Agitación en los digestores y parámetros de diseño

Make a vital contribution 18 15.5%

Make a Important

Contribution 26 22.4%

Make a moderate

contribution 27 23.3%

Make a small contribution 30 25.9%

Do not make a contribution 15 12.9%

Total 116 100.0%

Civil Soc Harm Reduction Frequency Percent

Make a vital contribution 19 16.4%

Make a Important

Contribution 31 26.7%

Make a moderate

contribution 25 21.6%

Make a small contribution 25 21.6%

Do not make a contribution 16 13.8%

Total 116 100.0%

Govt Demand Reduction Frequency Percent

Make a vital contribution 20 17.1%

Make a Important

Contribution 30 25.6%

Make a moderate

contribution 33 28.2%

Make a small contribution 19 16.2%

Do not make a contribution 15 12.8%

Total 117 100.0%

Govt Harm Reduction Frequency Percent

28. Aware of any laws, regulations, policies, or schemes in India that comment upon broad based education and / or vocational education and livelihood skills for drug users.

Only 21% of respondents were aware of laws, regulations, policies or schemes that commented upon basic education, vocational education and livelihood skills. During face to face interviews many of the respondents altered their opinion to

‘No’ when they could not specify any scheme.

29. Name the laws, regulations, policies or schemes.

Almost 50% of the respondents when requested to provide the name of a law, regulation, policy or scheme referred to the NDPS Act, Tobacco Prevention Law and the Mental Health Act. A few respondents provided the names of the following:

Rashtriya Mahila Kosh; Rajiv Gandhi Yuva Rojgar;

Abkari Rules and Schemes; and Tribal Welfare Schemes. The information provided for both question 28 and 29, indicates that the majority of the respondents representing treatment agencies had little knowledge and understanding of the schemes that existed, and how recovering drug users may be able to benefit, access or utilise them.

30. Need for government improvement for policies and practices in the area of broad based education and/or vocational education and livelihood skills for drug users.

There was overwhelming support among respondents for government improvement for policies and practice with basic education, vocational education and livelihood skills for drug users, ex-drug users and people vulnerable to drug use. These were all areas that require considerable

Yes 25 21.0%

No 73 61.3%

Do not know 21 17.6%

Total 119 100.0%

Policy/law Awareness Frequency Percent

Coordination & harmonizing all different stakeholders

in the field 86 73.5%

Stimulating basic human rights by ensuring drug users have access to basic

services 84 71.8%

comprehensive response 89 76.1%

Promotion of peer education

model among drug users 91 77.8%

Design research strategy to plan, monitor and evaluate policies/programs

/activities 84 71.8%

Ensuring livelihood training for drug users as a means for

social inclusion 93 79.5%

Others 24 20.5%

Need for Government Frequency Percent Improvement

thought as to how may the government put into place some of these policies and practice to facilitate a meaningful and practical approach for the social and economic reintegration of drug users. A fifth of respondents added some suggestions of which some overlapped with other areas for consideration.

These included the following:

G Assistance for small rehabilitation centres;

G To promote the aspect that the drug abuse is a disease;

G Network of NGOs for comprehensive response to drug use;

G Treatment education, adherence support, dissemination of information;

G Deglamorise drug use;

G Supply reduction, strengthening of community based organisations like mahila mandals (women’s organisations)

G Generate policy to facilitate treatment and rehabilitation;

G All educational programmes should be oriented towards personality development;

G Life skill training from middle school level; and

G Vocational training and employment opportunities

Research of this type, has to our knowledge, not been undertaken in India. This research proved labour intensive: over 500 telephone calls, 400 emails, and 87 postal questionnaires sent to staff working at drug treatment facilities around India. Despite the many obstacles and the extent of the geographical land mass, a total of 25 States and one Union Territory participated in this mapping exercise. An important caveat to this research report was that the various responses received do not represent all the drug treatment and rehabilitation facilities of India.

However we do believe that important new insights can be gleaned from the various findings of the key-informants, focus group discussions and questionnaire response.

The literature identified the ‘whole person recovery’ model as part of the rehabilitation process and focus should not just be on clinical management of treating drug dependency. Issues of basic education (numeracy and literary), vocational education and the move towards developing livelihood skills for drug users was acknowledged to be important but overall implementation of such interventions was lacking. As identified in the survey, 61% of facilities did not provide opportunities for basic education. It can be suggested that many of the agencies surveyed catered to the literate client group as payment was most often a requirement for treatment. Yet the results show 23% identified as illiterate with an additional 11% achieving primary school only. It was plausible that the figures of illiteracy could be higher as defining of literacy can be open to interpretation. With a third identifying as illiterate or of primary education level only, emphasis on the need for more basic education among this group needs encouragement. Further more it is important to note that from a human rights approach, the Universal Declaration of Human Rights adopted by the United Nations General Assembly in 1948,

Discussion

in which India is a signatory, states in Article 26 (1). Everyone has the right to education (United Nations 2009). It is within this context that drug users should be offered the opportunity for education which would contribute towards social inclusion and the creation of sustainable livelihood.

HIV and drug education was undertaken by virtually all facilities and a group session discussion with verbal explanations was the most common mode of imparting education in the various settings. Quality assurance of how the information was imparted to drug users cannot be provided but it was an important area to examine as a number of key informants suggested the delivery of messages was often prescriptive and didactic.

As far as the responses are concerned some limitations are that a gender breakdown was not undertaken and that it has not been possible to determine an assessment of the needs of children substance users from this study sample.

The lack of gender assessment in the study was a regrettable oversight as the position of women as drug users and partners of users, particularly within the Asian context, are often overlooked.

In the main much of the research and programmatic response lacks focus when addressing the needs of women vulnerable to drugs, directly or indirectly, (largely it can be assumed because the vast majority of drug users are male) and further research into this area should be encouraged. The majority of clients (64%) were aged 16 to 30 years. The survey shows that various drugs were consumed, and responses suggest poly drug use was widespread. While it was true swallowing was the main mode of administration, the degree of injecting was substantial (29%), and sufficiently widespread among the various facilities.

The majority of agencies (69%) responded positively to having material for those who cannot read. Yet it was observed that few facilities were involved in developing materials for this target group and it can be suggested that most existing material available was related to HIV. Preliminary observations suggest that there was a need for materials related to drug use in a pictorial form. Exploring the need for information other than Hindi and English was an area for consideration. Many facilities (56%) tested education materials amongst their clients but the consultant observed during face to face interviews that of those testing, few had produced their own materials to address specific gaps in the information.

It was interesting to note the widespread undertaking of monitoring and evaluation (77%) to assess the success of education programmes by the facilities. However, during the face to face interviews, almost 50%

withdrew their affirmative answer when enquiries were made about their process.

Respondents were requested to describe monitoring and evaluation processes. Majority of responses produced inadequate text to provide meaningful answers: it can be suggested gaps in thorough understanding of the processes involved were likely. Only a couple of NGOs stated issues linked to a base line collection of data which could then be compared to follow up surveys to compare knowledge gained from a programme conducted. Most key informants suggested scope for improvement with monitoring and evaluation and further research into this area should be undertaken.

Responses indicated that 89% of clients were either unemployed or involved in casual work with an irregular income. Despite many facilities stating that they had the capacity to offer broad based education and livelihood skills, 61% of facilities did not provide any skills for drug users and half the key informants considered that lack of capacity was a reality. Of the 38% who

do provide a skill building service, it was most often occupational therapy for income generation and not always suited for long term employment opportunities upon completion of drug treatment. Focus group discussions with drug users show an improved preparation for employment was highly desirable. Many facilities were likely to be overburdened with many tasks and cannot provide all services.

Research found 64% do not provide regular referrals or linkages with other organisations for vocational training, and 74% had not formulated a partnership with outside agencies and institutions to assist in the process of social and economic re-integration of drug users.

These findings suggest that treatment facilities should form partnerships with those that were best equipped to provide vocational education and livelihood skill training. Potential partnerships should be broad ranging and can include those from the Government, NGO and the corporate sector. For example one such government scheme was the Jan Shikshan Sansthan (JSS) which offer quality vocational skills and technical knowledge, at low cost, not only focusing on those in the urban areas but to the numerous neo-literates and unskilled and unemployed youth throughout the country.

Today there are 223 JSSs established throughout India offering over 300 different types of vocational courses.

Alternative employment approaches for drug users were considered, such as self-help groups but it can be suggested that this term among treatment facilities could be misinterpreted as

‘Narcotics Anonymous’ and ‘Alcoholics Anonymous’ as some had suggested in face to face interviews. Despite only a small number of agencies responding positively to micro credit schemes (14%) and apprenticeships (8%) this was an area worthy of greater expansion as the literature review highlighted some positive outcomes within an Indian setting.

Many respondents believe the degree of

contribution by civil society towards the drug use and demand reduction response was substantially important but many (39%) did not think civil society contributed as much importance to harm reduction. Increased advocacy efforts would be required with the community for them to better understand the merit of harm reduction. Many respondents stated the overall contribution (vital, important, and moderate) by the government towards the drug use and demand and harm reduction response was similar (75% and 71% respectively) indicating an acknowledgment that harms reduction as a concept and approach was taken seriously by the government.

Most respondents were not aware of any laws, regulations, policies, or schemes that comment upon broad based education and / or vocational education and livelihood skills for drug users.

Some respondents provided suggested answers but most referred to the NDPS Act, which as indicated in the literature review does not provide any specifics on rehabilitation per se. It appears that no mention was made of the ‘Scheme for Prohibition and Drug Abuse Prevention 1985 – 1986’, which was more orientated towards the whole person recovery.

The majority of responses felt the need for government improvement in policies and practices in the area of broad based education and/or vocational education and livelihood skills for drug users through a series of suggested interventions. These ranged from the

development of livelihood skills training for drug users to the mainstreaming of drug use prevention/education programmes. The processes involved in undertaking the various interventions would require greater exploration and would require ongoing advocacy efforts encouraging government participation in the way forward.

In conclusion, gaps in basic education, vocational education and development of livelihood skills of drug users within the overall drug treatment and rehabilitation system were identified. Within a broad ranging education framework there was a need to move towards an evidence based and practical response. To aid the process of whole person recovery, basic education, provision of appropriate vocational education and skill development compatible with the needs of the society will be necessary. Only then could the social and economic re-integration of drug users into the community at large, be ensured.

The research findings of this report were presented to a broad range of participants attending a UNESCO event in New Delhi, 10 November, 2008, titled ‘National Consultation on Education and Harm Reduction related to drug use, HIV and AIDS in India’. The event not only highlighted the findings, accompanied with participatory discussions about the recommendations, but also provided a platform for various UNESCO funded projects in India that focus on various aspects of HIV and drug use (see Annex 6).

Despite many facilities stating that they had the