April 2006
P-PG/Epid (2006) E
FINAL REPORT
of the
PROJECT “LOCAL MONITORING OF DRUG PROBLEMS”
Introduction
The project had a confusing start due to different interpretations of the concepts of “small and medium sized towns” and “monitoring adopted to local needs”.
The project team resolved the first issue by setting no limits to size and accepting any interested town, city or region as target area for the project.
The second issue proved to be more complex. The request for “monitoring adopted to local needs” originated from the aims of the Work Programme 2001-2003 to improve the links between research, policy and practice and the experiences of the Multi-city Study of the Pompidou Group. The monitoring activities in the Multi-city Study were set up as test cases for the development of indicators for epidemiological research and not driven by demands of local policy and practice. Therefore the new Local Monitoring project was supposed to start from the needs of policy and practice.
This implied however two complications. First, it assumes that drug policy and practice is a reality at local level. Although drug problems in Europe are largely local urban problems, the local level has in general little say in policy and practice. As the general framework of drug policy is usually formulated at national and international level and in most cases local authorities have no or little control over the instruments of response and intervention (law enforcement, treatment, prevention) local engagement in monitoring activities is hard to get, whereas on the other hand the lack of adequate information about the local drug situation does not help to bring drug issues at the local policy agenda.
Second, in the international research community today there is a broad consensus about what could and should be monitored to assess the drug situation, being it at national or local level. This consensus, which was one of the intended results of the PG Multi-city Study, inhibits the introduction of various local alternatives. Combined with the general absence of local data the experts in the project team were more inclined to promote established instruments and indicators than to assess vague local needs and to develop new instruments and indicators accordingly.
In the discussions of the project team the acknowledgement of these complications resulted in 2002 in a reformulation of the project aim as follows.
The Local Monitoring project aims to promote cooperation and evidence-based approaches in drug policy and practice at local level by means of developing a local monitoring system in collaboration of all actors involved.
In this context the development or implementation of monitoring was no longer the objective of the project but the instrument to achieve the wider aim of an integrated approach to drug problems at local level. The project focus shifted from elaborating data collection methods and epidemiological analysis to promoting communication and networking. Along this outline has been continued until the Work Programme 2004-2006 and it resulted in the activities and products described below.
This final report gives an overview of the project activities and the products developed in the period 2001-2005. At the end of the paper we present a short evaluation including the lessons learned.
Activities
1. Project team meetings
The project team convened six times for one or two days. In these meetings the participants discussed the aims and objectives of the project and the tools and guidelines elaborated by the project consultant. As far as applicable participants also presented and discussed their experiences and the problems encountered in the implementation of the project in their countries.
The meetings have been organized at the following dates and locations.
December 2001, Amsterdam, Netherlands
May 2002, Strasbourg, France
February 2003, Strasbourg, France
June 2003, Strasbourg, France
December 2003, Cascais, Portugal
November 2004, Rome, Italy
Over the years 17 countries have participated in some of the project meetings. The table below gives an overview of the countries represented at the individual meetings. Countries listed in bold have at some time carried out some activities related to the project in one or more cities.
LM Meeting |
||||||
|
Country |
1o |
2 o |
3 o |
4 o |
5 o |
6 o |
Year |
2001 |
2002 |
2003 |
2003 |
2003 |
2004 |
Belgium |
x |
x |
||||
Bulgaria |
x |
x |
x |
x |
||
|
Cyprus |
x |
x |
x |
x |
||
Czech Republic |
x |
x |
||||
Estonia |
x |
x |
x |
x |
x |
x |
France |
x |
x |
x |
x |
||
Greece |
x |
x |
||||
Hungary |
x |
x |
||||
Ireland |
x |
x |
x |
x |
x |
x |
Italy |
x |
x |
x |
x |
x |
x |
Malta |
x |
x |
||||
Netherlands |
x |
x |
||||
Poland |
x |
x |
x |
|||
Portugal |
x |
x |
x |
x |
x |
|
Russian Federation |
x |
x |
x |
x |
x |
x |
Slovakia |
x |
x |
x |
x |
x |
|
Sweden |
x |
x |
x |
|||
Number of participating countries |
15 |
13 |
11 |
11 |
8 |
5 |
2. Training seminars
In order to introduce the aims, objectives and methods of the local monitoring project and to enhance local commitment to the project training seminars have been organised in the following cities by the project consultant, in some cases in collaboration with other experts.
November 2002, Galway, Ireland (Ruud Bless)
November 2002, Pisa, Italy (Ruud Bless)
March 2003, Zilina, Slovakia (Ruud Bless, Jacek Sekiewicz)
March 2003, Ostrava, Czech Republic (Ruud Bless, Jacek Sekiewicz)
April 2003, Cascais, Portugal (Ruud Bless)
November 2003, Cyprus (Ruud Bless)
October 2005, Orenburg, Russian Federation (Ruud Bless, Marcel Busterd, Quirinus van Arnhem)
Target audiences were local politicians, policy makers, workers of local prevention, treatment and law enforcement agencies, data collectors and researchers. All seminars were hosted by the local authorities and organised in cooperation with the expert of the country involved participating in the project team.
The training seminar in Orenburg included also a scientific session on methods of prevalence estimation.
Products
1. Tools
The participants were encouraged to make use of already existing methods and instruments for drugs monitoring, in particular the toolkits of the Global Assessment Programme (GAP) of UNODC and the revised Multicity Annual Reports Questionnaire (MARQ), which had been developed by the Pompidou Group in the final stages of the preceding Multicity Study.
The following tools have been developed for the purposes of the Local Monitoring project as adapted and simplified versions of some GAP-toolkits of UNODC.
Guidelines for Information, Needs and Resources Assessment (Annex 1), including worksheets for recording information and a template for model reporting.
Guidelines for Rapid Situation Assessment (Annex 2), including a model questionnaire for collecting and recording qualitative information about local demand reduction activities. For collecting and recording quantitative epidemiological data the participants of the Local Monitor project were advised to use the MARQ.
Several participants have used the tools to start the development of a local monitoring system. In most cases the participants have translated the tools first into the local language. As the completed documents were intended for local use only they are not included in this report. The table below gives an overview of the documents produced by the participants.
City / country |
INRA |
MARQ |
RSA |
Responses |
|
Cyprus |
Cyprus |
x |
|||
|
Ostrava |
Czech Republic |
x |
|||
|
Tallinn |
Estonia |
x |
x |
x |
|
|
Galway |
Ireland |
x |
|||
|
Genova |
Italy |
x |
x |
x |
|
|
La Spezia |
Italy |
x |
|||
|
Pescara |
Italy |
x |
|||
|
Venezia |
Italy |
x |
|||
|
Gdansk |
Poland |
x |
x |
x |
|
Cascais |
Portugal |
x |
|||
|
Orenburg |
Russia |
x |
x |
x |
x |
|
Zilina |
Slovakia |
x |
x |
x |
x |
Due to the rather fragmentary implementation of the tools, the great variety in completeness and quality, the considerable delays in the production and the lack of reports on how the tools have been used in the local networks, the project team decided in 2005 to abandon the original idea of completing the project in 2006 with a manual on local monitoring. As the tools were largely based on the GAP instruments of UNODC the experiences will now be incorporated into the integrated electronic GAP manual that UNODC intends to publish in 2006.
2. Training materials
In the course of the project several Powerpoint presentations have been developed and tested in training seminars. At each seminar the presentations were more or less adopted to the local situation and presented in the local language. The experiences result in the following standard presentations in English as training materials.
Concepts and development of local Monitoring
Information, Needs and Resources Assessment
Rapid Situation Assessment
Print versions of these training materials are included in Annex 3. The Powerpoint versions can be obtained from the Secretariat of the Pompidou Group.
Project evaluation and recommendations
By the start in 2001 many countries showed an interest in the Local Monitor project and nominated a research expert to participate in the project team. Participation however decreased in the course of time for various reasons. Not every expert managed to find a city in his or her country to use as a pilot city for the project or was in a position to coordinate a local pilot project.
At the beginning the experts in the project team were national researchers with a lot of experience in international collaboration and fluency in English or French. After the initial confusion about the aims and scope of the project had been resolved many of them had been replaced by local coordinators from policy or practice without this experience. Although this improved the necessary link to local policy and practice, several pilot projects still ended in the early stages due to lack of resources for the actual coordination and the implementation of the intended activities like collating existing data and writing situation and progress reports. In some cases it also proved impossible to transfer the funds available for the participation of the original national expert to the local coordination preventing him or her to attend the meetings of the project team.
Achievement of the project aims
The project succeeded in raising awareness of the need for monitoring to address local drug problems. We found much consent for the general approach of starting with network building followed by identification of information sources and performing a rapid situation assessment to produce a start-up document to describe the local situation before embarking on the details of data collection and the introduction of standard indicators.
More important, the network based focus on the “neutral” issue of situation assessment that acknowledged also expert opinions and scientifically imperfect data proved to be an adequate instrument to bring all sectors dealing with drug issues together in a sort of local drug action teams. Unfortunately the initial commitment for concerted action could not always be consolidated due to the lack of resources to continue intended activities and to produce situation reports.
In Italy, that participated with three and later four cities, the Local Monitoring project has been used as an incentive to support the setting up of regional monitoring systems under the umbrella of the National Focal Point of the EMCDDA.
Implementation of pilot activities
Most pilot cities completed the Information, Needs and Resources Assessment to identify the local information base but only a few could produce a situation report with or without making use of the model questionnaire formats of MARQ and Responses. The quality of the reports varies considerably. In particular, all pilot cities had problems to write reports from the perspective of policy or practice. This seems related partly to the impossibility of local policy and practice to formulate concrete information demands and partly to the reluctance of the project team members to accept the imperfections of existing data.
The quality of the local reports has also been affected by the lack of resources, which among others caused much delay in delivery by the coordinators production that in turn caused a decrease in commitment of the networks involved.
Lessons learned
The development of a monitoring system is a useful instrument to create networks in which local cooperation and integrated drug policy and practice can be promoted as it brings together all parties involved around a topic of common interest not complicated by different views on how to address drug issues
The aim of promoting local cooperation however can only be achieved when the network activities bring quick results and sufficient resources can be allocated to do so. If not, policy and practice tend to fall back on traditional and often separate working methods. Timely reporting related to local decision processes is a pertinent condition. In this context researchers that assist local policy and practice in setting up monitoring activities should focus more, at least in the start-up phases, on techniques of rapid situation assessment than on the implications and complications of sustainable data collections for the long term.
The scope of a local monitoring system should take into account the level of control of local policy and practice on drug issues. A local monitoring system should be adapted to the local situation and is not necessarily a copy of the national monitoring system including all standard epidemiological indicators. Too much focus on data that relate to interventions, which are not controlled by the local level, will frustrate the local network and disconnects the intended link between research, policy and practice.
The need to adapt to the local situation does not imply however that local monitoring systems require specific instruments and methodologies different from monitoring at national level. A local system might use a limited or less advanced set of indicators but it will and should use the same general accepted methods of data collection and analysis.
When the Pompidou Group launches projects that require more than the personal input of nominated experts at project meetings, it should be ensured in advance that the experts and others that have be involved will have the resources to carry out activities and to attend project meetings. If projects imply commitment and cooperation of other authorities, this also should be guaranteed in advance.
Ruud Bless
Project consultant
April 2006