Transcript Szczecin Power Map - Temple University

The Governance of Care:
Mapping Local Influences on IDU
Health Interventions in a Polish
City
Sobeyko J (1)(8), Leszczyszyn-Pynka M (1)(2), Duklas T (7),
Parczewski M (1)(2), Bejnarowicz P (1), Chintalova-Dallas R (5),
Lazzarini Z (4)(6), Case P (5), Burris S (3)(6).
The RPAR
Rapid Policy Assessment and Response (RPAR) is a community-level action
research intervention process. An RPAR was conducted in Szczecin, Western
Pomerania Province, Poland from January-October 2005. The aim of the
RPAR was to diagnose the drug policy problems in the region and, working with
a diverse Community Action Board (CAB), to create an Action Plan to improve
the well-being of injection drug users in the region.
Rapid Policy Assessment and Response is an action research method in which local researchers guided by a Community Action
Board (CAB) collect and analyze laws, epidemiological and criminal justice statistics, and data from focus groups and key informant
interviews to learn how the law, policies and their implementation influence health risks among IDUs. Analytic tools included a “power
map” depicting the institutions that play important direct or indirect roles in shaping and implementing policies and how these
institutions interact. The ultimate goal of RPAR is to stimulate local cooperation to reduce environmental risks to IDU. The RPAR was
conducted in Szczecin between January and October, 2005, a final report was released in March, 2006. The CAB included
representatives of law enforcement (the police, judiciary, prisons), both public and private drug treatment providers, health care
(physicians, nurses) and social welfare agencies (Family Support office). Existing laws and formal policies in ten domains relevant to
drug policy and health (including harm reduction, drug treatment and prevention) were collected. To determine how these laws were
being put into practice, three focus groups were conducted, and the team interviewed 24 people in law enforcement, health care and
social services, as well as 14 IDUs.
Outcomes and Lessons Learned
The Szczecin power map showed a diversity of government agencies and NGOs influencing
the risk environment for IDUs. We reflected upon the factors that allow interventions aimed
at drug users, including the RPAR, to go forward with a reasonable degree of success:
Local harm reduction and
drug treatment agencies are
well established in law and
practice.
•
National legislation clearly
authorizes both syringe exchange and
methadone maintenance treatment.
•
On paper, harm reduction and
treatment are official national policy with
the same validity as drug control
policies.
•
Polish drug demand policy is
decentralized and it is municipal task to
implement local drug policy, which
means that the city government of
Szczecin directly funds a number of
NGOs and programs, giving them
immediate local legitimacy and a voice in
policy.
Return from U [Addiction]
supports families of people
with drug addiction. It has had
long term government
funding, and was represented
on RPAR CAB
The Szczecin
Power Map
Nat’l
MOH
TADA was founded in 1995 to prevent
HIV/STDs among Szczecin sex workers.
After RPAR it leads a network of
agencies serving drug users and their
families, funded by national Ministry of
Labor and Social Affairs
Nat’l
AIDS
Center
Prison
TADA
Church
Business
Detox
program
Media
Participated in CAB and/or
focus group interviews;
worked with RPAR to
develop training scheme
Judges
Psychologists
outpatient
clinic
When SEP was first
introduced, national
authorities instituted
training for law
enforcement
National Office
for
Counteracting
Drug
Addiction
MONAR
RPAR
•
Cost-effective health interventions
like methadone and syringe exchange
have been implemented, at least in
major cities.
The National AIDS Center
provides funding for TADA
and other local prevention
projects, and data and
technical assistance to
RPAR
City
Government
Return
from U
MONAR is the oldest Polish NGO
providing treatment, social support and
harm reduction services to IDUs.
It has been funded for many years by
national and local government
•
Drug users are seen as deserving of
social assistance.
•
Public health and harm reduction
agencies have a voice in city politics,
and physicians caring for people with
HIV have provided training for police on
AIDS/STI and drug issues.
RPAR brought together NGOs
(e.g. MONAR, TADA), health
and social service providers
and law enforcement to
address policy barriers to IDU
health
•
In spite of prohibitions legislation in
the late 1990s, Polish law has continued
to promote treatment instead of
incarceration.
•
Police, prosecutors and courts have
generally not been putting people into
prison for possession of small amounts
of drugs.
•
In practice, health, drug treatment
and harm reduction agencies have the
status and resources necessary to
balance the law enforcement approach
to drug issues.
•
The RPAR was endorsed by the city
government, which provided a meeting
facility for the CAB in the City Hall
The municipal “blessed”
the RPAR, helped recruit
CAB and provided a place
to meet in City Hall
The prohibitionist aspects
of Polish drug policy have not
de-legitimized public health
approaches.
In both law and daily
practice, the police did not
have a monopoly on
governance of drug issues.
Methadone
clinic
Defense
lawyers
Prosecutors
Interagency
Alcohol
committee
Infectious
Diseases
Clinic
Medical
rescue
Police leaders participated
on CAB
Police officers provide drug
abuse training in schools
Police
Social
aid
The Szczecin Methadone
Clinic began service in the
late 1990s. It has 70 clients
and close connections with
AIDS treatment system
This research was supported by NIDA/NIH Grant # 5 R01 DA17002-02 PI: LAZZARINI, ZITA . The findings and conclusions expressed are
those of the authors and not necessarily of NIH, NIDA, or the US Government.
The development of RPAR was supported by the International Harm Reduction Development Program of the Open Society Institute in
2001-2002.
(1) Infectious Disease Prevention and Public Health Promotion Association AVICENNA, (2) Department of Infectious Diseases &
Hepatology, Pomeranian Medical University, Szczecin, (3) Temple University Beasley School of Law, (4) University of Connecticut Health
Center, (5) Fenway Community Health Center, (6) Center for Law and the Public’s Health at Georgetown and Johns Hopkins Universities,
(7) Association for Health Promotion and Social Risks Prevention “TADA”; (8) Independent Laboratory of Family Nursing, Pomeranian
Medical University