TERMS OF REFERENCE FOR CONSULTANT TO DEVELOP STRATEGY AND ACTION PLAN FOR ART PRICE REDUCTION IN 4 COUNTRIES OF SOUTH EAST EUROPE
South-Eastern Europe Regional TB and HIV Community Network (SEE RCN) is implementing the Regional Programme Sustainability of Services for Key Populations in Eastern Europe and Central Asia, funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria and led by the Alliance for Public Health from Ukraine.
The objective of the programme is to address the inadequacy of the HIV response across Eastern Europe and Central Asia (EECA), and the SEE RCN is implementing a part of the regional project in five countries of South-Eastern Europe, including Albania, Bosnia and Herzegovina, Montenegro, North Macedonia and Serbia. The proposed goals of the Multicountry EECA Alliance for Public Health HIV grant include:
• Institutionalizing effective HIV response models and processes to strengthen the HIV care cascade in the EECA region.
• Removing barriers to services for key populations, thereby enabling quality health interventions based on human rights principles; and
• Budget advocacy for sustainable services for key populations in EECA.
With this in mind, SEE RCN is seeking a consultant to provide technical support to SEE RCN and national SEE CSOs to advocate for ART procurement price reductions in four (4) countries of South East Europe: Bosnia and Herzegovina, Montenegro, North Macedonia and Serbia.
The difference between the lowest and the highest price paid in Bosnia and Herzegovina, Montenegro, North Macedonia and Serbia can reach 10 times or more for some medicines, i.e. in the case of the combination tenofovir/emtricitabine, it ranges between €228 per patient, per year in North Macedonia and €2,520 per patient, per year in Serbia. North Macedonia has the best prices in most cases across the four countries; however, even its prices are significantly higher for nearly all medicines in comparison with other countries of the EECA region. For instance, prices for dolutegravir are nearly 5 times higher than the price for patent protected dolutegravir in Kazakhstan. Among the essential medicines for first-line treatment in Bosnia and Herzegovina, generics are registered just for one specific ARV (tenofovir) while Montenegro has no generics; In 2019, only 59% of people diagnosed with HIV were on life-saving antiretroviral therapy (ART) in the selected 5 SEE countries, significantly lower than the global rate of 82%. Currently, first line ART is available to just 25% of PLHIV in Serbia. State budgets for ARVs tend to be limited and have not increased in recent years. For example, in North Macedonia, budgeting is not based on the number of patients and has not increased, though the number of patients has increased by 50% in the past 5 years. ARV pricing is high and greatly differs across countries of the SEE sub-region, based on the 100% Life desk-review assessment conducted in 2019. Low use of generics, including because of registration-related barriers, contribute to high pricing. Optimization of treatment regimens, improved pricing for medicines, as well as the increasing presence of generics have a potential to create savings in state budgets. These savings could fund more people to receive ART and prevention services. Though the scaling up of ART is a top priority for countries of the EECA region, increasing access to HIV rapid testing for key populations who are at higher-risk of acquiring and transmitting HIV is one of the major drivers to stop the epidemic. Late diagnosis of HIV remains a challenge across most countries of Eastern Europe; according to estimates, only 74% of PLHIV are aware of their status. A further issue is the potential harm for PLHIV caused by transferring them to other treatment regimens without due medical research, including resistance testing and viral load analysis, thereby worsening the life quality of people undergoing treatment. All these factors need to be considered and evaluated when advocating. Expected Outcome is at least 15% savings achieved due to the optimization of procurement prices for ART (all treatment lines) in 4 SEE countries - Bosnia and Herzegovina, Montenegro, North Macedonia and Serbia
In order to achieve the objective of the assignment, the Consultant is expected to implement the following tasks:
The period for implementation of the study is September 2022 – December 2022, with the following specific deadlines:
How to apply
Interested parties should send a Letter of Interest with relevant CV(s), expressing the interest in implementing the study with references and a financial offer with breakdown of costs per task.
All applications are to be submitted to firstname.lastname@example.org no later than 22 August 2022 COB. An evaluation panel will review all submitted offers based on following criteria
Understanding of Global Fund processes and procedures
Experience in implementing similar strategies in EECA region
The Consultant with the highest score will be selected to implement the assignment.