1. Strategies for sustainable financing of harm reduction:
Addressing The Harm Reduction Funding Crisis
Emily Rowe
Project Officer- Harm Reduction Advocacy in Asia
Harm Reduction International
Vienna, March 2018

2. 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.

3. Harm Reduction is Cost Effective
If compared to investment into harm reduction activities, criminalisation and incarceration appear 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 is currently being 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. 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.

4. The first factor our researchers considered was coverage
The first factor our researchers considered was coverage. For example, in Thailand, harm reduction services were distributing 14 needles and syringes per PWID per year across 12 sites, well below the coverage level of 200 needles per PWID per year recommended by development partners. However, in Indonesia coverage was assessed as being comprehensive, with 17,000 PWID from35,000 being reached by harm reduction services. In the Philippines, as I am sure we are all sensitive too, the situation is even more dire - aside from one NSP established in Cebu City under an internationally funded Operations Research project, there are currently no documented NSP or OST services across the archipelago.
(now on to transparency of data) Overall it was relatively difficult to access data related to harm reduction funding across the region. Particularly in Cambodia, key stakeholders were not forthcoming by any means with information. This lack of true understanding about the importance of transparency is a serious concern. From our study it was evident that even ngos and govts cannot also explain where money is actually being spent, an issue also reflected in other studies by HRI in other regions.
(when considering government investment) Findings from our study indicate that there is a Lack of political will and readiness of govt to invest in harm reduction initiatives. Considering that sources of funding for harm reduction are already very limited (especially with the transition away from Global Fund sources for example), this is of serious concern. Across the region there was very little if at all government investment into NSP, and funding allocation mainly focused on OST or ARV. In the Philippines, there is no budget currently being allocated to OSTs and Needle Syringe Ps. Nor are there allocations for HIV services specifically targeted at people who use and inject drugs. In Indonesia, Until now almost all components of harm reduction program are funded by foreign aid (and even this has been seriously reduced).
(sustainability) In Cambodia, the sustainability of funding for harm reduction is a real concern for civil society organisations due to the nature of funding they receive, their relationship with the government, and Cambodia’s transitioning economic status. Sustainability for hr funding in Indonesia is also a serious concern as until now almost all components of harm reduction program are funded by foreign aid. In the Philippines the situation is critical where Significant barriers include: the national drug law, which might be difficult to amend to allow for harm reduction; persisting negative views on drug use as well as harm reduction being seen as “condoning” drug use; a political climate which emphasizes punitive measures and a “drug-free” goal; and a lack of correct demographic information on PWIDs. In Vietnam and Thailand there have been mechanisms recently put in place addressing funding for harm reduction work (generally under health budgets/HIV programming) for the next period however it is uncertain whether or not these allocations will be realised as government priorities continue to shift.

5. 10 by 20 Campaign
HRI is collecting evidence to advocate to governments to redirect 10% of the resources currently spent on ineffective punitive responses to drugs and invest it in harm reduction by 2020.
A 10% redirection of funding from drug control to harm reduction by 2020 would:
End AIDS among people who inject drugs by 2030.
Cover annual hepatitis C prevention need for people who inject drugs. Globally. Twice over.
Pay for enough naloxone to save thousands upon thousands of lives every year from opiate overdose.
Ensure effective advice, healthcare and emergency responses in the face of newly emerging challenges.
Strengthen networks of people who use drugs to provide peer services and campaign for their rights.
The data just presented to you will be part of a greater global body of data which will inform our 10by20 campaign. So similar studies are also being implemented by us, in other regions, not only across Asia.

6. Recommendations
HRI’s modeling projections demonstrate how just a tiny shift in global priorities in drug control funding could end injecting-related HIV infections by 2030
Our study indicates that there is an evident need for data on harm reduction spend to be made more transparent
Undertake cost effectiveness studies into harm reduction in conjunction with law enforcement spending assessments
Rebalance or redirection of available funding in favour of harm reduction
(2030…) redirecting investment away from punitive drug control by 7.5% would enable us to cut new HIV infections among people who inject drugs by 94% and reduce HIV-related deaths by similar proportions

7. Website: www.hri.global/10by20
Campaign hashtag: #10by20
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