Unlocking state money for harm reduction – Darko Antik on helping NGOs in Macedonia


Following a workshop in Budapest on how to secure sustainable funding for harm reduction in Central and Eastern Europe, Jeffrey Lazarus has been speaking with participants about what is working in their countries. The resulting interviews were conducted as part of the European Joint Action on HIV and Co-infection Prevention and Harm Reduction (HA-REACT). For this interview, he spoke to Darko Antik, coordinator for budget monitoring and advocacy at the Association for Emancipation, Solidarity and Equality of Women (ESE). ESE helps NGOs promote human rights and social and economic justice in Macedonia and neighboring countries, particularly NGOs that work in the areas of health and social protection.

What is ESE’s connection with harm reduction funding?

We don’t provide harm reduction services ourselves, but we work closely with organizations that do, providing them with technical assistance and capacity-building. One key area where we provide support is in how to conduct government budget monitoring, analysis and advocacy. Our goal is to help NGOs ensure the long-term sustainability of their harm reduction programs, especially after countries in Southeast Europe became ineligible for grants from the Global Fund to Fight AIDS, Tuberculosis and Malaria several years ago.

Why should NGOs monitor state budgets?

People who use drugs or live with HIV are constantly confronted with obstacles to accessing public health services. These obstacles often arise from how governments set budget priorities to support implementation of existing public policies. And politicians don’t prioritize harm reduction. When civil society becomes involved in public budgeting and financial management, it promotes transparency and accountability, helps combat corruption, and improves the use of public funds to address the public health needs of vulnerable populations.

We realized that financial planning and implementation of policies are more critical than the mere existence of these policies. If a policy isn’t budgeted for, it doesn’t get implemented.

We used to focus on getting government bodies to adopt better policies, and then improve their programmatic implementation. That’s still very important, but we realized that financial planning and implementation of policies are more critical than the mere existence of these policies. If a policy isn’t budgeted for, it doesn’t get implemented.

At ESE, we build NGOs’ capacity to monitor the relevant areas of the budget so that they themselves can identify potential funding sources, request budget information, analyze it, and then undertake budget advocacy.

Anything special that NGOs should keep in mind when starting out?

NGOs need to become familiar with the entire fiscal system of their governments. It’s not easy or quick to figure out, especially when it comes to mapping relationships.

When we train people to be budget advocates, we usually begin by educating them about the national health system, with a special emphasis on health rights. In other words, how these rights are protected by international agreements that their country is party to, and how national policies reference these instruments.

Budget advocacy isn’t just about trying to increase program funding; you’re trying to change the system.

The key advice I give people when they’re starting out is “Be patient.” You won’t see results immediately. Budget advocacy isn’t just about trying to increase program funding; you’re trying to change the system – its priorities and the behavior of its public representatives. You have to get good data and analyze it well before you develop your advocacy strategy and messages. The process is time-consuming, but it pays off in the long run.

Tell me a bit more about relationship mapping.

Relationship mapping is critical for effective budget advocacy. We help NGOs to create a power map and then to analyze it and identify their primary and secondary targets. The map focuses attention on stakeholder relationships. Initially it consists of officially defined relationships. Once an NGO has gone through a budget cycle, it can amend the map based on personal relationships and actual practice. Each organization has to develop its own map, because each one interacts with different officials.

Can you describe the monitoring you did with a particular organization?

One NGO we work with is Healthy Options Project Skopje (HOPS), which provides harm reduction and other services to vulnerable populations. Our goal with HOPS was to help them find resources to ensure the long-term sustainability of their programs. We started with a customized training on the fiscal system for the Macedonian health sector and the methodology of budget advocacy. Since then, we’ve been providing daily technical assistance on putting the methods into practice.

Together we analyzed the Ministry of Health budget, and later the entire state budget. During the mapping process, we found a provision in the Macedonian Law on Health Protection that earmarks a percentage of the money collected through alcohol and tobacco taxes for preventative health programs. We discovered that most of this revenue was never allocated to prevention; the state was using it for things like salaries instead. Now we’re helping HOPS make sure that this revenue is used as it was intended.

Any other advice?

Just start! Budget monitoring is one thing in theory and another in practice – you need to roll up your sleeves and begin.


ESE website

Darko Antik and Jasminka Friscik, “Regional budget advocacy workshop conducted with NGOs from Serbia, Montenegro, Macedonia, and Bosnia and Herzegovina in December, 2017[in Macedonian]

Hepatology, Medicine and Policy is now accepting submissions on this and related issues. For more information, visit: www.hmap.biomedcentral.com.

View the latest posts on the On Health homepage

One Comment


I really like what you did but still using the Greek name “Macedonia” is not right historical and misleads people who read this article please use the right name.
Thank you

Comments are closed.