Representatives of civil society selected to join the multistakeholder task force for the UN high-level meeting on HIV

Photo: UNAIDS

To ensure an open, transparent and participatory process of preparation for the United Nations General Assembly high-level meeting on HIV< which will take place on June 8-10, 2021, UNAIDS and the Programme Coordinating Board nongovernmental organization delegation have selected 16 representatives of civil society and the private sector to join the multistakeholder task force.

In the run-up to the meeting, before the end of April 2021, an interactive multistakeholder hearing will be held with the participation of communities and other stakeholders, who will also participate in other activities before and during the high-level meeting itself. The task force will advise UNAIDS on the format, theme and programme of the multistakeholder hearing and will help to identify speakers for the hearing and high-level meeting plenary and panel discussions.

Earlier, different constituency networks were invited to apply and to use their own networks and selection processes to nominate people to be considered for the task force.

“As the task force is necessarily limited in size, we are particularly interested in nominations of people from networks, who are closely linked across their communities and across regions, to be able to bring a deep and broad perspective. Additional opportunities for people living with HIV, key populations and other affected groups to engage with be made available throughout the lead-up to the high-level meeting,” said Laurel Sprague, UNAIDS Chief/Special Advisor, Community Engagement.

More than 560 nominations were received and the task force has been established with a broad and diverse expertise. There are at least two members per region. More than 50% of the members are women and 25% are under the age of 30 years. Six are openly living with HIV and all key populations are represented.

There are 2 representatives from the region of Eastern Europe and Central Asia (EECA):

Adilet Alimkulov, Kyrgyz Indigo, Kyrgyzstan

Aleksey Lakhov, Humanitarian Action and Coalition Outreach, Russian Federation

The full list of selected representatives can be found on UNAIDS website

End Inequalities. End AIDS: UNAIDS has adopted a new Global AIDS Strategy 2021-2026

Photo credit: UNAIDS

On March 25, 2021 the UNAIDS Programme Coordinating Board (PCB) has adopted by consensus a new Global AIDS Strategy 2021–2026 to get every country and every community on track to end AIDS as a public health threat by 2030. 

The new Global AIDS Strategy 2021–2026, End Inequalities, End AIDS, is a bold approach that uses an inequalities lens to close the gaps preventing progress to end AIDS.

The UNAIDS Secretariat and its 11 Cosponsors worked to develop the new strategy, which received inputs from more than 10 000 stakeholders from 160 countries.

“This year marks 40 years since the first cases of AIDS were reported and 25 years since the establishment of UNAIDS. We are at a critical moment in our historic effort to end AIDS,” said Winnie Byanyima, Executive Director of UNAIDS.

“Like HIV before it, COVID-19 has shown that inequality kills. COVID-19 has widened existing inequalities that block progress to ending AIDS. That’s why I’m proud that our new strategy places tackling inequalities at its heart. We must seize this moment to ensure health equality for all in order to beat COVID-19 and end AIDS.”

The strategy puts people at the centre and aims to unite all countries, communities and partners across and beyond the HIV response to take prioritized action to transform health and life outcomes for people living with and affected by HIV.

The three strategic priorities are to:

(1) maximize equitable and equal access to comprehensive people-centred HIV services;

(2) break down legal and societal barriers to achieving HIV outcomes;

(3) fully resource and sustain HIV responses and integrate them into systems for health, social protection and humanitarian settings.

If the targets and commitments in the strategy are achieved, the number of people who newly acquire HIV will decrease from 1.7 million in 2019 to less than 370 000 by 2025 and the number of people dying from AIDS-related illnesses will decrease from 690 000 in 2019 to less than 250 000 in 2025. The goal of eliminating new HIV infections among children will see the number of new HIV infections drop from 150 000 in 2019 to less than 22 000 in 2025.

“The Global Network of People Living with HIV (GNP+) fully supports the Global AIDS Strategy 2021–2026. The strategy’s life-saving framework for ending inequalities is fundamental to ending the AIDS epidemic and achieving the Sustainable Development Goals,” said Alexandra Volgina, Program Manager, GNP+.

The strategy is based on human rights, gender equality and dignity, free from stigma and discrimination for all people living with and affected by HIV, and is the result of extensive analysis of HIV data and an inclusive process of consultation with countries, communities and partners.

High-level meeting on HIV/AIDS 2021: Action Alert

International Council of AIDS Service Organizations (ICASO) along with partners has issued ACTION ALERT, which aims to inform civil society organisations about getting involved in the high-level meeting on HIV/AIDS, scheduled to happen in the United Nations in New York on June 8-10, 2021.

This Action Alert describes the process’s essential features and focuses on civil society involvement opportunities. It also guides on key advocacy actions that you can take now.

  • In February 2021, the General Assembly approved Resolution A/75/L.59 that sets out the process (modalities) for the organization of the 2021 high-level meeting (HLM) on AIDS, which will “undertake a comprehensive review of the progress on the commitments made in the 2016 Political Declaration towards ending the AIDS epidemic by 2030”.
  • The interactive multi-stakeholder hearing will take place no later than 15 April 2021 in preparation for the HLM session in June.
  • In-person, virtual or hybrid, the meeting’s format will be decided by April 2021 by the President of the General Assembly based on an assessment of the health conditions and in close consultation with the Member States. The proceedings will be webcast.
  • The high-level meeting will comprise plenary sessions and up to five thematic panel discussions. The opening plenary meeting will feature statements by the President of the General Assembly, the UN Secretary-General, the Executive Director of UNAIDS, a person openly living with HIV and an eminent person actively engaged in the AIDS response.
  • It is expected that the HLM Outcome Document adopted will be a concise and action-oriented declaration to be agreed upon by the Member States towards achieving the commitment of ending the AIDS epidemic by 2030. In the past, only the most contentious paragraphs were left to be approved at the HLM.

GET INVOLVED IN THE HIGH-LEVEL MEETING:

KEY ADVOCACY ACTIONS YOU CAN TAKE NOW

ICPCovid-HIV study

As the Covid-19 containment measures ramp up around the world, different countries implement different strategies, and health systems are overwhelmed to varying degrees. Generating high-quality evidence on the impact of Covid-19 and related measures on both the quality of life and the management of HIV in different settings, will help provide guidance for decision-making and better preparedness in case of future pandemics.

In this light, researchers based at the University of Antwerp (Belgium) have designed a small study in collaboration with Sensoa and EATG to investigate the impact of the Covid-19 pandemic on HIV care and the well-being of persons living with HIV (PLHIV).

Aims of the ICPCovid-HIV study:

1. To identify possible consequences of the ongoing Covid-19 pandemic on the quality of life of PLHIV

2. To assess access of PLHIV to healthcare services and HIV treatment

3. To compare the impact of different Covid-19 containment measures in different countries on the quality of life and management among PLHIV

4. To identify associations between specific antiretroviral regimens and Covid-19 incidence and/or Covid-19 clinical outcomes

More information – here. 

Response of AFEW Kyrgyzstan to COVID-19

COVID-19 rapidly spreading around the world requires urgent and decisive actions. AFEW Kyrgyzstan quickly responded to the emerging threat and prepared the support measures, which can help the key populations in this challenging time. Natalia Shumskaya, director of AFEW Kyrgyzstan, told AFEW International about them.

Social bureau for women living with HIV

The social bureau for women living with HIV offering peer support services as well as consultations of psychologists and social workers continues its operation during the lockdown. Before the state of emergency was announced, most people living with HIV (PLWH) in the city received Antiretroviral therapy (ARVs) for up to three months. If people were not able to come and pick up their medications, the social worker brought them to their homes. However, PLWH still need ARVs, so every day a representative of our organization brings such medications to two or three addresses using an official vehicle of the AIDS centre.

Nutritional support

About one-third of PLWH in Kyrgyzstan live in poverty. People who used to earn money for their living with odd jobs are now left without any sources of income and have urgent needs in food products, hygiene items, diapers for their babies and mobile charge cards to stay connected. Every day, the psychologist from the AIDS Centre gives calls to women living with HIV and provides them with psychological support. If people need food, the psychologist gives them contact details of the Bishkek district headquarters for them to receive humanitarian aid. We have sent a request to the Red Crescent Society of Kyrgyzstan asking them to allocate food packages for 40 women living with HIV.

In community centres for women with substance abuse problems, there was also a need in masks, disinfectants and food packages, so we procured all the needed materials to comply with the infection control measures from our project budget.

Psychological support

Three psychologists of our organization continue providing psychological support over the phone and using WhatsApp. Mostly they are contacted by women with severe anxiety, panic attacks or those who faced domestic violence. Some women have relatives with mental health problems. Besides, we received phone calls from young people with drug abuse problems.

Young people help!

There is a volunteer headquarters launched in the youth centre together with the National Agency for Youth and Physical Culture. People working at the organization and other city residents make donations to a special account to procure food products for those in need. Our Champions for Life from the Dance4life programme signed up as volunteers and deliver the humanitarian aid.

For prisoners

We procured and provided to the National Law Enforcement Service two thousand masks, 850 kg of bleach, and 50 bottles of antiseptics for the prisoners.   Besides, we developed leaflets for prisoners and prisons staff. Soon brochures will be published and distributed among the prisons.

We are currently carrying out negotiations with different donors and I hope that in the nearest future we will be able to raise more funds to support the National Law Enforcement Service.   We are waiting for the response from the German Agency for International Cooperation (GIZ) concerning our project proposal on carrying out training sessions for prisoners and non-medical personnel working in prisons on COVID-19 and on procuring soap and laundry detergent for prisoners.

Due to the physical contact being impossible, our peer consultant (PLWH) provides support to the prisoners living with HIV remotely, through phone calls.

For reference

As of today, there are 144 confirmed cases of COVID-19 and one registered death in Kyrgyzstan.

Since March 25, the government declared the state of emergency. A curfew has been introduced, so people are not allowed to leave their homes after 8 p.m. In the daytime, there can be only three reasons to go outside: to a supermarket, pharmacy or to visit a doctor provided that the person has an itinerary sheet. Public transport and taxi services are closed.

What people living with HIV need to know about HIV and COVID-19?

UNAIDS developed a guidelines for people who live with HIV.

Read it here

What UNAIDS recommends:
1. HIV services must continue to be made available for people living with and at risk of HIV. This includes ensuring the availability of condoms, opioid substitution therapy, sterile needles and syringes, harm reduction, pre-exposure prophylaxis and HIV testing.
2. To prevent people from running out of medicines and to reduce the need to access the health system, countries should move to the full implementation of multimonth dispensing of three months or more of HIV treatment.
3. There must be access to COVID-19 services for vulnerable people, including a targeted approach to reach those most left behind and removing financial barriers, such as user fees.

Voices from the East

AFEW International is actively advocating for the needs to sexual and reproductive health and rights (SRHR) of the EECA region at the international arena.

On 11th March AFEW International on behalf of the partnership ‘Voices from the East’ has submitted a proposal to the Dutch Ministry of Foreign Affairs under the Policy Framework for Strengthening Civil Society for 2021-2025, Grant Instrument SRHR Partnership Fund. Under the leadership of AFEW International, the Voices from the East Partnership brought together 11 strong advocacy and service-oriented organisations and networks to improve access to SRHR for women and youth of Key Population (KP) groups and transgender people:

AFEW International; Eurasian Harm Reduction Association (EHRA); ECOM – Eurasian Coalition On Health, Rights, Gender And Sexual Diversity; Eurasian Union Of Adolescents And Youth Teenergizer; Eurasian Women’s Network On Aids (EWNA); Sex Workers Rights’ Advocacy Network (SWAN); Eurasian Network Of People Who Use Drugs (ENPUD); Dance4life; AFEW-Ukraine; AFEW-Kyrgyzstan; AFEW Kazakhstan.

The partnership plans to work with over 150 local partner organizations from across Easter Europe and Central Asia, advocating for SRHR of women and young people from key populations (living with HIV, sex workers, using drugs, LGBT, in prison) and transgender people as integral part of the Universal Health Coverage (UHC). Through capacity strengthening and mobilizing local communities of key populations the Partnership will work towards evidence-based community-led advocacy for access to high quality, inclusive, stigma-free, integrated and gender transformative SRHR services.

We will know the results of this application in the end of May 2020.

The Dutch Government Policy Framework for Strengthening Civil Society is focused on the West-Africa/Sahel, Horn of Africa, and Middle East and North Africa (MENA) regions. The Voices from the East Partnership is asking for attention to the continued health crisis in the EECA region, being the only region in the world with a growing AIDS epidemic.

Women in prison: mental health and well-being – a guide for prison staff

People in prison have a disproportionately high rate of poor mental health, and research shows these rates are even higher for women in prison. While primary care remains the responsibility of healthcare professionals, frontline prison staff play an important role in protecting and addressing mental health needs of women in prison.

Penal Reform International (PRI), in partnership with the Prison Reform Trust (PRT), has published a guide for prison and probation staff to help them understand how prison life can affect a person’s mental health, with a focus on women. The guide aims to break down the stigma and discrimination attached to poor mental health, especially for women in prison.

This guide is written to help understand how life in prison can affect a person’s mental health, with a focus on women. It describes how to recognise the signs of poor mental health and how best to respond. It also includes a checklist based on international human rights standards aimed to help with the implementation of key aspects of prison reform and advocacy initiatives in line with international standards and norms.

Published with the support of Better Community Business Network (BCBN) and the Eleanor Rathbone Charitable Trust.

Find the guidelines here – PRI-Women-in-prison-and-mental-well-being.

So many women, so many fates

 

In Tajikistan, there is an increase in the proportion of sexual transmission of HIV infection from year to year and an increase in the number of women of reproductive age among those registered with the diagnosis established for the first time. That is why in 2019 the public organization “Tajik network of women living with HIV” (TNW+) with the support of AFEW International in the framework of Bridging the Gaps project conducted a study “Key problems of sexual and reproductive health of women living with HIV in Tajikistan through the prism of human rights”.

Before the International Women’s Day on 8 March, Tahmina Khaydarova, head of TNW+ discussed with AFEW International HIV, sex, violence and gender inequality in Tajikistan.

What does sex mean for men and women in Tajikistan?

For men, sex is an opportunity to satisfy their desire, and only then is it a way of making children. For women, sex is almost always a way of making children and extending the family. As a rule, women in Tajikistan cannot talk about sex and take the initiative in sexual relations, as it is considered to be debauchery.

Generally speaking, the sexuality in Tajikistan is highly exposed to traditional gender stereotypes. It is not common here to discuss sexual relations, either in the family or in society. Some people talk about it with their partners, doctors, etc. But even if they do that that they do not really understand the meaning and significance of the concepts of “sex” and “sexual relations” and most often talk about contraception, methods of protection against unwanted pregnancy, hygiene, etc. But not more.

Does it happen because of national traditions and religion?

Yes, in many ways. However, Islam is a religion of peace and good. Islam does not talk about the abuse of women, but there are other factors that affect women’s lives. These are stereotypes, which can be connected with religion.

One of them is “a woman is obliged to take care of her husband and all members of his family, to be obedient and kind”. Therefore, girls have been brought up in a spirit of obedience since childhood. Women themselves think that men’s interests come first. One of the features of families in the republic, especially in villages, is the predominance of extended families, where several generations of adults and children live in the same house – parents, their adult sons/daughters already married, grandparents, adult sisters or brothers. As a consequence, relatives constantly interfere in the husband and wife relationship.

In the family, girls are taught to be housewives, in most cases have no education, especially in villages, and after marriage the girl becomes very dependent on her partner and family members. Without the permission of her elders and husband, a woman has no right to leave her home and receive information about sexually transmitted diseases (STDs) if she wants. A woman must stand one step behind the man in everything: in decision-making, in expressing her opinion. A woman should listen to her husband’s words, she should keep silence, this is respect. It is also rare for women to be able to decide for themselves when, how and with whom to have sex, how many children to have, etc.

At the same time, sexual violence from an intimate partner increases the risk of HIV infection. During our survey, we heard from the respondents reasoning that non-consensual sexual intercourse is a normal phenomenon, and so it should be in the family, “This is your husband: if he wants to do something then you should obey. He’s young, and that’s why you have to satisfy his desires!”

Inequality between men and women in Tajikistan is developed not only in private life, but also in public life, isn’t it?

Yes, gender inequality is one of the problems hindering sustainable development in Tajikistan. Inequality is everywhere – in access to all types of tangible and intangible resources (property, land, finance, credit, education, etc.); in decision-making in all spheres and participation in political life, and violence against women.

Why do women tolerate violence?

Because it fits within the established system of gender inequality in Tajikistan. Men provide for women, control family relations, and therefore can do, in fact, whatever they want.

But the saddest thing is that society does not sufficiently understand the importance of this problem. It is convinced that domestic violence is a private matter. It is considered that the manifestation of abuse of wife, daughter-in-law, sister, etc. or constant control over their life and behavior is not violence but a norm. At the same time, it is widely believed that a woman is to blame if her husband or his relatives use physical force against her. There are many supporters of this opinion among young people, women themselves, and especially among their mothers-in-law. Therefore, in my opinion, special attention should be drawn to solving the problems of relations between mother-in-law and daughter-in-law, the relationship to the wives of migrant workers during the period when their husbands are outside the country, early and forced marriages, etc.

Are women with HIV more vulnerable?  

Definitely! Despite the fact that very often the source of HIV infection for a woman is her husband, she is subjected to violence and discrimination by her husband and his relatives. One woman said that her husband infected her, but did not consider himself guilty. Sometimes he closed the house and left his wife without food, hungry and helpless. One day he even tied her to a pole with a rope and beat her up, and then left for two days. After this she went to her parents, where she was also discriminated.

Why are women with HIV afraid to visit doctors?

Practice shows that those who go to the AIDS centre receive quality care and many are happy with it, including me. However, the main challenges for women are when they go to other health care facilities (for surgery or dentists), including primary health care (PHC). In these facilities women living with HIV (WLHIV) are most likely to experience discrimination against themselves. During focus groups, there were a lot of situations when health care workers refused to provide medical assistance to WLHIV and disclosed their status. Most of these cases were in maternity hospitals, dental clinics and during other surgeries. Therefore, most HIV-positive women are afraid to disclose their status and do not seek services from health care institutions, including primary health care services in their place of residence.

Have you talked to these doctors? What do they say about discrimination against people living with HIV?

We haven’t interviewed the health workers. However, many women believe that the reasons are in the lack of preparedness of health workers to work with PLHIV, as well as the low level of knowledge about HIV among staff. One woman, who went to the clinic, told doctors about her status. They immediately refused her services. The woman said it was a violation of her constitutional rights. But doctors said that she was ill and they could not help her anymore. Just imagine – that’s what the doctors said!

Besides in Tajikistan there is not good medical personnel who have experience working with PLHIV. A lot of professionals are leaving our country.

Let’s imagine – a woman found out about her status, she is ready to be examined, receive treatment and do everything that doctors say. Can she face any obstacles even in this case?

An antiretroviral therapy (ART) in our country is bought from the Global Fund, so there are virtually no interruptions. If a person wants to take ART, he or she can get it at all AIDS centers. But according to WHO’s recommendations, people living with HIV are assigned to PHC services and according to these requirements a person has to get the service at home. Due to the fact that in rural areas and small towns and districts everybody practically knows each other, PLHIV are afraid of disclosing their status. So there is a possibility that they will not apply to these services locally for ART services.

How difficult is it for women to accept their status?

More often it depends on their level of awareness and education – they might not know anything about HIV or have distorted information about the virus. Because HIV does not show strong symptoms in the early stages, women think that they are not sick and that the virus does not affect them. Also, accepting a diagnosis depends on a specialist working with the woman, conducting pre-test and post-test counselling.

Do you plan to use the results of your research in future work?

At the moment, the country is developing a “National Program to combat HIV/AIDS epidemic in the Republic of Tajikistan for the period 2021-2025”, and we have joined the working group on ART treatment and prevention of stigma and discrimination against PLHIV. As part of this platform, we are actively promoting the recommendations in our report.

At the same time, the research results helped us to identify and understand a number of issues, which we have not always paid due attention to before. Therefore, we will use this information in our daily work.

You can find the research here

 

What should be a Primary Care?

In 2019 Anke van Dam, executive director of AFEW International, became a member of advisory board of European Forum for Primary Care (EFPC) to bring knowledge and vast expertise about the EECA region and a great network of contacts with organizations, institutes, agencies and professionals to the EFPC.

Which level does primary care (PC) in the EECA region have nowadays and how to improve that Prof. Jan De Maeseneer, Former Chair of European European Forum for Primary Care, professor emeritus at Ghent University, talked to AFEW International.

Jan, what are the features of a strong primary care (PC)?

We can speak of a strong primary care system when primary care is accessible for a large range of problems, coordinates care on a continuous basis, provides a broad range of health care services in partnership with informal care givers and operates with supportive governance structures, with appropriate financial resources and investments in the development of the primary care workforce. Effective primary care not only prevents diseases at early stages, but also stimulates people to take up healthier life-styles. Overall health is considered within primary care in a more holistic matter, paying attention not only to biomedical and mental health needs, but also to other causes of ill health, such as social determinants (e.g. housing conditions, employment). This makes primary care more person- centred than disease-centred.

PC of which country/region is the most developed nowadays?

Mostly it’s Europe. The countries with relatively strong primary care are Denmark, Estonia, Finland, Lithuania, the Netherlands, Portugal, Slovenia, some regions in Spain and Belgium, and the United Kingdom. Especially I like the examples of Denmark, Estonia, and Finland. These countries have «primary care zones». They look at the population 100-200 000 people and try to install a PC system at that level. That enables give a high degree of participation of all stakeholders. At that scale cooperation is easy, and there is an oversight of population’s health needs, to be addressed. The scale is not too big but big enough to have a “critical mass” for effective intervention for different kinds of problems.

And what about the EECA region?

A good primary care needs democracy. Unfortunately, the former “Semashko” Soviet Union healthcare system (HCS) with policlinics, lacking family physicians, and with doctors that earn very little money don’t allow to set up a good PC. I appreciate the development of Kazakhstan – recently they rediscovered the importance of family physicians. Also, I was very surprised by Kyrgiz Republic. Last year I had the opportunity to lecture for 5th year medical students in Bishkek. In discussion on patients’ stories, they demonstrated a high commitment and patient-centeredness, and excellent skills in clinical decision making. EFPC is trying now to help countries in the EECA region to establish better inter-professional training for primary care, using primary care practices in local communities

It’s important for countries in the region to work together and to build their own PC systems. In Eastern Europe Estonia and Lithuania are doing well. Belarus is not the best example, because of the political situation. It is difficult to combine strong primary care with political dictatorship. In Russia I see some nice things. In Saint Petersburg, for example, there are good departments of family medicine with person-centered approach. But it’s still a difficult country. Good PC is possible only in countries with freedom of speech, human rights, democracy and respect for diversity.

Why good PC is especially important for people living with HIV?

Usually in countries of the EECA region if a person has one of 3 diseases – HIV, TB or Hep, most of the health care resources focus on them. There is no general comprehensive, integrated Primary Care.

PC functions very well when you integrate the care and treatment for those diseases in the broader primary health care system (HCS) as World Health Assembly has clearly stated in resolution 62.12 (in 2009). In Africa I met people who had, for example, 5 diseases, so they had 5 different vertical programs of treatment and 5 different doctors who even didn’t speak with each other. Wise HCS is when you integrate these 5 approaches into one, because, for example, diabetes can be easily an (indirect) consequence of HIV treatment.

Is there a difference between European and the EECA region’s approaches in treatment of HIV+ people?

In western countries HIV/AIDS patients are patients like all the others, they are treated in PC. When primary care providers have problems, they refer patients to the secondary care. Such approach also avoids stigmatizing of people, because when they are treated differently, are included in a separate program, there is a huge risk of stigma. Also, the integrated approach is more cost effective.

How to change people’s minds, also doctors’, towards people with HIV?

Well, first of all, you need to retrain family physicians and other primary care providers. In Russia doctors have limited, if any, training in patient-doctor communication, are not familiar with a human rights approach. For example, in the undergraduate training in my university (Ghent University), there are 55 hours of practicing doctor-patient communications with videotaping, simulated and real patients. Also, it’s necessary to train a sufficient number of family physicians for Primary Care: this requires 3 years of full-time post-graduate training, with specific programs and standards. Besides, it’s important to inform and educate population.

People should understand that every person deserves our respect, and we shouldn’t stigmatize others because they have certain diseases. It’s an open culture in a country, and it is a responsibility of the government and civil society.

What is the goal of EFPC in the region?

EFPC has several goals everywhere, including the EECA region. They are:

– to provide a one-stop information hub and building a substantial collection of information and data over time;

– to guide the development of innovative interventions based on the principles of equity, access, quality, person- and people centeredness, cost-effectiveness, innovation and sustainability.

– to connect four groups of interested parties: patients, citizens and civil society organizations.

– to share communication and information;

– to establish networking and training.

Today we have a good contact with countries from the region, people join our meetings. On the 27 September 2020, we will have a big conference in Ljubljana and in the future possibly also a conference in Central Asia. We want to create a regional platform for exchanging experiences. We hope to bring together health care providers and governments so they can learn from each other how to organize service that reflects people needs.