Harm reduction programmes aim to minimize the negative impacts of illicit and licit drug use through evidence-based and cost-effective health and social services fully supported by UN and European agencies. People who inject drugs (PWID) are most vulnerable to HIV and hepatitis C (HCV) but high levels of stigma and discrimination by society, including healthcare workers, means that civil society organisations (CSOs) deliver harm reduction services as part of a national response.

Countries of South-Eastern Europe and the Balkans have experienced relatively high rates of HIV and HCV among PWID as well as new waves of drug injecting. For example, in Bucharest, Romania, closure of harm reduction services due to improperly planned transition from Global Fund support, and the influx of new injectable drugs, resulted in HIV increasing among PWID from 1.1% in 2009 to 53.3% in 2012.

Until recently, Governments have relied on the Global Fund to pay for harm reduction services but, as countries develop, the Global Fund is no longer the bank of last resort, with support ceasing for most countries as shown in the following table.

In most cases, the Global Fund has aimed to assist countries to transition HIV financing to sustainable national resources but has failed in most instances through a lack of flexibility and political will by the Global Fund and each Government. A recent analysis has identified common challenges facing the scale-up of harm reduction programmes in the region, including: (a) lack of connection between communicable disease programmes and drug strategies and the absence of PWID in the development of such plans; (b) reliance on very costly imprisonment for drug possession and use; (c) lack of access to health care services by PWID; (d) lack of Government awareness of cost savings by adopting a public health- and socialled approach to drug dependence; (e) endemic stigmatisation and discrimination of PWID leading to unfair and limited funding for harm reduction services; (f) no legal recognition of CSOs as service providers or a social contracting mechanism for Government to contract-out harm reduction services to CSOs; and, (g) no formal recognition by national health insurance mechanisms of CSO health services, resulting in PWID being unable to claim costs.

At the end of 2021, Correlation – European Harm Reduction Network, the Eurasian Harm Reduction Association and the Drug Policy Network of South-Eastern Europe, with the support of national organizations in the area, have conducted research on the impact of transition from Global Fund to Government support and opportunities to achieve sustainable harm reduction services for people who inject drugs in Albania, Bosnia and Herzegovina, Bulgaria, Kosovo*, Montenegro, Romania and Serbia. The following report, policy briefing and factsheet present and analyze current common challenges of scaling-up harm reduction programmes in the countries of South-Eastern Europe and the consequences of the limited funding of the harm reduction services for public health and national healthcare systems. Building upon this research, these publications highlight opportunities available for the governments of the region to act and invest funds and efforts in effective and proven models of harm reduction in their respective countries.

Please find a presentation via link https://www.correlation-net.org/hr_funding/ and pdf version of the document below, together with an executive summary and extract