Project proposal LATS
February 1999
‘Developing a local response to the drug problem: the Latin American travelling seminar’
1. Introduction
In March 1998, the 9th International Conference on the Reduction of Drug Related Harm was held in Sao Paulo, Brazil, gathering over one thousand drug experts from all over the world. It was the first time that this conference had been held in a developing country. This was actively stimulated by the International Harm Reduction Association (IHRA), which is one of the sponsors of the International Conference, since it was felt that problem drug use is no longer exclusively a matter of developed countries. The IHRA's assumption turned out to be true: during the conference, overwhelming evidence was presented, that harm caused by the use of drugs is indeed no longer a phenomenon of the developed world. Numerous experts from developing countries presented information about the spread of Aids and other infectious diseases by and through drug users, drug related crime, disruption of family life and the exclusion of youngsters who are trapped in a pattern of compulsive drug use.
The preparation of the conference stimulated an extensive interaction between drug experts in Latin America and as a result, they established RELARD, the Latin American Harm Reduction Network in January 1998. During the conference not only were contacts further intensified between Latin American experts, but also between Latin American experts and their colleagues from other parts of the world.
Directly after the conference, a group of experts from Latin America participated in a training in Rapid Assessment, sponsored by UNAIDS.
In October 1998, Brazilian experts organized a follow-up meeting in Sao Paulo with guests from The Netherlands and the United States of America. Subsequently, a Brazilian group of experts who wish to ameliorate drug interventions, was formed.
In October 1998, the city of Buenos Aires, Argentina, organized a two-day drug conference. Over 600 delegates who attended this meeting, were involved in lively debates and listened to presentations on drug interventions in Buenos Aires, other parts of Argentina, other countries in Latin America and in Europe. During this meeting the URB-AL programme, a co-operation between European and Latin America cities, sponsored by the European Commission, was presented as well.
The above mentioned events, brought a group of drug experts together, who developed the idea of a Latin American travelling seminar, which is described in this proposal.
2. Background and justification
There are numerous indications that problems related to the use of substances are growing rapidly in Latin America. Reported problems concern:
Another factor, which might explain the increase in drug related problems, is a tougher Latin American policy against the export of drugs to the USA. This new policy came about through active involvement of the American DEA and agreements between the USA and Latin American countries to intensify the fight against the export of drugs. This action might have led to an increase of drugs on local markets.
Data available on the spread of Aids in Latin America from UNAIDS, indicate a major difference between countries. Brazil has an estimated cumulative number of 25,000 drug injectors with Aids (21% of total number). Argentina has an estimated number of 5,500 drug injectors with Aids (36% of total). Other countries, such as Chile, Bolivia and Colombia still score relatively low.
The actions taken in response to these drug problems have mainly been focused on drug supply reduction, education and on a limited scale, programs to assist drug users in stopping their drug use.
A public health response has hardly been developed. Local authorities are now starting to realise that they are facing a serious problem in their community and that a local response is needed. In the base document of the URB-AL programme (November 1997) it was stated as follows:
"Making the drug problem a municipal issue is part of the process to municipalize social problems that is being implemented by the post-modern state both to streamline its own operations as well as to democratise solutions: Locating the drug problem in the local community has the advantage that the community can participate directly, including its own drug users, in an understanding of the phenomenon and in the development of solutions to their problems.
Public health and criminal policies are specific tools of national governments that have appropriate institutions to implement them with the title -- monopoly -- to exercise their administrative and punitive attributions. On the other hand, primary health care, preventive and hygienic education, attention to social problems of absence of means and a decomposition in primary relations as well as the faults, violations and minor offences are matters of local competence which correspond to the daily life of local communities where the phenomenon of the use and sale of drugs unfolds as part of the social life of contemporary times."
In the European Union, countries increasinly stimulate the development of an active local policy on drugs. In the URB-AL document this was summarised as follows:
"As stated in the declaration of the EU program:
AThe role of cities is increasingly important. The affirmation of their role as an engine in economic and social development implies a widening of the political role of representation. The city is the scene where social phenomena take shape and intercross at the risk of their own equilibrium. The city is at the same time the place of the expression of all tensions, although also the site where social dialogue can materialise. Social dialogue is possible because of the capacity to analyse and diagnose problems and also because of the localisation of policies to reduce social tension (...)."In light of the above mentioned information about drug related problems in Latin America and the needs expressed by Latin American experts to strengthen the local response to drug related problems, a plan was developed for the Latin American travelling seminar.
In the following chapters, we will outline a plan for assisting local authorities in Argentina, Brazil, Bolivia,Chile and Colombia in developing a comprehensive approach to the local drug problem. The core of this proposal is the organisation of seminars regarding the management of the local drug problem.
To ensure quality, cultural sensitivity and continuity, an ‘international steering group’ will be formed with drug experts from Latin America, Europe and the USA.
In the initial phase, the Amsterdam Municipal Health Service (GG&GD) will assume responsibility for the overall coordination over the seminars in co-operation with URB-AL, the International Harm Reduction Association (IHRA), RELARD (Latin American Harm Reduction Network) and PROAD (Sao Paulo, Brazil). In a later phase, the GG&GD will hand over the responsibility for the overall coordination to the Dutch organisation Quest for Quality (Q4Q). More information about these organisations can be found in the addendum.
The project objective can be summarised as ‘stimulating local initiatives in cities in Latin America regarding drug demand reduction, drug prevention, drug treatment and public health, in order to better manage local drug related problems’.
We anticipate working towards concrete, pragmatic and feasible initiatives, which are relevant to the local cultural, social and political setting and which will be sustainable over time.
The core of this proposal is a ‘tour’ along cities in Argentina, Chile, Brazil, Bolivia and Colombia, which are affected by severe drug problems. In every city, a three-day seminar will be held, where the (further) development of local responses to the drug problem will be discussed. Every seminar will be designed and planned together with local partners and after the seminar an evaluative meeting will be held. In phase one, two pilot seminars will be organized. Based on the evaluation of these two seminars, a blueprint for the other seminars will be outlined and finilized. Phase one, is anticipated in 1999. In phase two, another 8 seminars will be organized. Phase two will be carried out in 2000 and 2001. In phase three, follow-up activities will be developed. Phase two and three will overlap and would depend on local needs. Anticipated period of phase three: 2000, 2001 and 2002.
In ensuring the relevance of the seminars to the local setting, 50% of the speakers will consist of local experts and local organisers will be responsible for the logistics. The framework of the seminar and the selection of the external experts will be the responsibility of the ‘international steering group’.
5. Target groups and beneficiaries
Participants of the seminars will be (1) policy makers and technicians who are responsible for developing the drug intervention system, (2) practitioners who work in public health, mental health, social affairs and the drug intervention system, (3) representatives of those who are directly affected by the drug problem, such as community groups, the church, parents of drug users and (ex) drug users themselves and (4) staff of Universities. Althouth the seminar is focussed on drug demand reduction and public health interventions, it might be advisable to invite a fifth group, namely representatives from the police and criminal justice system. Whether or not this will be done, will depend on the local partners.
The community at large will be the beneficiary of the seminars when drug intervention systems, which are effective in reducing problems associated with drug use, are put into practice.
The core of the activities will be the organisation of a three-day seminar on the development of a local response to the drug problem.
During the seminar, a range of topics will be discussed, such as Aids, violence, the relation between drug abuse and social conditions (poverty, inequality, unemployment, lack of perspective for the future, exclusion), alternative responses when traditional treatment fails, co-operation and adaptation of the local response to the culture and specifics of the community.
In every city, the activities will be taken in three steps: (1) preparation, (2) the seminar and (3) an evaluation.
6.1 The preparation
The International steering group will advice which cities the seminars could be held in. Contacts will be established with local partners. Based on the various responses, a final selection will be made.
Q4Q staff will pay a two-day visit to the cities in question. During these visits preparatory meetings will be held with the local partners, where the following issues will be discussed:
Q4Q staff will visit a number of local projects to assess which projects could be presented during the seminar. Project material will be collected during these visits and –where possible- both still- and moving pictures as well as slides will be made for use in a ‘project presentation’ on the second day of the seminar.
Thereafter, the local representatives will start with the organisation and will stay in regular contact with the staff of Q4Q (through email, telephone and fax). The local representatives will be responsible for all the logistics: arranging conference centre, arranging hotel accommodation for the guest speakers, inviting local participants, inviting local speakers, assigning a local moderator, contacts with the local press etc.
Q4Q will provide the local organisers with the framework for the meeting and with a number of guest speakers from Europe, Latin America and North America. Furthermore, Q4Q will be responsible for a moderator who will –in co-operation with the local moderator- make sure that the seminar follows the planned structure and that there will be a satisfactory outcome at the end of the meeting.
6.2 The three-day seminar
The following is a tentative outline of the three-day seminar.
| Day 1: What do we know? | |
| 9.00 | Opening and introduction by local organiser and representative of Q4Q |
| 10.00 – 10.30 | Presentation on the local drug problem by local expert |
| 10.30 – 11.00 | Presentation on the drug problem in Latin America by external expert |
| 11.00 – 11.30 | Presentation by local expert about local initiatives to gain insight into drug problem. |
| 11.30 – 12.00 | Example of a method to gain insight into the drug problem (for example rapid assessment, snow-ball technique) by external expert |
| 12.00 – 14.00 | Lunch |
| 14.00 – 17.00 | Discussion in subgroups Group 1: Aids Group 2: violence Group 3: influence of social factors (poverty, inequality, unemployment, exclusion) on the drug problem |
| Day 2: How do we respond? | |
| 9.00 – 12.00 | Presentation of local projects (this will have a lively format using video’s, slide shows, testimonies by clients, parents and discussions) |
| 14.00 – 16.00 | Presentation of initiatives, projects and ‘best practice’ (both by local and by external experts) |
| 16.00 – 17.00 | Discussion |
| Evening | Social gathering |
| Day 3: Towards a local drug policy | |
| 9.00 – 12.00 | Ingredients of a local drug policy ¨ Defining objectives¨ Implementation (which instruments can be used, how to involve the various actors, marketing the new approach, how to overcome resistance, working with the media etc.)¨ Evaluation/monitoringPresentations by both local and external experts |
| 12.00 – 14.00 | Lunch |
| 14.00 – 15.30 | Discussion in subgroups Topic: ‘towards a local drug policy’ |
| 15.30 – 16.30 | Follow-up ¨ Co-operation¨ Exchange of expertise¨ Local steering group¨ Further funding¨ Need for training (prevention, junior researchers, media etc.) |
| 16.30 – 17.00 | ‘wrap-up’ and closure |
6.3 Evaluation
Within 8 weeks after the seminar, Q4Q will hold a one-day evaluative meeting with the local representatives to determine the effect of the seminar and how a loner-lasting impact could be ensured. In this meeting the following issues will be discussed:
¨
strategies for co-operation (local, national, international/ possible pitfalls/ working towards continuity/ implementation);¨
possibilities for exchange of expertise and experience (for example by visiting projects in other cities and other countries);¨
how to secure funds for future interventions;¨
the forming of a local steering group;
The main objective of the seminars is the stimulation of the development of a local drug intervention system. We anticipate that many initiatives will be developed after the seminar. It concerns:
Every city will set their own priorities concerning the initiatives which should be developed and will make their own decision concerning organisational and financial aspects. This means that –at this moment- we can not be more specific about the follow-up phase. However, we will request the cities to present a follow-up plan within 6 months after the seminar.
In the budget proposal we have included the follow-up phase as a p.m. post. However, the steering group will be available to assist local partners should they need support in the further development of initiatives.
We also hope to be able to involve those who have already had a seminar which we organized in their own city, in seminars we organise in other cities. In this way they can share their experience with those who are still in an earlier phase.
The ‘ideal’ expected outcome of the seminars is an amelioration of the local drug intervention system, with concrete and continued pragmatic activities. Furthermore, the intensive exchange of expertise between experts in the drug field and the training of those involved will enhance the quality of the interventions. Finally, a better co-operation between those who are responsible for the local drug policy and the interventions will lead to a co-ordinated approach. Put together, this will result in a reduction of drug related problems.
In practice, the outcome might be less in some cases, due to lack of finances to carry out plans, unwillingness to co-operate, ideological differences, lack of priority given to the drug problem etc. Such drawbacks will be discussed during the seminars and where possible, actions will be undertaken to minimise them.
After every local seminar, a report will be produced containing texts of presentations, summaries of the discussions, conclusions and a list of actions to be taken. This report will be disseminated amongst policy makers, professionals in the field of drug abuse, the media and others who have shown their interest. Furthermore, these reports will be available on internet.
About the parties involved:
International Harm Reduction Association
The International Harm Reduction Association is a society of individuals and organisations involved in the study of the reduction of the harm caused by the use of drugs. It has been formed to:
The founders are: Patrick Aeberhard, France; Ernst Buning, The Netherlands; Dave Burrows, Australia; Ernie Drucker, USA; Fabio Mesquita, Brazil; Pat O’Hare, Italy; Diane Riley, Canada; Marsha Rosenbaum, USA; Bill Stronach, Australia; Alex Wodak, Australia
Contact person:
The Rede Latino Americana de Redução de Danos (RELARD or Latin American Harm Reduction Network) was founded in São Paulo, Brazil, in January 1998. It is a net of people and organisations that support Harm Reduction Strategies in the Continent, especially for the prevention of the HIV/AIDS, based on the principals of Public Health, Human Rights and Citizenship in Latin America.
RELARD has the following objectives:
Executive Director: Fábio Mesquita (Brazil)
Executive Secretariat: Regina Bueno (Brazil)
Executive Committee:
Contact persons:
Fábio Mesquita: iepas@atribuna.com.br
Graciela Touze: gratouze@cvtci.com.ar
URB-ALUrb-Al is programme sponsored by the European Commission based on a decision in December 1995 by the European Union Member States. The objective of the programme is the strengthening of the co-operation between cities in Latin America and Europe, stimulate a dynamic interaction and exchange of knowledge and expertise between cities in the two regions. It aims at contributing towards improving socio-economic conditions and quality of life of the populations in inner city areas. URB-AL consists of 8 networks, one of them being ‘Drugs in the cities’. The co-ordination of this network is done in Santiago, Chile. Contact person is:
Juan Leyton
PROAD (Programa de Orientaçâo e Assistencia a Dependentes) is part of the department of Psychiatry of the Federal University of Sao Paulo, Brazil.
It works in four areas:
PROAD has a staff of twelve psychiatrists, sixteen psychologists, an anthropologist, three family therapists, a social worker, an occupational therapist, two support staff and various trainees.
Contact persons:
The Amsterdam Municipal Health Service (GG&GD)
The Amsterdam GG&GD is a public health organisation with about 1000 employees. It was founded in 1900. Since the mid seventies, it has been involved in developing public health oriented interventions for drug users (out-patient clinics, outreach services such a the methadone bus, assisting arrested drug users in Amsterdam police station, assisting patients and staff in general hospitals) and advising the local government in drug issues. Yearly, it is in touch with 60 to 70% of the drug addicts. In the first phase of the Latin American Travelling Seminars project, the Bureau International Affairs of the GG&GD will be the responsible for the activities. Later on, these activities were handed over to Q4Q (see under).
Quest for Quality is a private organisation founded by Ernst Buning. Ernst Buning is a Dutch psychologist who has worked in the drug field since 1977. During his work for the Amsterdam Municipal Health Service (GG&GD) he was involved in the development of a public health approach to the Amsterdam drug problem, he set up the methadone by bus program, evaluated world’s first needle exchange and in 1992 he developed the Bureau International Affairs Drugs and Aids. He is one of the founding members of the International Harm Reduction Association (IHRA). Q4Q has been founded to enable Ernst Buning and his colleagues to work in the international arena on improving the response to the drug problem and making the expertise collected in many years of working in the drug field available to a wider range of people. Q4Q carries out projects which were done by the Bureau International Affairs of the Amsterdam GG&GD (see above) for the Dutch Ministry of Health, the European Commission, the European Addiction Training Institute and the International Harm Reduction Association.