Established in 2009, TB Europe Coalition (TBEC) is the only regional civil society network working exclusively on TB in the European region. Since its foundation, TBEC has been actively supported by RESULTS UK. With increasing rates of drug-resistant TB, limited funding, and low awareness among decision-makers in the region, TBEC focuses its efforts in two key areas. First, TBEC actively engages with various international decision-makers and networks such as the Union, WHO Europe and various EU institutions. Secondly, TBEC actively identifies, trains and engages civil society organisations and individuals working on TB at national level.
One of the best examples of TBEC’s commitment to working with national civil societies around the region took place in early July this year. Together with the European Harm Reduction Network, TBEC organised a three-day advocacy workshop that, uniquely, brought together activists from HIV, TB and harm reduction local NGOs in Bulgaria. The aim of the workshop was to prepare civil society for the consequences of Global Fund withdrawal from Bulgaria, and the subsequent cut in financial support for national HIV and TB programmes. The Global Fund has been providing partial funding for the National HIV and TB Control and Prevention programmes since the early 2000s, supporting essential services, including purchase of second-line TB drugs for the drug-resistant TB patients.
Although the Bulgarian Government has adopted new TB and HIV programmes and budget for 2017-2020 earlier this year, they haven’t been able to contract NGOs to provide services, as there are some legal barriers for fast-track contracting of civil society organisations. As a result, the NGOs carrying out HIV outreach and prevention work have not received any funding since the Global Fund support stopped in May of this year. At the moment, the NGOs have either stopped providing services or are doing so on a voluntary basis and had to let go some of their staff. Now, the NGOs fear that the situation will repeat itself next year, after the Global Fund withdrawal of TB funding in 2018. In addition, the current level of committed domestic funding is insufficient for the full range of interventions previously funded by the Global Fund. For example, funds for preventive care and social support services for patients provided by NGOs are limited.
The TBEC workshop aimed to help Bulgarian civil society agree on the advocacy strategy needed to address the current challenges, and to train civil society on how best to engage with the Government. After two days of intense training, they had a chance to put their skills into practice in a two-hour meeting with key Government officials. In addition to building their skills and experience, the workshop helped participants not only identify shortcomings, but also appreciate their successes, especially in comparison to the civil society achievements in neighbouring countries.
The contracting of Bulgarian NGOs, supported by the Global Fund, has long been considered to be one of the best examples of civil society engagement in TB response in the region, showing incredible results, with the TB incidence rate decreasing by half since the early 2000s. Furthermore, TBEC’s presence often provides civil society with much needed support with regard to the national Government, either by providing additional pressure for officials to take their concerns seriously, or by showcasing best practices and problem solving approaches successfully used in other countries.
TBEC’s reach and ability to communicate with the vast majority of TB activists is a cornerstone for ensuring legitimacy and even-handedness of TBEC member organisation policy asks to various high-level decision makers. TBEC can also be used as a sharing platform between those TBEC members with extensive experience in international advocacy and those who have little or no experience. Those TBEC members focusing on service delivery can often provide “on the ground” examples and factual information on how international decisions affect individual countries to those TBEC members who are actively engaged in regional and international advocacy work. Furthermore, TBEC members can exchange advice on best advocacy approaches for specific decision makers. For example, the NGOs approaching the EU institutions will choose to focus their advocacy on integrated health care or access to medicines, but when reaching out to the G20 or G7, the focus will be on antimicrobial resistance.
TBEC membership also provides insight for its member organisations into the various degrees of civil society engagement in each particular country. For example, in the UK and the Netherlands, for historic reasons, civil society is far more active in TB response than in Germany or Spain. Similarly, some of the high TB incidence rate countries such as Romania or Tajikistan have civil society leading the health reforms, while in other countries such as Estonia, the government leads the TB response. This valuable information provides an instant understanding of differences in civil society engagement in TB response in the region.
RESULTS UK believes that stronger and more active national civil societies are at the centre of an effective response to TB within countries and around the region. TBEC not only ensures efficient information exchange and coordination of policy asks, engagement activities amongst TB activists and civil society organisations within in each country and across the region, but also empowers its members via regular training and mentoring activities, thus providing a more professional and capable civil society in its response to fight TB. TBEC members are able to call for health system reforms, participate in policy processes, and advocate for increased financial commitments at the regional and international levels, contributing to the universal fight against TB.