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/ SOUTH CAUCASUS ANTI-DRUG (SCAD) PROGRAMME (Phase V)This Programme is funded by the European Union
and implemented by UNDP /
D R A F T (3rd August 2009)
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Contents
Introduction 2
Armenia 3
Summary 3
Introduction 3
Deliverables and other activities 3
Suggestions for the future activities 5
Conclusions 5
Azerbaijan 6
Summary 6
Introduction 6
Deliverables and other activities 6
Conclusions 7
Georgia 8
Introduction 8
Deliverables and other activities 8
Suggestions for the future activities 9
Conclusions 9
The Region 10
Conclusions 10
Annex I: Assessment Mission Programme 11
Annex II: Regional Conference on Drug Addiction Treatment, Rehabilitation and Harm Reduction
Annex III: Treatment/rehabilitation and harm reduction in the community (24-29 August 2008, Bremen/Germany)
Annex IV: Treatment/rehabilitation and harm reduction in prisons, (1-5 September 2008, Bremen/Germany)
Annex V: Regional Conference on Drug Addiction Treatment, Rehabilitation and Harm Reduction, Tbilisi, Georgia, 7-8 July 2009
References
Acknowledgements
Special thanks to the three national SCAD Teams and their leaders: Grigory Malintsyan (Armenia), Mezahir Efendiyev (Azerbaijan), and Platon Nozadze (Georgia), and especially to the three Local Experts with responsibility for Treatment, Rehabilitation and Harm Reduction: Artur Potosyan (Armenia), Tural Ismailov (Azerbaijan) and Khatuna Todadze (Georgia) and to Gregory Connor, the Regional Programme Advisor. Special thanks to Eka Gegia, Programme Assistant and Eka Kavtiashvili, Psychologist, Research Institute on Addiction, both for help with administrative issues,.
Heino Stöver, Prof. PhD, August 2009
(email: )
Introduction
This Report summarises the achievements of the treatment, rehabilitation and harm reduction activities of the SCAD V Programme. It is based mainly on the Assessment Mission carried out in July 2009 using some additional material; the Programme for this Mission and the agenda of the conferences held within this Mission are annexed. During this Mission, meetings were held with key stakeholders and with the Country Managers and the Local Treatment, Rehabilitation and Harm Reduction Experts from each of the three countries. The focus of these meetings was to assess whether the programme deliverables in the area of treatment, rehabilitation and harm reduction had been achieved. Meeting were also held with the Regional Programme Advisor.
The deliverables in the Programme’s Work Plan were described in the Inception Report
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(30th March, 2008, pp 19-20). The planned activities were detailed; overall results are noted, as follows:
1. In-depth assessment of drug treatment capacities in each of the three South Caucasus countries both in free society and in prisons by an international expert (including mission report, detailed work plan, and needs in terms of training and health equipment will be elaborated and submitted to UNDP and the European Commission). The international expert(s) will also assess the possibility of organising distance learning courses in cognitive behavioural therapy to support rehabilitation.
The in-depth assessment of drug treatment, rehabilitation and harm reduction capacities (prisons and community) in each of the three countries has been carried out in June and July 2008 (see Stöver et al. 2008).
2. Health and counselling staff in each country will be trained and acquainted with innovative drug treatment approaches in and outside of prison. Treatment here implies counselling and other therapeutic activities for the complete rehabilitation of the drug addict.
In all of the three countries trainings for health and counselling staff have been conducted. Details are presented in the respective country chapters.
3. Ongoing advocacy will be delivered to ensure the long-term feasibility of the action. From the outset, the programme will work with the Ministry of Health to develop a long-term strategy to ensure the sustainability of treatment services including new staff and running costs of each treatment centre.
Various examples of advocacy in order to ensure sustainability of the achieved results will be presented in the country sections of this report. Close co-operations with both Ministries of Health and Justice, resp. Correction can be noted in all three countries.
4. Renovation and/or health equipment will be provided based on the initial in-depth assessment of the international expert(s). In the case of Armenia, where policing might obstruct access to treatment services, the selection of beneficiary institutions may be contingent upon the outsourcing of certain services and/or support may be provided to national NGOs involved in treatment on a long-term or interim basis. In Georgia, expanded support may be provided to the National Scientific Institute on Addiction following the assessment of the international expert, which will take into account in all three countries all viable institutions providing treatment services. A requisite to any support envisaged will be that the selected institution must prove to work in the public good and such assurances will be provided to this effect to the contracting authority.
Renovation works have been successfully conducted according to the recommendations in the assessment mission report (see Stöver et al. 2008). Various health care equipment has been purchased in order to deliver the basis for the foreseen utilisation of the renovated premises.
5. One study tour will be organized for senior Ministry of Health officials to one EU treatment centre with similar profile to the drug situation in the South Caucasus. The objective of the study tour will be to sensitise authorities on new treatment approaches being used in the EU and to establish links with the host and other treatment centres in the EU.
The study tour with delegates from treatment, rehabilitation and harm reduction services from all 3 countries took place from the 24th-29th of August in Bremen (see Annex III). The study tour for senior Ministry of Health officials to EU-based treatment centres had the aim to familiarise authorities on new treatment approaches used in the EU and to establish links with the host and other treatment centres in the EU.
Various treatment, rehabilitation and harm reduction interventions have been visited. The services seen were to a certain extent the basis for improvement of services in the three countries
6. One study tour will be organized for senior Ministry of Justice officials to one treatment centre in the EU. The objective of the study tour will be to orient authorities to treatment services in EU prisons and to establish links between the respective EU and South Caucasus institutions.
The study tour with delegates from prisons and Ministries of Justice from all 3 countries took place from the 1st -5ht of September 2009 in Bremen and other cities in Northern Germany (see Annex IV). The study tour for senior Ministry of Justice officials to custodial treatment centres in the EU aimed at orientating authorities to treatment services in EU prisons and to establish links between the respective EU and South Caucasus institutions. During this study tour different types of institutions have been visited (women, male juvenile, male, remand prison, prison for sentenced convicts).
7. Additionally, in Azerbaijan, where national authorities are planning to develop a more specialised than currently available treatment centre for drug addicts, a study tour will take place within the SCAD programme but outside of the SCAD budget to support the sharing of good practices on drug treatment with a partner institution in Poland.
Negotiations conducted with “Monar” Association in Warsaw, Poland for possible visit of local narcologists to get acquainted with treatment and rehabilitation services. “Monar” agreed to host a delegation and share their experience, however, due to limited funding by the “Mini Dublin Group” member embassies in Baku, it was not possible to organize a visit of whole delegation and therefore it was decided to cancel it. It should be mentioned that, the embassy of Norway and Open Society Institute expressed their readiness to cover certain expenses related to the study visit.
8. Support will be provided to national authorities to ease access of drug addicts to anonymous treatment services (See Legal Assistance).
In Armenia, public health approach to smoothen harm related to drugs was widely advocated through individual meetings/discussions as well as trainings/workshops held for the MoH and MoJ authorities. During and beyond above activities, treatment and continuum of care were emphasized as an effective secondary and tertiary prevention measures. The Rehabilitation Centre within the Narcological Clinic will initiate group therapies for IDUs, including NA methodologies. Fully anonymous paid treatment is available in other departments of the Narcological Clinic. The similar (Atlantis-like) projects are very likely to be launched at the new Narcological Dep.-t of the Hospital for Detainees.
For Azerbaijan the translation of a manual for physicians of narcological clinics has been recommended. A manual on Motivational Enhancement Therapy with Drug Abusers is to be translated and published for medical staff if the budget allows.
9. Support will be provided to expand and improve treatment services in prisons. Harm reduction strategies and recommendations will also be elaborated to decrease the transmission of HIV and other blood-borne infectious diseases.
In all three countries prison settings are of major concern with regard to improvement of health conditions. The recommendations in the Assessment Mission Report are focussing specifically on necessary improvements in the reduction of the transmission of HIV and other blood-borne viruses.
10. Equipment and/or re-furbishing will also take place in treatment facilities in prisons based on the recommendations of the international expert(s).
In all three countries this has successfully been done.
In Armenia, new narcological department was established under the Hospital for Detainees of the MoJ. Premises standing for that department were completely refurbished by a cost-sharing between the SCAD Programme and International Committee of Red Cross (ICRC) delegation in Armenia. The staff received computer equipment.
In Azerbaijan renovation works have been conducted in the narcology unit of treatment institution of the penitentiary of the Ministry of Justice. Renovation works covered sanitary of 2nd and 3rd floors of the narcological unit and also, check up cabinet was totally renovated.
In Georgia, according to the agreement between MoJ and SCAD, the unit for rehabilitation program “Atlantis” was renovated by MoJ at the prison #2 in Kutaisi, while SCAD provided furniture, health and computer equipment for the same unit. The staff of “Atlantis” program is to be trained in 12-step program if the budget allows.
11. A regional conference will be organized with the objective to present the main findings of the component, to share experiences and identify best practices, to increase awareness of authorities on new treatment practices and to strengthen ties between authorities and experts on national, regional and international levels.
The Regional Conference took place from 7-8 of July 2009 in Tbilisi (see Annex II). Participants from all three countries, who were involved in the SCAD V - Programme were presenting and discussing achievements and difficulties of implementing the recommendations of the Assessment Mission Report (see minutes of the discussion of future perspectives in Annex V). The Regional meeting convincingly showed the progress being made in all three countries in implementing modern drug treatment, rehabilitation, harm reduction services as well as health care for drug addicted prisoners.
Armenia
Summary
In preparing this Report, information was collected from a number of local stakeholders as well as from the Local Experts and the Country Manager. Deliverables have been achieved, and additional innovative activities developed.
Training for health professionals directed to capacity building in the field of treatment, rehabilitation, substitution treatment and harm reduction, cooperation with the Government of Armenia, advocacy, the creation of a Rehabilitation Center in the Narcological Clinic of Psychiatric Medical Center, MoH in Yerevan and the creation of a New Narcological Department in the Hospital for Detainees, MoJ also in Yerevan were the main achievements.
Introduction
In gathering evidence for this Report, the International Expert met with the Country Manager and the Local Expert on treatment, rehabilitation and harm reduction and several other experts from Armenia during the Regional Conference (see Annex II), to discuss the work of SCAD V in the area of treatment, rehabilitation and harm reduction, and also, separately with the Country Manager and the Local Expert to identify the deliverables and other activities outputs that the programme had achieved. The Stakeholders were:
· Petros Semerjyan, Head of Narcological Clinic of Psychiatric Medical Canter, MoH
· Ararat Vardanyan, Director of Kapan Neuro-Psychiatric Dispensary
· Alexander Manukyan, Narcologist at the Nairi Medical Centre Grigor Grigoryan, Head of Narcological Dep.-t of the “Hospital for Detainees” (Criminal-Executive Entity, CEE) of the Ministry of Justice (MoJ)
· Mambre Nanayan, Psychiatrist, “Nubarashen” CEE, MoJ
· Artak Musheghyan, President of “AIDS Prevention, Education and Care” NGO
Deliverables and other activities
Assessment Report
The Assessment Report was translated into Armenian in July 2008 and provided to all beneficiaries for their comments and recommendations
Training for health professionals
1. A 2-days National Training for health professionals has been organised on 25th and 27th of June 2008
· The National Training aimed at capacity building in the field of treatment and rehabilitation of drug addicts was organized.
· More than 30 professionals acting in the field of drug treatment and harm reduction (MoH, MoJ, NGOs) participated in the training.
· Topics discussed:
- Ethics of Drug Services and Consensus on what works in Treatment
and Care;
- Comprehensive and Coordinated Responses to Drug Addiction and
Use;
- Evidence-Based Addiction Medicine;
- Drug-Related Harm and Risk Reduction Approaches;
- Drug Addiction Treatment in Penitentiary System: Best Practices
2. A re-training on “Innovative Treatment Methods and Effective Ways to Ensure Continuum of Care for Drug-Addicted People” for health professionals has been organized on 25-26th of April 2009
· More than 20 representatives acting in the field of drug treatment and harm reduction (MoH, MoJ, NGOs) participated in the training.
· Topics discussed:
- Armenian Legislation related to treatment of drug addicts;
- A new perspective to provide daily rehabilitation services at the Narcological Clinic;
- Methadone Maintenance Treatment (MMT) as a treatment of a chronic disease;