10 by 20 campaign: Strategies for tracking and rebalancing investment in drug law enforcement and harm reduction Emily Rowe, Harm Reduction International 26 July, 2018 Thank you all so much for taking the time to attend our workshop today. We are sensitive to the fact that there are so many of us here, and as much as we would love to get to know all of you individually, and learn about the work we are doing, it doesn’t seem possible today, so please take one of my business cards, and feel free to contact me any time if you would like chat further, through skype or email. There are also a number of workable tools for how to track harm reduction investment and law enforcement expenditure which we would love to share with you and guide you further on how to possibly apply these tools in your country contexts. So thank you all once again for attending today. Just to introduce myself, my name is Emily Rowe and I work for Harm Reduction International, on the Global Fund Harm Reduction Advocacy in Asia project. The core objectives of the project is to Create an enabling legal and policy environment to support implementation of HIV and Harm Reduction programs for PWID, Strengthen community systems, in particular networks of PWID and harm reduction CSO’s to meaningfully engage in dialogue with key stakeholders for a sustained HIV and drug use response , Generate strategic information to shape advocacy for a health and rights based harm reduction response. HRI’s work within the project focuses on how to establish an evidence base for funding advocacy in the Asian region, and develop tools on law enforcement tracking. Today we will begin our learning by presenting on the objectives for documenting harm reduction investment and also on the tools that HRI has developed (as I mentioned please contact me via email any time you want to access the complete tools). I will also disseminate some information about on the kinds of indicators we can use to capture data on law enforcement in your countries. After I have presented on how to approach this kind of research, I will present on advocacy steps in order to effectively utilise data collected, through our 10by20 campaign. So that the work is not simply research for research sake, but becomes useful information for advocating for funds for harm reduction. After I have spoken we will work together with a number of peer facilitators- we have Rajiv from Asian Network of people who use drugs, Achiel from Rumah Cemara, an NGO based in Indonesia, Noy from OZONE Foundation Thailand and my colleague from HRI Naomi. You can recognise us by our lovely 10by20 tshirts. We may not have time for question and answer unfortunately but as I said please take my card or we can have a chat after the workshop.

The Global State of Harm Reduction Although harm reduction programs are being implemented globally, in many places these are small-scale/NGO-driven, reliant on donor resources and under threat from underfunding. Countries that have invested into cost effective and evidence based harm reduction approaches have seen a decline in BBV infections and improved health and societal outcomes. Evidence indicates that punitive drug laws and policies do not reduce drug use, and impede public health efforts to prevent drug-related harms.

Harm Reduction is Cost Effective When compared to investment into harm reduction activities, criminalisation and incarceration are expensive and ineffective. Furthermore, evidence suggests policing and punishment have had little or no impact on the number of people using drugs nor prevented millions of drug related deaths. Researchers and advocates continue to encourage shift in spending away from investment in punitive approaches to financing programs that inevitably prevent new HIV infections, save lives and prove to be more sustainable. A study into harm reduction investment was conducted in Thailand, Indonesia, India, Cambodia, the Philippines, Nepal and Vietnam Information obtained has provided valuable insight into current investment into harm reduction initiatives in the region The research worked to established whether current expenditure is proportionate to public health need within the context of national spend on HIV programming The information gathered through this research will inform national and regional advocacy efforts for increased strategic funding for harm reduction programming.

Why is the tool needed? Harm reduction programmes in many low and middle income countries are overly reliant on international donors for sources of funding. To ensure the sustainability of services, there is an urgent need for increased national government investment in harm reduction approaches. The tracking of international and national investment in harm reduction is essential to inform advocacy for increased resources for harm reduction. This information is challenging to gather as most donors and governments do not record or disaggregate their budgets in a way that is useful for monitoring harm reduction spend. The tool provides a template for assessing expenditure on priority harm reduction interventions and national spending estimates. Crucially, it provides researchers with options for data collection to account for differences and gaps in the available information. After obtaining data on funding we asked each of our country researchers to score/rank a number of factors related to harm reduction financing, color coding them as either green (to indicate the funding situation had a positive outlook, amber to indicate that the situation could go either way and red to indicate that the funding environment is critical.

What are our key questions? The harm reduction investment tool is designed to capture and estimate national spending on harm reduction programmes and antiretroviral treatment for people who use drugs What is the level and source(s) of current financial investments in harm reduction programming within the country? How is this money being spent? To what extent does funding go towards priority interventions such as needle and syringe programmes, opioid substitution therapy and antiretroviral treatment for people who use drugs? To what extent does this funding come from government and/or international donor sources?

What is the approach? The methodology includes a comprehensive list of indicators and provides various options for collecting relevant costing data from different information sources in selected countries, for example survey and literature review. The tracking tool provides an evidence base to inform harm reduction resourcing advocacy, to include calling for strategic investment, reinvestment of funds away from punitive measures towards harm reduction approaches and the better disaggregation of government and donor budgets to facilitate the tracking of harm reduction spend. Option 1: Provide an estimate of the national spending only Option 2: Provide an estimate of national spending with breakdowns Option 3: Provide programme investment funded by individual projects Option 4: Survey programme spending based on a single programme site The three costing templates are designated for the collection of the costing data for opiate substitution treatment (OST) programme, needle and syringe exchange programme (NSP) and antiretroviral treatment (ART) among drug users, respectively. The tools will be made available to you, and I am happy to guide you further on how to use these after the conference.

Documenting Law Enforcement Expenditure In order to sufficiently carry out budget advocacy to stakeholders, we must also capture information on law enforcement expenditure. These two approaches are complementary. To feed into our advocacy strategy and enforce the message that harm reduction is cost effective, and punitive approaches have done little stop discourage drug use let alone improve people’s lives, HRI has also developed tools to analyse the cost of drug control and law enforcement at the country level. These tools include a quantitative tracking tool (a prescriptive spreadsheet) and a survey. The research tools are designed to capture both spending on drug law enforcement and the unintended costs of this punitive approach to drugs. Particulatlry the government!! These tools are also available, simply send me an email and I can share these.

What should we look for? Although law enforcement approaches regarding drug use in our respective contexts may vary, methodologies for recording expenditure can be applied universally. HRI has developed a list of indicators to document this, along with a survey for exploring further issues with implicated stakeholders. Points of inquiry can include looking into: Drug law enforcement budgets and spending National drug laws and policies Drug law enforcement and harm reduction Compulsory drug detention and rehabilitation centres Access to opioids for pain relief Trends in drug law enforcement For example, Is there a recent, published estimate of spending on the criminal justice system in your country? What are the sources of funding for drug law enforcement in your country? What are the different areas of spending on drug law enforcement in your country, e.g. policing, interdiction, judiciary, prisons, compulsory drug detention and rehabilitation? Among others. 2. in this category we can explore for example, Has drug use, or possession of drugs for personal use been decriminalised within national law? Has there been an effort to provide for alternatives to incarceration for drug offences and is this reflected in national law, or policies? 3. this theme looks at the intersections of harm reduction and law enforcement: for example, Do drug law enforcement efforts impede access to harm reduction programmes, such as needle and syringe programmes? To what extent does drug law enforcement have a presence in public health care environments, such as working directly with healthcare providers to identify people for compulsory drug detention and rehabilitation or any other punitive measures? To feed into this we also suggest collecting data on national estimates, for example estimates of people living with HCV, and annual reported estimates of overdose, data on annual expenditure on law enforcement, information on interdiction efforts and border control, expenditure on judicial processes, as well as on prisons. HRI has developed guidance on how to calculate these but as our time is limited today, I have focused on socializing the kinds of information you can collect in order to promote a redirection of funding away from law enforcement expenditure, and towards harm reduction work, as we know evidence proves that harm reduction is cost effective and save lives. Noe that we have all of this information, how do we use it within our advocacy work in order to ensure the greatest impact? I will now over to share with you ways in which to advocate for a redirection of funding through the 10by20 campaign.