Activity 4.2 Drafting the National Drug Strategy

1. Activity 4.2Drafting the National Drug Strategy

2. Evaluation of Drug Policies in EUDr. Peter DegkwitzViktor Mravčík M.D.

3. Drug Strategies in EU At EU level Drug strategy = general orientation and longer term planning (8 years) Drug action plan = detailed short term planning (4 years) At national level Drug policy documents, Strategies, Action plans, plans, programs From one year to undetermined duration But, a tendency to progressively adopt the EU framework

4. National drug strategies and action plans in the EU-27, Croatia, Turkey and Norway

5. Overall development in EU Member States and the EU now have Detailed drug strategies and action plans (29 countries) Multi-level drug coordination mechanisms Sophisticated monitoring systems Drug policies in the EU are increasingly Comprehensive and balanced Based on scientific knowledge and sensitive to changes Transparent Realistic rather than dogmatic

6. Evaluation of Drug Strategies in EU Different contexts exist (federal, decentralised, centralised) Only a limited number of countries have already produced (impact) evaluations (France, Portugal, Spain, etc.) Approaches and methods differ

7. Role of EMCDDA and Reitox network EMCDDA and Reitox play central role in monitoring/evaluation of EU and national strategies/action plans Reitox network: The European Information Network on Drugs and Drug Addiction Consists of 30 National Focal Points NFPs are the “interface” between participating countries and EMCDDA Diverse national arrangements for NFPs reflecting differing national contexts

8. EMCDDA (and EU) Needs 5KIs, Information on Policies and Interventions, EU Action Plan, • National Scientific • Community • National experts • Academic institutions • National Government • - Policies and interventions • Administration and funding National Focal Points Parent institution Sub-national Administrations Devolved responsibilities Specialist Agencies e.g. public health, statistics Local Agencies In the Centre of Network of Networks...

9. Different Scopes of Evaluation Impact/Outcome Evaluation Scientifically based judgment about the effect The assessment of whether an action achieves its objectives Progress/Process Evaluation Follow-up of the implementation of an action or action plan, with a view to correction or improvement Monitoring/Output Evaluation The regular, systematic collection of data on a drug situation Monitoring of implementation of actions Conception Relevancy and/or formulation of an action plan Evaluability

10. Drug Policies - What is Evaluated? Drug-related interventions Drug action plan Drug strategy Drug policy Other policies

11. Evaluation of Impact? Socio-cultural-economical-political context Black box of various factors Drug policy Drug situation Other policies: health, social, education, employment

12. EC study: Analysis of the global illicit drugs market, drug problems and drug policy responses 1998–2007 (Trimbos Institute/RAND, 2009) Conclusions: • Drug policy has limited effects on drug demand • Policy measures can not affect: • Whether an epidemic starts • Severity of epidemic • Prevalence of dependence • Drug use is driven by broader social, economic and cultural factors • Unintended consequences of drug policies (violence, changes at black markets) • Policy can reduce harmfulness of drug use (efficiency of harm-reduction measures) • Drug situation drives drug policy

13. OK. Evaluation of impact is dificult.But what about impact of evaluation?

14. impact where research linked directly to the policy networks, think-tanks and policy entrepreneurs key actors – champions of an idea or set of evidence appropriate packaging of findings communication channels to allow the translation of research evidence, i.e. a knowledge transfer process. receptive audience and a window of opportunity timely delivery of findings, to act quickly alliances of researchers (MacGregor, 2011) What is required for research to have impact on drug policy?

15. Examples

16. Evaluation of EU drug strategy 2005-2012 • Assessment of the implementation of the EU Drugs Strategy 2005—2012 and its Action Plans (Rand Europe, 2012) • http://www.rand.org/pubs/technical_reports/TR1228.html • External evaluation

17. The EU Drugs Action Plan 2009-2012 Five areas and 72 actions: Coordination (9 actions) Demand reduction (14 actions) Supply reduction (21 actions) International cooperation (18 actions) Information/research/evaluation (10 actions)

18. EU Action Plan 2009-2012 68. To develop analytical instruments to better assess the effectiveness and impact of drug policy (e.g. model evaluation tools, policy effectiveness indices, public expenditure analysis etc.) 70. Member States to evaluate and fine-tune national drug policies on a regular or ongoing basis

19. Evaluation of EU drug strategy 2005-2012 Goals • To assess barriers and facilitators to the implementation of objectives and priorities at EU and Member State level • To assess the relevance and influence of the Strategy with respect to national drugs policy and legislation • To assess possible impact on the drugs situation in the EU • To identify key aspects and recommendations for future EU Drugs Strategies

20. Evaluation of EU drug strategy 2005-2012 Methods

21. Evaluation of EU drug strategy 2005-2012 Main conclusions • strategy has provided added value to the efforts of the Member States • promotion of evidence-based interventions in the EU strategy was commended by stakeholders • highlighted the area of information, research and evaluation, where the EU approach and infrastructures actively support knowledge transfer within Europe Recommendations for the next strategy: • maintaining the balanced approach • adopting integrated policy across licit and illicit substances including new psychoactive substances • building up the evidence base in drug supply reduction • clarifying the roles of EU coordination bodies.

22. Evaluation of the Croatian National Drug Strategy 2006–2012 • By Trimbos institute (NL) and CroatianDrug Office (HR) • External/internal evaluation (presentationof Franz Trautmanat 45th Reitox meeting in Lisbon, November 2011) Scopeofevaluation • its qualities as a policy document • the process of its implementation • the development of the drug problem and drug policy in the period covered by the Drug Strategy

23. Evaluation of the Croatian National Drug Strategy 2006–2012 Methods • Assessment of the view of drug policy stakeholders (Trimbos) • exploratory interviews with key stakeholders • web-based survey among a wider group of stakeholders • individual interviews with selected stakeholders • focus groups • Review of the available data (Croatian Drug Office)

24. Evaluation of the Croatian National Drug Strategy 2006–2012 Key findings • Overall positive judgement • Drug strategy is seen as good, comprehensive document but too extensive • Drug Strategy and the Action Plans important impulse for developing consistent drug policy • Discrepancy: Quality of programmes judged as fairly good, doubts about their impact

25. Evaluation of the Croatian National Drug Strategy 2006–2012 Key findings - specific • Coordination: Unclear definition of power, responsibilities and mutual relationships • Insufficient communication and cooperation (communication between treatment- police/justice; unclear position of NGOs) • Quality/efficiency: need for more standardisation, complaints about bureaucracy, lack of financial transparency • Monitoring well developed, not enough evaluation and research

26. Evaluation of the Croatian National Drug Strategy 2006–2012 Recommendations for new strategy: • Less ambitious • Clarifying main direction, setting clear targets • SMART objectives: specific, measurable, attainable, realistic, timely • Consultation of all stakeholders • Budget plan • Link with policy on other substances (alcohol, tobacco, pharmaceuticals, gambling, etc) • Connect all elements: coordination, cooperation, communication, quality, efficiency, monitoring, assessment, evaluation!

27. Evaluation of Turkish Action Plan 2007-2009 In 2010 as part of twinning project Process/output evaluation Survey among stakeholders

28. A. GENERAL PART: this part relates to the activities of theAgency/Organisation as a whole. Make a comprehensive description on the activities of your Agency/Organisation within the framework of the counter-drugs policy. List the factors that have had a positive or negative impact on the realisation of the action plan. List 3 factors for each category (positive and negative factors) that have had the most positive and most negative impact. Indicate the fields where the scope of both the activities listed in the action plan and your Ministry’s own activities have turned out to be insufficient. Evaluation of Turkish AP 2007-2009

29. B. SPECIAL PART: Each activity is to be evaluated separately. Has the action been realised? (Y-N-Y partially, specify between 1 – 99 % ): Has it been realised on time? (Y-N) If realised, have you experienced any problems? Specify: If not or partially realised, specify problems and reasons: If something such as results, minutes, reports, materials or publications etc have been produced, please specify: If possible, please make a estimation with regard to the cost generated by the action: Will you continue the action in the future? (Y-N) Comments, if any: Evaluation of Turkish AP 2007-2009

30. Let‘s look closely into methodology...

31. The challenge of evaluation ... • Evaluation on „Public Health“ Interventions; normally:Comparison of Pre-Post situation– with or without intervention • Evaluation of “Complex Interventions” is difficuilt – with no control of external factors or interactions of subsystems (market fluctuation, (sub-)cultural trends) • Evaluation and Monitoring of “social policies” (and development of policies based on evidence) is normally not an important aspect of EU-(or national) policies (for example: unemployment rates under young adults, debts crisis, agricultural policy …) • Drug action is one of the few exceptions (and that matters!!); it’s a demand since the 80th that prevention in schools, treatment offers, the “war on drugs” general have to show evidence … • But: simple (chronological) models of cause and effect or action and result cannot (apart from exceptions) concluded form drug action plans (especially not in short cycles)

32. Model of interactions and indicators • General objective: change “drug markets und drug related behaviours”in the direction of improvement – implying the reduction of harm for individuals and society • Drug markets and drug behaviours or drug-related problemsPersons are in various stages: no users or ex users, users in interventions, experimenting adolescents … • Demand and SupplyThe markets and drug behaviours are influenced reciprocally by demand and supply. Drug users affect the demand and also non-users for whom primary prevention has not worked. Drug policy aims at effecting demand and supply by a series of different interventions.

33. Model of interactions ... • Interventionsand respective actionsInterventions range from prevention to supply reduction. The different intervention areas are directed first of all to the drug markets and drug behaviours. They will transform both in a defined direction such as to reduce harms related to drug use. • The state of the entities may be changed in each component, which corresponds to the transformation of input into output (users attend treatment and reduce risk behaviour) and the flow of new input to the subsequent components.

35. ... The main flows • The four pillars – prevention, treatment, harm reduction and supply reduction – are directed to the interactive drug markets and drug related behaviours • with the overall aim to significantly reduce the harm, the social and health problems caused to individuals and society … • To meet this aim specific actions are planned in the different intervention areas (pillars). • In the model, each component of an intervention pillar (e.g. a treatment intervention) worksas a sub-systemthat receives inputs (activitiesperformed) and delivers outputs (results). The results of a sub-system correspond to individuals whose state has been modified or to the drug markets which has changed. The modifications will then be part of the inputs in the next sub-system, and are regarded as precedent results.

36. Every pillar – a subsystem with inputs (activities) and outputs (results) (Main) focus of evaluation is the relation of • Inputs – performance of actions • Outputs – direct results (“External factors” or “general results” only if possible)

37. Indicators for evaluation

38. Levels of indicators The evaluation indicators may be classified for • interventions – quantification of the actions carried out or • situation – related to the circumstances of the drug problem There are three large groups of indicators: • Indicators for the objectives and actions of the National Drug Strategy of Serbia (NDS). The NDS include different kinds of objectives: Objectives related to interventions such as the implementation of prevention programmes and objectives related to the general situation such as the reduction risk behaviour of drug users. Accordingly there are indicators for objectives in both the “intervention” and “situation” area.

39. ... indicators • Indicators for the intervention areas and strategic instruments cover performance and result indicators. Performance indicators enable to evaluate if and how actions in the intervention pillars have been performed. Result indicators enable to assess which results have been achieved by the performance. Indicators imply direct results such as for instance the number of schools and students involved in prevention activities; entries in treatment, confiscated drugs etc. • Indicators for the global situation derive on the one hand directly from the general objectives of the NDS and are on the other hand concluded from the overall objectives of drug policy. These indicators give a global overview of the drugs situation in Serbia and its development. In addition, the indicators allow to assess the final results achieved in the five-year period (2009-2013).

40. Thanks  p.degkwitz@uke.uni-hamburg.de mravcik.viktor@vlada.cz

41. Заједно камодернијоји ефикаснијојпревенцијии сузбијањудрога уРепублици Србији Together towards a more modern and a more effective prevention and suppression of drugs in the Republic of Serbia!