Integration of health care and harm reduction services for people who use drugs

Executive summary

Background

The integration of harm reduction services into the general health system provides the opportunity for improving service provision for people who use drugs (PWUD). Limited attention has been paid to the current situation. This study fills that gap and in addition studied what is needed to sufficiently integrate services, to ensure acceptable, accessible, high-quality and available health care for people who use drugs in Kyrgyzstan and Indonesia. The objective of the study was to gain insight into the current state of the integration of services and on how service integration can be improved in Kyrgyzstan and Indonesia.

Methods

An explorative qualitative research was performed. First, a pilot interview and focus group discussion, with four participants, were conducted for familiarisation with the research subject. After that, data were obtained via semi-structured interviews. The study population consisted of experts in the field of drug use, harm reduction and services. In total fifteen interviews were conducted with eight men and seven women. The interviews were recorded and transcribed verbatim. Thereafter, a content analysis was applied.

Results

A wide range of harm reduction and health care services are available in both Kyrgyzstan and Indonesia. A distinction was made between the provision of governmental services and community-based services. The accessibility, acceptability and quality of mainly the governmental services are not believed to be sufficient for people who use drugs. The accessibility is impaired by lack of trust, stigma, lack of funding, and time and locations of the service provision. Acceptability of services is impeded by stigma and the lack of choice, and services are not acceptable for female drug users.  The most common definitions of integration of services among the respondents were ‘one stop shop’ and ‘the referral system’. The following barriers related to integration of services were mentioned: funding crisis, political willingness, capacity and communication issues. The main facilitators for integration of services mentioned were: governmental support, mapping of available services and involvement of the community.

Conclusions

Integration of services may be used as a strategy towards accessibility, availability, acceptability and quality, rather than integration of services being the outcome or objective. The study results can facilitate improvement. Assessments of separate regions, mapping of services and case studies should be done to improve the implementation of an integrated service system beneficiary to people who use drugs.