Risks to Health

Eastern Europe and Central Asia is one of only three regions in the world where the HIV epidemic continues to grow. New HIV infections are rising dramatically and so are AIDS-related deaths. According to UNAIDS 2023 Global AIDS Update Report “The Path that Ends AIDS”, between 2010 and 2022, new HIV infections have risen by 49 percent and AIDS-related deaths have increased by 46 percent. This is a setback for a region where many countries have demonstrated commitment to addressing HIV mother-to-child transmission, fostering social contracting, and focusing on the needs of people living with HIV. 

Of the 2 million people living with HIV in the region, only 51 percent are on treatment. Key populations and their sexual partners are disproportionately impacted, accounting for 95 percent of new HIV infections in 2021, such as people who inject drugs (approximately 39 percent), clients of sex workers, and sexual partners of these populations (23 percent). 

The region is lagging behind in reaching the 95-95-95 targets, with 62 percent of people living with HIV knowing their status, with 51 percent of these on treatment and 48 percent virally suppressed. Punitive laws and policies regarding same-sex relationships, drug use and sex work continue to increase stigma towards vulnerable populations, further fueling the epidemic. Fear of prosecution keeps populations away from testing and knowing their HIV status.

Eastern Europe and Central Asia region has one of the highest shortfalls in HIV funding globally, with a 60% gap to meet the UNAIDS 2025 targets to end AIDS as a public health threat by 2030. This is reflected in the region’s slow progress in the fight against HIV and with domestic funds having to replace donor investments advances may be further challenged. Funding shortfalls are common not only for HIV, but also for the entire health sector in the region, where citizen out-of-pocket payments and government under-budgeting for health are common. UNDP focuses its work on endorsing sustainable financing strategies, such as social contracting, in the EECA region and beyond as well as supporting procurement and local manufacturing initiatives to decease costs for governments and consumers.

The region is also experiencing high rates of other infectious diseases especially with Tuberculosis. Eight of the world’s 30 countries with a high burden of multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant TB (XDR-TB) are in the Eastern Europe and Central Asia region.

Meanwhile, non-communicable diseases (NCDs), including diabetes, cardiovascular diseases, cancer, chronic respiratory diseases and mental disorders account for an estimated 86% of the deaths and 77% of the disease burden in the region.

With health systems challenged by the recent COVID-19 pandemic and other risks, such as climate-related crises, war, and migration, domestic health commitments, innovative financing, as well as pandemic preparedness and response and resilience in the face of climate change will be key issues to tackle for the region. 

UNDP's work in health focuses on:

• Promoting laws, regulations and policies that help address HIV-related issues and protect the rights of key populations at higher risk of HIV, such as people who use drugs, sex workers, men who have sex with men, transgender people, migrant workers and people living with HIV;
• Supporting sustainable financing of HIV and health responses by promoting access to affordable and quality HIV and other medicines of public health importance;
• Identifying and promoting the most impactful and efficient investments in the HIV and TB response, and encouraging more sustainable domestic financing including through NGO social contracting;
• Focusing on innovative financing through taxation for SDGs;
• Promoting the establishment of sustainable and transparent procurement in the health sector in partnership with other UN agencies, global health financing institutions, civil society and the private sector; and
• Addressing the nexus of climate and health for securing additional resources for the region to focus on climate adaptation of health systems and communities;
• Introducing digital governance pathways for health as well as addressing integrity in the health sector;
   

Human rights, HIV and health

In its UNAIDS co-sponsor role, UNDP focuses on human rights, stigma and discrimination, HIV prevention among key populations, and investment and efficiency.

Eastern Europe and central Asia is off track to ensure less than 10% of countries have punitive legal and policy environments. To improve access and rights around HIV and health issues, UNDP:

• Supports countries with implementing programmes on HIV, TB and malaria, working closely with the Global Fund to fight AIDS, Tuberculosis and Malaria. UNDP is currently the main implementer for HIV and/or TB grants in Kyrgyzstan, Tajikistan, Turkmenistan and Belarus;
• Assists countries with applying efficient value-for-money policies and procedures for lowering the cost of drugs and diagnostics to increase access to medicines and services (including such as Trade-related Intellectual Property Rights flexibilities);
• Promotes country ownership through the introduction and development of rights-based and gender-sensitive multi-sectoral AIDS plans; and
• Partners with and strengthens regional organizations representing various key populations most at risk of HIV and TB.
• While there have been significant improvements in the legal environment relevant to HIV and TB in the region, legal barriers persist including criminalization of HIV transmission and exposure, drug use, sex work, same sex relationships.
• Through the Being Lesbian, Gay, Bisexual, Transgender and Intersex (LGBTI) in Eastern Europe initiative, co-funded by USAID, UNDP provided a platform for sub-regional inclusive dialogue  for government representatives, development partners, national human rights institutions, LGBTI people and other civil society members from 10 different countries to openly discuss key issues and agree on potential solutions. The project led to the development of 4 flagship national LGBTI rights reports for Albania, Bosnia and Herzegovina, North Macedonia (Former Yugoslav Republic of Macedonia) and Serbia, including a first ever intersex report and Video.
• UNDP together with national partners has also conducted HIV and/or TB Legal Environment Assessments (LEAs) in Belarus, Moldova, Tajikistan and Ukraine, supporting countries to understand better the key legal, regulatory and policy barriers for key population and people living with HIV to access essential services and protect their rights. 
• UNDP supported the establishment of a regional network of judges on HIV, human rights and the law to focus on exchanging experience, expertise and knowledge on how the judiciary can better protect the rights of key populations at higher risk of HIV and people living with and affected by HIV.
• UNDP together with local key populations and CSOs, PEPFAR, the Global Fund, the UNAIDS Secretariat and relevant Joint Programme co-sponsors launched the SCALE Initiative to counter punitive and discriminatory laws and HIV-related criminalization, and thus removing barriers to HIV services and ultimately achieving 10-10-10 targets.
   

Sustainable and Innovative financing of health programmes

The sustainability of the HIV response in the region remains a major concern. Many countries are still heavily dependent on external funding for their national HIV and TB responses. Even though US$ 1.5 billion was allocated for the HIV response in the EECA region in 2022, a 60% deficit exists in reaching the 2025 goal. Although HIV treatment is funded mostly with domestic sources, prevention services rely heavily on donor support and are not financially sustainable in the long term. 

There is a strong push by the Global Fund and other donors for countries to further increase domestic (both public and private) funding for the National HIV responses.

Additionally, in the region where NCDs cause high morbidity and mortality, increasing taxes on tobacco products, alcoholic beverages and sugar-sweetened beverages is a cost-effective, evidence-based, and under-utilized way to accelerate progress towards SDG3 on good health and wellbeing.  In addition to improving health outcomes, these interventions also provide a sustainable and predictable source of domestic revenue, spur macroeconomic growth and improve equity.

Given these factors, sustainable financing of national health programmes is a priority concern for many countries in this region. UNDP and its partners provide support to countries in the following areas:

• Accessing affordable and quality HIV, TB, cancer, and other NCD medicines;
• Investing their limited resources in the most impactful HIV and TB activities and programmes;
• Helping governments transition national HIV and TB responses to more cost-efficient investment approaches; and
• Supporting countries to recognize NGOs as critical partners in the delivery of HIV and TB services by establishing NGO social contracting as a critical part of sustainable financing of national responses.

Supporting investment cases and providing technical assistance for countries to create projections of the expected impacts of health tax reforms.
 

Sustainable, climate resilient and pandemic prepared health systems

Standard medical ethics dictate “primum non nocere” (first, do no harm). While health care saves lives, it can also harm the environment and threaten the ability to guarantee good health for future generations.

The health sector, whose mandate is to prevent and cure disease, makes a major contribution to the global climate crisis. In fact, if the global health sector were a country, it would be the fifth-largest greenhouse gas emitter on the planet. The global health sector releases greenhouse gases while delivering care and procuring products and technologies from a carbon-intensive supply chain. Health care contributes to carbon emissions through energy consumption, transport, and products manufactured, used, and disposed of.

As COVID-19 progressed in 2020 and 2021, the health systems’ impact on human and planetary health has increased resulting in an equally increased need to procure health care commodities. This created an unprecedented challenge to health care waste management across the globe, a process that has ripple effects in many regions of the world, especially in developing nations. As the number of patients needing health care exploded, managing massive health care waste became a challenge.

While there has been an urgent call for health commodities to be delivered to all corners of the world, there is still a significant need to ensure the upholding of sustainable standards and dimensions. In response to COVID-19, health systems are rethinking their supply chains, and the opportunity to integrate future pandemic preparedness with principles of climate resilience, adaptation, mitigation, and sustainability arises.

Procurement, done sustainably, has the potential to decrease health sector’s contribution to the climate crisis and advance the Sustainable Development Goals (SDGs). By greening our health systems, especially in the areas of procurement and supply chains, we can treat people without harming the environment.

In 2012, recognizing the potential to contribute to climate action, development, humanitarian, governance and peacebuilding nexus through sustainable procurement, seven UN agencies (UNDP, UNICEF, UNEP, UNFPA, UNHCR, WHO, UNOPS) and three global health financing institutions (Unitaid, The Global Fund and Gavi) joined forces under the UN Sustainable Procurement in the Health Sector (SPHS) initiative to contribute to more sustainable health systems and inclusive greener economies. The SPHS, whose secretariat is hosted by UNDP IRH, is supporting the development and implementation of sustainable and ethical procurement policies that positively impact the global health care supply chain to achieve net-zero carbon emissions by 2050.

Furthermore, UNDP together with Health Care Without Harm (HCWH) is implementing the Sustainable Health in Procurement Project (SHiPP). The project addresses the intersection between health, human rights and the environment in 10 countries (Argentina, Brazil, China, India, Moldova, South Africa, Tanzania, Ukraine, Vietnam and Zambia). SHiPP promotes procurement practices that consider environmental and social impacts, as well as cost-efficiency and affordability when defining how processes can be sustainable and mainstreams gender and human rights including anti-corruption, transparency and accountability.

In EECA, UNDP is launching exploratory work linked to local manufacturing and collaborating with government and other partners to foster digitalization including in the health sector. 

In collaboration with WHO, UNDP also launched regional work on the nexus of climate and health – looking at the impact of climate on health systems and fostering resilience in health systems and communities.
 

Highlights of our work

UNDP developed an environmental questionnaire to assess the performance of suppliers and manufactures of health commodities, promoting environmental and social sustainability.

UNDP has been maintaining the SPHS platform to strengthen engagement with health care suppliers and manufacturers. The SPHS network unites global leaders and technical experts from over 90 countries and shares knowledge on events, projects and best practices related to sustainable health procurement, manufacturing, waste disposal and management.

In collaboration with partners, UNDP helped Ministries of Health and UN procurers, suppliers and manufacturers understand, design and put into place sustainable health manufacturing, procurement, waste disposal and management practices.

Through SHiPP, UNDP created several resources, including a list of chemicals of concern to health and environment; guidelines on sustainable procurement; and a guidance note for COVID-19 health care waste management to help decrease negative impacts on people and the planet.

UNDP has established the Sustainable Procurement Index for Health (SPIH), a measurement tool for policy makers, manufacturers, suppliers, procurers and health care facilities end users. The index is designed to provide an incentive for entities to improve their environmental and social sustainability record.

UNDP also organized five Saving Lives Sustainably Global Forums (Asia 2018, Africa 2019,Arab States 2020, LAC 2021, and Europe 2022), featuring some of the world’s most eminent thinkers and practitioners who initiated important discussions on the global heath sector’s sustainable production, procurement, and logistics’ supply chains. The events provided opportunity for global health sector stakeholders, consisting of UN agencies, international organisations, governments, policymakers, multilateral financial institutions, manufacturers, technical experts, academia, philanthropists, humanitarian supply management and logisticians, civil society organisations and others to explore the current state of the health commodities’ sector in relation to sustainable consumption and production patterns and how they contribute to humanitarian-development-peace nexus.

UNDP closely worked with the government of Ukraine to reform its health procurement system, generating preliminary savings of over USD$12 million and improving overall access to quality medicine and vaccines.

With WHO, UNDP launched regional work on the nexus of health and environment to foster climate-resilient health systems and communities
 

Non-communicable diseases

Non-communicable diseases (NCDs) represent a major public health and broader societal problem, causing with just over 70 percent of all deaths globally. The relative burden is even higher in the Europe and Central Asia region, where NCDs caused 90 percent of deaths, a three percent increase since 2000.

NCDs – namely, cardiovascular disease, diabetes, cancer and chronic respiratory disease – are the greatest cause of preventable illness, disability and mortality worldwide, with large impact on productive capacity. They share behavioural risk factors – tobacco, harmful use of alcohol, physical inactivity and unhealthy diet - as well as social, economic and environmental determinants.

UNDP takes a comprehensive and integrated approach towards tackling NCDs, addressing relationships between NCDs, poverty, inequalities, sustainable cities, economic growth, health financing and climate action.

UNDP, with the World Health Organization, supports countries in the region to establish national responses to NCDs. UNDP undertakes comprehensive  investment cases analyses to determine the potential savings or expenditures a country might incur based on its present investment strategies. UNDP also strengthens the implementation of global, regional and national legislative frameworks including the Framework Convention on Tobacco Control 2030 (FCTC), through which UNDP partners with the Convention Secretariat and WHO to support fifteen low- and middle-income countries to strengthen tobacco control in line with the SDGs.

UNDP has completed or is finalizing NCD, FCTC and/or mental health investment cases for Armenia, Belarus, Kyrgyzstan, Serbia, Turkey and Uzbekistan. They contribute not only to increasing political commitment but also developing country-tailored cost-benefit analysis of actions to address NCDs and key behavioral risk factors.

The first ever country-specific framework convention on tobacco control investment case was conducted in Georgia (English, Georgian), which became a strong contributor for legislative and regulatory changes in the national tobacco control law, completely banning public indoor smoking, advertising, sponsorship and promotion. Recently, Armenia engaged in an extensive collaborative partnership to advance its work on health taxes and several other countries followed.