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National Action Plan Italy COLOPHON Colophon csidp National Action Plan Italy COLOPHON Colophon This National Action Plan is developed in the framework of the European Civil Society In- volvement Project - CSIDP, fi nanced bty the European Commission, DG Home. More informatio via: www.csidp.eu csidp Author(s): Lella Cosmaro, Susanna Ronconni. Copyright © 2018 Copyright remains with the publisher De Regenboog Groep / Correlation Network PO Box 10887 1001 EW Amsterdam Correlation The Netherlands European Harm Reduction Phone: +31 20 5707829 C Network [email protected] www.correlation-net.org European Union (Home/2015/JDRU/AG/DRUG/8842). The contents of this publication are the sole responsibility of INDEX Introduction 04 Overview of the National Situation 04 Overview of the National Action 06 Plan Key outcomes 06 Formation 07 of the National Action Plan Stakeholders 07 Process 08 Final National Plan 09 Implementation 10 of the National Action Plan Overview 10 Challenges 11 Assessment of success 12 Learning 13 Conclusions and Recommendations 14 3 checking, outreach interventions, drop in centres) are not included in the LEA and therefore it is not INTRODUCTION mandatory for the Regions to implement them. As a consequence, HR interventions are carried out in 12 Regions only and lack homogeneous HR guidelines/standards and monitoring systems; PUDs’ right to health on the Italian territory is unequal and fortuitous. Lastly, no clear political OVERVIEW OF THE NATIONAL support means no routine monitoring. SITUATION Lately, two positive changes occurred: in 2017, the The lack of both political support and HR national introduction of HR in the LEA at national level - it guidelines still represents a crucial problem for is now necessary to develop and articulate LEA HR in Italy: HR interventions have been provided at regional level in order to implement them; since 1995, but intermittently. During the years, the inclusion by the DPA (Drug Policy Agency) positive steps in the right direction have inevitably in the Annual Report to the Parliament 2016 of a been reversed by conservative governments’ chapter focused on Harm Reduction development, prohibitionist drug policies; HR interventions have which was written by CS organizations. This CS been penalized by an ideological political approach. contribution included a suggested roadmap on HR, which could be used as the basis for our national Italy has a universal National Health System; action plan and advocacy actions. its 20 Regional governments decide their own investments and budgets, provided that they In such changing context, the possibility to take comply with national LEA (Livelli Essenziali di part to the European project CSI – Civil Society Assistenza or basic assistance levels, i.e. standard, Involvement in Drug Policies – represented a great guaranteed and totally or partially free treatments chance for Italian CS to bring back policy makers’ and services). Drug treatments are guaranteed attention to drug policies in general and more by both the National and Regional Public Health specifically to HR. Systems; services can be provided by non-profit In the spring of 2017, the two Italian partners organizations, financed by the public health budget. Forum Droghe and Fondazione LILA Milano, This system guarantees PWUDs’ access to free drug in collaboration with the national partnership, services and treatments. launched an online survey addressed to CS While OST is not considered as a HR measure but networks and associations on the priorities in the as a treatment and it is therefore not included in Harm Reduction dialogue between CS and policy the national LEA, it is free of charge and accessible makers in Italy. to all (including migrants in an irregular status),HR The survey was online for 32 days, from March 27 interventions (NSP, naloxone distribution, drug to April 28; 73 valid questionnaires were collected. 4 It gave some interesting indications, which with continuity, eliminating regional differences guided the defi nition of the Italian roadmap for and giving clear political support to interventions development of a dialogue on HR between CS and through two fundamental tools: national guidelines policy makers. Following are the main results: and LEA on HR. These two objectives call for participated processes, which attribute a crucial Harm Reduction: role to different stakeholders such as DPA, Regions HR was represented in its complexity of both and the Conference of Regions, including also approach/strategy transversal to numerous Ministries and the Government. The Italian areas and operational programs. Participatory system is multilevel; national, regional and processes tend to combine different contexts municipal stakeholders all play a crucial role. The (political, technical/political and technical) and identifi cation of contexts and processes facilitating to value the different components present within and guaranteeing dialogue is indicated as a priority CS (competences of experts and professionals and stakeholders’ competences). The questionnaire gave a clear picture of such a complexity by highlighting HR legal and social communication dimensions beside the health and social ones Dialogue CS-policy makers: Unsurprisingly, the concordant opinion/judgement on the state of the art of participatory processes and dialogue between CS and policy- makers was defi nitely negative and described an under-developed, stuffy and stuck Agenda of priorities for a Roadmap on situation, especially when compared to European strategies and guidelines on drugs. Such negative Harm Reduction: picture called for urgent changes; HR must be The role of research and monitoring: recognized as a fundamental pillar of national Great attention was devoted also to the topic of policies, based on scientifi c evidences academic and independent research on patterns of drug use, impact of drug policies and consideration/ Guidelines, LEA (Essential Assistance evaluation of possible alternatives (i.e. legalization), Levels) and political clarity: as well as on program monitoring. Research The survey emphasized the need to ensure that development calls for a plurality of institutional HR is implemented throughout the entire country and independent stakeholders, who from a dialogue 5 with CS can derive indications for new research (Cartello di Genova), which was in a stalemate objectives and different, enriching perspectives since early 2017 Transparency and assurance of processes: 2. To open a political dialogue on HR and Survey results gave a negative picture of establish a structured place for it with the participative processes, which are described as DPA, National Drug Department, starting from poor, marked by opacity and perpetual uncertainty. two concrete proposals: a) a Working Group According to respondents, only few CS stakeholders on HR guidelines and b) CSOs participation in succeed in interacting with policy makers; in the new DPA Observatory on Drugs, and in the addition, critical remarks were made about debate on objectives, methods and contents difficulties in the dialogue CS-policy makers, which of the research on drug issues, functional to is not clearly formalized. It is therefore urgent to monitoring, evaluating and innovating national start a process based on transparent processes drug policies and interventions guaranteeing recognition and formal assurance 3. To start and develop a political dialogue with the Regions and the National Conference of Challenges for CS: Regions / Health Commission and Interregional The survey also highlighted limits and weaknesses Drug Group on the implementation of the in CS, suggesting internal problems that need to HR LEA (introduced in 2017, but not yet be addressed; a roadmap on HR needed to take enforceable) all over the country care also of such challenges. Improved cohesion capacity, effective negotiation of common goals, extension of alliances within CS, increased mobilization, advocacy and communication KEY OUTCOMES activities, support and inclusion of stakeholders’ associations and networks appear to be transversal • Active participation of CSOs involved in HR goals that need to be kept in the background of a (Cartello di Genova) in designing, implementing participative development process. and co-organizing the action plan activities; further strengthening of new and old alliances and networks; relaunch of the Cartello and its OVERVIEW OF THE NATIONAL propulsive action; CSOs’ commitment in to ACTION PLAN the continuation of advocacy actions after the project conclusion; endorsement of a common The Italian action plan focused on three main lines: statement on HR development and promotion (Napoli Declaration 2017, during the Naples CSO 1. To ensure that the CSI project acts as a further Conference) propulsive thrust in CSOs networking and alliances, giving new impulse to the current • An open dialogue with some Regions and with Italian drug policy reform and HR CSOs network the National Conference of Regions - Health / 6 Drug Departments has been established with regard to the implementation of HR LEA in FORMATION OF all Regions. A process in this direction has THE NAP started thanks to CSOs and the project actions: the Coordinator of the National Conference of Regions - Health Department committed to include in the Commission’s agenda the implementation of HR LEA in all Regions just after the summer; some Regional coordinators STAKEHOLDERS have been involved in the process of innovating The Italian collaborating partners in the CSI DP / developing local HR systems.
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