a number of
acti!ities to combat stigma and discrimination were implemented such as public
awareness campaigns# numerous trainings# information# educational materials#
sensitising decisionIma-ers and so on. *nder Phase II there are plans to redo this
study in DL:E in order to obtain comparati!e data.
Sc'olars'ips, .0c'ange $isits, Stud/ Tours, Con!erences and Pilot
,rants
2.1!0 1riginally in Phase II# a number of study tours# e9change !isits
and attendance at conferences were planned2 howe!er# these were not
appro!ed by the G3ATM. +onetheless# small grants will be pro!ided to
organisations to support P&'I( acti!ities such as li!elihood support#
condoms# social ser!ices and so on. This acti!ity will also build the
capacity of P&'I( organisations.
84 PR+BRA22E EVAI1A-I+, S*+PE7 +B!E*-IVES A,D
2E-H+DS
Evaluation Boals and +/Ge'tives
!.1 The purpose of the e!aluation# as described in the 6eNuest for Proposals#
was threefold
To determine the impact and outcome of the 'I( programme in "osnia and
'er,ego!ina toIdate# including an assessment of Nuality of ser!ices
pro!ided2
To dePne the most e0ecti!e inter!entions going forward to yield an impact
on the epidemic2 and
To produce a report on the !alidation of the +ational Population Si,e
;stimates of P%ID# MSM and S% in "osnia and 'er,ego!ina that will be
submitted to +A" for appro!al.
The e!aluation too- place at the same time as a !alidation of the population
estimate si,e# both underta-en by the APMG Team. 'ence# while this report is
the Pnal ;!aluation 6eport# there is also an Inception 6eport and a PS; 6eport
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina EH
plus two papers .i/ Paper I Summary of Inter!iews and 3ieldwor-2 and .ii/ Paper
II Summary of 3indings# $onclusions and 6ecommendations. The latter paper
was presented at a sta-eholder meeting held at *+DP on Tuesday :L December
DL:G# and again on the same day at a meeting of +A".
Evaluation Approa'h
!.2 $ollaborati!e and participatory processes are core elements of all APMG<s
wor-. ;mployment of a range of methodologies including document re!iews#
focus group meetings# inter!iews and Peld in!estigations promotes inclusion and
ensures that the e!aluation is consistent with gender eNuity principles and good
de!elopment practice.
!.! To create a positi!e en!ironment for dialogue# APMG used Appreciati!e
InNuiry .AI/ methodology throughout the e!aluation. This approach combined a
rigorous e9amination of data with a focus on the strengths and achie!ements of
programmes and institutions to determine ways to build on those strengths for
increased e0ecti!eness. At the core of the AI methodology was an e9amination
of what has wor-ed# drawing out the successes and progress that implementing
partners and benePciaries identiPed. It is APMG<s e9perience that this positi!e
starting point re!ealed di0erent information and brought enthusiasm to the tas-
of e!aluation rather than an immediate focus on problems# barriers and
obstacles. It engaged programme sta0 and other sta-eholders in a constructi!e
dialogue that ac-nowledged and rewarded the considerable e0ort that has
brought them to this point in the Programme<s implementation. It was not a
substitute for an objecti!e and rigorous e9amination of progress and process# but
complemented this by de!eloping an e!aluation en!ironment that was
constructi!e and participatory. It ensured that positi!e processes and outcomes
were identiPed# analysed and reproduced.
!." ;!aluators# partners and sponsors were attracted to the AI approach as it
b ;ngaged sta-eholders in structured dialogue to de!elop e!aluation
Nuestions2
b 6eframed e!aluation tools to strengthen Nualitati!e data collection2
b Increased use of e!aluation results and learning2 and
b $omplemented and strengthened the e!aluation process.
!.# APMG designed and focused the e!aluation criteria in two main areas
e0ecti!eness .outcomes and impact/ and e>ciency. A mi9 of Nuantitati!e and
Nualitati!e data collection methods promoted triangulation as demonstrated in
the attached ;!aluation Matri9 .Anne9 :/
Eor( Plan
!.0 The major tas-s of the e!aluation fell into three phases
Phase : Inception
Phase D Intensi!e Data $ollection
Phase G Analysis and 6eporting
Phase % In'eption
!.1 The APMG Team initially de!eloped a protocol for all phases of the wor-# in
consultation with the *+DP P6 team and +A")$$M. The protocol included drafts
of all e!aluation Nuestions# instruments# focus group guides# plans for !isits#
numbers of inter!iewees and timelines. This phase also included preparing
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina EE
guidelines for deciding on the inclusion and e9clusion of documents for re!iew
and agreeing this protocol with the *+DP P6. SubseNuently# the Team
commenced the des- re!iew of documents rele!ant to the Programme. This
included V but was limited to V the Pndings from the DL:D 6SQA2 the DL:D ""S
among MSM and S%# prisoners and P%ID2 documents related to Programme
acti!ities .including co!erage and Nuality of ser!ices pro!ided to -ey
populations/2 and Global 3und Pnancing reports. The full list of sources and
bibliography are in Anne9 D.
Phase # Intensive Data *olle'tion
!.2 The agreed methodology# matri9 and instruments de!eloped in the
Inception Phase guided the Intensi!e Data $ollection phase of the e!aluation.
The Team undertoo- a two and a half wee- mission inIcountry# including Peld
!isits# to meet with the organisations and indi!iduals identiPed in Phase :. These
!isits encompassed both ;ntities of the 3ederation and 6epubli-a Srps-a as well
as "r8-o District. The le!el of contact was in line with that identiPed in Phase :
and in!ol!ed electronic distribution of sur!eys as well as the facilitation of
indi!idual and organisational .focus group/ inter!iews.
!.3 More detail regarding the e!aluation criteria and the fundamental
Nuestions which the Team addressed .as outlined in the T16/ is set out in the
aforementioned ;!aluation Matri9 .Anne9 :/. Throughout the Intensi!e Data
$ollection Phase# the team wor-ed with the *+DP P6 to report on progress#
discuss preliminary Pndings and organise e9tra inter!iews as deemed necessary.
Phase 8 Anal"sis and Reporting
!.1/ The APMG Team analysed the Nuantitati!e and Nualitati!e data collected
from the des- re!iew and inIcountry and engaged with *+DP on any early
signiPcant Pndings from the programme e!aluation. The Team ensured that the
collation# analysis and presentation of data were compatible with that discussed
in Phase : and the 3inal ;!aluation Matri9. A comprehensi!e yet concise draft
e!aluation report summarising the Pndings# conclusions and recommendations
was submitted to *+DP for consultation and feedbac- on K December DL:G. As
pre!iously noted# the Team &eader presented the -ey Pndings# lessons learned
and recommendations to a meeting of -ey sta-eholders# +A" and $$M
representati!es on :L December DL:G with guided discussion on the Pndings for
the purpose of information sharing and data !alidation.
!.11 "ased on feedbac- from the *+DP P6 and the +A")$$M# the draft report
was re!ised. The Pnal Programme ;!aluation 6eport with recommendations for
further strategies to ensure progress towards impact for Phase Two of the
Programme and beyond will be submitted to *+DP by DL December DL:G.
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina EJ
&4 EVAI1A-I+, FI,DI,BS
".1 The ;!aluation Team<s Pndings are presented under the following
headings
.a/ Social# economic and political factors2
.b/ Target Groups.
.c/ 'I( Programme ser!ice deli!ery2
.d/ ($T and A6T pro!ision2
.e/ Stigma and discrimination2 and
.f/ Sta>ng and training.
So'ial7 E'onomi' and Politi'al Fa'tors
".2 The socioeconomic situation in "i' is poor. Although the %orld "an-
classiPes the country as upperImiddle income# this mas-s the true economic
situation in which o>cial unemployment is stated to be low but uno>cial
unemployment is said to ho!er around HL S. The gap between rich and poor is
growing as shown by the Gini coe>cient
:M
which started to rise in DLLH and
reached GJ.D: in DLLF. +o later data are a!ailable but a worsening situation can
be inferred from recent %orld "an- economic data.
".! The health system is fragmented due to the political and go!ernmental
organisation comprising the two ;ntities of the 3ederation "i' and the 6S# and
one administrati!e department ."r8-o District/# resulting in one centralised
administrati!e ;ntity .the 6S/ and one decentralised ;ntity .3/ wor-ing with a
total of :MG ministries. This means an e9tremely comple9 and challenging
en!ironment in which to pro!ide uniPed and cohesi!e ser!ices with
heterogeneous policies and procedures# and eNuitable ser!ices throughout the
two ;ntities and one department2 and it ma-es coordination among players
di>cult. As a result# there is a systemIwide inability to address problems due to
the economic and socioIpolitical situation. There are therefore gaps in ser!ice
pro!ision# which are described below.
"." At the State le!el# the $onference of 'ealth Ministers meets Nuarterly#
representing the 3ederation# 6S and "r8-o# and plays an ad!isory role. %hile this
ma-es the health sector operate more e>ciently than other sectors# the public
health system remains wea- and e9tremely bureaucratic# with P'$ underfunded
at D.E S of the health budget# and therefore considered to be of low status.
".# Poor primary health care will continue to e9acerbate the gaps between the
rich and the poor and lead to greater ineNualities in health. It also implies that
the country may be at ris- of epidemics such as polio and other diseases which
reNuire action at the primary health care le!el.
".0 3ragmentation in administrati!e organisation in "i'<s health sector
appears to be one of the main reasons why not all citi,ens are co!ered by the
health protection system. +umbers !aried depending on who the ;!aluation
:M
The Gini inde9 measures the e9tent to which the distribution of income .or# in some cases#
consumption e9penditure/ among indi!iduals or households within an economy de!iates from a
perfectly eNual distribution. A Gini inde9 of L represents perfect eNuality# while an inde9 of :LL
implies perfect ineNuality. "i' is ran-ed KGrd in the world.
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina EF
Team tal-ed to# but a conser!ati!e estimate appears to be that appro9imately DL
S of the population do not ha!e health insurance and this is a serious
impediment for the 'I( Programme<s ability to pro!ide co!erage to all target
groups.
-arget Broups
".1 In accordance with the identiPed needs# under 6ound K the target groups
included the general population but particular emphasis was placed on the
following -ey populations e9posed to increased ris- of 'I( infection MSM# P%ID#
S% and their clients# asylum see-ers# refugees# prisoners# IDP# the transient
population# young people and persons who li!e on or below the po!erty line. It
also includes those persons e9posed through a professional capacity to 'I(
healthcare wor-ers who come into contact with bodily Cuids as well as other
professionals such as policemen# soldiers# correctional o>cers# Pre Pghters#
rescue ser!ice o>cers and members of associations and foundations that pro!ide
harm reduction ser!ices and similar. In addition# the "i' 'I()AIDS Strategy DL:LI
DL:J indicates that signiPcant attention should be paid to the 6oma population
due to their marginalisation and youth I particularly adolescents and primary
school pupils in rural areas. 'owe!er# it should be noted that no programme
e9ists at the State le!el capable of targeting all these populations2 but in Phase II
the target groups ha!e been cut to e9clude the general population# young people
and those e9posed to 'I( in their professional capacity.
3outh
".2 5outh# pre!iously a target group under 6ound K# ceased to be so in Phase
II. Support to DJ youthIfriendly clinics o0ering life s-ills approach# implemented
by Association 45# was suddenly dropped under Phase II with no e9it strategy.
%hen the acti!ities aimed at supporting the DJ youthIfriendly clinics were
abruptly cut at the end of Phase I# no e9it strategy was put in place. %hile youth
5er se are now not a target group as they do not all belong to one of the si9
primary target groups identiPed under Phase II .migrants and refugees# MSM#
prisoners# P%ID# 6oma# S%/# the Phase II programme originally also included a
se!enth category !ulnerable youth.
".3 The abrupt closure of the youthIfriendly centres was one of the most
freNuently mentioned issues during inter!iews. +ot one person felt that it was a
good idea. The Team were told that -nowledge concerning S6'# including STI
and 'I(# among youth still does not appear to be su>ciently high2 this was a
common theme brought up by many of the Team<s inter!iewees. Indeed# there
are three factors that support continued inter!entions aimed at youth .i/ the
generally low le!el of -nowledge of S6' issues including STIs and 'I(2 .ii/ the
high le!el of stigma and discrimination that stops 7APS see-ing help2 and .iii/ the
possibility that many young people will grow up to become members of one of
the 7APS populations themsel!es# or go into wor- in the health care Peld.
".1/ Gi!en high le!els of stigma and discrimination# rising le!els of abortion and
STI .primarily 'epatitis " and $ infections/# plus the li-elihood that some youth
are the future health wor-ers and uniformed wor-ers in "i' .and others may
become members of 7APS/# it seems premature to ha!e cut all support to
wor-ing with youth.
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina EM
Roma Population
".11 Global 3und support has without a doubt brought health ser!ices# and
especially 'I(# closer to the 6oma community. This has helped raise awareness
of 'I( among marginalised societies. ;!en so# there remain some remote 6oma
communities that ha!e yet to be reached# and this situation is li-ely to pre!ail
due to a lac- of funding.
".12 6oma population acti!ities were included in 6ound E and their co!erage
e9panded in 6ound K to e9tend health ser!ices for 6oma women# including S6'
and 'I(. %orld (ision# an international +G1# has partnered with a 6oma +G1 and
succeeded in getting 6oma representation on the $$M .see "est Practices V "o9
:/. The project has built capacity among DE outreach wor-ers and three 'I(
centres co!ering EL municipalities with the highest 6oma population. Since the
beginning of 6ound K# J#KLH 6oma ha!e been reached. Their programme is
comprehensi!e# including S6' as an entry point for bringing 6oma women into
health facilities# and specialist s-ills ha!e been built in dealing with
administration# P%ID# ad!ocacy# public spea-ing. Also# I;$ materials ha!e been
produced in the 6omany language# respecting their culture.
BES- PRA*-I*ES N B+0 %
Eorld Vision N HIV Prevention E6orts Rea'hing +ut to 2ost Vulnera/le
2inorities of Roma
16GA+ISATI1+ %orld (ision<s second acti!ity with the 'I( Programme started under the
Global 3und 6ound E grant is with the 6oma population. %orld (ision started acti!ely
wor-ing with and inside 6oma communities in its earlier days in "i' .:KKK/. This wor-
included a S6' and rights project for 6oma women# 6oma communities and refugees.
This acti!ity pro!ided a strong foundation for their latest 'I( pre!ention inter!ention
funded under 6ound K.
G1A& A+D 1"=;$TI(;S The project aims to ensure the sustainable pre!ention of 'I(
transmission amongst 6oma# the largest and the most !ulnerable minority in "i'# by
information sharing within 6oma communities# counselling# organising !isits to ($T
centres# distributing of materials2 sensitising and mobilising 6oma communities of the
need for 'I( pre!ention2 street actions and awareness campaigns on 'I( pre!ention and
healthy lifestyles2 and building the -nowledge and s-ills needed to e9pand acti!ities in
new communities.
M1D;& The inter!ention relies on e9tensi!e outreach acti!ities and creation of a
supporti!e en!ironment through in!ol!ing 6oma community members# thus increasing
the sense of local ownership and at the same time building their capacities. This
approach results from intensi!e wor- between %( "i' and 6oma +G1s# joint strategic
planning and the enrolment of 6oma women and youth in community wor-# creation of an
outreach system in 6oma communities# and sensitisation of 6oma leaders# and
community members. In DLLJ# %( "i'# "1SP1# and EL 6oma +G1s also designed the
+ational Action Plan for 6oma 'ealth.
Since DL::# %orld (ision and 6oma community leaders ha!e established three 'I(
Information $entres in the country employing a total of DE outreach wor-ers and three
coordinators and each co!ering up to :G municipalities. The acti!ities of the $entres
include education# informationIsharing# promotion# and awarenessIraising on 'I( and
AIDS pre!ention in selected 6oma communities# monitoring of outreach acti!ities#
insuring access to 6oma communities# empowering and liaising with other 6oma leaders#
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina EK
cooperation with rele!ant health institutions regarding di0erent health issues and
organising public e!ents and round tables.
1utreach wor-ers who ha!e been e9tensi!ely trained on the topics related 'I(# safe
beha!iour# S6' and rights# and pro!ided with the necessary information materials and
condoms# regularly !isit selected 6oma communities and pro!ide information and
education I tal-ing to community members in streets# going from door to door# or inside
the houses when they are in!ited in. They distribute information materials and condoms
and accompany and support their clients to ($T sites for 'I( and 'epatitis testing and
counselling.
Ta-ing into account the high le!el of
illiteracy among the 6oma population in
"i' and large number of community
members who ne!er attended .:F.: S/ or
ne!er completed .GE.F S/ primary school
.%orld (ision<s Situation Analysis of 6oma
in "i'# DLLJ/# this model has been
specially designed to address the illiteracy
le!el. This inno!ati!e approach uses a
special set of :: posters .se!en on 'I( and
four on STI related issues/ designed and
de!eloped to eNuip each outreach wor-ers
going to local communities. 1ne such
poster# co!ering ways of 'I( transmission#
is included here as an e9ample.
Another important element of the model is the recruitment of outreach wor-ers from
among young people with a special focus on 6oma girls and young women who ha!e
completed secondary school education who can also Ulead by their own e9ample<.
In addition# special information sessions for 6oma community members are held regularly
at the 'I( Information $entres and gather substantial audiences. Themes and topics for
such sessions are selected based on the needs of the target groups and di0erent e9perts#
including medical doctors and peers# are in!ited to spea-.
$onsiderable attention is paid to the wor- with community leaders as well as state
o>cials and medical wor-ers outside 6oma communities see-ing to bridge the gap and
sensitise participants on e9isting health needs# culture# and e0ecti!e approaches for
wor-ing with 6oma communities. This wor- has been performed through a series of
special wor-shops and round tables conducted across the country
6;S*&TS ;ach year almost E#LLL indi!idual 6oma community members are reached#
HE#LLL condoms and I;$ materials distributed and o!er DLL referrals to ($T are made as
a result of the project. A team of DE outreach wor-ers operates in the country pro!iding
I;$ and personal e9periences for 6oma of di0erent ages. 3inally# se!eral hundred
medical wor-ers# state o>cials# and community leaders ha!e benePtted from the
opportunity to start a dialogue on healthIrelated issues and the broader needs of the
integration of 6oma into "i' society.
$1+$&*SI1+S A+D &;SS1+S &;A6+;D %hile the !ery Prst "SS among the 6oma
population in "i' is still under way at this moment# much anecdotal e!idence suggests
signiPcant positi!e beha!iour change in 6oma communities across the country that has
occurred as a result of this inter!ention. The most freNuently Nuoted successes include
the brea-ing of stigma and taboos that earlier surrounded issues of 'I()AIDS2 a shift in
unprotected se9 and other ris-y beha!iours .such as tattooing/ towards safer practices2
and an increased number of 6oma tested for 'I( and 'epatitis. 3inally# the 'I(
Pre!ention inter!ention goes beyond health and achie!es the e!en greater impact of
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina JL
enhancing dialogue between 6oma and ethnic majorities in "i' see-ing to promote the
integration of 6oma into "osnian society.
Source1 7%radif BieroviA, Head, 4*7A.* D4*7 .G*B4oma HI< Information 'enter,
CiviniceD $lavica BradviA>Han%EiA, GFA67 Grant 9ead, )orld <ision>BiH, .ovemer 2/1!.
".1! FJ patronage .mobile/ T" nurses wor- on directly obser!ed treatment#
short course .D1TS/ among 6oma communities and 6oma T" outreach wor-ers
wor- with patronage nurses. "oth 'I( and T" outreach wor-ers train together
and this helps ensure that ser!ices are complementary.
".1" Again# there are issues of sustainability once the Global 3und supported
component of the 'I( Programme Pnishes. 6oma +G1s will continue to need to
wor- closely with Go!ernment to absorb outreach wor-ers into the national
health system# as they are the eyes and the ears of the communities they ser!e#
the bridge between the 6oma community and local health clinics. The outreach
wor-ers are a great resource and could do e!en more# such as o0er rapid testing#
and so on. 'owe!er# outreach wor-ers are clearly frustrated that they do not
ha!e su>cient means to meet their clients< needs# particularly with regard to
S6'.
".1# There is little in!ol!ement of the education sector beyond life s-ills
programmes in schools and it appears that information on 'I( and S6' is not
currently a!ailable in schools. If and when it is introduced# there is the added
problem that school drop outs occur mainly among the 6oma population who are
already !ulnerable .due to stigma and discrimination/# and through early
marriage among 6oma girls. More attention must be gi!en to reaching 6oma
children# as the ;!aluation Team was told se!eral times by the 6oma DI$ and
young 6oma girls wor-ing there# that parents learn from their children. There is a
need for peer education among young people from rural areas and young 6oma
who do not ha!e access to health I;$.
+ther 2inorit" Populations
".10 Throughout the past decade# this region has been used by human
tra>c-ers both as a destination and as the major transit route to %estern ;urope.
Although the number of women tra>c-ed to and through "i' has reduced
signiPcantly# the number of domestic !ictims of tra>c-ing has increased#
according to se!eral inter!iewees.
".11 There are rising numbers of illegal immigrants from Arab countries# $hina#
7enya# 7oso!o and Somalia among others. Due to the economic situation# many
"osnians go abroad for wor-. Some returning migrants come bac- infected with
'I(# although this number appears to be falling2 according to I1M# in DLLG FD.F S
of returning migrants with 'I( infection were infected abroad but by DL:D this
had dropped to ED.G S.
".12 ($T is now a!ailable for truc-ers at three customs borders)posts through
the I1M component of the 'I( Programme. Anecdotal e!idence from the sta0 at
the mobile clinic in Saraje!o indicate that the programme aimed at "osnian
truc-ers and migrants# which only started last year under Phase II# has been
successful2 HLH truc-ers were tested in DL:D under Phase I and# since Phase II
started# MLL truc-ers were tested in DL:G. 'owe!er# attrition rates were high
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina J:
because many did not return se!eral wee-s later for their results. Since the rapid
test was introduced in DL:G# increasing numbers of "osnian truc- dri!ers are
coming for testing and most return within the hour for their results. The change
to rapid testing# therefore# appears to ha!e had a positi!e impact. Syphilis and
'epatitis $ testing is also o0ered2 those testing positi!e are referred for
treatment. To date there ha!e been no 'I( positi!e tests.
HIV Programme Servi'e Deliver"
".13 "i' is a low 'I( pre!alence country with an estimated 'I( pre!alence of
^L.:S S. Due to the lowIle!el of the 'I()AIDS epidemic# the measures in the
country are predominantly focused on the promotion of protecti!e beha!iour
among -ey populations at ris-.
".2/ Appro9imately JE S of the 'I( Programme is funded through the ;ntities
and District# and GE S through the Global 3und. Treatment .A6T/ will continue
because it is o0ered through ;ntity and District facilities but pre!ention e0orts
are not sustainable without funds from the G3ATM# especially as there is little or
no practical ;ntity)District Pnancial support for +G1s and any e0ecti!e
pre!ention inter!entions aimed at 7APS can only be deli!ered through +G1s.
&i-ewise# public ($T clinics are sta0ed by ;ntities)District employees who recei!e
salary topIups from the Global 3und2 unless the ;ntities)District is willing and able
to assume these salaries or ma-e ($T centre sta>ng an integral part of P'$ with
direct budget support# it is unli-ely that these ser!ices would continue to be
o0ered after the end of Phase II. Most sta0 in the ($T centres !isited by the
;!aluation Team commented on the stigmatising attitudes of their colleagues in
other hospital departments towards the ($T centre sta02 most seemed to ha!e
scant understanding of or sympathy towards those infected with 'I( or see-ing
testing# and most thought the e9tra funds for the ($T centres would be better
used elsewhere.
".21 Gi!en the nature of the 'I( epidemic in "osnia# the Programme should
continue to focus on ensuring that all 7APs -now their 'I( status so that# if
positi!e# they can immediately start treatment. +ot only is this a good Prst line
pre!ention strategy but it supports current thin-ing on Treatment as Pre!ention.
Thus both pre!ention and treatment are eNual priorities in the conte9t of a
concentrated epidemic# especially gi!en the fact that for some 7APs# such as
MSM# longIterm pre!ention through beha!iour change and condom promotion is
di>cult. 6educing the amount of 'I( in the population becomes an eNually high
priority. 'owe!er# the numbers of 7APs accessing ($T remain low.
".22 *nli-e any other disease# both the 'I( and T" Programmes ha!e
succeeded in bringing together a wide array of sta-eholders from se!eral sectors
with di0ering roles# opinions and agendas# both at the Go!ernment le!el as well
as $S1s. 'owe!er# unli-e T"# which is !iewed more as a direct health issue and
addressed largely through actions within public)pri!ate health deli!ery#
successful 'I( programming reNuires a multiIsector response. In countries with
concentrated epidemics# the health sector needs nonIhealth organisations that
can assist it to bridge the chasm between traditional health ser!ices and ones
that appeal to Uhidden< populations with ris- beha!iours that are often regarded
as abhorrent2 in particular# successful 'I( programmes reNuire a s-ill set that is
capable of tac-ling the pre!ailing stigma and discrimination which ine!itably
a0ects wor-ing in concentrated 'I( epidemic situations. +onetheless# in spite of
the con!olution of go!ernmental organisations# there is signiPcant collaboration
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina JD
among the !arious players both at a Go!ernmental and nonIgo!ernmental le!el.
"osnia<s 'I( Programme is a role model for multiIsector collaboration in the face
of comple9 political and organisational challenges. 'I( is the only health
programme .other than T"# which as discussed is less comple9 and not multiI
sector/ to ha!e a national .state/ le!el 'I( programme and supporting Strategy in
place.
".2! *+DP has performed well as a P6 in the current system of political
intricacy. Its neutrality has enabled it to successfully bridge the delicate
tightrope between ;ntities. It is doubtful that a local structure would ha!e been
able to achie!e so much simply because of this political comple9ity.
".2" Although de!elopment and monitoring of the +ational 'I()AIDS Strategy
functions at the state le!el# planning and coordination has been done at the
;ntity le!el. 'owe!er# while data ha!e been rigorously collected# little or no
analysis has ta-en place.
".2# The ;!aluation Team were informed that many regulatory issues ha!e been
sol!ed through the de!elopment of policy papers on di0erent aspects of 'I(# and
treatment guidelines co!ering many marginalised populations.
".20 The 'I( Programme established DG ($T centres .of which DD are
functional/ within Go!ernment health institutions. +G1s co!er the ser!ice
pro!ision gaps for hardItoIreach populations# who would not otherwise be catered
for by Go!ernment ser!ices. The Programme has identiPed and strengthened
+G1s administrati!ely resulting in :D S6s o0ering a combination of ser!ices
co!ering all si9 target populations with 'I( testing and referral for A6T# 'epatitis
$ and occasionally 'epatitis " testing# pro!ision of condoms and lubricants# I;$
materials# +;P# and 1ST. Ser!ices are deli!ered through the Go!ernment ($T
centres and A6T clinics# DI$# outreach wor- through outreach wor-ers and
gate-eepers from target populations. Migrants and mobile populations are also
addressed through mobile ($T. The Programme recognises that ci!il society
strengthening is critical to the continued success of inter!entions# and has made
pro!ision for small grants to incipient and)or grassroots $"1s in Phase II.
Additionally# the Programme has built national capacity and deli!ered ad!ocacy
and media campaign.
".21 The 'I( Programme is !iewed as e9tremely successful in terms of meeting
or e9ceeding its targets2 howe!er# there are strong arguments that some targets
are in fact not the correct ones and some were set at relati!ely low le!els. That
said# it must be recognised that the setting of appropriate target le!els is
rendered di>cult because PS; remains problematic
:K
.
:K
During 6ound K Phase I of the grant# the G3 had a di0erent approach in regard to
targets which focused on the number of people recei!ing ser!ices through the
Programme. 3or Phase II the G3 has a new approach which is based on the percentage of
co!erage of 7APs. 'ence the appro!ed targets in the Phase II Performance 3ramewor-
were set in accordance with a!ailable data from 6ound K and the PS; conducted in DL:D
by the Public 'ealth Institute# e!en though the data did not represent national Pgures. As
an e9ample# no le!el of co!erage has been uni!ersally agreed as su>cient for all
situations. Some ha!e suggested that +;P co!erage rates of DLVGG S are su>cient2
others ha!e suggested that Whigh co!erage sitesX are those where EL S of P%IDs ha!e
been reached by one or more 'I( pre!ention programmes. 'owe!er# now the PS; data
ha!e been !alidated and the preliminary results of the $ensus conducted in DL:G are
a!ailable# the Programme has been able to re!ise its targets accordingly. 'ence the
national si,e of the MSM population has been estimated as H#GLL V K#ELL persons
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina JG
".22 3or the Programme to continue to build on its success# there is a need for
ownership of the Programme within the health sector as a whole and not just with
the Go!ernment sta0 who are paid incenti!es to wor- on 'I(. The Team<s
impression is that +G1 sustainability is doubtful without G3 funds.
".23 Se!en to eight years after the start of implementation of 6ound E# 'I(
pre!alence remains low. The 'I( pre!ention programme# largely deli!ered by
+G1s# targeted 7APs before a concentrated epidemic bro-e out and thus it is
reasonable to assume that it has contributed signiPcantly to -eeping 'I(
pre!alence low .according to *+AIDS DL:D $ountry Progress 6eport/. 'owe!er#
there is no actual e!idence base for this.
".!/ Sur!eillance and data collection are a problem because there is no
systematic methodology for data collection and monitoring and the Nuality of
data is inconsistent and !ariable.
V*- and AR- Provision
".!1 The Global 3und has pro!ided a considerable amount of eNuipment# testing
-its# P$6# $DH machine# reagents# and technical support including computers. It
is surprising# therefore# that due to a lac- of eNuipment and training# A6T
resistance testing is not a!ailable for patients. The guidelines say resistance
testing should be done before starting A6T. $urrently# clinicians and laboratory
wor-ers do not -now how A6T a0ects patients.
".!2 %hile there is no problem regarding a su>ciency of singleIuse instruments
.S*I/# there appears to be an issue regarding a consistent a!ailability of glo!es
and mas-s# and sharps bo9es2 howe!er# some people felt there was no problem
with a!ailability. 'ence there were se!eral di0ering opinions on this issue.
".!! +G1s o0er clients !ouchers for ($T ser!ices at Go!ernment clinics. 3or
monitoring use# the unit of measurement is the number of !ouchers distributed
rather than how many are e9changed for ($T. 'owe!er# as pre!iously
mentioned# this does not reCect an accurate picture of how many 7APs attend
($T ser!ices since clients do not need to present a !oucher to recei!e ser!ices.
".!" Although ($T centres ha!e increased the number of people coming in for
tests# many of these come from the general population or for mandatory testing
.immigrants and emigrants/. Most Go!ernment ($T centres are barely used by
7APs .although this !aries considerably between centres/. ($T centres ha!e
mostly been located at state health care facilities. This has not been !ery
e0ecti!e in terms of co!ering hidden populations but it is useful as part of a longI
term sustainability strategy as doctors are paid and testing centres established
by the state and will continue wor-ing after G3 support is discontinued.
Stigma and Dis'rimination
.a!erage !alueJ#KLL/ and the target set for 5ear E is H#GDJ .JGS co!erage in accordance
with the a!erage !alue/2 the national si,e of the P%ID population has been estimated as
K#ELL V :E#ELL persons .a!erage !alue :D#ELL/ and the target set in 5ear E is J#MGK
.co!erage EES in accordance with the a!erage !alue/2 and the national si,e of the S%
population has been estimated as D#ELL V E#ELL persons .a!erage !alue H#LLL/ and the
target set for 5ear E is D#:DF .co!erage EG S in accordance with the a!erage !alue/.
".!# $urrently# there is no I;$ strategy to tac-le beha!iour change and stigma
and discrimination which cannot be addressed by training alone. 5et# similar to
surrounding countries# stigma and discrimination against P&'I( and 7APs is
identiPed as one of the main obstacles in the country<s 'I( response. In rural
areas there is an e!en higher le!el of stigmatisation and prejudices e9pressed
towards 7APs. Surprisingly# according to the MI$SG DLLJ# JH.D S of women and
girls in "i' support at least one of the discriminatory attitudes towards P&'I(.
6esearch has been done on stigma and discrimination but# to date# there has
been no follow up. The failure to analyse and act on the data collected by
Partnership in 'ealth is demoralising to those who pro!ide the data as they ha!e
no way of -nowing how the data are used# what the results show# and so on.
".!0 'I( ser!ices are not targeted speciPcally to meet women<s needs. 3ar
fewer women are seen than men .e9cluding 3S%/ and there are no lin-ages with
S6' other than condom distribution. 5et teenage pregnancy is rising among
6oma women# and abortion is high among adult women.
".!1 There is a need to address gender issues# although "i' has not yet seen a
rise in infection among women. There is also a need to focus on people with
disabilities.
".!2 Stigma and discrimination is also !iewed as high among health wor-ers of
all cadres. 'owe!er# health wor-ers ha!e to deal with many di0erent types of
subIpopulations and this is not always recognised. Sta0 in ($T centres report
that they are themsel!es stigmatised. 1n the positi!e side# there has been a big
change o!er the past si9 years with an increase in understanding and respect for
conPdentiality.
".!3 The 'I( programme is not integrated into primary health care and thus
wor-ing in the pro!ision of ($T is considered to be an e9tra job and not part of
medical sta0<s job description. Go!ernment human resources to deli!er the 'I(
programme rely on subsidies)incenti!es from the G3ATM. An incenti!es scheme
is not sustainable and e9acerbates stigma and discrimination within the health
system.
"."/ 1n the positi!e side# 'I( stigma reduction inter!ention has resulted in
mobilising and supporting for o!er ELL faith leaders# faith teachers and 3"1
representati!es and o!er E#LLL community members ha!e recei!ed information
through printed informational and educational materials# public e!ents# and radio
shows .see "est Practice V "o9 D/
BES- PRA*-I*ESD B+0 #
Eorld Vision D *onsensus Building via HIV Stigma Redu'tion in Religious
*ommunities
16GA+ISATI1+ %orld (ision is an international $hristian humanitarian organisation
dedicated to wor-ing with children# families and communities to o!ercome po!erty and
injustice worldwide2 and wor-s in partnership with communities in their struggle to
establish the right relationships# diminish po!erty# and ha!e society embrace those that
are disenfranchised. %orld (ision launched its acti!ities in "i' in :KK: and currently has
GL ongoing projects countrywide with an annual budget of about *S [ E million. %orld
(ision became a S6 under both the 6ound E and 6ound K G3ATM grants and is
successfully implementing two inter!entions on 'I()AIDS Pre!ention and Stigma
6eduction within the ongoing 6ound K Programme.
G1A& A+D 1"=;$TI(;S The -ey goal of the 'I( Stigma 6eduction inter!ention was to
in!ol!e representati!es of the -ey four 3"1s .=ewish# Muslim# 1rthodo9 and 6oman
$atholic/ in the implementation of the country<s 'I( Programme through sensitising
religious leaders and their communities to the needs of people a0ected by 'I()AIDS# and
mobilising them to implement acti!ities on 'I( pre!ention# ad!ocacy# care and support.
At the initiation of the project in DL:L# a baseline Stigma Assessment was conducted in
cooperation with the InterI6eligious $ouncil in GD municipalities through sampling :#JLL
inter!iewees. The sur!ey pro!ed that 'I(Irelated stigma and discrimination pre!ail
among belie!ers in all churches and the four faith communities. The most common
causes for this included insu>cient -nowledge of 'I( and the !irus transmission as well
as incorrect interpretation of morals and other aspects of faith related to 'I(. This
assessment ser!ed as a basis for further joint and more systematic engagement of
churches and faith communities.
M1D;& Throughout the project# a specially designed and conte9tualised model and
methodology# U$hannels of 'ope<# was used. Initially de!eloped by the $hristian AIDS
"ureau for Southern Africa as a tool to assist $hristian communities# %orld (ision has
successfully adapted the original training manuals and de!eloped four faithItailored
pac-ages for =ewish# Muslim# 1rthodo9 and 6oman $atholic communities. The manuals#
each GLL pages long# contain healthIrelated information as well as Nuotes from related
holy boo-s. The full endorsement by the leadership of all faith groups was achie!ed by
in!ol!ing them in the manuals< re!iew and adaptation process.
Simultaneously# a series of wor-shops to sensitise faith leaders from the four main
religions were held as part of the inter!ention initiation. Additionally# a series of meetings
with religious leaders of all four religions ha!e resulted in the formation of a %or-ing
Group within the InterI6eligious $ouncil with the aim of addressing 'I(Irelated issues in
faith communities and churches. In September DL:L# a $hannel of 'ope wor-shop was
attended by GL representati!es of all four faith communities# where an agreement was
reached that each of the faith entities need trained $hannel of 'ope facilitators.
Accordingly# D: faith leaders were selected and trained as $hannel of 'ope facilitators to
facilitate wor-shops for their own constituencies and beyond. ;9perienced facilitators
from %orld (ision too- the lead# with health care e9perts wor-ing hand in hand with faith
e9perts as coIfacilitators to bridge the gap between health and moral)religious aspects
associated with 'I(. SubseNuently# faithIspeciPc initiati!es representing each of the four
faith communities were de!eloped by leaders of the four religious groups and funded as
pilots in Phase I. These initiati!es en!isaged further peer education and rollIout of the
model in di0erent religious communities.
6;S*&TS 'I( Stigma 6eduction Inter!ention has resulted in mobilising and supporting
for o!er ELL faith leaders# faith teachers and 3"1 representati!es who adopted
-nowledge and s-ills in order to address stigma associated with 'I( and AIDS# and
respond to the needs for pre!ention# care and support in their communities. In addition#
o!er E#LLL community members ha!e recei!ed information through printed informational
and educational materials# public e!ents# and radio shows.
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina JJ
Pilot stigma reduction projects implemented by 3"1s within the four faith communities
ha!e trained an additional :#:LL priests# imams and faith teachers and ha!e
disseminated information and rele!ant messages about 'I(Irelated stigma to o!er HL#LLL
community members.
$1+$&*SI1+S A+D &;SS1+S &;A6+;D In a country such as "i' with a traditional#
patriarchal# closed and multiIethnic society where religious beliefs play an important role
in forming societal patterns# faith leaders and faith wor-ers ha!e pro!ed to be -ey agents
of change that go beyond a successful 'I( response and has a much broader positi!e
impact. Such leaders form the correct social !alues and norms which are necessary for
combating 'I(Irelated stigma and discrimination# and inCuence public attitudes and
beha!iour in health and other Pelds. "y pro!iding faith wor-ers with the tools needed to
spread constructi!e messages of tolerance in line with their faith doctrines# the Project
has initiated a powerful process with the potential to reach all segments of society and
has already had !isible and strong nonIhealth impacts of peace and consensus building.
OOO
FFait( leaders ecame aware of t(e com5leGity of :HI<; to5ic and are very committed to
t(e task, des5ite its sensitivity, w(en it comes to t(e need for artic%lating t(ese iss%es in
c(%rc(es and fait( comm%nities. I elieve t(at, t(anks to t(is works(o5s, t(e
fort(coming small 5ro-ects on HI< and sigma red%ction in fait( comm%nities will e well
im5lemented.H :4e5resentative of I4'.;
FI (ave een working as an imam for over 1/ years and in my s5eec(es I (ave never
mentioned t(is to5ic. 6(at is going to c(ange.H :Imam;
F$ince my c(ild(ood I did not (ave t(e c(ance to s5end time Iwit(J or talk to 5eo5le w(o
werenKt ort(odoG. In 2/1/, I got involved in )orld <isionKs 5ro-ect of stigma red%ction
towards 5eo5le living wit( HI< and AID$. I attended t(e Lrst meeting t(at was organized
y )orld <ision and It(eJ Interreligio%s 'o%ncil as a re5resentative of It(eJ $erian
*rt(odoG '(%rc(. Besides me, t(ere were also re5resentatives of ot(er traditional
c(%rc(es and religio%s comm%nities in Bosnia and Herzegovina. D%ring t(e meeting, and
as a res%lt of my 5re-%dices t(at stem from t(e war, I was very vigilant and s%s5icio%s
regarding t(e 5ossile coo5eration and -oint stance for solving t(is ig social 5rolem.
6(ro%g( t(e $tigma 5ro-ect, (owever, I ecame close and efriended re5resentatives of
ot(er religions and my (ard stance from t(e eginning com5letely c(anged. 6wo years
I(ave 5assedJ since t(e start of t(e 5ro-ect. )e (eld many -oint seminars and works(o5s
on HI< and AID$ and It(eJ accom5anying stigma. From o%r coo5eration, one ig
friends(i5 grew etween me and t(e )orld <ision staM, re5resentatives of t(e Islamic
comm%nity, Ire5resentatives of t(eJ 4oman 'at(olic '(%rc( and Newis( 'omm%nities.
After com5leting t(e '(annels of Ho5e training in 2/11, I (eld over "/ works(o5s for
5riests and ort(odoG elieversH :$erian *rt(odoG Priest;
Source& $lavica BradviA>Han%EiA, GFA67 Grant 9ead, )orld <ision>BiH, .ovemer 2/1!.
StaPng and -raining
"."1 The number of *+DP P6 PM* sta0 was hal!ed at the start of Phase II. The
Programme went from :G people in PM* and :G S6s# to si9 PM* sta0 and :D S6s.
The challenge of the programmatic MO; of :D S6s spread between two ;ntities
and one District operating di0erent health system organisations# plus the hea!y
project management wor-load generated by managing :D S6s# means that PM*
sta0 are o!erIstretched. Indeed# sta0 are so busy monitoring the S6s and coping
with G3 bureaucratic reNuirements that they ha!e little if any time for wider
programmatic issues.
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina JF
"."2 A considerable amount of training has been o0ered o!er the past se!en
years2 howe!er# this has not been based on a capacity building needs
assessment. The lac- of a comprehensi!e training plan means that training is ad
hoc and uncoordinated. This applies to both medical and nonImedical
professionals within Go!ernment ser!ices as well as +G1 sta0. *nder Phase I#
little had been done to harmonise training and this has resulted in an
unnecessary repetition and duplication of training among the S6s. 3or Phase II
there were se!eral discussions at the $$M)&3A)G3 le!el regarding capacity
building for health and nonIhealth professionals as well as for S6s. The originally
proposed training plan# designed in accordance with the G3Iappro!ed 'I( budget
for Phase II# has been cut bac- in an e0ort to harmonise trainings. In addition# a
Nuestionnaire to assess the Nuality and benePts of the training was de!eloped by
the P'I<s MO; *nits during Phase I. This will continue to be implemented during
Phase II. To date# Pndings show that although many training sessions had similar
or the same titles# or were conducted in the same facilities# there was no
duplication of participants. +onetheless# this does not negate the need for a
training needs assessment or full training plan.
"."! The Global 3und has supported education for primary and secondary
health care pro!iders2 but# without such support in future# the pro!ision of this
type of education will li-ely discontinue.
"."" There is not enough local capacity for diagnostics# and especially for the
diagnosis of latent infections. 'owe!er# medical professionals are not obliged to
ta-e any training to e9tend their licences.
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina JM
:4 RE*+22E,DA-I+,S
#.1 The ;!aluation Team<s recommendation are presented under the same
headings as the Pnding in the pre!ious section
.g/ Social# economic and political factors2
.h/ Target Groups.
.i/ 'I( Programme ser!ice deli!ery2
.j/ ($T and A6T pro!ision2
.-/ Stigma and discrimination2 and
.l/ Sta>ng and training.
So'ial7 E'onomi' and Politi'al
#.2 $$M and *+DP should ta-e a more proIacti!e role in coordinating partners<
e0orts within the transition period# especially on the issues of sustainability of
ongoing e0orts# gender sensitising of e9isting ser!ices# and ad!ocacy at local
le!el. This may reNuire creating additional wor-ing groups at the le!el of +A")
$$M.
#.! To better support $S1s in their ad!ocacy e0orts at local le!el# their
ad!ocacy s-ills must be de!eloped and appropriate mechanisms designed and
introduced. This could be through representation# coordination of e0orts and
support of wor-ing groups and other e!ents that would bring state and $S1
members together and assist in de!eloping the transition to state funding plans
and amending relating legislation .e.g. ensuring a legal framewor- for social
contracting# de!elopment of social enterprises etc./ to the e9tent possible.
#." To achie!e sustainability# changes in policy and budget allocation at
3ederal and 6S le!el will be reNuired.
#.# ;0orts should be made to Increase collaboration with other international
and local sta-eholders .for e9ample# %orld "an-# ;*# Swiss Agency for
De!elopment and $ooperation/ engaged in o!erall health system strengthening
in order to ensure better co!erage and inclusion of 7APs with regard to health
and social security co!erage.
-arget Broups
3outh
#.0 A 7AP" sur!ey should be underta-en to ascertain the le!el of -nowledge
and understanding of S6'# including 'I(# among young people. Their attitudes
towards 7APs and P&'I( should also be e9plored in order to determine the le!el
of stigma and discrimination among youth. Such sur!eys would inform the
de!elopment of a "$$ strategy to wor- with young people and foster a more
conduci!e en!ironment for rolling out information sessions on S6'# 'I( and
stigma and discrimination towards 7APs and P&'I(. Topics should include
modules on gender issues# including G"(. The 7AP" sur!ey should also be used
to identify and wor- with +G1s who wor- with young people in the informal
sector# and who would be willing and able to run education sessions with young
people.
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina JK
#.1 The decision to close the youthIfriendly clinics should be reconsidered#
including e9amining the possibility of reopening these with nonIG3ATM funds.
3ailing this# a strategy for the inclusion of life s-ills programmes# or educational
sessions that used to be run at the youthIfriendly centres# should be de!eloped
and e0orts made to establish alternati!e !enues to hold such sessions.
#.2 More in!ol!ement of the Ministry of ;ducation is -ey to getting the right
messages to children in the formal education system. 'I( mainstreaming in the
education system could be strengthened by# for e9ample# establishing a dialogue
with education ministries wor-ing through other partners such as the *nited
+ations Population 3und .*+3PA/ and *+I$;3. Through this mechanism an
appropriate life s-ills programme should be de!eloped with a focus on S6'
.including STIs# 'I( and adolescent pregnancy/ and stigma and discrimination#
for inIschool and outIofIschool .nonIformal sector/ young people. The
programme should also ta-e account of the needs of 6oma youth.
Roma Population
#.3 The pro!ision of communityIbased outreach wor-ers to !isit 6oma women
should be continued# with e0orts made to encourage 6oma women to ta-e up
ser!ices. +ecessary resources V for e9ample# mobile clinics# transport pro!ision#
other incenti!es V should be made a!ailable to enable outreach wor-ers to be
able to !isit 6oma populations in hard to reach areas.
#.1/ The 'I( Programme should continue to ad!ocate for the pro!ision of health
insurance co!erage for all 6oma# and support 6oma $"1s to do so.
+ther 2inorit" Populations
#.11 Data on migrants should be collected and used to inform the de!elopment
of targeted inter!entions.
#.12 The population target group should be e9panded to include all truc-ers#
not just "osnians. +ew ways should be de!ised to reach truc-ers2 for e9ample#
peer leaders .young men chosen from among the truc-er population willing to
distribute I;$ materials to their peers and accompany their colleagues to mobile
($T/ would be a good way of assisting the mobile clinics to widen their clientele
base.
HIV Programme Servi'e Deliver"
#.1! To ensure programme sustainability once G3ATM has withdrawn and to
enable the 'I()AIDS Programme to become embedded within the health system#
a Transition Strategy and 1perational Plan must be de!eloped and adopted by
the Pnal year of the Global 3und grant. De!elopment of the Strategy should
commence with underta-ing a Sta-eholder Analysis to identify acti!ists#
supporters# possible opposition and stumbling bloc-s. Abo!e all# such an Analysis
will bring sta-eholders together# ensure that noIone is left out# raise awareness
and deepen support for the Programme# and engender consensusIbuilding and
ownership.
#.1" The Strategy must dePne who in "i' will be responsible for follow up and
sustaining acti!ities. The Strategy must also ensure that pre!ention e0orts
remain the focus for the foreseeable future# with attention paid to dePning the
most e0ecti!e inter!entions going forward to yield an impact on the epidemic#
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina FL
and building and sustaining the capacities of the Go!ernment entities and $S1s
to deli!er these inter!entions. This will call for wor-ing with Go!ernment and
$S1 partners to identify the most e0ecti!e inter!entions and to build support for
their sustainability. ;mphasis should be placed on building capacities of $S1s
wor-ing with the most e9cluded and marginalised populations# such as MSM and
6oma# with special attention to community mobilisation.
#.1# The de!elopment of a Transition Strategy must be accompanied by a
$apacity +eeds Assessment and $apacity De!elopment and Training Plan.
#.10 Gi!ing eNual priority to pre!ention and treatment has two implications for
future programming
.i/ the a!ailability of rapid testing should be e9panded and introduced
across the board# and o0ered through outreach wor-ers# DI$s and
mobile clinics to ensure that access becomes easier for all 7APs2 and
.ii/ the Go!ernment will ha!e to commit to funding all A6T and 1I# include
the drugs on the list of essential medicines# and guarantee that health
insurance co!erage is there for those most in need.
#.11 The numbers of P&'I( will increase# albeit slowly# and care must therefore
be ta-en to ensure that they are supported and that their physical and
psychological needs are met through a comprehensi!e ser!ice deli!ery model
that encompasses clinical and psychosocial inter!entions.
#.12 *+DP should continue to manage the Programme through the Transition
phase# wor-ing hand in glo!e with Go!ernment and +G1 counterparts to ensure
a smooth transition. =ob sharing# job shadowing and job swaps would be some of
the inno!ati!e ways for the PM* to e9pand the capacity of the counterparts to
assume control of 'I( Programme deli!ery. Study tours might be arranged for
Go!ernment and +G1 sta0 to similar and)or neighbouring countries who ha!e
also mo!ed# or are in the process of mo!ing# from an independent# international
P6 to a local one..
#.13 The necessary regulatory framewor- must be in place before the end of
Transition phase. In order to achie!e this# policy guidelines with regard to 7APs#
A6T and 1I ser!ice pro!ision should be re!iewed and updated# with minimum
training standards established.
#.2/ Go!ernment sta0 should not ha!e to be paid incenti!es to wor- in ($T
clinics2 rather# these tas-s should become incorporated into regular job
descriptions. This will contribute towards greater ownership of the 'I(
Programme within the Go!ernment health ser!ice.
#.21 A PS; should be repeated for the three major 7APs .MSM# P%ID and S%/#
but also including a fourth# the 6oma# in DL:H or DL:E# aided by the census
results and using the PS; Manual prepared by APMG..
#.22 The $$M should establish a %or-ing Group with MO; responsibility .this is
also a condition of the Global 3und !isIcI!is the $$M/ who will meet on a regular
basis and wor- with the three P'Is to de!elop a national MO; strategy with
realistic and manageable targets# and design a feedbac- mechanism so that data
are not just collected but analysed and fed bac- into the system.
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina F:
#.2! This %or-ing Group should also be mandated to re!iew the e9isting body
of research underta-en during the past se!en to eight years to identify gaps in
research and determine future research needs in order to pro!ide the e!idence
base that can be used to inform the design of the most e0ecti!e and targeted
programme inter!entions.
#.2" Mechanisms for data Nuality and control and data accountability must be
part of this.
V*- and AR- Provision
#.2# 3ull co!erage of A6T must be assured within Transition Strategy# including
pro!ision for resistance testing# and transfer of all responsibility concerning A6(s
and drugs for 1Is to Go!ernment# reCected in the list of essential medicines for
the ;ntities)District as appropriate# and liaison with appropriate bodies to ensure
complete co!erage of A6( patients through health insurance.
#.20 The Transition Strategy must ensure adeNuate co!erage of glo!es# sharps
and other necessary eNuipment during Transition Strategy with clear guidelines
on protocol for minimum standards and identiPcation of responsible parties
following completion of the transition phase.
#.21 During the Transition phase# Global 3und subsidies to Go!ernment ($T
centres sta0 should be phased out and the Go!ernment should ta-e o!er the
future costs of human resources for ($T centres are met by the Go!ernment.
This implies a re!iew of the le!el of use of the ($T facilities and closure of some
facilities as appropriate.
#.22 The introduction of widespread rapid testing by nonImedically NualiPed
professionals .such as outreach wor-ers and gate-eepers# sta0 running DI$s and
mobile clinics# and so on/ is a -ey strategy for impro!ing upta-e of 'I( testing
among 7APs. If current legislation cannot support the pro!ision of rapid testing
through nonImedical personnel# e0orts should be made to re!iew and re!ise the
e9isting regulatory framewor- to allow such pro!ision. The 'I( Programme
should change the unit of measurement)indicator from the !ouchers gi!en out to
the number of !ouchers e9changed for ser!ices.
Stigma and Dis'rimination
#.23 A stratagem to address stigma and discrimination and foster beha!iour
change should be an integral part of the Transition Strategy. A good way to start
would be to re!iew and follow up on pre!ious research underta-en on stigma and
discrimination. %here successful inter!entions ha!e been identiPed .such as the
wor- of %orld (ision through 3"1s# this new Stigma and Discrimination approach
could build on current successes# de!eloping tools and models of wor-ing with on
'I( and other healthIrelated issues. A "$$ strategy should include use of
multimedia and in particular newspapers# tele!ision# radio and Internet.
#.!/ A di0erent approach might be needed to address stigma and
discrimination in healthIrelated settings. IdentiPcation of inCuential and
respected Uchampions< or agents of change from among peers should help with
publicising and addressing the -ey issues that a0ect stigma and discrimination in
medical settings.
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina FD
#.!1 The 'I( Programme should consider how best to liaise with P'$ ser!ices
o0ering S6' to ensure that 'I( is addressed within the conte9t of wider STI.
#.!2 There must be a focus on gender sensitisation of ser!ices in the Transition
period# including design# de!elopment# relating training and integration of gender
sensiti!e ser!ices into current programmes and projects .which could encompass
!ery simple and easy ideas such as holding women<s days at DI$ and childcare
facilities# or women<s health sessions within ongoing training)education acti!ities
at those DI$/.
StaPng and -raining
#.!! The G3ATM)*+DP should maintain the number of sta0 agreed to be
necessary to ensure the smooth transition of the 'I()AIDS Programme from being
largely G3ATMIsupported to other sources of funding# o!er an agreed time period
but probably not less than P!e years.
#.!" As mentioned in se!eral preceding sections# a training)capacity building
needs assessment must be underta-en and used as the basis for de!eloping a
comprehensi!e training plan for all sta0 V Go!ernment# *+DP# $S1# 3"1 and
others as necessary.
#.!# The Transition phase must follow through with the inter!entions outlined in
Phase II of 6ound K to build the capacities of $S1s in terms of intelligent
management# fundraising and other support to strengthen $S1s< ability to multiI
sectoral collaboration and changes in legislati!e framewor- as beforehand.
#.!0 The ;ntities)District as applicable should agree to integrate the 'I(
training syllabus into e9isting health wor-er training curricula to strengthen
-nowledge among health professionals# including tools for combating stigma and
discrimination.
#.!1 The aforementioned "$$ Strategy and implementation plan must also be
an integral part of the Transition Strategy# including a focus on communication
techniNues.
#.!2 3inally# the 'I( Programme should re!iew the curriculum for joint T")'I(
patronage nurses)outreach wor-er training to ensure the inclusion of S6' and
STI.
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina FG
Anne. %
Evaluation 2atri.
*riteria and assessment Indi'ators
2eans of veri9'ation
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: 'as there been a change
in outcomes and
beha!iours# positi!e or
negati!ed
:.: 7nowledge of 'I( status among 7ey
Populations
9 9 9
:.D $ondom use at last se9 with nonIregular
partner
9 9
:.G :DImonth A6T retention by A6T treatment
cohorts by year by ris- group
9 9
D 'as there been an
increase in co!erage of
-ey inter!ention ser!ices#
and ha!e these reached
groups at ris-d
D.: A6T co!erage
9 9
D.D PMT$T co!erage# including co!erage with A6T
to reduce motherItoIchild transmission of 'I(
9 9
D.G Management of 'I()'$( and 'I()'"( coI
infection
9 9 9
D.H 1pportunistic infections prophyla9is co!erage 9 9 9
*riteria and assessment Indi'ators 2eans of veri9'ation
D.E Pre!ention inter!entions co!erage .harm
reduction# methadone# testing# condom
pro!ision# etc./ by ris- group
9 9 9 9 9 9
G 'as access by age# se9#
eNuity and Nuality of -ey
inter!ention ser!ices
impro!edd
G.: ;Nuity by age# se9# rural)urban# and subgroup
.e.g. 3S%)ID*# MSM)S%/
9 9 9
G.D 3or each ris- group dePned ser!ice pac-age#
ser!ice deli!ery# freNuency# ser!ice pro!iders#
pac-age of ser!ices implemented according
to design# implementation issues
9 9 9 9
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H 'as there been a change
in disease burden#
positi!e or negati!ed
H.: Mortality by A6T treatment cohorts by year
.among people on A6T and among total
reported cases/
9 9
H.D Morbidity .including opportunistic infections/
9 9
H.G Incidence for each ris- group
9 9
H.H Pre!alence for each ris- group
9 9
E
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E %hat was the G3
contribution in scale up of
resources# increase of
co!erage of -ey
inter!ention ser!ices#
impro!ement of ser!ice
Nuality and outcomed
E.: G3 Pnancing toIdate
9 9
E.D Ser!ice deli!ery and other acti!ities#
population groups targeted and areas the
funding has contributed to
9 9 9
J %hat were the other
competing e9planations
and hypotheses of
changes in outcomes and
impacts# positi!e and
negati!ed
J.: 3inancial contributions according to budget for
national# donor)partner and Global 3und
sources
9 9 9
F 'ow can contributions of
the Global 3und be
redirected to better
contribute to outcomes
and impactd %hat are
the management
F.: 6eIprogramming# priority groups and highI
impact inter!entions
9 9 9 9
F.D "est pac-age of ser!ices for highIimpact
inter!entions
9 9 9 9
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina FE
*riteria and assessment Indi'ators
2eans of veri9'ation
recommendationsd
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina FJ
Anne. #
Iist of Referen'es
Agency for Statistics of "i' .DL:G/. Preliminary 4es%lts of t(e 2/1! 'ens%s of
Po5%lation, Ho%se(olds and Dwellings in Bosnia and Herzegovina. Pro!ided by
*+DPI"i' sta0 for ;!aluation Team on D: +o!ember DL:G.
"i' $ouncil of Ministers .DL::/. $trategy to 4es5ond to HI< and AID$ in Bosnia
and Herzegovina 2/11>2/10. Saraje!o.
"i' Presidency .DL:G/. A!ailable at http))www.predsjednist!obih.ba)hron)d
cideFH#:#: .Accessed on DE +o!ember DL:G./
$ain# =. et al. In $ain# =. and =a-ubows-i# ;.# eds.# .DLLD/. Heat( care systems in
transition& Bosnia and Herzegovina. $openhagen# ;uropean 1bser!atory on
'ealth $are Systems. A!ailable at
http))www.euro.who.int)ffdata)assets)pdffPle)LL:M)FE:GD);FMJFG.pdf .Accessed
on DH +o!ember DL:G/
$ouncil of ;urope .$1;/ V Saraje!o 1>ce .DL:L/. Analysis of 9aws on Healt(
Ins%rance in Bosnia and Herzegovina :Ontity, BrPko District and 'antonal w(ere
a55licale; in *rder to Identify DiMerences Between 6(em and t(e OGisting OQ
Princi5les. A!ailable at http))www.coe.ba)webD)en)do-umenti)catf!iew)D:LI
regionalIprojects)D:GIsocialIsecurityIcoIordinationIandIreforms.htmld
limite:LOorderenameOdireAS$ .Accessed on DE +o!ember DL:G./
;uropean *nion .DL::/. G%ide to t(e 4ig(ts to Healt( 'are in BiH.
*npublished .d/# Saraje!o# March DL::. http))www.rightsforall.ba)publi-acijeI
bs)docsIbs)!odicf,dra!st!enaf,astita.pdf
International 1rgani,ation for Migration .DL:D/. $caling Q5 Access to
Prevention and $ervices Among 7igrants and 7oile Po5%lations in Bosnia
and Herzegovina& P(ase II. I1M Proposal# unpublished# Saraje!o DL:D.
Ministry for 'uman 6ights and 6efugees .DL::/. Analysis 4egistration of 4oma
Po5%lation and 4oma Ho%se(olds = Incl%ding t(e As5ect of 4oma '(ildren. "i'
Saraje!o.
Prism 6esearch .DL:G/. Rnowledge, Attit%des and Practices of 7igrant )orkers in
4elation to HI<BAID$& t(e 4es%lts of S%antitative 4esearc(. Saraje!o# August
DL:G.
Public 'ealth Institute 6S and 3"i' .DL:G/. 3/
t(
Anniversary of Instit%tional P%lic
Healt( in Bosnia and Herzegovina. Saraje!o.
6esource $entre of the Institute for Public 'ealth of the 3ederation of "osnia and
'er,ego!ina .DL:D/. 4e5ort on 7onitoring and Oval%ation of Programme
Im5lementation. *+DP)G3ATM# Saraje!oIMostar DL:D.
6ifat A. et al.# .DLLF/. DiM%sion of com5leG (ealt( innovationsT im5lementation
of 5rimary (ealt( care reforms in Bosnia and Herzegovina. 'ealth Policy and
Planning .DLLF/2 DDDMVGK.
doi:L.:LKG)heapol)c,lLG:. A!ailable at
http))heapol.o9fordjournals.org)content)DD):)DM.full.pdf .Accessed on DE
+o!ember DL:G./
*+AIDS .DL:D/. 2/12 Gloal AID$ 4es5onse Progress 4e5orting, 2/12 Qniversal
Access in t(e Healt( $ector 4e5orting, and 2/12 D%lin Declaration 4e5orting,
Bosnia and Herzegovina. A!ailable at
http))www.unaids.org)en)dataanalysis)-nowyourresponse)countryprogressreports
)DL:Dcountries)cef"Af+arrati!ef6eport.pdf .Accessed on DH +o!ember DL:G./
*+DP .DL:D/. $caling Q5 Qniversal Access for 7ost at 4isk Po5%lations in Bosnia
and Herzegovina& P(ase II. *+DP "i'# Saraje!o.
%'1 .DLLJ/. 1/ Healt( S%estions ao%t t(e .ew OQ .eig(o%rs. A!ailable at
http))www.euro.who.int)en)publications)abstracts):LIhealthINuestionsIaboutItheI
newIeuIneighbours .Accessed on DE +o!ember DL:G./
%'1 .DL:D/. Rey Facts on HI< O5idemic In Bosnia and Herzegovina and Progress
In 2/11. A!ailable at
http))www.euro.who.int)ffdata)assets)pdffPle)LLLF):K:LJM)"I'I'I(AIDSI
$ountryIProPleIDL::Ire!isionIDL:DIPnal.pdf .Accessed on DH +o!ember DL:G./
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina FM
Anne. 8
2ission S'hedule
2onda" %% ,ovem/er #$%8
Federation 2inistr" of *ivil A6airs =F2+*A>
Dr Aerifa Godinja-
$$M $hairman# and 'ead of Department for ;uropean Integration and
International $ooperation# Sector for 'ealth in the 3M1$A
I+T;6(I;%
1,FPA
Daniela Alijagi@# MO; Programme Analyst
I+T;6(I;%
I+2
Mirsada ]e@o# Medical Programmes $oordinator2 and Mladen 7a-uca# Project
1>cer
I+T;6(I;%
,B+ PR+I DSaraGevo
Samir IbiBe!i@# +G1 President# and *liana "a-h# Programme Director
I+T;6(I;%
Asso'iation 03
Ismir 'od?i@I Project $oordinator2 +ed?ad D?ebo# MSM 1%2 Darijo 7rme-# MSM
1%2 and 7erim D?e!lan# MSM counsellor.
I+T;6(I;%
1,DP PR P21 -eam 2eeting
+eBad Aeremet# 'I()AIDS Programme Manager2 D?anela "abi@# 'I()AIDS
Monitoring and ;!aluation ;9pert2 I!ana Stojadino!i@# 'I()AIDS Procurement
Associate2 Aejla "ran-o!i@IMerd?o# 'I()AIDS 3inance Associate2 +ejla Sa-i@ 7adi@#
'I()AIDS 3inance Associate2 SaBa Pote?ica# 'I() AIDS MO; Assistant2 and Arijana
Drini@# 'I()AIDS Monitoring and ;!aluation Data $ollection $ler-
"6I;3I+G A+D DIS$*SSI1+
-uesda" %# ,ovem/er #$%8
1,I*EF
Selena "ajra-tare!i@# Programme 1>cer
I+T;6(I;%
Eorld Vision
Sla!ica "rad!i@ 'anuBi@# Grant &ead2 Alma "u,u-# 3inance 1>cer2 and Maja
Gruji@# 'ealth and Ad!ocacy Programme Manager
I+T;6(I;%
2edi'al Fa'ult"7 1niversit" of SaraGevo
Prof. Dr. Semra `a!aljuga# epidemiologist
I+T;6(I;%
1,AIDS
Mir,a Musa# former *+AIDS 3ocal Point
I+T;6(I;%
Ca(anG HIV *entre
Mujo 3afulic# 'I()AIDS 6oma $entre $oordinator
I+T;6(I;%
Partnerships in Health
Damir &ali8i@# Project coordinator
I+T;6(I;%
Integrated Prevention7 -reatment7 *are and Support =IP-*S>
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina FK
Amer Paripo!i@# Project 1>cer P&'I(
I+T;6(I;%
Eednesda" %8 ,ovem/er #$%8
Pu/li' V*- and ARV *entre
Dr (esna 'ad?iosmano!i@# clinician and infectologist at Infectious Disease $linic
Saraje!o2 ($T centre coordinator
I+T;6(I;%
PEID and +S- *entre
Dr. sci.med. +ermana Mehi@I "asara# Director of the Institute for Alcoholism and
Substance Abuse of Saraje!o $anton2 Prim. Spec. Dr. Senija Selman2 Magbula
Grabo!ica# 'ead +urse2 D?email Mehmedspahi@# Medical technician
I+T;6(I;%
Eorld Health +rganisation
Dr 'aris 'ajrulaho!ic# 'ead of %'1 $ountry 1>ce
I+T;6(I;%
AP+HA
]!je,dana =a-i@# Director and Psychosocial $ounsellor2 Mersha 'useini#
Psychosocial $ounsellor2 Adis DelibaBi@# Psychosocial $ounsellor2 gamil
1smanagi@# Project 1>cer2 Melisa "ulbul# Psychosocial $ounsellor2 Alden
'us-o!i@# 1%2 and Sanela Abla-o!i@# 3inance Manager
I+T;6(I;%
I+2 I !isit to border customs mobile ($T for truc-ers at 'alilo!i@
Mir,a 'abul# acti!ist)peer educator2 Ae!ala Suljagi@# medical technician2 and
Mirsada ]e@o# Medical Programmes $oordinator# I1M
I+T;6(I;% A+D 1"S;6(ATI1+
-hursda" %& ,ovem/er #$%8
FBiH 2+H
Dr ]lat-o `arda-lija2 3ederal 'I( $oordinator in the M1'
I+T;6(I;%
**2 2eeting
Presentation and Discussion of Draft PS; Paper
2onda" %@ ,ovem/er #$%8
1,DP Regional +P'e7 2ostar
"o,ena "hhm 7alta-
I+T;6(I;%
FPHI7 2ostar
:. Dr ]lat-o (u@ina# 'ead of the centre for health management P'I 3"I'#
'I()AIDS 6esource $entre $oordinator in 3"i'
D. Dr =elena 6a!lija# Manager of the Department of ;pidemiology P'I 3"i'
'I()AIDS Programme $oordinator
I+T;6(I;%
1,DP Regional +P'e BanGa Iu(a
Goran (u-mir# 'ead of 6egional 6epresentation 1>ce# *+DP
RS PHI
:. Dr =o!an Ti!-o!i@# ;pidemiologist
D. Dr &jubica =andri@# MO; 1>cer
G. =elena Medar Petro!i@# Senior Pharmaceutical 1>cer# 6S M1'S%
I+T;6(I;%
Pu/li' Health Institute7 2ostar# FBiH
;milija Primorac# +urse I;9pert Associate for immunisation# 'I()AIDS MO;
Assistant# ($T Site
I+T;6(I;%
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina ML
,B+ 2argina7 DI* for PEIDs and SEs7 2ostar
:. +atasa Dadaji@#Project $oordinator for P%ID
D. Denis Dedaji@#6egional $oordinator for S% and Prisoners#
G. Mir,a ;fendi@IProgramme 1>cer for P%ID
H. &eo =uri@# 1% for S% and Prisoners
I+T;6(I;% A+D 1"S;6(ATI1+
,B+ 2argina7 DI* for PEIDs and SEs7 2ostar
31$*S G61*P %IT' P%ID
,B+ 2argina7 DI* for PEIDs and SEs7 2ostar
31$*S G61*P %IT' S%
-uesda" %A ,ovem/er #$%8
RS PHI BanGa Iu(a
Dr Slobodan Stani@# Director of Public 'ealth Institute in 6S2 'I()AIDS 6esource
$entre $oordinator 6S
I+T;6(I;%
V*- Site7 State Hospital of St4 Iu(a7 Do/oG7 Respu/li'a Ser/s(a
Dr S!jetlana Ad,i@
I+T;6(I;%
+S- Site7 Do/oG7 RS
Dr 3erhad 'ad?iibrahimo!i@ # Department of Psychiatry# General 'ospital# Doboj#
physician specialist Vpsychiatrist
I+T;6(I;% A+D 1"S;6(ATI1+
PHI V*- *entre BanGa Iu(a
:. Dijana 7ne?e!i@# nurse# ($T counsellor
D. Dr Milan Petro!i@ # ($T counsellor
I+T;6(I;%
P+E,-A BanGa Iu(a
:. (i-tor "jeli@# 3inance Manager
D. Tanja 1lja8a# Data $ler-
G. Mirosla! Petro!i@# Programme Manager
I+T;6(I;% A+D 1"S;6(ATI1+
AAA BanGa Iu(a
31$*S G61*P %IT' 51*+G MSM
,B+ PR+I NBiha'h
:. Samir IbiBe!i@# +G1 President
D. Pan-a (ojni-o!ic# DI$ 1perator
G. +e!,eta IbrahimpaBi@# ($T counsellor
I+T;6(I;%
Roma HIV DI*7 Qivini'e7 FBiH
Muradif "ibero!i@# 'I()AIDS 6oma $entre $oordinator
I+T;6(I;%
Eednesda" #$ ,ovem/er#$%8
PHI BrL(o
Dr Mirjana 7u,mano!i@# ;pidemiologist
I+T;6(I;%
A'tion Against AIDS ,B+ =AAA>7 BGelGina7 RS
Asmira Mulaimo!ic# 1utreach %or-er
I+T;6(I;%
V*- Site7 BGelGina7 RS
:. Dr. Ale-sandra 6adoj8i@# ($T counsellor
D. Sr_an lli@# ($T counsellor
I+T;6(I;%
PR+% DI* BrL(o Distri'tV
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina M:
31$*S G61*P %IT' P%ID A+D DI$ 1P;6AT16
,B+ PR+I7 Biha'
fo'us group )ith PEID
Samir IbiBe!icI President of Association P61I
I+T;6(I;% A+D 31$*S G61*P
,B+ Poenta7 BanGa Iu(a
Telj-o Marjanac# Director# and :D P%ID
31$*S G61*P %IT' P%ID
,B+ AAA"anja &u-a#
Se_an 7u-olj#President of AAA
I+T;6(I;% A+D 31$*S G61*P %IT' D 3S%
-hursda" #% ,ovem/er #$%8
,B+ 2argina7 DI* for PEID and SE7 -uzla7 BiH
Denis Dedaji@# President
31$*S G61*P %IT' H S% A+D D GAT;7;;P;6S
,B+ 2argina7 DI* for PEID and SE7 -uzla7 BiH
:. Dinj-o Stoja-o!i@# police inspector
D. Adnan Mustedanagi@# police inspector
31$*S G61*P %IT' D P1&I$; I+SP;$T16S
,B+ 2argina7 DI* for PEID and SE7 -uzla7 BiH
31$*S G61*P %IT' S%
V*- and ARV Site7 -uzla7 FBiH
Dr Sana Aabo!i@# Infectologist at $linic for Infectious Diseases in Tu,la# 'I()AIDS
($T $oordinator
I+T;6(I;%
,B+ 2argina7 DI* for PEID and SE7 -uzla
I+T;6(I;% A+D 1"S;6(ATI1+
+S- Site7-uzla
Dr. Me!ludin 'asano!i@# 'ead of Psychiatry $linic in Tu,la
I+T;6(I;%
Frida" ## ,ovem/er #$%8
FBiH 2+H
Dr garda-lija# 3ederal 'I( $oordinator in the M1'
I+T;6(I;%
IFA
Dr +arcisa Pojs-i@# *+1PS
I+T;6(I;%
1,AIDS
Mir,a Muso# former *+AIDS country coordinator
I+T;6(I;%
1,DP PR P21
Dr +eBad Seremet# Programme Director
I+T;6(I;%
-uesda" #< ,ovem/er #$%8
1,DP PR P21
+eBad Aeremet# 'I()AIDS Programme Manager
D?anela "abi@# 'I()AIDS Monitoring and ;!aluation ;9pert
I!ana Stojadino!i@# 'I()AIDS Procurement Associate
Aejla "ran-o!i@IMerd?o# 'I()AIDS 3inance Associate
+ejla Sa-i@ 7adi@# 'I()AIDS 3inance Associate
SaBa Pote?ica# 'I() AIDS MO; Assistant
Arijana Drini@# 'I()AIDS Monitoring and ;!aluation Data $ollection $ler-
D;"6I;3I+G 1+ ;(A&*ATI1+ 3I+DI+GS# $1+$&*SI1+S A+D 6;S*&TS
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina MD
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina MG
Anne. &
-he *on'eptual Frame)or( for the Evaluation
The programme e!aluation is di!ided among the three phases as follows
:. Des- re!iew of e9isting documentation and de!elopment of
protocols for Peldwor-# including design of Nuestionnaires and
identiPcation of target groups)programme benePciaries to be inter!iewed2
the team will re!iew# inter alia# programme design# management and
implementation# including by P6# SubIrecipients and SubIsubIrecipients
.S6 and SS6/# Go!ernment and other signiPcant sta-eholders .for e9ample#
rele!ant donors/2
D. 3ieldwor- for further data collection# referring to the implementation
and ser!ice pro!ision le!els and sta-eholders dePned in the T16s and
through the des- re!iew abo!e2 and
G. Data analysis# resulting in a report describing the programme and its
inter!entions# lessons learned and recommendations for future
programming.
The relationship between these three phases is depicted in 3igure : below.
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina MH
Figure % +vervie) of the Programme Evaluation Frame)or(
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina ME
*
R
I
-
E
R
I
A
Ser!ice
pro!iders
Programme
sta0
1ther
related
Go!ernmen
t
institutions
"enePciarie
s
2ethodolog"
$ollaborati!e and participatory processes will be core elements of this e!aluation.
;mployment of a range of methodologies including document re!iews# focus
group meetings# inter!iews and Peld in!estigations will promote inclusion and
ensure the e!aluation is consistent with gender eNuity principles and good
de!elopment practice.
To create a positi!e en!ironment for dialogue# the e!aluation team will use
Appreciati!e InNuiry .AI/ methodology throughout the e!aluation. This approach
combines a rigorous e9amination of data with a focus on the strengths and
achie!ements of programmes and institutions to determine ways to build on
those strengths for increased e0ecti!eness. At the core of the AI methodology is
an e9amination of what has wor-ed# drawing out the successes and progress that
implementing partners and benePciaries can identify. It is the team<s e9perience
that this positi!e starting point re!eals di0erent information and brings
enthusiasm to the tas- of e!aluation rather than an immediate focus on
problems# barriers and obstacles. It engages programme sta0 and other
sta-eholders in a constructi!e dialogue that ac-nowledges and rewards the
considerable e0ort that has brought them to this point in the project<s
implementation. It is not a substitute for an objecti!e and rigorous e9amination
of progress and process# but complements this by de!eloping an e!aluation
en!ironment that is constructi!e and participatory. It ensures that positi!e
processes and outcomes are identiPed# analysed and reproduced. ;!aluators#
partners and sponsors are attracted to this approach as it
b ;ngages sta-eholders in structured dialogue to de!elop further the e!aluation
Nuestions# and to !alidate them2
b 6eframes e!aluation tools to strengthen Nualitati!e data collection2 hence
e!ery tool that is de!eloped will need to be adjusted according to the conte9t and
the target population2
b Increases use of e!aluation results and learning2 and#
b $omplements and strengthens the e!aluation process.
*se of the AI method will assist the e!aluation team to determine if the planned
acti!ities will in fact produce the e9pected outputs V for e9ample# if they are
consistent with each other with regard to the dePnition of components .acti!ities
and outputs/ I from the point of !iew of their logical seNuence# temporal
dimension# and the reNuisite organisation for the achie!ement of results. It
ensures
6e!iew of the programme at two le!els
o &e!el : Go!ernance through the $ountry $oordinating Mechanism
.$$M/# Programme Steering $ommittee .if such e9ists/# P6 Project
Management *nit .PM*/ organisation and structure# S6T and SS6
organisation and structure2 monitoring and e!aluation .MO;/
framewor-.
o &e!el D Programme implementation# including P6 and S6)SS6#
ser!ice deli!ery sta0 and mechanisms for programme coordination
and support.
$lear dePnition of the milestones of the programme# inputs# processes#
outputs and outcomes or results associated with each milestone.
$lear dePnition of the indicators associated with each programme
objecti!e# e9pected outputs# results and impact according to the
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina MJ
Programme Performance 3ramewor- .PP3/# related annual wor- plans and
time line.
$lear assignment of responsibilities for the achie!ement of each of the
components and subcomponents at the implementation le!el.
$lear dePnition of responsibilities for the achie!ement of the acti!ities and
assigned tas-s.
$lear trac-ing of progress toward meeting the programme<s performance
goals and objecti!es by ser!ice deli!ery area .SDA/.
The e!aluation team will select and focus the e!aluation criteria on two main
areas effecti!eness .outcomes and impact/ and e>ciency. A mi9 of Nuantitati!e
and Nualitati!e data collection methods will promote triangulation2 both the
Nualitati!e and the Nuantitati!e information will interact to produce an
e9planation of the results as demonstrated in Table : below# Assessment 'riteria
and 7et(ods .page :L/. The methodology for the e!aluation will also ensure an
e9amination of the programme<s adherence to the G3 principles regarding !alue
for money and eNuity of ser!ice pro!ision.
The Global 3und was designed to pro!ide e0ecti!e and e>cient funding to
combat the three diseases .'I(# malaria and tuberculosis/. It is committed to the
principles outlined in the Paris Declaration on aid e0ecti!eness and to continuing
to strengthen measures to impro!e the !alue for money of ser!ices deli!ered.
Through its demandIdri!en approach# the Global 3und supports countryIowned
solutions# enabling local sta-eholders to identify the most appropriate and
e>cient ways to manage their programmes. ;nsuring !alue for money at e!ery
stage of the Pnancing chain is a priority for the G3 and *+DP# e9tending from
donors to the people who benePt from ser!ice pro!ision. Increasing !alue for
money throughout the grant life cycle in turn impro!es the e>ciency of grant
implementation and programme ser!ices directly.
Phase I Des( Revie)
The e!aluation team will underta-e an e9tensi!e and in depth des- re!iew of
documentation related to the Programme# as well as the national en!ironment in
which the Programme operates.
Phase II Data *olle'tion
To be able to pro!ide an objecti!e measurement of performance# se!eral
dimensions of the Programme will need to be assessed.
3irst# at the Programme management le!el# two types of assessments will be
conducted
A'tivit"D/ased7 measuring the Sage of acti!ities completed# as well as
the correlation of the e9pected inputs and processes with the e9pected
outputs# results and impact .the Programme<s appro!ed PP3/2 and
-imeD/ased7 measuring the Sage of completed acti!ities and tas-s#
outputs and outcomes# and e9pected impact in the dePned time frame.
Second# criteriaIdePned assessments will be conducted with !arious
sta-eholders# grouped as follows
Programme /ene9'iaries target groups and -ey a0ected populations
.7APSs/ such as men who ha!e se9 with men .MSM/# people who inject
drugs .P%ID/# se9 wor-ers .S%s/# people li!ing with 'I( .P&'I(/# and
caregi!ers2
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina MF
Servi'e providers health care professionals including medical personnel
and people pro!iding psychosocial and palliati!e care who are not
medically trained .counselling sta0 and ser!ice pro!iders from communityI
based organisations .$"1s/# others as appropriate2
De'isionDma(ers at the national level federal authorities and -ey
sta-eholders from# inter alia# the Ministry of 'ealth .M1'/# Ministry of
3inance .M13/# the $$M and other de!elopment partners.2 and
De'isionDma(ers at the lo'al level this includes republican#
community and district health authorities and subInational go!ernmental
structures.
The set of predePned criteria will be applied through a !ariety of methodologies
such as semiIstructured inter!iews7 focus groups and# in speciPc cases# small
sur!eys within selected communities. $ommensurately# health care pro!iders
will also pro!ide a signiPcant data source through the e!aluation team<s re!iew of
selected 'I(Irelated ser!ices facilities.
The criteria that will be used to assess impact are
6ele!ance
;0ecti!eness
;>ciency
Sustainability
$oherence
"enePciaries .Programme target groups/
Ser!ice pro!iders
6ightsIbased approach
Application of the criteria by sta-eholder le!els will be as follows
Relevance1
+ational decisionIma-ing le!el# including management and steering committee
le!el
%hat is the Programme<s rele!ance in terms of ad!ocating for and
facilitating national 'I( pre!ention and treatmentd
Ser!ice pro!iders
To what e9tent is the training component appropriate in response to the
training needs of the target groupsd
Programme benePciaries)target populations
To what e9tent is the Programme rele!ant in terms of contributing to
impro!e benePciaries< wellbeing# Nuality of life impro!ement and
beha!ioural changed
.2ectiveness&
+ational decisionIma-ing le!el# including management and steering committee
le!el
To what e9tent is the Programme<s go!ernance structure suitable to
implement in an e0ecti!e# transparent and participatory way and to
promote upstream policy change in the areas of concernd
+ational decisionIma-ing le!el
To what e9tent is the Programme e0ecti!e in facilitating the adoption of
new policies# policy changes# Nuality impro!ement and go!ernance of the
health system in line with rele!ant Programme objecti!es and goals
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina MM
dePned in the appro!ed grant application# and international best practices
and standards .i.e. *+AIDS# *+3PA# *+I$;3# %'1/d
6egional and community decisionIma-ing le!el
To what e9tent has the Programme contributed to health authorities and
other institutions promoting 'I( pre!ention and treatment# and beha!iour
change# as well as informed decisionIma-ing on resource mobilisation and
sustainable planning in line with international standardsd
Ser!ice pro!iders
'ow e0ecti!e is the Programme in impro!ing ser!ice pro!iders< -nowledge
and s-ills in selected aspects of ser!ice pro!ision and in terms of Nuality of
care against the indicators set in the Programme<s logical framewor- and
in line with international standardsd
To what e9tent ha!e trained ser!ice pro!iders .indi!iduals/ modiPed their
regular practices related to !arious Programme inter!entions against set
indicators and in line with international standardsd %hat are the
enabling)constraining factors that facilitated)hindered this beha!iour
changed
In the ser!ice facility wor-places where trained practitioners wor-# to what
e9tent ha!e regular practices related to selected Programme inter!entions
been modiPed in line with rele!ant international standardsd
To what e9tent has the Programme contributed to the impro!ement of
o!erall resource management in the rele!ant ser!ice facilitiesd
To what e9tent has there been an impro!ement in terms of co!erage of
target populations# Nuality of care and the Programme benePciaries<
beha!iour changed
To what e9tent is the MO; system e0ecti!e in reinforcing s-ills application
and trac-ing of both human resources and s-illsd
.3cienc/1
Does the 'I( Programme use its resources in the most economical manner
to achie!e its objecti!esd Are the a!ailable resources .Pnancial# human
and)or technological/ adeNuate to meet Programme needsd
Sustainabilit/1
+ational decisionIma-ing le!el
To what e9tent do the M1' and other Go!ernment agencies demonstrate
ownership of the Programmed
To what e9tent is the Programme part of national policies and strategies in
order to facilitate the M1'<s mainstreaming and)or integration of 'I(
pre!ention and treatment into the "i' health system# therefore assuring
sustainability of the results achie!edd
SubInational decisionIma-ing le!el
To what e9tent does the M1' at the region# district and community le!els
demonstrate ownership and capacity for resource mobilisation to be able
to consolidate and sustain achie!ements and the e9pansion of Programme
inter!entions within their catchment areasd
Ser!ice pro!iders
To what e9tent are the changes in the Nuality of care o0ered by health
pro!iders e9pected to lastd %hat are the bottlenec-s and gaps in the
continuum of care that hinder ser!ice pro!iders< capacity to pro!ide
ongoing Nuality and eNuitable 'I(Irelated ser!icesd
"enePciaries .target populations/
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina MK
To what e9tent are the beha!ioural changes among benePciaries e9pected
to lastd %hat factors e9ist that are li-ely to assist or obstruct sustainable
changesd %hat are the bottlenec-s and gaps in the continuum of care that
hinder the capacity of target populations to access and use Nuality 'I(
related ser!ices for themsel!es and their peers or partnersd
Co'erence1
To what e9tent is the Programme contributing to and in line with health
sector national policies and plansd
To what e9tent does the Programme facilitate synergies and a!oid
duplication with inter!entions and strategies promoted by other
de!elopment partnersd
Programme bene4ciaries1
To what e9tent do benePciaries percei!e any o!erall change in access to
counselling# testing and treatment at the community and household le!el
.especially in terms of impro!ed health care pro!ision# impro!ed pro!ision
of pre!ention and health promotion information and tools# increased
see-ing of health care# decreased costs of health care and ease of access
to health ser!ices/d
To what e9tent ha!e benePciaries increased the freNuency of their
participation in 'I( pre!ention and health care .through !isits by outreach
wor-ers and health see-ing beha!iour/ as a result of percei!ed
impro!ement in 'I( ser!ice pro!ision Nuality and as a result of reduced
costs and impro!ed access to ser!icesd
To what e9tent ha!e benePciaries changed their beha!iour and reduced
ris-y practices as a conseNuence of impro!ed counselling and other
ser!icesd
To what e9tent is the communications strategy e>cient in terms of
reaching the target groups as compared to its cost
Service providers
To what e9tent is the training system# including follow up) in ser!ice
training# e>cient in terms of resource absorption as compared to the
results achie!ed
Rig'ts5 based approac' (R)61
To what e9tent does the Programme ta-e account of the 6"A to
programmingd
To what e9tent does the Programme consider eNuity .i.e. its focus on the
most depri!ed areas# areas with high 'I( pre!alence or incidence/ and
facilitate the benePciaries< access to 'I(Irelated ser!icesd
To what e9tent does the Programme consider gender eNuality throughout
the planning and implementation processd
To what e9tent is the Programme facilitating the use of the 6"A to inform
policies and planning within 'I( pre!ention# treatment# care and support at
central and subInational le!eld
$alue !or mone/
If time allows# the e!aluation will also try to obtain information on how !alue for
money has been achie!ed# through as-ing the following Nuestions
Has there /een a 'hange in disease /urden7 positive or negativeR
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina KL
Mortality by antiretro!iral .A6T/ treatment cohorts by year .among
people on A6T and among total reported cases/
Morbidity .including opportunistic infections/
Incidence
Pre!alence

Has there /een a 'hange in out'omes and /ehaviours7 positive or

negativeR
:DImonth antiretro!iral medicines .A6(/ retention by A6T cohorts by
year
"y ris- group
Has there /een an in'rease in 'overage of (e" intervention
servi'es7 and have these rea'hed groups at ris(R
A6T co!erage
Pre!ention of motherItoIchild transmission .PMT$T/ co!erage# including
co!erage with A6T to reduce motherItoIchild transmission of 'I(
Management of 'I()'$(.hepatitis " !irus/ and 'I()'"( .hepatitis $
!irus/ coIinfection
1pportunistic infections .1I/ prophyla9is co!erage
Pre!ention inter!entions co!erage .harm reduction# methadone#
testing# condom pro!ision# etc./ by ris- group
Has a''ess /" age7 se.7 eSuit" and Sualit" of (e" intervention
servi'es improvedR
;Nuity by age# se9# rural)urban# and subgroup .e.g. 3S%)P%ID#
MSM)S%/
3or each ris- group dePned ser!ice pac-age# ser!ice deli!ery#
freNuency# ser!ice pro!iders# pac-age of ser!ices implemented
according to design# implementation issues
Ehat are the fa'tors =politi'al7 legal7 'ultural or 'onte.tual>
a6e'ting implementations =fa'ilitating and impeding su''essful
implementation>R
Ehat )as the BF 'ontri/ution in s'ale up of resour'es7 in'rease of
'overage of (e" intervention servi'es7 improvement of servi'e
Sualit" and out'omeR
Ehat )ere the other 'ompeting e.planations and h"potheses of
'hanges in out'omes and impa'ts7 positive and negativeR
3inancial contributions according to budget for national#
donor)partner and Global 3und sources
Ho) 'an 'ontri/utions of the Blo/al Fund /e improved to /etter
'ontri/ute to out'omes and impa'tR Ehat are the management
re'ommendationsR
6eIprogramming# priority groups and highIimpact inter!entions
DePne best pac-age of ser!ices for highIimpact inter!entions
Independent ;!aluation 'I()AIDS Programme "osnia and 'er,ego!ina K: