Understanding the crisis in harm reduction funding in Central and Eastern Europe
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RESEARCH
Understanding the crisis in harm reduction funding in Central and Eastern Europe Michal Miovský1, Silvia Miklíková1, Viktor Mravčík1,2, Jean‑Paul Grund3 and Tereza Černíková1,2*
Abstract Background: The harm reduction (HR) approach to injecting drug use was rapidly adopted in Central Europe follow‑ ing the fall of the Iron Curtain. The associated social and economic transformation had significant consequences for drug policies in the region. A large number of emerging services have been dependent on funding from a wide range of national and/or local funding programmes, which continue to be unstable, and closely associated with political decisions and insufficient institution building.A sharp distinction is made between health and social services, often without regard to client input. The main objective of the paper is to identify the causes of the funding problems cur‑ rently faced by HR services in the context of their history of institution building which represents a major threat to the future of HR services in the region. Methods: Qualitative content analysis of documents was conducted in the development of two case studies of the Czech and Slovak Republics. The body of documentation under study comprised policy documents, including National Drug Strategies, Action Plans, ministerial documents, and official budgets and financial schedules, as well as documents from the grey literature and expert opinions. Results: The insufficient investments in finalising the process of the institution building of HR services have resulted in a direct threat to their sustainability. An unbalanced inclination to the institutionalisation of HR within the domain of social services has led to a misperception of their integrity, as well as to their funding and long-term sustainability being endangered. In addition, this tendency has had a negative impact on the process of the institutionalisation of HR within the system of healthcare. Conclusion: The case study revealed a lack of systemic grounding of HR services as interdisciplinary health-social services. The aftermath of the financial crisis in 2008 fully revealed the limitations of the funding system established ad hoc in the 1990s, which remains present until today, together with all its weak points. The entire situation is responsi‑ ble for the dangerous erosion of the interpretation of the concept of harm reduction, which is supported by various stereotypes and false, or ideological, interpretations of the concept. Keywords: Harm reduction, Drug policy, Comparative qualitative analysis, Financial support, System analysis, Case studies, Czech Republic, Slovak Republic
*Correspondence: [email protected] 1 Department of Addictology, First Faculty of Medicine, and General University Hospital in Prague, Charles University, Prague, Czech Republic Full list of author information is available at the end of the article
Background The history of harm reduction policies concerned with drug-related problems in Western Europe can be traced back to as
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