national drug programmes · 2003-04-28 · (ndps) act (1985) provides the current framework for...

91VI : National Drug Demand Reduction Programmes

National DrugDemand ReductionProgrammes

CHAPTER VI

R. Ray

National DrugDemand ReductionProgrammes

92 VI : National Drug Demand Reduction Programmes

In order to combat and minimize the problem of drugaddiction, a nation requires strategies and programmes forboth the control of supply and reduction of demand fordrugs. Supply reduction measures connote lawenforcement activities. On the other hand, demandreduction activities include primary prevention, treatmentand social reintegration. In recent times, greater emphasishas been placed upon demand reduction activities. Thischapter reviews and summarizes the various steps andmeasures adopted by respective governments towardsdemand reduction. International agreements provide thebasic guidelines and the core legislative framework isdeveloped based upon the country’s status as signatory ofvarious international conventions and treaties. Obligationsto these conventions require appropriate legal provisionstowards control of drug abuse for the nation (UNDCP,1997).

First and foremost, any plan would require an assessment ofthe current situation and resources available. National bodieswould need to examine several issues. These include :l Need for such a programmel Objectivesl Principles involvedl Policy formulationl Formulation of strategyl Identification of various components and drawing up

an action planl Programme administration including inter-sectoral co-

ordination and role delineationl Setting prioritiesl Phasing and time scaling of various activitiesl Outputs expectedl Resources required/availablel Monitoring and evaluation.

Further, national policies and programmes are influencedby economic and political stability and the existing natureof legal and judicial systems of the country (details in thenext chapter). Specific objectives and activities aredetermined by visibility, population sub-group mostaffected and the magnitude of threat perception by thecommunity (UNDCP, 1997).

A national plan is expected to examine these issues andpropose various activities and programmes. Preciseestimates of the nature and extent of drug abuse are difficult

to make in any country including the ones in this region.This is because drug abuse is often a hidden phenomenon.However, some approximation and estimates are possible.These have been reviewed in chapter II. Based upon these,a nation prepares itself and develops national policies andprogrammes. The plan of action is not uniform as differentcountries attempt different measures due to culturaldiversity, and differences in philosophy, strengths andweaknesses. Supply reduction activities, i.e. suppressionof trafficking is a cross-border issue, while treatment andprevention are specific to a country and can also vary indifferent regions within it. Thus, these cannot be easilytransferred to or be applicable in another country. Thedifferences may be more obvious than similarities. Forexample, a country with “zero tolerance” would attemptexclusively abstinence oriented programmes. A countrywith a higher degree of tolerance would adopt “harmminimization” as one of the major objectives of the nationaleffort.

Successful planning requires considerable investment/inputs from academicians, technical experts, policyplanners and administrators. Sensitization of key persons,advocacy, and public and media pressure to initiate aprogramme are also important. Political and administrativewill are absolutely crucial. International agencies likeUNDCP, WHO, SAARC (for this region), etc. can play verydecisive roles as catalysts and facilitators. (The role ofUNDCP will become clear in the following pages.) Theseefforts and initiatives must be reinforced by strengtheningnational institutions and organizations. For a programmeto be successful, support must come from all three bodies,i.e. the government, non-government sector and privatesector. Often, health and law enforcement objectives canbe contradictory. Successful drug policies are a balancebetween enforcement and persuasion, i.e. betweensanctions and incentives (UNDCP, 1997). Efforts, initiativesand measures adopted by various countries are discussedsubsequently.

It can be seen from the earlier chapters that in this region,Bhutan and Maldives are the least affected countries asregards drug abuse. Bangladesh, India, Nepal and Sri Lankahave varying degrees of drug problems. However, certaincommonalities also emerge. In all these countries, policyformulations refer to both supply and demand reductionactivities. By and large, the emphasis has been on supply

CHAPTER VI

NATIONAL DRUG DEMAND REDUCTION PROGRAMMESR. Ray


reduction. Of late, the importance of demand reductionactivities has been realized.

Besides the government, in most of these countries thereare a number of active NGOs who participate in policyformulation as well. This is most obvious from policiesand programmes in Sri Lanka. Finally, in some countries(viz. India) even law enforcement authorities are involvedin demand reduction activities. This has led to integrateddrug control strategies. Specific projects and activities ondemand reduction activities are further elaborated inchapters VIII, IX, X and the related box items.

BANGLADESH

Essential information is available from the National MasterPlan (1991), National Drug Demand Strategy (1995) andFive Year Strategic Plan (1995). The Government ofBangladesh is yet to formulate a policy on drug control,but sufficient information is available from the above threedocuments.

The focal point for activities is the Department of NarcoticsControl (DNC), Ministry of Home Affairs. The DNC wasestablished in 1990, under the Narcotics Control Act, isheaded by a Minister, and has members from several ministriesand eminent public persons. It is responsible for all theactivities to control drug abuse in Bangladesh includingpreventive education, treatment, rehabilitation and research.

BANGLADESH: NATIONAL DRUG CONTROLACTIVITIES

Significant EventsNarcotics Control Act - 1990Creation of DNC - 1990National Master Plan - 1991Sector Plan, Demand Reduction - 1993Five Year Strategic Plan - 1995

For demand reduction activities the following ministries/departments are involved :

Health : To provide treatment throughgovernment treatment centres inmedical colleges.

Social Welfare : To provide some degree of careand counselling to affectedindividuals and their families.Financial assistance is providedby the government.

Youth and Sports : Various training centres areinvolved in educating youth onhazards of drug abuse.

Education : National Curriculum and TextBook Board is mandated toinclude chapters on drugs anddrug abuse in text books forstudents from class VI to X.

INFEP : The Integrated Non-FormalEducation Programme is involvedin imparting knowledge topersons outside the formaleducation system.

Women’s Affairs : Is expected to provide training towomen on drug abuse.

NGO Affairs Bureau : Supports NGOs.Information : National TV and radio to carry

mass awareness programmes forprevention.

BANGLADESH: DEMAND REDUCTION ACTIVITIES

Ministries/Departments involved :l Health l INFEPl Social Welfare l Women’s Affairsl Youth and Sports l NGO Affairsl Education l Information

The National Master Plan (1991) provides the frameworkand basis of development of various programmes. Itsimplementation has required a high level of resources andefforts from UNDCP (UNDCP-ROSA, 1997), in a five yearjoint project between the Government of Bangladesh andUNDCP. The proposed activities for demand reduction are

Workshop on review of National Drug Demand Reduction Strategy,Bangladesh


categorized as sector plans for:l preventive education and informationl treatment and rehabilitation.

The long term objectives are containing and reducing theeffects of drugs on individuals, families and the community.The immediate objectives are to establish centres fortreatment and rehabilitation and initiate preventiveeducation.

Following the development of the National Master Plan, aFive Year Strategic Plan has been developed (1995). Severalworkshops and widespread consultations were held toformulate this plan. It was envisaged that drug abuse controlshould have a judicious combination of both demand andsupply reduction activities. Several goals were identifiedfor demand reduction in the areas of treatment; relapseprevention, work place intervention, reduction of sale ofpharmaceutical products, community support andinvolvement of NGOs were suggested.

Specific strategies for preventive action viz. restructuringof the DNC, development of a preventive package, trainingfor several groups of persons, development of media andadvertising policy, health warnings for pharmaceuticalproducts, sector based programmes and work placeintervention have been proposed.

Specific strategies for treatment and rehabilitation includedevelopment of a client monitoring system (CMS), treatmentstrategies including harm minimization, development ofcommunity based care and rehabilitation services, humanresource development, co-ordination mechanism betweengovernment and NGOs, and promotion of research,monitoring and evaluation. Special emphasis was laid onpublic health campaigns against HIV/AIDS and drug abuse.Though the country does not have any surveillance systemfor HIV/AIDS as yet, the National AIDS Committee underthe department of health has been identified for suchactivities. A detailed monitoring mechanism has also beenproposed. As most programmes are funded by external donoragencies, it has become obligatory to monitor variousactivities closely. Formation of various committees such astechnical committees, zonal committees and communitycoordination committees have been proposed.

Currently, four government funded treatment centres arefunctional in four cities. Further, eight medical collegehospitals and one mental hospital are mandated to providebeds for detoxification. About 20 NGOs are actively involvedin drug demand reduction. Some of these (six in Dhaka)provide residential treatment facilities. Some are activemostly for public education and awareness building activities(National Drug Demand Reduction Strategy, 1995).

The Drug Demand Reduction Programme (UNDCP assisted)was evaluated in early 1997. The two components —preventive education and treatment and rehabilitation —were reviewed. It was noted by the review team that demandreduction activities had not received adequate attention. Thetwo components were not integrated and were being viewedindependently. It was further noted that even though thecurrent drug use prevalence rate was low, drug abuse wasincreasing, particularly the use of injectible buprenorphine.Thus the risk of spread of communicable diseases like HIV/AIDS and hepatitis could increase. The sector plans werewell conceived, though there was a delay in implementation,and the actual operations began in mid-1994.

ACHIEVEMENTS

Preventive EducationDemand reduction training materials have been developedand are in use. A drug education curriculum for schoolgrades six to ten is ready. Education through print andelectronic media have been carried out. Finally, a NationalResource Centre on drugs has been established.

BANGLADESH: DEMAND REDUCTIONPROGRAMME

Achievements in Preventive Education:l Training materials developedl Drug education curriculum for schools developedl Education through medial National Resource Centre Established

Treatment and RehabilitationThe review team noted that most of the outputs had beenachieved. Excellent training materials were available andseveral training workshops had been held. The ClientMonitoring System was operational.

Public Awareness Programme at Grassroot Level


BANGLADESH: DEMAND REDUCTIONPROGRAMME

Achievements in Treatment and Rehabilitation:l Training workshops heldl Training materials availablel Client Monitoring System operationall Treatment centres established

Further, it was seen that capacity building did receive priorityover direct service delivery. This was a healthy move. Theteam had several recommendations. These includedsuggestions for improvement regarding management,organizing study tours, conducting training workshops,offering incentive remuneration, monitoring and evaluation.Upgrading and strengthening of the National ResourceCentre were also suggested. Summarizing, the evaluationteam felt that the likelihood of the majority outputs andobjectives being achieved was high. However, in order tomake it sustainable, a suggestion was made to involve morepeople, and bring more experts into the fold.

INDIA

In India, the Narcotic Drugs and Psychotropic Substances(NDPS) Act (1985) provides the current framework for drugabuse control in the country. It replaced earlier legislationson the subject. Essentially, the Act deals with supplyreduction activities. However, certain provisions for healthcare for drug dependent individuals exist. It authorizes theCentral Government (Government Of India) to takenecessary measures for identification, treatment, aftercare,rehabilitation of addicts and preventive education. It givesthe Central Government the power to establish, maintainand regulate treatment centres. The Act permits supply of“drugs” to registered addicts, and use of these substancesfor medicinal and scientific purposes. It would be importantto note that bhang (cannabis leaves only, herbal cannabis)does not come within the purview of the NDPS Act.

There is no provision for compulsory treatment of addictsunder this Act. However, the personal option of anindividual is recognized. The law provides light penaltyfor possession of “small quantity” (defined for various drugsas per Government’s notification) or for personalconsumption. In such a situation the person may bedirected by the court to undergo treatment in recognizedtreatment centres.

The focal points for demand reduction activities are theMinistry of Health and Family Welfare, and the Ministry of

Welfare. Other ministries involved are Ministry of HumanResource Development (Department of Youth Affairs,Education) and Information and Broadcasting. However,India being a federal state, a large number of responsibilitieslie with the State governments.

INITIATIVES SO FARSoon after this Act was passed, the Ministry of Healthand Family Welfare appointed an Expert Committee in1986 to suggest various activities. In the opinion of theCommittee, the NDPS Act was considered the single mostimportant social legislation after independence with a farreaching impact. It has been mentioned earlier (chapterIII) that even before the formation of this ExpertCommittee, the Government of India had formed anearlier Committee in 1977, to initiate various demandreduction activities. Activities were initiated in somehealth institutions. However, due to a lack of resourcesno major programmes could be launched.

The Expert Committee (1986) noted that India not onlyhad a large number of raw opium, cannabis and alcoholusers, but also a sizeable youth who could be inductedinto abuse of other substances including heroin which wasclearly visible. The Committee recommended severalmeasures:l Development of a National Centre under the Ministry

of Health and equivalent centres in various States.

l Development of these centres should take precedenceover development of treatment centres (designatedcentres).

l Human resource development should receive highpriority.

l Existing general hospitals should be strengthened toprovide treatment.

l Treatment of subjects with drug dependence shouldbe the responsibility of the health ministry at thecentre and State health departments.

l Several treatment modalities both short term and longterm were suggested. Of particular interest was thesuggestion of a maintenance programme for treatmentof heroin dependece. The Committee provided guide-lines for such a programme including qualifying crite-ria for patients. At that point of time raw opium/tinc-ture opium was suggested for maintenance.

l Monitoring of patients’ profiles from treatment centreswas suggested through the development of a DrugAbuse Monitoring System (DAMS).


l As regards policy, the Committee suggested drug andalcohol dependence should have a separate visibilityin the National Health Policy.

l It was also noted that abuse of psychotropics mightincrease soon. Thus in due course, prescriptionmonitoring should be established. Rational use ofpsychotropics should be promoted through national/state level workshops.

l For effective programme implementation, it was notedthat inter-sectoral integration and linkages with otherprogrammes (viz. Integrated Child DevelopmentSchemes, National Rural Employment Programmes,etc.) should be promoted. Involvement of the Ministryof Welfare, and social scientists besides the healthexperts, was considered crucial.

An action plan for service augmentation was proposed.Several measures were initiated following the submissionof this report.

ADMINISTRATIVE MECHANISMS FORIMPLEMENTATIONAs a follow up to the Act, the Government of India createdthe Narcotics Control Bureau (NCB) in March 1986 andempowered it to coordinate all activities for administrationand enforcement of the Act. For demand reduction activitiesNCB was required only to coordinate action taken by theMinistries of Health and Family Welfare, Welfare and theconcerned departments. As per the assigning of roles, theresponsibility for educational and social welfare aspectsof drug addiction was assigned to the Ministry of Welfare.Surprisingly in 1986, medical and health care aspects ofdrug abuse were not separately earmarked! Inspite of this,the Ministry of Health and Family Welfare initiated severalmeasures along with the Ministry of Welfare. It was statedearlier that in India’s federal system, public health care isa responsibility of the States. Thus the central healthministry assumed the role of coordinator and of providingpartial assistance to the programme. Over the years, theMinistry of Health and Family Welfare became involvedwith treatment and the Ministry of Welfare with counsellingand rehabilitation.

Under the NDPS Act, an advisory committee called theNarcotic Drugs and Psychotropic Substances ConsultativeCommittee was constituted in February 1988 to formulatea national policy towards drug abuse control measures.The Committee (20 members) was broad based andincluded members of parliament, professional experts,social scientists, and secretaries of all concerned centralgovernment ministries. A National Fund for Control of DrugAbuse was established. Several other measures followed.

The central government constituted a Cabinet Sub-Committee in April 1988 and in August 1993, anotherhigh level committee with members of parliament, expertsand senior level officers was constituted. Further, in orderto have effective coordination a committee of secretaries(Narcotics Coordination Committee of Secretaries) wasconstituted in March, 1994. The members are theSecretaries of the Ministries of Health and Family Welfare,Welfare, Department of Revenue (Finance), Home Affairsand the Director General (DG), Narcotics Control Bureau.

INDIA: NATIONAL DRUG CONTROL ACTIVITIES

Significant events:l NDPS Act - 1985l Creation of NCB - 1986l Formation of Expert Committee

(Ministry of Health & Family Welfare) - 1986l Consultative Committee - 1988l Cabinet Sub-Committee - 1988l Committee of Secretaries - 1994

INDIA: DEMAND REDUCTION ACTIVITIES

Nodal points of activity:l Ministry of Welfarel Ministry of Health and Family Welfare

Others:l University Grants Commissionl State health departmentsl Ministry of Human Resource Developmentl NGOs

On the basis of recommendations made by the ExpertCommittee (1986) and the Cabinet Sub-Committee (1988),five centres were established with central government(Ministry of Health) assistance. In July 1988, specificprogramme documents were developed on drug demandreduction as a collaborative activity between UNFDAC(now UNDCP) and Government of India. This project,“Development of Drug Abuse Prevention, Treatment,Rehabilitation and Control Measures”, for the years 1988-93 had sub-projects on prevention, treatment andrehabilitation. Programme A was to be implemented bythe University Grants Commission, programme B by theMinistry of Health and Family Welfare and programme Cby the Ministry of Welfare and NGOs. A detailed workplanlisting objectives, outputs, activities, budget andmechanism of implementation was worked out jointly.


There was rapid development of projects followed by aslow down from 1990 and these were initiated again in1992. The activities were reviewed by a team (nationaland international experts) in February 1994 (discussedbelow). In March 1994, a National Master Plan for drugabuse control in India was submitted.

INDIA: DEMAND REDUCTION ACTIVITIES

Important eventsProject on Development of Drug Abuse Prevention,Treatment, Rehabilitation and Control Measures.Joint activity between UNFDAC (UNDCP) andGovernment of India - 1988 onwards.A. Drug Abuse Prevention - University Grants CommissionB. Drug Dependence Prevention and Treatment - Ministry

of HealthC. Rehabilitation and Social Integration - Ministry of

WelfareDetailed Workplan Developed

Ministry of Health and Family WelfareOn the basis of recommendations made by the ExpertCommittee in 1986 and the Cabinet Sub-Committee in1988, five centres were established by the centralgovernment. Further, with assistance from UNFDAC(UNDCP), two regional centres were also established.These seven centres carried out several activities:l Treatment, with special emphasis on community based

treatmentl Development of health educational materiall Training of numerous medical and para-medical staff.

One of the centres served as a National Apex Centre andwas involved in carrying out several activities includingresearch. In October 1989, the assistance from UNDCPstopped. An interim workplan for 1990 was implemented,pending approval of the revised plan of activities(Government of India and UNDCP). Another nationalconsultant submitted its report of a work plan in March1990. Implementation of this report was also postponed.Meanwhile, between mid- 1992 and March 1994, theMinistry of Health and Family Welfare (hereafter,Ministry of Health), with assistance from UNDCP, startedproviding construction grants to various Stategovernments (Depts. of Health) to establish treatmentcentres. Some centres did receive token recurring grantsas well. By 1994, 27 centres in various States receivedassistance. Thus a total of 34 centres in various settings(medical colleges, district hospitals and prison hospitals)were established in various States. Most of these werefunctional in 1994, though not fully.

Eighteen of these institutions carried out several trainingprogrammes for health personnel with assistance fromUNDCP. During this period 32 courses were carried outand about 1000 doctors were trained, based on a formalcurriculum. Central observers were also present duringthese training courses. Between 1988 and mid-1994, 34centres were established.

MINISTRY OF HEALTH, GOVERNMENT OF INDIA

Treatment centresEstablishment of 5 centres - 1988by central governmentRegional Centres (2) - 1988State Centres (medical colleges,district hospitals) (27) - by 1994

In August 1994, a Training Master Plan was formulated.As a part of support services and with UNDCP assistance,6 treatment centres received laboratory instruments todetect drugs of abuse in body fluids. Thus clinical servicereceived additional support to monitor treatment progress.Additionally, 21 centres received ECG machines andvehicles to carry out community based activities.

MINISTRY OF HEALTH, GOVERNMENT OF INDIA

Activitiesl Treatmentl Community based treatmentl Health educational activityl Human resource development

Ministry of WelfareThe Ministry had encouraged establishment of counsellingand de-addiction centres by funding several NGOs acrossthe country. Further, public awareness campaigns, mediapublicity and community based action for identification,treatment and rehabilitation were carried out. Forawareness building, the following activities wereundertaken:l Audio-visual publicityl Development of print materialsl Press advertisementsl Out-door publicityl Distribution of materialsl Publicity through traditional media

Till end-December 1992, 145 counselling centres, 86 de-addiction centres and 14 aftercare centres were supported


by the Ministry in 32 States and union territories of thecountry.

In 1991-92, 3,24,437 persons registered and were helpedthrough these centres; the numbers dropped slightly in1992-93 and 1,32,073 addicts were registered. However,these figures do not suggest the actual number of personsseeking help as more than one centre reported the sameindividual for three kinds of activities, namely counselling,de-addiction and aftercare.

MINISTRY OF WELFARE, GOVERNMENT OF INDIA

Centres established till December 1992Counselling Centres - 145De-addiction Centres - 86Aftercare Centres - 14

In 1991-92 - 3,24,437addicts were registered

Monitoring of the programme was carried out on a monthly/quarterly basis. On the basis of experience gained, stepswere taken to reformulate the plan for subsequent years(1992-97).

In 1989, the Ministry had sponsored a study covering 33cities to assess the drug abuse situation in the country. Thereport was made available in 1992 and the findings havebeen reported in chapter II. However, in the absence of acentral coordinating executive organization, thecapabilities were under utilized.

MINISTRY OF WELFARE, GOVERNMENT OF INDIA

Activitiesl Awareness buildingl Community based action for identification, treatment

and rehabilitationl Human resource development in drug abuse prevention

NATIONAL MASTER PLAN (1994)The team responsible for the development of the NationalMaster Plan (NMP) reviewed the current (1994) drug abusesituation, available facilities, existing legal andadministrative arrangements and measures initiated by theMinistries of Welfare and of Health and Family Welfare.The team proposed a comprehensive plan, sector-wise, forthe years 1994-2000 for both demand and supply reductionactivities.

The team noted that the proposed 7-year period of theNMP overlaps with the time period of two nationaldevelopmental plans covering the years 1992-97 (8th Plan)and 1997-2002 (9th Plan). The allocations for health andsocial welfare activities for the 8th Five Year Plan wereexamined.

The team made several recommendations. Theseincluded developing an appropriate administrativemechanism for the National Drug Abuse ControlProgramme in the Ministry of Health and the creationof a coordinator for voluntary activities of drug abusecontrol in the Ministry of Welfare. It suggested activitiesfor these ministries.Ministry of Health:l establishment of national and State apex centresl establishment of Drug Abuse Monitoring Systeml establishment of treatment centresl development of several levels of treatment modalities

(brief to intensive)l establishment of maintenance programme for opiate

dependent subjectsl human resource developmentl establishment of laboratory services (drug abuse

screening)l development of health educational materiall surveillance of supply and use of psychotropicsMinistry of Welfare:l establishment of national centre for drug abuse

preventionl development of comprehensive awareness schemel preventive education for several population sub-groupsl development of treatment centres in the NGO sectorl providing treatment facilities in prisonsl development of pilot projects on rehabilitation of drug

abusersl training of personnel in drug abuse prevention

It is obvious that there is some degree of overlap regardingthe proposed roles and activities of the two ministries.Estimated expenditure, and phasing the mechanism ofmonitoring and evaluation were also suggested. Plans forthe health sector contained a State-wise framework,keeping in mind the role of State health departments andlocal problems that are unique to a given State. This planis at the draft stage and yet to be formally adopted by thegovernment. However, it has been examined by theconcerned ministries and departments and several activitieshave been strengthened and new initiatives undertaken,on the basis of this draft version.

The activities on demand reduction have been reviewedby several committees, both formally and informally. Aformal evaluation in 1994 revealed that :


l Overall, budgetary utilization was low.

l There was slow pace of implementation due to severalfactors, namely inadequate monitoring and review, andfrequent change of staff in key ministries.

l The quality and range of services were limited. It wasfelt that low cost intervention strategies should havebeen tried and the activities should aim to target bothdependent and non-dependent individuals.

l Primary prevention activities needed to be broadened.At that time it was mostly “warning” young people toprevent initiation. A shift to promoting a drug free,healthy lifestyle was suggested.

Recommendations were made to:l establish a national resource centrel emphasize the building of technical capacitiesl promote research.

Inspite of these views, the evaluation team felt that somevery useful steps had been initiated by 1994. UNDCP’s roleas a catalyst had resulted in the initiation of several measuresby both the central and State governments. As a matter offact, it was noted that quite a few activities initiated couldfunction without the support of any external agency. Hencethese gains were sustainable and the programmes did receivesome priority both in the health and welfare sectors. Theseachievements are enumerated below.

INDIA: NATIONAL MASTER PLAN, 1994

l Proposals for both supply and demand reductionactivities, 1994-2002

l Overlapping responsibilities for Ministry of Healthand Ministry of Welfare for demand reduction

ACHIEVEMENTSAchievements and progress made can be seen from severaldocuments and the terminal report prepared in October1996.

Ministry of Health and Family Welfare(see table 15)1. An office of the Project Manager for programme

planning, coordination, implementation, review andmonitoring was established in 1993. It was initiallyfunded by the UNDCP. From 1995 it has been fundedby the Government of India. This cell has 3 dedicatedstaff (full-time), the most senior rank equal to that of adeputy secretary.

2. A course curriculum for:a) general duty medical officers was developed in October

1988 and several institutions have carried out trainingprogrammes (3 weeks duration each). These are stillcontinuing with the Government of India’s initiatives. Amanual for doctors has been developed and is in press.

b) nursing personnel was developed in October 1995,and till date two such programmes (3 weeks duration)have been carried. One of them was for master trainers.

c) laboratory personnel for detecting drugs of abuse inbody fluids was developed in March 1992. Two suchprogrammes have been held. A manual for laboratorytechnicians has been developed and is in press. Acurriculum for training persons from both health andwelfare ministries was developed in August 1994 asthe Training Master Plan. This plan has been furtherexamined and suitably modified to build nationaltechnical capacities. Currently, this is being examinedby UNDCP and the ministries for implementation.

3. A total of 72 centres in various States were establishedtill March 1997. These are at various sites: medicalcolleges, district hospitals and civil hospitals. Theseoffer clinical services and varying degrees ofinterventions, acute and long term care with out-patientfollow up. The therapeutic approach consists ofjudicious use of short term/long term pharmacotherapyand psychosocial interventions.

4. Four centres in the country (medical colleges) areequipped to carry out both qualitative and quantitativeestimation of drugs of abuse in body fluids. They arefully functional. Another six centres have receivedsupport from UNDCP to start laboratory services,though these are not yet operational.

5. Several health educational materials have beendeveloped by individual institutions. These arebooklets, leaflets, pamphlets, and several TV and radioprogrammes have been carried out (see Box Item-37in chapter XI).

An important project in this regard was carried outjointly by All India Radio, Indian Council of MedicalResearch, and De-Addiction Centre, All India Instituteof Medical Sciences. This programme, Radio-DATE(Drug, Alcohol, and Tobacco Education), had 28episodes and was aired at prime time. These weresimultaneously broadcast in 16 regional languages andhad registered listeners (14,000) who received printedmaterial before airing.

6. A suitable data collection system, Drug AbuseMonitoring System (DAMS) has been developed and


aim at providing comprehensive services at thecommunity level, involving government medicalinstitutions/health infrastructure, NGOs, local self-government bodies (Panchayat, Zila Parishad), officeof the district administration, District Magistrate (DM),Sub-Divisional Officer (SDO), Block DevelopmentOffices (BDO), Community Development Officer(CDO) and others, office of the district policeadministration (Superintendent of Police), office of theDeputy Narcotics Commissioner (DNC). In otherwords, the project is an integrated approach involvingofficials from both demand and supply reductionactivities at the district level. One of the premiermedical institutions and the Ministry of Health act asagencies for execution, advice and monitoring. Theactual implementation is being done by the districtbodies. Each district has a local coordination committeeto carry out various activities. By and large, the districtcommittees are headed by District Magistrates. Thevarious activities being carried out are: survey to assessthe magnitude of the problem; delivery of treatmentand aftercare services; community awareness building;health education; integration with other parallelprogrammes of the government; and integration withsupply reduction activities. The actual activities beganin February 1996. Another unique aspect of the projectis that the action plan/programme activities aresuggested by the local coordination committee and atop-down approach is not followed. As has beensuggested by local bodies, technical capacity building

has been pilot-tested in three cities over three years(see data provided in chapter II). Efforts are now on todevelop it as a national activity and use the NationalInformatics Centre (NIC) of the government, utilizingits satellite network.

7. A number of research studies have been carried out ona) epidemiologyb) treatment and outcomec) biological studiesd) other clinical issues.These have been funded by national and local researchbodies and are discussed in various chapters (II, VIII,IX and XV).

8. Several national/regional workshops have been heldto strengthen delivery of service facilities. Specialemphasis was laid on activities needed in N.E. States,and strategies for harm reduction. These have focussedon development and review of course curriculum andtraining programmes, demand reduction with emphasison harm minimization, abuse potential ofbuprenorphine, rational use of psychotropics, cannabishealth damage and therapeutic usefulness.

9. New initiativesa) Over the last two years, as a part of innovative

approaches, community based pilot projects have beeninitiated in three districts. Two of the districts are licitpoppy growing areas of the country. These projects

TABLE 15: Ministry of Health and Family Welfare, India

Activities and Achievements

1 Establishment of office of the Project Manager 19932 Human Resource Development

a) Training of Medical Doctors: Uniform Curriculum, 1988 Review of Curriculum (1996), Manual - in press (1997)b) Training of Nurses 1995c) Training of Laboratory Technicians: Manual - in press (1997) 1992

3 Treatment centres established in various States (upto March, 1997) 724 Laboratory for drug abuse

a) Screening centres 4b) Additional, expected to be functional soon 6

5 Development of Health Educational Materials6 Establishment of data collection system (DAMS)7 Several research studies8 National/regional workshops (upto 1996) 169 District level rapid assessment surveys 610 Community based pilot projects 3Source: Terminal Report, 1996; Ministry of Health and Family Welfare, 1997


has been given priority. As a result, training of severalcategories of persons has been carried out. It is hopedthat the activities will be carried out with Governmentof India assistance for 5 years. Subsequently the Stategovernments or local bodies should be able to fundthe activities; only then is the project sustainable andviable. Periodic reviews are carried out by field visitswith formal mechanisms, i.e. proforma/schedules todocument change of perception of community leaders,progress and outcome following treatment. An interimevaluation report for the period upto July 1997 isavailable with the Ministry.

b) Over the last six months, another project is in progressin three other districts of eastern and north eastern Indiawith the assistance of WHO. This project has twocomponents:l Survey to assess magnitude of the problem.l Ethnographic observations by interviewing selected

number of drug users (mostly heroin addicts). Theproposed plan of action is to record various factorsresponsible for initiation, and maintenance of druguse, societal perception and cultural factors relatedto drug use. Projects to interview some “ex-addicts”to understand the factors responsible in achievingdrug free status are also planned.

Ministry of Welfare (see table 16)During the seventh Five Year Plan (1987-92), the Ministryof Welfare was promoting a community based approachtowards drug abuse prevention. In October 1994, duringthe eighth Five Year Plan (1992-97), certain changes werebrought about. The de-addiction and aftercare centres wereamalgamated into de-addiction cum rehabilitation centres,while counselling centres were converted into drugawareness, counselling and assistance centres. Industrialworkers and intervention at worksites (see Box Item-29)were also initiated. NGO forums in each city wereproposed. Under this scheme, financial assistance was

available to these centres. Additional activities pursuedwere de-addiction camps, preventive education andmanpower development.

1. The National Institute of Social Defence (NISD), aninstitute directly under the Ministry of Welfare,established a Bureau of Drug Abuse Prevention. TheBureau, with its small staff, was responsible for assistingthe Ministry in policy formulation, programmedevelopment and human resource development. ATraining Master Plan (1994) has also been developed.This has been further modified to enhance nationaltechnical capacity building.

2. By March, 1997, the total number of centresestablished were 341. Out of these, 218 were drugawareness centres and 123 were de-addiction cumrehabilitation centres. During the year 1996-97 about0.3 million subjects were registered and about 0.1million were detoxified. The expenditure from thegovernment increased to Rs. 110 million (1995-96)from Rs. 80 million (1992-93).

3. Several radio and TV programmes were carried out. Anumber of films were produced and several NGOswere given grants to undertake preventive educationamong specific target populations. These includedradio spots, phone-in-programmes, telefilms (3), docu-dramas, slogans/messages on railway tickets, postalstationery, posters and comic books.

4. One of the NGOs carried out several anti-narcoticpantomime plays using mobile teams.

5. In Rajasthan (western India - traditional opium use area)one of the NGOs carried out surveys, de-addictioncamps, and awareness building activities. The attemptwas to develop a drug free community.

TABLE 16: Ministry of Welfare, India

Activities and Achievements

1 Establishment of Bureau of Drug Abuse Prevention (under NISD)2 Total number of centres established (till March 1997) 341

a) Drug Awareness Centres 218b) De-addiction cum Rehabilitation Centres 123

3 Several Radio/TV programmes4 Anti-Narcotic Pantomime Plays5 Comprehensive demand reduction activities in one centre (Rajasthan)6 Training courses carried out (1988-96) 2557 Umbrella Equipment Project (no. of Centres) 140


6. NISD conducted several training courses of variableduration (between three days to two months). A totalof 255 courses of the above types were held between1988 and 1996. Majority (53 per cent) of these wereof one week duration.

7. Under the “Umbrella Equipment Project”, the Ministryrecommended the names of 95 counselling centresand 45 de-addiction centres for receiving variousmedical and other equipment. These items includedX-ray machines, ECGs, VCRs, refrigerators, musicsystems, typewriters and laboratory equipment.However, laboratory equipment were provided onlyto six NGOs. Mobile exhibition vans were suppliedto seven NGOs.

Summarizing, from the activities undertaken by the twoMinistries on demand reduction activities, the teamresponsible for preparation of the Terminal Report (period:upto September, 1996) concluded that:l There has been a significant upgradation in the

capabilities of the concerned departments.

l The achievements were visible and assistance from andinvolvement of UNDCP acted as a vital catalytic factor.Drug abuse control including demand reductionactivities did receive higher priority and created greaterawareness in the government.

l A number of institutions had come into existence bothin the government and NGO sectors. These centresare functional in different regions of the country.

l Human resource development (training of severalcategories of staff) took place through establishedinfrastructure of high quality. There is now a vastpool of trained manpower to undertake variousactivities.

l The policy and programmes for future developmentwere clearly formulated and clearly stated in the draftNational Master Plan.

l The Ministries (Health and Welfare) had developedtheir own programmes with budgetary allocations frominternal resources. Thus external assistancesupplemented these endeavours.

Several shortfalls in outputs were also noticed:l The activities under the project “Prevention of Drug

Abuse through Education” were not carried out, thoughboth ministries, of health and welfare, carried outseveral community based preventive and healtheducation activities for the general population.

l The funds for activities on “Drug DependencePrevention and Treatment” in the health sector weregenerally underutilized and only 13 per cent of thetotal budget (UNDCP) was used. However, the mosthealthy sign was that the Ministry of Health spentapproximately Rs. 125 million from 1992 onwardseven though the proposed allocation was Rs. 48 million.It was stated earlier that most of the activities related todelivery of health care come under the preview of Statehealth departments; thus the role of the central healthministry is restricted to policy formulation, acting as afacilitator and providing suggestions, guidance andassistance, mostly non-recurring. There were othercompeting national programmes and most oftencommunicable disease received priority. Inspite of this,resources were generated internally. However, thetreatment centres in the States had an acute shortage ofstaff, paucity of funds and the activities did not receiveadequate priority in State health departments.

l About, 64 per cent of the funds (UNDCP) allocated forthe project “Rehabilitation and Social Integration” wereutilized. Here too, the Ministry of Welfare spentapproximately Rs. 424 million between 1992-96, asagainst the proposed Rs. 67.5 million.

l Postponement of funding led to delays and non-utilization.

l Though other activities for demand reduction didreceive some priority, it was still not optimal. Thussustained and high profile activities were not visible.

TERMINAL REPORT: UNDCP FUNDEDPROJECTS, INDIA (1996)

Demand Reduction ActivitiesShortfalls:l Project on prevention through education not carried

outl Prevention activities carried out as part of other

activitiesl Overlapping functions in the two ministriesl Underutilization of funds (UNDCP)l Low level of priority by central/State governments

NEPAL

It was stated in chapter II that currently major drugs of abusein the country are heroin, cannabis and psychotropicsubstances. Since the emergence of escalating heroin usein the late 1970s, Nepal has initiated several important steps


to control and prevent drug abuse. The Narcotic DrugsControl Act was framed in 1976 and amended in 1981 and1987. The Act is comprehensive and covers both supplyand demand reduction activities, aiming towards overallhealth and economic well being of the people.

The Ministry of Home Affairs is the focal agency for allactivities related to drug abuse control. The National Co-ordination Committee for Drug Abuse is the highest bodyin the country and is chaired by the Hon’ble Minister forHome Affairs. This Committee is responsible for formulatingnational policy. An executive committee under the aboveCommittee is entrusted with the responsibility of executionof the approved policy. The Chief Narcotic Drug ControlOfficer is the head of this executive committee.

NEPAL: NARCOTIC DRUGS CONTROL ACT,1976 (Amended 1981,1986)

Focal Agency - Ministry of Home AffairsNational Coordination CommitteeChief Narcotic Drug Control OfficerNational Master Plan for Drug Abuse Control, 1992

With regard to demand reduction activities, the plan,programmes and strategies are outlined in these documents:l National Master Plan for Drug Abuse Control - 1992

l Sector Plan for Treatment, Rehabilitation and otherDemand Reduction Activities - 1992

l National Drug Control Policy - 1995

l National Drug Demand Strategy - 1996-99.

NEPAL: DEMAND REDUCTION ACTIVITIES

Sector Plan for Treatment, Rehabilitation and PreventiveEducation - 1992

National Master Plan, approved and implemented - 1995Drug Abuse Demand Reduction ProjectProject Steering CommitteeMost demand reduction activities carried out by NGOs

The National Master Plan was jointly developed by theHMG/N (His Majesty’s Government, Nepal) and UNDCPin 1992 and has been approved and implemented sinceJanuary, 1995. Following this, Drug Abuse DemandReduction Project (DADRP) was launched and now hasan office at the Teaching Hospital, Tribhuvan University.

The National Master Plan proposed that all demandreduction would be implemented by the Ministry of HomeAffairs in cooperation with the Ministry of Education, andNGOs involved in providing treatment. A Project SteeringCommittee was to implement the various proposedactivities under the overall supervision of the NationalExecutive Committee. The Master Plan addressed thefollowing issues :l Objectives - developmental, immediatel Expected end-of-project situationl Target beneficiariesl Project strategies and implementation arrangementsl Outputsl Budgetary requirements

Various activities for treatment and rehabilitation,preventive education and information were outlined. Theneed for consultants for the above two broad activities wasproposed.

POLICY CHANGES (see table 17)Initially, subjects with drug dependence were treated inpolice custody with short term interim measures. TheNational Drug Demand Strategy (1996-99) proposed toabolish these custodial services and replace them withtreatment facilities within the existing health care deliverysystem. However, because of paucity of resources andinfrastructure, the government delegated most of theresponsibilities related to demand reduction activities tothe NGOs. These include detoxification, rehabilitation andaftercare service, though the NGOs did not receive muchmoral or financial support from the government.

NGO ResponseA number of NGOs are providing detoxification and othertreatment services. Till date, 5 NGOs are providingtreatment though there are 81 registered NGOs, and mostare not active. Between these 5 NGOs, 102 beds areavailable. Additionally, 12 beds are available in onetreatment centre in the Teaching Mental Hospital(government centre). Many of these centres have developedprogrammes complementary to each other and carry outlow cost intervention strategy.

Of special interest would be treatment facilities for methadonemaintenance and needle exchange programmes. Theseare discussed in the chapter on treatment (chapter VIII).

Preventive Education and InformationThe National Master Plan recommended that it wasnecessary to formulate a coherent policy towardspreventive education. The Ministry of Education wasexpected to develop curriculum for schools, and audio-visual aids as preventive packages. Training programmes


for parents, teachers, community leaders, police officialsand other key functionaries were proposed.

Several TV spots (Nepal TV), jingles (Radio Nepal) andtelefilms have been developed. Various social groups andthe Nepal Medical Association have participated in theseactivities. School based programmes, and training ofcommunity leaders have also been carried out.

Resource ScarcityNepal is faced with a number of severe constraintsregarding its social and economic development. Despite aseries of concerted efforts, very little impact has been madein terms of raising the living standards of a great majorityof people. Thus government resources for demandreduction activities are scarce. It will therefore be necessaryto obtain support from the private sector and increaseexternal assistance for control of drug abuse.

ACHIEVEMENTS (see table 18)The National Master Plan led to the development of theNational Drug Demand Reduction Strategy for the years1996-99. This strategy document was developed by a groupof experts representing people working on drug abuseprevention, health care professionals, teachers, trainers,media persons, youth and drug dependent persons inOctober/November 1995. Objectives, activities, timeframes and earmarking of responsibilities were proposed.

Separating the two major demand reduction activities; a)preventive education, and information, and b) treatmentand rehabilitation was proposed (table 17). Under the sub-project on preventive education, provision of school basedprogrammes and those for non-student youth, preventionand intervention at work site, human resource developmentand regular research activities were proposed. Under thesub-project on treatment, cost-effective treatment andrehabilitation services in various settings including prisons

were proposed. Additionally, mandatory treatment, drugsubstitution programmes and other harm reductionmeasures, human resource development and ongoingresearch were also proposed.

Both formal and informal evaluations were carried out atvarious stages. An evaluation carried out in 1996 revealedthat several treatment centres were operational. Theseincluded a therapeutic community in a jail, a communityrecovery centre, drop-in centre and a detoxification centreat the Tribhuvan University Teaching Hospital, a zonalhospital. NGOs (Drug Abuse Prevention Association Nepal- DAPAN) had received financial assistance from thegovernment. A number of surveys (RAS, study of womendrug abusers) were carried out and enhanced the knowledgeof the current drug abuse situation. A project involving lowcost technology for treatment and rehabilitation has beencarried out and was found to be successful. Various activitiesin this project were women’s literacy classes, workshops,vocational training and production of telefilms.

As regards preventive education, a National Drug ControlPolicy has been approved by the Cabinet and this wouldprovide the framework for drug control policy in thecountry’s 9th National Plan (1997-2002). A wide range ofeducational materials for both formal and non-formalsystems of education have been developed. Several trainingprogrammes (1-5 day) for teachers, trainers, and voluntaryworkers have been carried out.

Additionally, the climate and quality of relationshipsbetween various administrative offices has been verycordial. It was further seen that most of the achievementstook place between mid-1995 and end-1996; the progressbefore this period was slow. Overall, the project made asignificant contribution. However, in order for it to besustainable UNDCP’s presence and continued assistancewas thought to be very crucial.

TABLE 17: National Drug Demand Strategy (1996 - 99), NepalObjectives

Preventive Education Treatment and Rehabilitation

Funding for NGOs (DAPAN)School based programmes Cost-effective treatmentProgrammes for non-student youth Treatment in prison and other settingsPrevention at worksite Mandatory treatmentHuman resource development Drug substitution programmesResearch Harm reduction strategies

Human resource developmentResearch

Source: National Drug Demand Strategy, HMG/N and UNDCP, 1996


SHORT FALLSDuring evaluations some cause for concern was noted.Even though an office of the Programme Coordinator(DADRP) of the project has been created, staffing level islow. Thus effective coordination was lacking. Monitoring,support and clarity of roles between HMG/N and NGOsand HMG/N and UNDCP needed improvement. TheProject Office needed upgradation, including basichardware. The evaluation team suggested several measuresfor effective functioning. These included:

l Continued support from UNDCP

l A new sector plan for demand reduction was required,as the current project was likely to be completed beforethe scheduled time and activities should be expanded.

l The Social Welfare Council, and health and educationministries need to be more involved.

l Resources for training and infrastructure developmentshould be extended by the government.

l NGOs required more support.

l The curriculum developed should be incorporated intotextbooks at the earliest.

Nepal in a span of two years (1995 and 1996) has madesignificant progress towards demand reduction. Severalprojects have been launched and are ongoing both ontreatment and rehabilitation, and preventive education.The adoption of a work plan clearly indicates thecommitment of the government to address drug problems.As a matter of fact, as per the plan, demand reductionactivities may be completed ahead of time and a newsector plan is needed. However, without the support ofexternal agencies, notably UNDCP, these initiatives arestill not sustainable. Increased involvement of the HMG/N and higher resource allocation would be needed for

effective implementation and to achieve the targetedobjectives of the National Drug Control Policy and theNational Drug Demand Strategy.

SRI LANKA

The Government of Sri Lanka became concerned aboutgrowing drug problems as early as the 1970s. For effectivecontrol, a National Narcotics Advisory Board wasestablished in 1973, to advise on various drug controlmeasures. In the early 1980s, the problem of drug abusegrew and the government initiated the process offormulating a comprehensive national policy to controldrug abuse. As a result, in April 1984, the Parliamentenacted the National Dangerous Drugs Control Board Actand created the National Dangerous Drugs Control Board(NDDCB) under the Ministry of Defence. Since then, theNDDCB has been the focal point of all activities related todrug abuse control. The Board is a multi-member bodyand has representation from the departments of education,health, police, customs, as well as government analystsand experts on the ayurvedic system of medicine.

SRI LANKA: NATIONAL DRUG ABUSECONTROL PROGRAMME

Important eventsNational Dangerous Drugs

Control Board Act - 1984National Dangerous Drugs

Control Board (NDDCB),Ministry of Defence - April, 1984

National Policy formulated - 1990NDDCB the focal point of all activities

A National Policy was formulated by the NDDCB, and itsother activities included enforcement, preventive

TABLE 18: National Demand Reduction Activities, NepalAchievements

Preventive Education Treatment and Rehabilitation

Development of National Drug Control Policy Establishment of treatment centresPolicy paper on preventive education Therapeutic CommunityDevelopment of educational materials Drop-in centre; methadone maintenance

(formal and non-formal education) Needle exchange programmeDevelopment of curricula Detoxification centreSeveral training programmes conducted Low cost intervention strategy

Development of support systems for NGOs


education, public awareness, treatment and rehabilitation,aftercare, research, training, drug abuse testing andinternational and regional cooperation. The above activitiesare carried out by various divisions of the Board. As regardsdemand reduction, preventive education and treatment arethe identified activities. In 1985, the Board set up varioussub-committees for assistance. The role of NGOs wasappreciated very early on and was encouraged forinvolvement in demand reduction activities. As a result,in January 1986, the Federation of Non-GovernmentOrganizations Against Drug Abuse (FONGOADA) wasborn. The Federation, an umbrella organization, is a legalbody, and is mandated to contribute to the following:1. Establishment and development of a working

relationship with GOs and NGOs.

2. Collection, collation and dissemination of informationon drug abuse, treatment and prevention modalities.

3. Coordinate activities of NGOs, national andinternational organizations.

4. Suggest policies and strategies to achieve a drug freenation.

5. Assist in the development of effective treatment andprevention strategies.

6. Raise funds to carry out various activities.

FONGOADA has eight full-time agencies as its membersfor anti-drug activity and another 14 service centres. TheFederation has grown over the years and has a very fruitfulpartnership with NDDCB.

SRI LANKA: DEMAND REDUCTION ACTIVITIES

FONGOADA - established January, 1986l Umbrella organization of NGOsl Legal bodyl Preventive education and awarenessl Involvement of other government bodies

FONGOADA is a member of the International Federationof NGOs against Drug Abuse (IFNGO) and brings togetherboth GOs and NGOs to participate in demand reductionactivities. However, there are a few non-FONDOADAorganizations who also carry out demand reductionactivities.

In the government sector, the ministries of health, labourand vocational training, social services, education and

cultural affairs and information are involved in a majoreffort to carry out various activities.

PREVENTIVE EDUCATION AND PUBLIC AWARENESSFor these activities, NDDCB, ministries of education,cultural affairs and information, labour, social welfare,public administration, youth affairs and sports, and NGOsare the implementing agencies. The strategies involveeducation through mass media, prevention through formaleducational institutions, work place prevention, vocationalskill training and promotion of leisure time activities.

TREATMENT, REHABILITATION AND AFTERCAREThe team involved in the preparation of the National MasterPlan (NMP) noted that till the late 1980s, treatmentmodalities were highly medically oriented, beds availablewere limited, no serious effort was made towardsrehabilitation, and services in the NGO sector were notorganized. During the early 1990s NGOs began a highlysystematic programme consisting of counselling, treatmentand rehabilitation. The camp approach was quite popular.In 1993, there were five NGOs offering treatment/rehabilitation at 120 sites. NDDCB was directly involvedin offering services through four centres. Additionally, theprison department was involved in providing care to drugdependent individuals through an “open-prison”programme.

NATIONAL MASTER PLAN, SRI LANKAThe Sri Lanka National Master Plan (1993) is an effort todevelop an action plan to implement the alreadyformulated National Policy for the prevention and controlof drug abuse. The Master Plan proposed implementationin four phases. Phase 1 would consist of linking problemsand needs, phase 2 would secure broad politicalcommitment, phase 3 would strengthen administrativemachinery, and phase 4 would carry out selected (demandreduction) activities. A policy and plan for control oftobacco and alcohol consumption in addition to illicitdrugs were also stated. For all programmes includingdemand reduction, specific objectives, activities,implementation, resource requirements, monitoring andevaluation were proposed. FONGOADA and other NGOshave been identified primarily for preventive education,and NDDCB, GOs and NGOs are responsible fortreatment and rehabilitation.

Various activities and strategies proposed for preventionare educational programmes using mass media to impartrelevant knowledge, foster a positive attitude and improvecoping skills, particularly directed towards youth. It wasproposed that preventive education should be attemptedthrough both formal and non-formal education systems.


SRI LANKA: PREVENTIVE EDUCATION

Suggested Activities, NMP (1993)Educational programmes through mass mediaImprove coping skillsPromotion of leisure time activitiesFormal and non-formal educationTarget group: youth, work force

For treatment and rehabilitation, it was proposed thatdetoxification and other modalities of treatment should beintegrated with rehabilitation and aftercare. These shouldbe supported by counselling and other psychosocialinterventions. Specific objectives, activities, implementationand a monitoring mechanism were suggested. NDDCB, GOand NGO treatment centres would be responsible forcarrying out these activities. NDDCB has already initiatedtreatment and rehabilitation centres in three major citiesin Sri Lanka. It was proposed that a comprehensivetreatment programme should be developed andimplemented by the health sector. Community support andmobilization would be essential for follow-up andrehabilitation. Till date, four government treatment centreswith a total capacity of 143 beds and seven counselling /rehabilitation centres with 30 beds have been established.These are centres dedicated for de-addiction. Further, thereare three training institutions for training on various demandreduction activities.

SRI LANKA: TREATMENT AND REHABILITATION

Suggested Activities, NMP (1993)Strengthen NDDCBCollate informationPromote awarenessEstablish criteria for funding NGOsEstablish national training centre

Specific projects, mechanisms for strengthening awarenessrequirements, were also proposed. Special emphasis wasplaced on delivery of care through non-medical persons,training of health care staff, establishing a drug abusemonitoring system and sensitization of key employees asregards vocational rehabilitation of recovering addicts.

BHUTAN AND MALDIVES

It has been stated earlier that as of now Bhutan andMaldives are the least affected countries in the sub-region.

Cannabis products are the only drugs which have beenreported most often. Both these countries are party to theSAARC Drug Control Convention and have participatedin previously held workshops on drug abuse control in1995 and 1996. In a recent workshop on relapse prevention(SAARC meeting, New Delhi, September, 1997) the countryreport from Maldives showed that the Ministry of Healthhas proposed a comprehensive plan for counselling,treatment, education of general population and a schoolbased preventive education programme. Governmenthospitals have been recommended for treatment, and theresponsibility of preventive education falls on NGOs. Asingle NGO is currently active. In the coming year it isproposed to expand these as community based activities.Further details on treatment and delivery of care in Maldivesare discussed in chapter VIII.

REGIONAL DEVELOPMENT ANDCOOPERATION

It is evident from the review of national drug demandreduction programmes that even in the absence of preciseinformation on the extent of the problem, most countries inthis region have initiated several steps to control drug abuse.Significant advances have been made, and quite a few thingshave been achieved. Master Plans have been formulated byBangladesh, India, Nepal and Sri Lanka and have beenadopted by their governments. India, however, is yet toformally adopt it own plan, though several measures havebeen initiated on the basis of the draft. National Master Plansprovide the basic framework to develop strategies andprogrammes. In Nepal and Sri Lanka, national policies ondrug abuse control have also been drawn up. Followingthis, strategy plans have been formulated (in Bangladesh,Nepal). Development and implementation of the NationalMaster Plans and strategy plans have required a high levelof involvement and resources from UNDCP. Nationalgovernments have also mobilized varied internal resources.However, in most countries, enhancement of literacy, generalwelfare programmes, control of infectious diseases, maternaland child health care, family welfare (population control)programmes receive higher priority, and understandably so.Therefore, drug abuse programmes have received lowpriority; this is particularly evident in comparison with thehealth sector programmes.

In relation to drug abuse control programmes, supplyreduction activities have received higher resourceallocation, though in recent times the importance ofdemand reduction measures have been realized. However,these two activities are often seen as separate and distinct.Only recently have some steps been initiated (viz. in India)to integrate the two. It has been observed that with harsh


penal measures for illicit compounds, people have startedabusing pharmaceutical preparations. Thus, abuse of awhole range of new products has emerged. Thesecompounds have medicinal value and cannot be banned.With strict control, genuine patients have often suffered;this was observed in the case of phenobarbitone in India.With stricter enforcement a few years back, availabilitybecame scarce and patients with epilepsy suffered the mostas it was their prescription drug (cheap and effective).

In the sphere of demand reduction, it is seen that preventiveeducation, and treatment and rehabilitation run parallel,with different agencies responsible for implementation. Itis encouraging to see that preventive education is currentlyreceiving greater attention. Most countries have felt that ahospital based “cure”oriented approach has led to thedevelopment of services for urban populations, resultingin the neglect of preventive and promotive aspects of care,including health care. Involvement of community basedorganizations and voluntary workers is very necessary forcarrying out effective preventive strategies. The role ofNGOs has been realized; most are encouraged and manyare very active regionally and have formed associations intheir respective countries. Sri Lanka has achieved the mosttowards organizing and motivating the NGOs, and bringingthem together. In Nepal, most of the demand reductionactivities are carried out by NGOs. However, therelationship between GOs and NGOs is yet to bestreamlined in these countries. In some countries NGOsreceive substantial support (e.g. India). These are thenextensions of government centres, as regards their financialsupport. Very few have mobilized resources on their own.In some countries, the support, both moral and financial,is minimal (viz. Nepal). Efforts by NGOs are discussed inchapter X and Box Items 30-35.

Many of these countries already have a vast network ofpublic health bodies for treatment through governmentcentres. The national programmes have attempted tointegrate drug demand reduction activities with them bycreating treatment facilities. A few dedicated centres havealso been established.

In all four countries (Bangladesh, India, Nepal and SriLanka), a nodal agency for overall drug abuse control hasbeen created. These are alligned with the Ministry of Home/Defence/Finance. Some have created nodal agencies ornational resource centres for demand reduction activitiesas well.

The Master Plans reflect the sensibility that control of drugabuse would have to be seen in the context of overallhuman development which includes measures likeimproved literacy, poverty alleviation, economic

development, availability of safe drinking water, goodsanitation and better quality of life. Drug addicts are oftenpeople of lower socio-economic status. Poverty,unemployment, poor educational achievements and lackof gainful employment are critical factors for initiation andcontinuation of drug abuse. Thus measures should beinitiated to address these issues. Demand reductionactivities in isolation are unlikely to show results. Finally,it is not out of place to reiterate that without the requisitepolitical will, drug abuse control activities will not receivehigher priority. Such political commitment would naturallylead to policy formulation.

In this region, religion, culture and strong family ties areassets in drug abuse control. There are several protectivefactors against drug use. These need to be identified andstrengthened to prevent drug use. For far too long we haveasked the question “Why do people take drugs”, and havecontinued with the “scare technique”. We also need toask why many people do not take drugs. There is enoughresearch data to suggest that education alone or the aboveapproach of instilling fear does not help. We need toformulate newer programmes for drug abuse preventionby promoting healthy lifestyles, alternate motivating factorsand strengthening traditional, cultural, and family values.

Regional and sub-regional cooperation is based on therecognition that certain problems related to drug abuse canbe addressed in a collaborative way by countries who havecommon borders, particular vulnerabilities or shared culturalties. Thus specific responses may not be identical to globalones. Such a move has already been made. Together withUNDCP, a sub-regional drug control cooperationprogramme for Central Asia (1996-99) has been signed.MOUs have been signed in other regions as well (UNDCP,1997). In this region all these countries are also members ofSAARC and have adopted the SAARC Convention onNarcotic Drugs and Psychotropic Substances. These ties havefurther been strengthened by the joint endeavours of SAARCand UNDCP in May, 1995. These two organizations canjointly help in formulating a regional action plan. In thisregard, institutional strengthening and human resourcedevelopment should receive the highest priority. Appliedresearch along with information sharing between identifiedinstitutions would lead to the refinement of policyformulations and improved strategies for drug demandreduction. These are further elaborated in Box Item-16.


BANGLADESH

1. National Master Plan, Vol. 1 (1991).

2. National Drug Demand Reduction Strategy (1995).

3. Five Year Strategic Plan (1995).

4. ‘Mid-term evaluation of UNDCP-Bangladesh DrugDemand Reduction Programme’ (1997).

INDIA

5. Ministry of Health and Family Welfare, Govt. of India(1983): National Health Policy.

6. Ministry of Health and Family Welfare, Govt. of India(1986): ‘Expert Committee—Report on DrugDependence Services’.

7. National Master Plan for Drug Abuse Control (1994).

8. ‘Mid-term evaluation of UNDCP-India Country Projecton Development of Drug Abuse Prevention, Treatment,Rehabilitation and Control Measures’ (1994).

9. Ministry of Health and Family Welfare, Govt. of India(1995): Drug Abuse - Consequence and Responses.India Country Report.

10. Ministry of Welfare, Govt. of India (1995): Drug Abuse- Consequences and Responses. India Country Report.

11. ‘Terminal Report on UNDCP Funded Projects’ (1996).

12. Ministry of Welfare, Govt. of India (1997): ‘CountryProfile—India’.

13. Ministry of Health and Family Welfare, Govt. of India(1997): ‘Drug Abuse in India’.

NEPAL

14. National Master Plan, Vol.1 (1992).

15. Sector Plan, Demand Reduction, 1993-95.

16. National Drug Control Policy, (1995).

17. ‘Evaluation—National Master Plan’ (1996).

18. National Drug Demand Strategy, 1996-99.

19. ‘Country Report’. SAARC Workshop on RelapsePrevention, 1997, New Delhi, India.

SRI LANKA

20. National Dangerous Drugs Control Board (NDDCB)(1991): Hand Book of Drug Abuse Information1981-89.

21. National Master Plan (1993).

22. NDDCB (1996): Handbook of Drug Abuse Information,1991-95.

23. NDDCB : ‘Sri Lanka National Policy for the Preventionand Control of Drug Abuse’.

OTHERS

24. WHO, ‘Programme on Substance Abuse—Action toReduce Substance Abuse’, 1991,1992,1993.

25. UNDCP-ROSA: Annual Field Report, 1996.

26. UNDCP-ROSA: Annual Field Report, 1997.

27. UNDCP (1997): World Drug Report. Oxford UniversityPress, New York.

RESOURCE DOCUMENTS


DRUG ADVISORY PROGRAMME OF THECOLOMBO PLANThe member governments of the Colombo Plan noted thatdrug abuse was posing a serious problem to the Asianregion, at the Colombo Plan’s 22nd ConsultativeCommittee Meeting held in New Delhi in 1972. It wasagreed to appoint a Drug Advisor to the Colombo PlanBureau who would consult with governments, assist in theorganization of seminars, workshops and similar activities,and help develop cooperative programmes designed toeliminate the causes and ameliorate the effects of drugabuse. The United States government offered to meet theexpenses of this Advisor. The Drug Advisor assumed dutiesin August 1973 and the programme of activities began.While the United Nations and other internationalorganizations were working on a global scale, the DrugAdvisory Programme (DAP) of the Colombo Plan took ona pioneering role directed towards the promotion ofeffective national, regional and sub-regional efforts intackling local and international problems and identifyingareas in which bilateral and multilateral assistance andcooperation would be required in the Asia-Pacific region.

To this end, the DAP established liaison (consultation andcoordination) with drug abuse/narcotics coordinatingbodies, prevention and control agencies of membergovernments, and regional and international organizations.Working arrangements and regular liaison/consultation wasestablished with the UN Commission on Narcotic Drugs(UNCND), UN Division of Narcotic Drugs (UNDND), UNFund for Drug Abuse Control (UNFDAC), UN Sub-Commission for Illicit Drug Traffic in the Near and MiddleEast, International Narcotics Control Board (INCB), WHO,ILO, FAO, UNESCO and other agencies.

Since it began, the DAP has organized, conducted,sponsored, co-sponsored or supported 92 activities. Theseinclude conferences, seminars, workshops, trainingprogrammes and development of training manuals. Inaddition, the organization has awarded study/trainingfellowships, with the aim of enhancing skilled manpowerand developing human resources in the field of drug abuseprevention and control of trafficking in narcotic drugs andpsychotropic substances (figure 8). More than 3200 officialsfrom member countries have been able to participate in

these programmes and gain knowledge, skills and expertise.The scope of activities covered under the two major areas,i.e. demand reduction and supply reduction are shown intable 19.

SOUTH ASIAN ASSOCIATION FOR REGIONALCOOPERATION (SAARC)In pursuance of a decision taken by the heads of state ofSAARC member countries during their summit meetingheld in Dhaka in December 1985, a Study Group meetingwas held to examine the problem of drug trafficking andabuse as it affects the region and to submit recommenda-tions as to how best the member states could cooperateamong themselves to solve the problem. The meetingagreed that cooperation between member states would beessential for effective prevention, control and eventualelimination of drug and illicit trafficking in South Asia.

NETWORKING OF BILATERAL/MULTILATERALAGENCIESThe Colombo Plan’s proposal to establish working relationswith the SAARC Secretariat (DAP Project 94-1; SAARCForum on the Role of NGOs in Drug Demand Reduction)was approved by the SAARC’s Standing Committee at itstwentieth session (New Delhi, April, 1995) and by theCouncil of Ministers at its fifteenth session (New Delhi,May, 1995).

In recent years, the DAP has started organizing joint projectsand collaborating with the United Nations InternationalDrug Control Programme (UNDCP). DAP organized aseries of legal workshops jointly with UNDCP Vienna andthe Commonwealth Secretariat with the aim of assistingthe signatory countries in the region to implement the UNConventions. As an area of immediate concern, a workshopon precursor regulation and control was held in Colomboin August, 1997 for participants from the South Asiancountries, jointly organized by UNDCP-ROSA and DAP.

In early 1996, in conjunction with the French Government,the DAP organized a training programme for the lawenforcement officers of Southeast Asian member countries.The Australian Federal Police provided the expertise for aTraining of Trainers Course on Drug Intelligence Collection,Analysis and Dissemination, organized by the DAP. This

BOX ITEM - 16

ROLE OF INTERNATIONAL ORGANIZATIONS IN SOUTH ASIA

Ravi Raj Thapa



training was done in two phases: the 1st phase for South Asiain April, 1995, and the 2nd phase for Southeast Asian countriesin November, 1997. Even though a non-member country,Brunei was given an opportunity for representatives toundergo training free of charge during this project. This trainingwas found very useful by recipient countries. The EuropeanUnion (EU), with the funding assistance and cooperation ofDAP, conducted the Forum Consultation Meeting in Colomboin November, 1996 for NGO participants in the South Asiaregion, supported by the EU. Daytop International Inc., USA,conducted several training programmes organized by DAPin the area of treatment and rehabilitation, introducing thetherapeutic community approach.

As the countries of the South Asian region are covered bythe UNDCP Regional Office for South Asia in New Delhi,

and these countries are also members of both SAARC andthe Colombo Plan, coordination, networking andcollaboration between these regional/international bodieswould be highly beneficial to the member countries; willenable the identification of specific needs; help developjoint efforts for better and effective programmes; andprevent wastage of resources.

In developing projects suited to the South Asian region,DAP used to organize programmes on a sub-regional basis,taking into consideration cultural, linguistic andgeographical constraints. However, since 1997, DAP hasintroduced ‘in-country’ training programmes in secondaryand tertiary prevention areas, especially in treatment andrehabilitation of drug addicts in correctional settings, andfacilitating the formation of ex-addict support group

TABLE 19: Scope of DAP’s Activities

DEMAND REDUCTION SUPPLY REDUCTION

I. Primary Prevention I. Organization and Conduct of International Conferences/Seminars/Workshops/Training Programmes

Training and exposure via 1. Sponsorship of Participantsa. Education/Awareness Programmes 2. Conducting Training Programmes for:b. Media Campaigns a. Intelligence Collection, Analysis & Dissemination

by Experts of Australian Federal Policec. Mobilization of NGOs against Drug Abuse b. Policy Development in the Administration &

Management of Juveniles/Minorsd. Women Counsellors c. Law Enforcement OfficersII. Secondary Prevention II. Legal Workshops Organized Jointly with UNDCP &

Commonwealth Secretariat to Assist Countries Implementthe UN Conventions

1. Forums and Meetings of Policy Makers2. Development of Training Guides & Manuals3. Training and support through/to:

a. Treatment and Rehabilitation (T&R)b. Trainers/Counsellorsc. National GO/NGO Projectsd. Management of T&R in Prisons/Correctional

Settingse. T&R of Juveniles/Minorsf. Mobile Camps

III. Tertiary Prevention III. Substance-specific Workshops and Trainings1. Support to Follow-up & Aftercare Programmes Control & Regulation of2. Training and Support in: a. Amphetamines

a. Relapse Prevention b. Precursorsb. Family Counsellingc. Re-entry & Aftercared. Formation of Ex-addict Support Groups

IV. Fellowships/Study Tours IV. Development of Manuals on Training of TrainersV. Collaborative Efforts with Regional & International Law

Enforcement Agencies such as Interpol, World Customs & DEAVI. Fellowships/Study Tours



networks. The advantages of conducting trainingprogrammes on an in-country basis are that (a) participantsfrom all relevant agencies within the country can be trained,(b) they facilitate networking among the national agenciesand encourage them for closer contact and cooperation,(c) by utilization of local resource persons and translatorsalong with outside expertise, they help participantsunderstand the contents better, (d) they encourage the hostcountry to play a role by being a co-sponsor and meetingsome of the local costs, (e) save on costly air fares, and (e)effectively manage scarce financial resources. Thisapproach also helps to plan better and effective follow-up.

Drawn from a needs assessment of member countriescarried out by DAP in 1996, figure 8 shows the trainingpriorities of member countries with regard to Demand

Reduction (DR) and Supply Reduction (SR). This may givesome ideas in planning future programmes and jointapproaches for the South Asian region.

As the UNDCP can now specialize in designing andorganizing specific programmes in the supply reductionarea, such as regulation and control of precursors andamphetamines in this region, the DAP is focussing itsattention on treatment and rehabilitation, follow-up,aftercare and relapse prevention areas, and is in the processof implementing projects in South Asian countries.

A joint approach and cooperation between the bilateral/multilateral agencies and international bodies in the SouthAsian region will have a greater impact, with enhancedbenefits for the recipient countries.


FIGURE 8: Training Priorities of Member Countries, Colombo Plan

DR - Demand ReductionSR - Supply Reduction

national drug programmes · 2003-04-28 · (ndps) act (1985) provides the current framework for...

Documents