Background Harm reduction services, despite their proved effectiveness in the prevention of infectious diseases, are still underdeveloped in several European states. The situation in the Visegrad Group countries is especially interesting. Notwithstanding the shared history, culture and political situation in the last decades, there are significant differences in the state of harm reduction between the countries. Methods The research applies the ecological systems model to identify the structural barriers and facilitators affecting organisations providing needle exchange services. It uses a comparative multiple case study design with embedded units of analysis complemented by within-case analysis to establish the relationship between the number and scope of identified factors and the performance of needle exchange services. The qualitative data were collected through semi-structured interviews with professionals working in needle exchange services in the Czech Republic, Poland, Slovakia and Hungary. Additionally, relevant documents, reports and online sources were analysed. Results A total of 24 themes (structural factors) were identified across 11 categories on 3 levels (mesosystem, exosystem, macrosystem). The list includes themes related to the broader society, politics and policy on state and local level, frameworks and amounts of funding, the situation on the education labour market, and attitudes of local communities, among others. The data shows that in the Czech Republic, many facilitators can be identified. In the three remaining countries, on the contrary, one can observe mostly barriers in NSP services delivery. Conclusions The study addresses a highly unexplored topic of the functioning of harm reduction organisations in East-Central Europe. It sheds light on the environment of analysed services, identifying a number of structural factors in effective service delivery in the Czech Republic, Poland, Slovakia and Hungary. The research confirms the significant role of the barriers and facilitators in the services’ performance. It highlights the relationships between various elements of the needle exchange programmes’ environment, suggesting holistic strategies for addressing them. It also provides a potential starting point for further research. Electronic supplementary material The online version of this article (10.1186/s12954-019-0323-5) contains supplementary material, which is available to authorized users.
The present article aims to improve understanding of institution formation in (former) liberal-democratic polities characterized by autocratization tendencies. We examine how the critical juncture created by the COVID-19 pandemic was used, as well as the interplay between antecedent, structural conditions and the particular combinations of political agency and contingency. By comparing the two similar cases of Hungary and Poland – the two European Union countries that have progressed the farthest towards illiberal transformation – and using documentary and interview evidence, we conclude that: (1) whereas Hungary exhibited significant institutional changes, Poland did not; (2) these differences in institutional outcomes can be significantly attributed to differences in certain critical antecedent conditions; and (3) the ability of key political actors – Hungary’s Viktor Orbán and Poland’s Jarosław Kaczyński – to control their own political camp seems to have exerted an unmistakable effect as well. Points for practitioners The build-up and entrenchment of institutions of illiberal rule in (previously) liberal-democratic contexts are encumbered by diverse political and institutional constraints. External shocks, such as the COVID-19 crisis, may offer an opportunity to bypass those constraints and to change institutions permanently. Our study concludes that the extent to which such historical windows of opportunity can indeed be used to achieve lasting institutional changes depends not only on the objective, historically given political and institutional constraints that illiberal reforms face, but also on their subjective ability to act in a controlled, coordinated and coherent manner.
Collaborative governance research and practice seem underdeveloped in Central-Eastern Europe compared to its Western counterpart. Recently, one can also observe a turn from liberal values in CEE. Taking states’ important role in shaping collaborative governance as a starting point, this paper includes a theoretical ambition of developing a classification of collaborative governance regimes. Furthermore, through qualitative analysis of drug harm reduction policies in Visegrád countries, it aims to contribute to the understanding of how illiberal governance affects collaborative governance. The results show that the impact of illiberalism on collaborative governance regimes does not appear uniformly across different policy areas.
Aims. There are significant differences in harm reduction services availability and performance in various countries. The paper examines the state of one of the harm reduction interventions – needle exchange services – through the lenses of morality policy, attempting to establish possible relationships between policy framing and policy outcomes. Method. The research uses an explorative design with cross-country comparison. The unit of analysis is drug policy in a country, and the geographical scope includes Czechia, Hungary, Poland and Slovakia, following the maximum variation case selection procedure. Countries’ drug strategies are analysed to identify the policy frames and data on needle exchange programmes are used to assess the state of harm reduction. Results. The analysis identified health and social drug policy framing in Czechia and Slovakia, morality frame in Hungary and no frame in Poland. The availability of availability and coverage of needle exchange programmes is the highest in Czechia, followed by Slovakia, Hungary and Poland. Conclusions. The Hungarian case confirms the relationship between morality framing and poor policy outcomes, while the Czech case between health framing and effective policy. Further research is needed to establish the function of morality framing as necessary and/or sufficient condition for unsatisfactory policy outcomes.
The dissertation focused on identifying circumstances contributing to the policy's poor versus high performance, focusing on different aspects of policymaking, namely, policy framing, collaborative governance regimes, and structural factors affecting effective service delivery. Together, the results of the three articles making up the dissertation provide a holistic, complex picture of the performance of harm reduction policy in the region. The work contains the following contributions: The first paper: • The results confirm the association between using a morality frame to shape drug policy and poor harm reduction policy performance, and between a strong health-social framing and high policy performance; • The level of the data quality was characterised by significant variance between countries, which may be considered an indicator of the entire policy system's capacity. The second paper: • Novel conceptualisation of collaborative governance regimes and the development of their conceptual classification including operationalisation of each of categories along with a range of observable dimensions; • Identification of a relatively strong presence of a pro-collaborative regime in Czechia, a mix of pro-collaborative and neutral regimes' features in Poland and Slovakia, and a strongly anti-collaborative regime in Hungary. Inductive conceptualisation and operationalisation of the anti-collaborative governance regime; • Conclusion arguing that anti-collaborative governance regimes do not appear uniformly across various policy fields, and their materialisation in different policy areas may vary in space in time. The third paper: • The results confirm the relationship between the number and severity of identified barriers and poor policy performance on the one hand, and between the number and scope of identified facilitators, on the other. The study also confirms that structural factors are interrelated and affect one another, creating a complex system of relationships. Overall: • The great extent of the use of criminal law as a policy instrument in drug policy field seems to be related to the general societal consensus regarding the morally evil status of drugs and people who are engaged in their use, sales, production, etc.; • The situation one can see in many countries with respect to drug policy resembles the concept of moral panic; • Drug policy, and especially its harm reduction element, is still a very controversial policy field where deep beliefs are strongly involved, and ideology often dominates over the evidence; The main consequence is that harm reduction organisations have to overcome not only barriers resulting strictly from policy and politics but also those emerging, for example, in local communities; • The data shows that the contradictions between different policy priorities (e.g., incarceration of people who use drugs and harm reduction) are not addressed at the system level but need to be dealt with by the frontline policy implementers; • Policy goals formulated in policy documents have a limited impact on what the policy effects will be; • There are significant differences between the range of harm reduction services operating in countries with otherwise similar legal frameworks in terms of the criminalisation of drug use and/or possession for personal use. The reasons behind the availability of specific interventions in some countries and not in others cannot be placed within the legislation or general policy frameworks – other policy aspects need to be explored to shed some light on this phenomenon.
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