Department of Addictology, First Faculty of Medicine, and General University Hospital in Prague, Charles University, Prague, Czech Republic.
National Monitoring Centre for Drugs and Addiction, Office of the Government of the Czech Republic, Prague, Czech Republic.
Harm Reduct J. 2020 Oct 22;17(1):83. doi: 10.1186/s12954-020-00428-6.
The harm reduction (HR) approach to injecting drug use was rapidly adopted in Central Europe following 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 currently 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.
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.
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.
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 responsible 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.
铁幕落下后，减少伤害（HR）方法在中欧迅速被用于注射吸毒。相关的社会和经济转型对该地区的毒品政策产生了重大影响。大量新兴服务依赖于各种国家和/或地方供资计划的资金，这些资金继续不稳定，并与政治决策和机构建设不足密切相关。卫生和社会服务之间有明显的区别，通常不考虑客户的意见。本文的主要目的是确定 HR 服务目前面临的供资问题的原因，这些问题与其机构建设历史有关，这对该地区 HR 服务的未来构成了重大威胁。
在对捷克共和国和斯洛伐克共和国的两个案例研究中，对文件进行了定性内容分析。研究的文件资料包括政策文件，如国家毒品战略、行动计划、部长文件以及官方预算和财务计划，以及灰色文献和专家意见。
在完成 HR 服务机构建设过程中的投资不足，直接威胁到其可持续性。在社会服务领域内对 HR 机构化的不平衡倾向，导致对其完整性的误解，以及其供资和长期可持续性受到威胁。此外，这种趋势还对医疗保健系统内 HR 机构化进程产生了负面影响。
案例研究表明，HR 服务作为跨学科的健康社会服务，缺乏系统基础。2008 年金融危机的后果充分暴露了 20 世纪 90 年代临时建立的供资系统的局限性，这种情况一直持续到今天，以及其所有弱点。整个情况导致了对减少伤害概念的危险侵蚀，各种刻板印象和对该概念的错误或意识形态解释支持了这一概念。
