Study Finds Health Officials Reluctant to Take on Drug Problem

An independent researcher said he found “palpable resistance” among Cambodian health officials to a drug treatment program the UN hopes to use to show the government that a voluntary approach to handling addicts can work.

“There is palpable resistance within the [Ministry of Health] to the project,” writes Axel Klein, a lecturer on addictive behavior at England’s University of Kent hired by the UN Office on Drugs and Crime to evaluate its program. And though the $1.1 million program came to its natural end in March, the UNODS has used it as a model for a similar effort it plans to launch in Cambodia this month.

The UNODC published the report in September, half way through the year-long program, but kept it from the public at the government’s request until recently.

The government currently sends addicts to several drug centers across the country, all widely rebuked by non-government groups for physically abusing their charges and offering them little in the way of genuine treatment. To help convince the government of a better way, the UNODC launched a voluntary program for drug users in 10 communes around Cambodia in February 2009.

Several months into the program, however, some officials remained unconvinced.

Among them, Mr Klein’s report notes an unnamed Health Ministry officials who believed “drug users are dangerous and…are the proper preserve of the police.”

Mr Klein also attributed resistance to a lack or resources and a limited understanding of the problem.

Even some of those health officials who did recognize drug abuse as a health issue believed hospital-based treatment could not work without medication, his report says, even though “it is widely recognized in treatment circles that there is no strict need for medication at any stage of treatment” for dependence on amphetamine-type drugs.

But he also found those at the NACD who agreed with the need to address the problem as a health issue, and credited the UNODC program’s counselors for changing community attitudes.

“The direct approach of the [counselors] of reaching out to drug users and talking to them had an extraordinary educational impact on the communities in which this took place,” he said. “It does not take that much to empathize, but the opportunity has to be created, and [the program] did that.”

Graham Shaw, a technical officer on drug use for the World Health Organization in Cambodia, said he found Mr Klein’s report defensive of the UNODC and an incomplete account of what the program did and did not achieve. He said the Health Ministry was learning to take its share of responsibility for addressing the country’s drug problem.

“Over the last year or more there’s been a rapid awareness at the [Ministry], from the bottom levels to the top levels, that this is a health issue,” he said.

Since his report, Mr Klein said he had also heard from Health Ministry secretary of state Eng Huot professing the same opinion.

Contacted yesterday, however, Heng Taikry, another secretary of state and the Health Ministry, painted the issue as a matter for the police.

“The police have to be more active to prevent them from using the drugs,” he said. “It is the police’s job to get rid of the drugs, and then it will be no problem.”

As for the UNODC program itself, Mr Klein praised it for setting up a system for collecting drug use data. But he also found that counselors were ill trained to offer treatment and had nowhere to refer serious cases on to, and that an 11th hour change in direction-away from centers in favor of community-based teams-alienated other UN agencies.

“Whatever shortcoming,” his report concludes, “they are all compensated for by the vibrant activity of grassroots teams engaging clients in a constructive and humane process.”

The UNODC’s new program will build on the old by running out of the communities’ existing government health centers and training staff to better treat more sever cases of addiction.

It plans to start with two centers this month, one each in Phnom Penh and Banteay Meanchey province. The UNODC has said it hoped to eventually take the program to as many as 320 communities across Cambodia. But Juana Tomas, a program coordinator for the UNODC in Bangkok overseeing the new program’s launch, said recently that the figure would depend on a more accurate needs assessment.

And though NACD officials have expressed support for the program, they are also moving forward with the construction of a massive new drug center of the kind NGOs and aid agencies rebuke in Preah Sihanouk province.



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