Drug policy at the regional level in Ukraine. Current situation and prospects

Speaker: Maksym Demchenko (Charitable Association Light of Hope, Ukraine). Poster presentation.

Who is involved in decision-making at the regional level: Regional or municipal drug treatment clinics, social service centers for families, children and youth, representatives of the Ministry of Internal Affairs, and civil society organizations. Coordinating Councils (CC) for the Fight Against Drug Addiction were established in each region. In addition to the above-mentioned decision-makers, representatives of the AIDS Center, representatives of the departments of education and culture, and office of the Department of Corrections are invited to participate in the councils. Deputy governors on social and humanitarian issues coordinate the work of the CCs; Issues: Lately, less attention has been paid to the CCs; they are purely declaratory. This trend can be observed in all cities of Ukraine. The main topics discussed by the CCs include statistics and achievements of some of the agencies. There is a tendency of merging the CCs with HIV/AIDS Councils; Municipal and regional social service centers declare their involvement in harm reduction programs, as well as in those addressing re-socialization of drug dependent people. But this is only a declaration. The declared activities exist on paper only. They neither know the situation, nor have access to drug users; they do not have experts and are not interested in program development. Even if these social service centers wanted to carry out specific activities, they would not have the resources. One social service center could have 11 staff members dealing with 12-16 and more programs (including children from Chernobyl, disabled people, single mothers and others). Drug enforcement departments. Many representatives of the drug enforcement system are involved in illicit drug distribution. In their work, they target “ordinary drug users”. According to official data of the Ministry of Interior, while in 2009, 2,958 crimes related to drug trafficking were registered in Poltava region, only 22.3% of the crimes were associated with drug trade. However, this is only the official data, and very often structures of the Ministry of Interior falsify the data pursuing their own goals; Drug treatment clinics: there are few supporters and concerned parties among the directors and managers of these medical institutions. Services that these drug treatment clinics provide are inefficient and are fee-based (although the state declares that these services should be free-of-charge). There are doctors who still practice such quack treatment methods like coding. The fact that not all physicians are interested in quality care for drug users is evidenced by the difficulties and pressures encountered in the beginning of substitution treatment programs in Ukraine. Analyzing this information, one could conclude that only 5-7 regions of Ukraine have any interested people; At the city level, as a rule, drug treatment clinics have no influence on the formation of the city's social policy. Partially, this happens because of the set up of the system: drug treatment services are funded by the regional budgets; since the regional authorities provide the funding, city level authorities have no influence on the services. The city appears to benefit from this: when they need statistics, they refer to drug treatment clinics. However, when it comes to planning activities and budgets, they say: “These issues are the prerogative of the regional authorities, so let them decide.” Not all NGOs are involved in the formation of regional policies. Most are caught up in the implementation of service projects funded by the Global Fund, and few people are thinking about the future. In most cases, the government knows little about the work of NGOs. Few NGOs engage in advocacy at the regional level. Community representatives are not involved in policy-making; Experience of the Association “Light of Hope”. We are members of the city and regional coordinating councils. We engaged community representatives as CC members. We decided to take on the roles of developers and coordinators of the strategy to work in the field of drug policy. We have access to the target group and we know the drug scene and the needs. We are communicating this information to our partners. Thus, we want to influence the social policy in our region, we want those programs in our region to be effective. We have joined forces with the Regional drug clinic; management of this drug clinic shares our views. We have been able to integrate elements of harm reduction in the work of the drug service (in the services of visiting nurses). We have initiated the integration of reproductive health services for women IDUs in the services of the drug treatment clinic. We participate in the development of ST programs and have spearheaded the creation of a number of documents that provide continuity of treatment for ST in hospitals. We have built cooperation with municipal law enforcement agencies, initiated inclusion of the following topics in the curriculum of the MIA staff capacity building program: “Harm Reduction”, “HIV/AIDS”, “Human Rights”, and “Substitution Therapy”. We have initiated the development of a municipal program to prevent drug use and HIV among young people. Today, we are working to ensure uninterrupted ST treatment for detainees and those kept in detention and in prison; What is needed. We must defend the necessity of the Coordination council on drug related issues – they can be a good mechanism for solving many issues. CCs should fulfil their tasks – build cooperation among different sectors, coordinate work, build a strategy of assistance to drug dependent people, and prevention work. Community representatives should be involved in each council. The social service centers should move to the level of coordination and monitoring centers; they should establish partnerships with NGOs. Municipal authorities should be involved in implementation of programs that help drug dependent people. Existing practices of drug treatment clinics should be changed. Drug treatment clinics follow protocols, 80% of which were written during the Soviet era. The system of drug treatment clinics should integrate elements of harm reduction. NGOs should become more active in shaping drug policy at the regional level.