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Challenges of NGO-to-state 

Referral in the Delivery of HIV 

Prevention Programs in Ukraine 

Supported by the Global Fund  

 

Svetlana McGill  

 

Queen Margaret University, Edinburgh, United Kingdom  

 
Vol. 4, No. 2 (2015)   |   ISSN 2166-7403 (online)  
DOI 10.5195/cajgh.2015.213 |   http://cajgh.pitt.edu 

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Abstract 

Background: Ukraine has one of the world’s fastest growing HIV rates and was one of the largest recipients of funding from the 
Global Fund to Fight AIDS, Tuberculosis and Malaria (GF). The objective of this study was to close the gaps in the literature on 
the delivery of HIV prevention services by NGOs and the perceptions of NGO delivered services, using as an example HIV 
prevention programs in Ukraine funded by the GF.  
Methods: The aim of this qualitative study was to determine how NGO-based services were implemented in the context of a state-
owned healthcare system of Ukraine. An ethnographic study, which included 50 participant interviews, was conducted in three 
oblasts in Ukraine and in the capital, Kyiv, between 2011 and 2013. This article presents some of the findings that emerged from 
the analysis. 
Results: Participants reported that NGOs were focused more on reporting numbers of rapid tests, and less on motivating clients to 
continue onto treatment. The role division between NGOs and the state in HIV services was largely perceived by participants as 
unclear and challenging. Overall,  lack of clarity on the role of government healthcare providers and NGOs in providing HIV 
services compromised the process of finding, referring, and retaining HIV patients in care. 
Conclusions: Gaps in linking HIV patients to the HIV care continuum have been identified as a potentially problematic issue in 
delivery of HIV prevention services by GF funded NGOs. With an anticipated GF exit from Ukraine, the lack of clearly defined 
NGO-to-state referrals of HIV patients complicates the transition of NGO run services into state funding. Further steps to improve 
referral systems are necessary to ensure a smooth transition and enable Ukraine to fight its HIV epidemic effectively. 

Keywords: HIV care continuum, Global Fund, linkage to care, NGOs 

 

Challenges of NGO-to-state Referral 

in the Delivery of HIV Prevention 

Programs in Ukraine Supported by 

the Global Fund  

 

Svetlana McGill  

 

Queen Margaret University, Edinburgh, United Kingdom  

Research 

Since 2008, HIV rates have steadily increased in 
Eastern Europe and Central Asia.1 Russia and Ukraine 
account for over 90% of diagnosed HIV cases; however, 
Ukraine has the most severe increase among the Eastern 

European and Central Asian countries, with an estimated 
440,000 cases of people living with HIV2 and an 
estimated HIV prevalence of 1.63% at the end of 2007.3 
As of February 11, 2014, there were 247,101 registered 
cases of HIV infection, over 66,607 registered cases of 
AIDS, and 32,283 AIDS deaths.4 Recent political turmoil 
has led to claims that the Ukraine's AIDS program is 
"breaking down" and international organizations are 
concerned that HIV rates are beginning to rise for the first 
time since 2002.5 

Ukraine has been among the top ten recipient 
countries of the Global Fund (GF) to Fight AIDS, 
Tuberculosis, and Malaria.  In 2003, Ukraine received a 
GF Round 1 (R1) HIV grant of 95 million USD. The 
principal recipients were the Ministry of Health (MOH), 
United Nations Development Programme, and the 
Ukrainian Fund against HIV/AIDS. Utilization of the 
grant funds quickly stalled primarily due to inefficient 

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governance and slow program implementation.6 As a 
result, in 2004, GF suspended the funding to all recipients 
and transferred the R1 grant to an international 
nongovernmental organization, International HIV/AIDS 
Alliance, based in the United Kingdom. In 2012, a grant 
was awarded to two NGO principal recipients.   

An anticipated outcome of the GF decision to 
transfer funding to an international nongovernmental 
organization was the creation of robust and effective 
delivery of HIV services. With the MOH as an original 
implementer, the services were perceived to be delivered 
by state healthcare, the backbone of which was the 
network of specialized regional AIDS clinics. Ukraine’s 
healthcare is often viewed as a "hybrid Semashko” 
system7 because many elements of the previous Soviet 
healthcare system are still present. A network of AIDS 
clinics, known as AIDS centers, represents one such 
element. After control of GF funds was transferred to an 
international nongovernmental organization, the 
perceived division of roles between state healthcare and 
NGOs ceased to exist, bringing implementation 
challenges to Ukraine’s original GF program, which was 
geared to state healthcare.  

HIV care continuum and perceived NGO delivery roles 

in Ukraine 

For individuals with HIV infection to fully 
benefit from antiretroviral therapy, they need to know 
that they are HIV infected, be engaged in regular HIV 
care, and receive and adhere to effective antiretroviral 
therapy.8 ‘The HIV care continuum’ -- also known as ‘the 
HIV treatment cascade’ -- is a model used to describe the 
delivery of HIV services to people living with HIV across 
the entire continuum of care. 

 

Figure 1. A model of HIV treatment cascade (Gardner et 
al.2011) 

 

In Ukraine, a distinction is made between 
“testing to identify HIV” - typically done through rapid 
HIV tests at a variety of settings – and “making an HIV 
diagnosis” (or confirmatory test) – that includes other 
assessments/testing and can be performed only at 
healthcare facilities.9 Importantly, administration of 
antiretroviral therapy and other free HIV continuum 
healthcare services associated with an HIV positive test 
begin when a patient presents with a positive HIV result 
obtained from confirmatory testing for antibodies to HIV 
and antigen р24 HIV-1.10 The patient is then put on a 
dispensary list, which requires registration and 
submission of individual passport data to the AIDS 
center. Thus, confirmatory HIV testing is important to 
link the patient to Ukraine’s HIV healthcare continuum. 
Ukraine implements the combined voluntary counseling 
and testing model,  administered through an extensive, 
tiered HIV laboratory system in state-funded hospitals, 
sexually-transmitted disease (STD) clinics, narcological 
and tuberculosis dispensaries, family planning, and 
antenatal clinics.11 Virologic and immunologic testing is 
performed at over 27 regional AIDS center laboratories, 
as well as at a central HIV reference laboratory. Some 
761 state-funded Dovira (Trust) centers, located in 
residential areas in all oblasts (or states) in Ukraine,12 
conduct express testing and counseling. Rapid tests are 
also administered by HIV-service NGOs.11 An 
evaluation of the GF implementers in Ukraine by 
Australian AIDS Projects Management Group 
underlined that “successful referral from testing to 
treatment is key to controlling the epidemic,” but noted 
that “the division between the sectors and lack of 
government resources means that many people who test 
positive do not get treatment” and that the linkages 
between relevant NGOs and government services were 
“highly variable.”13 Eight years after the GF began 
supporting NGO provision of HIV services, a USAID 
funded publication found that a “licensing and 
accreditation system has not actually been developed or 
implemented.”14 Lack of a legal framework carried the 
risk that many NGO-based health services would have to 

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be provided ad hoc and, as such, might not be recognised 
by the state.  

While the HIV care continuum model appears 
to be well-established in many countries across the 
world, research into practices bringing people living with 
HIV into the healthcare continuum is insufficient in 
Ukraine. The objective of this study was to close the gaps 
in the literature on the delivery of HIV prevention 
services by NGOs and the perceptions of NGO delivered 
services, using as an example HIV prevention programs 
in Ukraine funded by the GF.  

 

Methods 

Consistent with a significant body of research of 
aid programs in post-communist countries,15-19 an 
ethnographic study design was chosen as the most 
appropriate research approach in this setting.  

Data collection  

Primary data were collected between 2011 and 
2013 through 50 in-depth, open-ended, face-to-face 
interviews with purposively selected participants with 
experience in GF programs, based in Kyiv, and in three 
oblasts of Ukraine. An interview guide was developed for 
use in conducting the interviews. The interview guide 
structured inquiry into the following open-ended 
questions: 

1. Principal Recipient NGOs roles and relations 
with other healthcare actors in GF programs; 

2. Linkage of HIV services provided by GF funded 
NGOs with state healthcare; and 

3. Focus on GF funded HIV prevention services. 

In addition, literature and documents were 
searched about HIV services provided by NGOs using 
PubMed and Google Scholar. Conceptualizations from 
the literature were synthesized with the findings that 
emerged from the interview data analysis.  

Secondary data analysis included review of GF 
program documents such as principal recipient annual 
reports, minutes of Country Coordinating Mechanism 
(CCM) and stakeholder meetings, PR and government 
press releases, documents on the web-sites of the GF, 
State Service of Ukraine for AIDS and Other Infectious 
Diseases, the Ukrainian Center for Disease Control, and 
two principal recipients.  

Respondents’ sampling criteria and setting 

A key criterion for inclusion into this research 
was the respondent’s experience of engagement with GF 
program implementation. Following a review by the 
Queen Margaret University Ethics Research Panel, 
ethical approval was obtained in order to conduct the 
interviews. Respondents were primarily national and 
regional government stakeholders, NGO service 
providers, and state healthcare service providers, 
purposively selected to have an experience of previous or 
current engagement with the Global Fund to Fight AIDS, 
Tuberculosis and Malaria program implementation. At 
the oblast level, key informant interviews were 
conducted with local government and health officials and 
staff of GF sub-recipient NGOs. The respondents were 
also categorised into three geographical levels according 
to their location: sub-national (region), national, and 
international. The choice of oblasts was meant to reflect 
on the regional balance of Ukraine, diffusion of its HIV 
epidemic, and the perceived depth of penetration by the 
the Global Fund to Fight AIDS, Tuberculosis and 
Malaria programs. Figure 2 represents the locations of 
the sampling points.  

 

Figure 2. Location of the sampling points 

 

Twenty-seven interviews were conducted in 
oblasts, and 23 interviews were conducted with national 
and international stakeholders. Respondent’s sector 
identification was determined through self-assessment 

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(Figure 3). The majority of the participants (72%) had 
five or more years of experience with GF programs, and 
only 8% of participants had less than 2 years of 
experience. 

 

Figure 3. Self-identification of participants 

 

Data analysis 

The interviews were transcribed verbatim, then 
coded and analyzed using thematic content analysis. The 
steps included matrix-based categorization of data from 
the interviews and theoretical coding in which open 
codes and categories were compared to generate an 
analytic schema to interpret the findings. In line with an 
ethnographic inquiry paradigm, the analysis attempted to 
capture as many accounts as possible within the chosen 
thematic categories, yielding broad accounts of various 
aspects of GF implementation. Following social science 
practices of data representation,20 verbatim quotations 
from participant interviews are used widely in this paper 
as evidence for the author’s interpretations, and for 
illustration purposes. Quotations are presented using the 
numbers rather than sector or regional identities in order 
to protect participants’ anonymity.  

 

 

Results 

The sections below outline the results that 
emerged from the analysis based on the interview data 
collected from 50 respondents. 

(1) Linkage of HIV services with state healthcare  

Following features characterized HIV services 
provided by NGOs:  

(1a) A ‘broken link’ in the chain of HIV services 

Participants reported that NGOs were focused 
more on reporting numbers of rapid tests, and less on 
motivating clients to continue onto treatment (to 
illustrate, participant verbatim quotations are provided in 
Appendix 1). 

(1b) Inconsistent referral practices 

Among participants overall, there was no 
uniform view of what constituted a successful referral. 
While some participants understood a successful referral 
as linking a patient to an official registration, others 
believed that only the retention of a patient in care 
constituted a full referral (see section 1b in Appendix 1). 
As to the reasons for inconsistent referral, respondents 
noted the following: (1) the absence of referral protocols, 
(2) ineffective client management, and (3) lack of 
patients. Some respondents doubted the existence of 
referrals and suggested there were no client referral 
services in Ukraine at all.  

(1c) Use of coupons to regulate referral 

Respondents identified the following problems 
about the coupon system: scarcity of coupons, number of 
coupons limited per day, and overburdened staff at AIDS 
clinics (see section 1c of Appendix 1).  

(2) Gaps in GF funded HIV prevention services 

A lack of focus on a confirmatory HIV testing 
was demonstrated by primary data analysis. Study 
participants reported that GF funded activities appeared 
to be more concentrated on the early ‘field stage’ of 
finding a client and providing a rapid test, rather than on 
follow-up to care. Participants reported that the focus on 
rapid tests conducted by NGOs led to services not being 
seen as part of state healthcare, nor being counted in state 
statistics (see section 2b in Appendix 1).  

 (3) Role division between NGOs and state and 

sustainability in GF programs 

The role division between NGOs and state in 
HIV services was largely perceived by participants as 
unclear and challenging, and it affected the division of 

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labor between them as actors in service delivery. The 
NGOs’ role as GF implementers was also described as 
contradictory. Unclear role division between GF funded 
NGOs and state could be a reflection of different views 
between GF and state on HIV prevention (see section 3 
in Appendix 1). 

 

Appendix 1. Participants’ view on NGO-to-state linkage 
practices in GF-funded programs 

 

Discussion 

This study is one of the first qualitative studies 
examining the delivery of NGO HIV services in GF 
funded programs in Ukraine. The study results suggest 
disconnect in the delivery of HIV services by GF funded 
NGOs, and identified gaps in linking HIV patients to the 
HIV care continuum.  

Literature suggests that the linkage between GF 
funded services and state healthcare in Ukraine should be 
comprised of providing services to vulnerable 
communities and to link clients to needed services.21 
When NGO referral practices to AIDS centers were 
reviewed, there was no follow-up conducted to ensure 
that the client engaged with the state services, indicating 
that HIV positive clients may be lost to follow-up.22 In 
addition, several publications noted a lack of consistent 
referral practices between NGOs and government 
services.13,23 These studies analyzed HIV services 
provided to the people who inject drugs, concluding that 
client referrals were “inconsistently applied and 
frequently consisted of informal sign posting rather than 
formalised referral across government and NGO 
providers.”13  These findings are consistent with the data 
collected from the interviews. Participants reported that 
the NGOs spent little effort on ensuring clients continued 
treatment, developing consistent referral protocols, and 
effectively transitioning clients from one stage of HIV 
care to the next.  

An analysis of published PR documents 
demonstrated that in Round 6 (R6), in response to 
concerns about the referral process, the principal 
recipients established a system of referring people who 
tested HIV positive using rapid tests by NGOs by 
providing them with talony -- appointment coupons to 
undergo confirmatory testing with an AIDS clinic. This 
procedure was also mentioned by Varban et al.11 
Interview respondents attested to a scarcity of coupons 
and daily limits on coupons, which may indicate a need 
to ration access to confimatory testing due to the number 
of rapid HIV tests conducted by NGOs generating more 
potential HIV carriers than the state sector’s screening 
capacity was prepared to handle.    

Confirmatory HIV testing, and not rapid HIV 
screening, is deemed important for the purpose of linking 
patients with appropriate care canters in Ukraine. Recent 
publications have identified three major gaps associated 
with rapid HIV screening: (1) failure of clients from 
high-risk groups to be identified at an early, rapid HIV 
screening stage “to return to the AIDS Center to receive 
their confirmatory test results;”13 (2) sub-recipients “not 
providing incentives to clients to pick up the results of 
the tests” from the AIDS Center;13 (3) legal constraints – 
by Ukrainian law, HIV screening by rapid tests can only 
be executed by the medical staff of state institutions, who 
also have the exclusive right to communicate test results 
to the patients.11 Similarly, Judice et al.14 noted 
regulatory gaps remaining in NGO run mobile units, also 
funded by the GF, such as the requirement to sub-contract 
a doctor to inform the patient of the HIV screening 
results, and the inability of NGOs to provide clients with 
official certification – spravka – of the test results.  In 
addition, the delivery of HIV prevention services 
between governmental and non-governmental service 
providers appear to remain poorly coordinated, which 
presents “a risk to the sustainability of prevention 
programs currently supported by the Global Fund grants 
and the viability of overall national prevention efforts.”24 

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Participant responses and analyzes of published 
data both suggest that GF funded HIV programs only 
partially fulfilled the objective of improving the National 
AIDS Prevention, Treatment and Support Program.  
While GF funded HIV services appeared to be more 
focused on outreach, field-based (polevye) activities, 
such as distribution of commodities (syringes, condoms, 
or information brochures) and on preliminary, rapid HIV 
screening, linkage to the next stages of HIV care 
continuum appeared weak, with no traceable follow-up 
for a confirmatory screening with state AIDS clinics, or 
entry and registration into antiretroviral therapy and other 
treatment. NGO referral systems varied among different 
NGOs and were mostly ad hoc with no referral protocol 
or coordination to track entities that provided services to 
clients. Lack of effective referrals meant that fewer 
patients could enter the HIV care continuum or receive 
antiretroviral therapy. The lack of clearly defined referral 
standards to facilitate referral of HIV patients from NGO 
services into the state care may impair Ukraine’s ability 
to fight its HIV epidemic effectively. 

There is an urgent need to balance the numbers 
of HIV positive individuals identified by NGOs with the 
ability of AIDS centers to provide HIV care that requires 
better defined referral standards, effective strategy of 
NGO-to-state referral, and an increased ownership of 
oblasts over local re-programming of GF funding. With 
an anticipated GF exit from Ukraine in 2017, NGO run 
HIV services would need to transit into state funding. 
Further steps to improve referral systems are necessary in 
order to enable Ukraine to assume full ownership of its 
health programs and to manage its HIV epidemic 
effectively. 

Results of this study question some of the 
existing views of civil society organizations as central in 
providing HIV services in conditions of insufficient, 
scattered, or even non-existent state healthcare settings 
that is typical in many regions where HIV is highly 
prevalent. Role division between state healthcare 
providers and NGOs in provision of HIV health services 

resulted in an accountability gap.25 While the NGOs 
received large funding from GF, they were not legally 
obligated to bring clients into care, while government 
providers had an obligation to provide care but did not 
have the funding, as reported by participants. As a result, 
the capacity of Ukraine’s post-Semashko healthcare to 
provide treatment for HIV patients appeared 
compromised by unclear boundaries between NGO run 
prevention services and state AIDS clinics, resulting in 
gaps in the process of finding, referring, and retaining 
HIV patients in care.  

Study strengths and limitations 

While this is one of the first studies conducted 
to evaluate HIV GF programs in Ukraine, it should be 
noted that this ethnographic study is limited in scope and 
does not evaluate the impact of such programs on the 
national level. The sample size and location of data 
collection points, while in line with qualitative research 
standards, may not be sufficient to generate generalized 
conclusions on the impact of GF programs to the whole 
country. This study has important implications for future 
research in this area, as it raises a number of problems 
and gaps in existing publications that may fuel further 
interest in researching GF programs in Ukraine. The 
analysis and the discussion presented in this paper are 
based on the research that was completed prior to later 
changes in the GF grant systems in 2012 and before the 
2014 economic and political crisis in Ukraine occurred.  
The major strengths of this study include analyzing a 
very important under-investigated problem in Ukraine 
and conducting interviews in multiple locations, thus 
improving generalizability of research findings. 

 

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http://www.library.pitt.edu/articles/digpubtype/index.html
http://www.upress.pitt.edu/upressIndex.aspx
http://data.unaids.org/pub/BaseDocument/2009/20090417_sie_countrysummaryreport_ukraine_en.pdf
http://data.unaids.org/pub/BaseDocument/2009/20090417_sie_countrysummaryreport_ukraine_en.pdf
http://ucdc.gov.ua/attachments/article/972/%D0%A1%D1%96%D1%87%D0%B5%D0%BD%D1%8C%202014.pdf
http://ucdc.gov.ua/attachments/article/972/%D0%A1%D1%96%D1%87%D0%B5%D0%BD%D1%8C%202014.pdf
http://www.euro.who.int/__data/assets/pdf_file/0005/167315/e96608-update.pdf
http://www.euro.who.int/__data/assets/pdf_file/0005/167315/e96608-update.pdf
http://www.aidsprojects.com/wp-content/uploads/2011/05/APMG-Eval-Ukr-Alliance-Final-Report.pdf
http://www.aidsprojects.com/wp-content/uploads/2011/05/APMG-Eval-Ukr-Alliance-Final-Report.pdf
http://www.aidsprojects.com/wp-content/uploads/2011/05/APMG-Eval-Ukr-Alliance-Final-Report.pdf
https://www.york.ac.uk/inst/spru/pubs/pdf/verbquotresearch.pdf
https://www.york.ac.uk/inst/spru/pubs/pdf/verbquotresearch.pdf
http://apps.who.int/iris/bitstream/10665/84971/1/9789241548601_eng.pdf?ua=1
http://apps.who.int/iris/bitstream/10665/84971/1/9789241548601_eng.pdf?ua=1


 

 

MCGILL 

 

 
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Table 1. A model of HIV treatment cascade8 

 

 

  

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MCGILL 

 

 
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Central Asian Journal of Global Health 
Volume 4, No. 2 (2015) |  ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2015.213|http://cajgh.pitt.edu 

 

 

Figure 2. Location of the sampling points (MapInfo 7.0) 

 

 

  

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CENTRAL ASIAN JOURNAL OF GLOBAL HEALTH 

 

 

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of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. 

 
Central Asian Journal of Global Health 

Volume 4, No. 2 (2015) |  ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2015.213|http://cajgh.pitt.edu 

 

 

Figure 3. Self-identification of participants* 

 

 *Note. Country Coordinating Mechanism (CCM) membership was reported in addition to the main respondent 

category. Therefore, the total number of respondents is above 50. 

  

16

2

7

14

5

6

21

0 5 10 15 20 25

State medical sector

State non-medical sector

National NGO

Regional NGO

International organisation

Independent expert

Government/CCM/RegionCCM

Number of respondents in each category

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MCGILL 

 

 
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of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. 
 

Central Asian Journal of Global Health 
Volume 4, No. 2 (2015) |  ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2015.213|http://cajgh.pitt.edu 

 

 

Appendix 1. Participants’ views on NGO-to-state linkage practices in GF-funded programs 

Emerging themes  Participant characterizations Verbatim illustrative quotes 

(1): Linkage of HIV 

services with state 

healthcare  

 

(1a) A ‘broken link’ in the chain 

of HIV services 

 

 

 

 

(1b) Referral practices: 

Inconsistent  

 

Successful referral means:  

- linking a patient to 

official registration: 

 

- only when patient is 

retained in care  

 

  

NGOs report numbers… but how to get people 

to start going to... get tested, how to stop them 

from being afraid of testing, and how to help 

those people who are found to have HIV become 

less afraid of getting treatment (009: 92-94) 

“[During] referral to confirmatory tests, 

coverage sharply falls.” (040: 299) 

 

 

 

There is a need to work continuously with a 

person who has received a positive result until he 

or she gets registered (028: 223). 

 

Here they found a drug user, took him to [get] 

methadone…There they provided him with 

information and counselling. But the final goal is 

not just finding a person, or even bringing him 

for treatment. It is retaining him there (020: 441-

443). 

You not only need to count services…You need 

to take the patient to the logical end. (019: 100)   

  Reasons for inconsistent 

referrals: 

 

- absence of referral 

protocols  

 

 

 

 

 

“There are many NGOs around the AIDS center, 

but no referral protocol” (013: 329-330);  

 

 

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CENTRAL ASIAN JOURNAL OF GLOBAL HEALTH 

 

 

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- ineffective client 

management  

 

 

 

- lack of patients  

“There is no client base. Clients may enter 

programme several times” (019: 571-586);  

“Client management is not well developed, there 

is lots of subjectivity” (018: 125-127);  

 

“In 2012, the government and the GF doubled the 

number of patients – to have twice as much more 

patients on antiretroviral therapy... but suddenly 

they realised that they could not find the people. 

First, there were not enough drugs, now there 

were enough drugs, but they could not get the 

people”. (050: 35-40) 

 Client referral did not happen ‘no client referral services in Ukraine at all’ (012: 

377), (014:24). 

 (1c) Practices of using coupons 

to regulate referral 

 

 

 

The coupon appointment system 

overburdened the AIDS center 

staff 

 

“the coupons were “scarce, hard to get” (019: 

344-345) 

“the number of coupons was limited per day” 

(032: 342-343). 

 

Our oblast AIDS center is suffocating. Our NGO 

takes 7 out of 20 coupons that are for an AIDS 

center visit. The remaining 13 coupons go to 

other NGOs. It means that an AIDS center can 

only receive 20 people per day, which means 100 

people per week. They are suffocating... Staffing 

is a problem (019:286-288). 

(2) Gaps in GF-funded HIV 

prevention services 

 

2(a) Services concentrated more 

on early ‘field’ stage of finding 

a client, less on linking him or 

her to care:  

 

 

“The lion’s share of the money is being spent on 

finding clients… when instead, it should be spent 

on retaining [them] in healthcare…they [NGOs] 

are fixated on field work… they spend so much 

money in the field… but their work ends there. 

Clients do not reach the treatment stage” (020: 

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MCGILL 

 

 
This work is licensed under a Creative Commons Attribution 4.0 United States License. 

 
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of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. 
 

Central Asian Journal of Global Health 
Volume 4, No. 2 (2015) |  ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2015.213|http://cajgh.pitt.edu 

 

 

 

2(b)‘rapid HIV tests by NGOs 

are neither viewed as part of 

state healthcare, nor counted in 

state statistics 

 

443-446). 

“A quick test is not confirmatory…People need 

to go to an AIDS centre to have the second test.” 

(028: 216-217) 

“The MOH does not report quick screening by 

NGOs. It only reports on the tests they have 

done.” (029: 232-233) 

“You can pass a quick test a million times, but 

you are nobody for the [health] system. You only 

become a patient after a confirmatory screening” 

(040: 299-300). 

(3) Role division between 

NGO and state services 

 

Unclear, challenging 

 

 

 

 

 

 

 

 

Contradictory 

 

 

 

 

Based on different views 

between GF and state on HIV 

prevention: 

 

 

 

 

There is no clear division of roles…What is state 

doing? What are NGOs doing?... We need to 

define this division clearly... and then we won’t 

interfere in their work and they won’t interfere in 

ours (020: 352-358). 

We do not want to take over the roles that the 

state should fulfil - treatment, or prevention... we 

cannot substitute the state. (036: 158-180)  

 

There is a discrepancy in that the government is 

responsible for prevention, but implementation 

rests with NGOs... There is a contradiction here... 

(049: 60-66). 

 

There is a big contradiction that large funds are 

concentrated with NGO but government is 

responsible for healthcare. The risk is that money 

will not be spent for the purpose it needs to be 

spent, because GF priorities in funding [HIV] 

prevention may not coincide with state policy or 

even run counter to it. (025: 267-270)  

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CENTRAL ASIAN JOURNAL OF GLOBAL HEALTH 

 

 

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Central Asian Journal of Global Health 

Volume 4, No. 2 (2015) |  ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2015.213|http://cajgh.pitt.edu 

 

 

 

NGO services are unsustainable 

 

The state is used to NGOs doing prevention. But 

if [GF] funding stops, the state is not ready to 

support this work. It is only loyal to NGOs 

because they receive grants. If the state has to 

fund this, it will not. It has other priorities. (036: 

204-231) 

 

 

 

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