Needle exchange programmes in Visegrad countries: a comparative case study of structural factors in effective service delivery

Abstract

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.

Differences in Beliefs About Cholesterol-Lowering Medications Among the Visegrad Group Countries: A Cross-Sectional Study

“…Taking these notions into account, and that there is a growing interest to investigate the various similarities and differences between the Visegrad Group countries (17)(18)(19), the aim of this study was to investigate the possible differences in the beliefs about necessity and concern regarding anticholesterol treatment between the Polish, Czech, Slovak, and Hungarian citizens taking cholesterol-lowering medications. Identifying similarities would mean that similar policies and best practices can be utilized to improve adherence in all four countries.…”

Understanding the crisis in harm reduction funding in Central and Eastern Europe

“…For the characteristics of harm reduction programmes in both countries, it is important to note that they are mainly provided by non-governmental organisations. The position of NGOs in this region is challenging; they often operate in a vague and inconsistent policy environment and play only a marginal role in governance processes [ 55 , 56 ]. However, the development of this network was made possible mainly thanks to the emergence and growth of specific drug services.…”

“…salaries, injecting paraphernalia). These limitations contribute to uncertainty, and the rigidity of the funding rules does not allow the dynamically changing circumstances and evolving needs of clients to be responded to [ 55 ]. Harm reduction is historically one of the four cornerstones of the Czech drug policy [ 66 , 67 ], and since 2019 even part of the main goal of the Czech strategy [ 68 ] and one of the five priorities of the Slovak strategy [ 69 , 70 ].…”

Understanding the Crisis in Harm Reduction Funding in Central and Eastern Europe

“…salaries, injecting paraphernalia). These limitations contribute to uncertainty and the rigidity of the funding rules does not allow the dynamically changing circumstances and evolving needs of clients to be responded to [55].Harm reduction is historically one of the four cornerstones of the Czech drug policy [66,67], and since 2019 even part of the main goal of the Czech strategy [68]and one of the ve priorities of the Slovak strategy [69,70]. Despite the stable position of harm reduction in the strategic documents of both countries, it has become clear that it has not been appropriately incorporated into the relevant systems in either country.…”

“…For the characteristics of harm reduction programmes in both countries, it is important to note that they are mainly provided by nongovernmental organisations. The position of NGOs in this region is challenging; they often operate in a vague and inconsistent policy environment and play only a marginal role in governance processes [55,56]. However, the development of this network was made possible mainly thanks to the emergence and growth of speci c drug services.…”