“While demand for treatment is generally high in Africa, only 1 out of 18 drug users who need treatment services actually get it”

Improving health, security and socio-economic wellbeing to reduce illicit drug use and drug trafficking. These are the goals of the AU Plan of Action on Drug Control and Crime Prevention (2019-2023), in short AUPA, adopted by the African Union (AU) in July 2019. As a social development specialist, Dr Jane Marie Ong’olo played an essential role in the development of this plan. With over 25 years of experience in the sectors of health and development, governance and social protection, as well as drug control and crime prevention she heads the Division of Social Welfare, Vulnerable Groups and Drug Control at the AU. In the past, she also worked for the Government of Kenya, the British Council, the International Labour Organization (ILO) and the United Nations Office on Drugs and Crime (UNODC). In this interview with GPDPD, she gave us an insight into how the AUPA is shaping current and future drug policy in African states and aims at protecting especially vulnerable groups of drug users such as women and young people.

GPDPD: Within the AU’s target regions, most recent issues relate to a growing use of cocaine, tramadol, Amphetamine-type Stimulants (ATS) and New Psychoactive Substances (NPS), as well as heroin use. How does the AUPA address these issues?

Dr Jane Marie Ong’olo: Africa is no longer merely a transit point for drug trafficking, but a destination and many types of drugs are increasingly being consumed across the continent. There are of course regional and country-specific variations. In terms of heroin in particular, we are talking mainly about Eastern African Countries with coastal borders, Southern Africa, as well as a few countries in Western Africa that are affected. In terms of cocaine, drug use is mainly concentrated in Western Africa, while tramadol is mainly consumed in Western, Central and Northern Regions; NPS are also fast emerging.

So, what are we doing? Through this action plan, the African Union continues to promote a multi-sectorial, balanced and integrated approach to drug control cognisant of global challenges relating to drugs including health, socio-economic wellbeing, crime, terrorism and security in our Member States.  A public health approach is fundamental. We can no longer use law enforcement approaches alone. We have people who have not made themselves drug users; they did not decide to be where they are. In this regard, through the Plan of Action, we are promoting the treatment of drug users with respect and dignity. We are encouraging member states to put in place evidence-based prevention, treatment and after-care services.

Again, regional variations have to be kept in mind here. Some countries have better infrastructure and have applied a comprehensive service provision approach, e.g. Eastern African countries. The data we have from the Pan African Epidemiology Network on Drug Use (PAENDU) indicates that the majority of people presenting themselves for treatment are seeking treatment for cannabis, alcohol and heroin and other opioid related substances, and to some extent for NPS. The latter, however, is still a new terrain for us and for cocaine, treatment has not been very well established either.

Recent years have seen an increase in the identification of drug production sites across Africa. Which regions are most affected and what does this imply with regard to the reality of drug trafficking in AU member states?

When we talk about drug production, this mainly concerns cannabis. We do not have evidence of coca cultivated nor cocaine produced in Africa. The same goes for poppy cultivation and heroin production. Cannabis however, is grown across the continent and NPS production is beginning to emerge everywhere in Africa as well. At least 13 clandestine methamphetamine laboratories were reportedly dismantled in Africa in 2018 (3 in Nigeria and 10 in South Africa.

Drug trafficking on the other hand has been reported across many African countries. Generally speaking, the West African region has been a hub for cocaine transhipment and trafficking out of the continent. For heroin, this hub is rather in Eastern and Southern African regions. We must address this and begin to have a balanced and integrated approach and this is really what the Plan of Action intends to promote: not only trying to manage and control the availability of drugs through law enforcement measures but also putting in place public health measures to address the socio-economic impact of drug use. That is why we consider this plan as forward looking. When you work on measures that include licit and sustainable livelihoods, you begin to address factors that may have been pushing people towards earning their livelihood via drug trafficking or production of illicit drugs.

The AUPA is the fifth strategic framework on drug policy development, how does it differ from the previous framework in terms of its focus?

The AUPA is updated every 5 years to capture emerging trends and policy directions envisaged by AU member states to be addressing the drug challenge in a comprehensive, and balanced manner. I would say that the most recent AUPA presents no fundamental shift as such but is much more comprehensive and balanced. There is increased recognition to address the health and social impact of drug use; and prioritising certain areas much more than they were before, especially regarding Harm Reduction and Alternative Development.

Previous Action Plans have always advocated for comprehensive, accessible, evidence-informed, ethical and human rights based drug use prevention, dependence treatment and aftercare services but without mentioning the term Harm Reduction. The current plan explicitly names it. Alternative development (illicit crop substitution) on the other hand, is a relatively new concept in the Plan of Action and while this still needs a lot of research, we are beginning to explore concepts for licit and sustainable livelihoods. What does it mean? How can it be applied and under what circumstances? Considering that, the main illicit drug being cultivated in Africa is Cannabis.  

Has the AUPA been inspired by international lessons learned and best practices? If so, what have been the main sources of orientation?

One of the documents that guided the development of this Plan of Action was the UNGASS (2016) Outcome Document and the Common African Position for UNGASS. This new consensus supports a drug policy that is much more public health policy-oriented, influenced in particular by how evidence-based, comprehensive services for drug prevention and treatment have clearly improved outcomes for people who use drugs. This helped us to articulate measures to address the health and social impact of drugs.

Experience from other organisations, such as the Inter-American Drug Abuse Control Commission of the Organization of American States (OAS/CICAD) was vital. Also, the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) was an important source of orientation. Moreover, the ECOWAS (Economic Community of West African States) and their WENDU (West African Epidemiology Network on Drug Use), which in turn influenced the formation of the PAENDU for the systematic collection of drug epidemiological data, were key regional sources. The African Economic Development blueprint (Agenda 2063) and the UN Sustainable Development Goals also influenced the AUPA. Hence, the Plan of Action was informed by regional as well as international documents and data.

What are practical implementations already instigated as part of the AUPA in the member states? Could you name any specific examples and whether there is evidence of their effectiveness?

The AUPA is still very new, having been adopted by African Union heads of state only in February 2020, very close to the outbreak of the COVID-19 pandemic. So, in reality, it is too early to talk about the effectiveness of measures.

What we have done and what we do best, is consultation with member states on how to align the drug policy framework to their national laws. One of the important activities we are continuing to implement from the previous Plan of Action is collecting systematic data from national epidemiology networks which feed the continental epidemiology network. To date, we have 30 member states linked to the continental network, systematically collecting treatment demand and supply reduction data. We have produced three continental drug epidemiology reports, which continue to provide insights on the status of drug trafficking and use in Africa, thereby informing legislative response.

A vulnerable group, the framework mentions, are young people. Past projects that were praised as effective prevention programs were the “Unplugged” school-based program in Nigeria and the harm-reducing Methadone Treatment Program in Senegal. Could you describe in what manner these programs were effective and whether such programs have been adopted in other AU member states?

Unplugged is an UNODC initiative, which works on developing stronger knowledge and skills and it is directly linked to preventing substance use by young people. What I like is the life-skills approach to it. It is being implemented at school level, it is 12 sessions long making it also very light on the education system and mainly develops social influence in protection. The initiative has been replicated in Mauritius, Nigeria, Egypt and Morocco. Since last year, Mauritius has involved the private sector to contribute substantially to it, so it comes with a sustainable element to it.

It targets children in schools and specifically those most vulnerable to drug use. It is a promising initiative and an approach we want to adopt. This could be done through involving the private sector (as was done in Mauritius). It is still very early to talk about how effective it is, however, programs that target life skills development really enhance resilience of young people not only against drugs and substance abuse but more generally.

The methadone treatment program in Senegal is a few years old and one of the best initiatives in harm reduction in West Africa.  We are proud of the programme in Senegal because it is one of the fastest growing in West Africa. It provides not only methadone but also related services, e.g. syringe programs, condom provision, testing etc. It also targets HIV and

Hepatitis C. By providing funding for opioid Substitution treatment, the Senegalese government has joined just a handful of similar initiatives in Sub-Saharan Africa.

Mauritius was the first in starting treatment programs that included methadone and needle exchange programs. Here, HIV prevalence among drug users decreased significantly, so it is really an approach that works. We are experiencing an exponential growth in drug use, including heroin in injectable form in many countries. Thus, it is an approach that the African Union is promoting.

Women constitute another vulnerable group in terms of being drug users, as well as being used as drug couriers in Africa. How does the Action Plan target this group specifically?

We are providing a lot of training for women and especially for women who are lured into drug trafficking. Whist being involved in drug trafficking, women also often engage in sex work and sometimes need to take drugs to be able to cope with this type of occupation.

So, what the Plan of Action is promoting now, are dedicated treatment facilities, where women are not stigmatised and where they are not abused. The AUPA also promotes the protection of women in drop-in centres, not to be harassed by the police, or the

community, or other male drug users when women go to collect their syringes or other commodities. Tanzania, as a specific example, put in a lot of measures protecting women drug users in this manner.

Importantly, women are often in conflict with the law. They are arrested for sex work, they are arrested for possession and for drug use. When they are incarcerated, these women have to leave their young ones at home. So, one of the measures we have in place is promoting alternatives to incarceration, diverting women away from the prison setting to do community work instead for example.

There is still a lot of stigma around women using, cultivating and trafficking drugs compared to men, thereby negatively impacting the services they receive. Generally, many people still think that drug users are criminals, who brought this on themselves and do not deserve any mercy. Therefore, a lot of work for us revolves around advocacy for destigmatisation. The Plan of Action aims to progressively bring countries to the same level of understanding regarding the needs of people who use drugs, and the potential alternative licit and sustainable economic activities for those involved in production and trafficking, especially the most vulnerable ones like women.

How does the framework instigate destigmatisation and decriminilisation of drug users more generally?

On various levels. Firstly, it all centres on improving the health, security and well-being of individuals and you cannot do that until you treat people fairly and equally, respecting their human rights and dignity. Therefore, in terms of the public health principle in the Plan of Action we are recognising addiction as a multifactorial health disorder requiring treatment like any other disease. Hence, one way to promote destigmatisation is through advocacy.

The other is more practical. The issue is that we have seen conflicting laws. We have laws that criminalise possession of drugs and we have public health policy, which focuses on providing services from a health perspective. So, you might be providing harm reduction services which are illegal from a law enforcement perspective. In addressing the needs of drug users comprehensively, through the Plan of Action, we advise countries to form national steering committees bringing players from all sectors - the law enforcement, public health and social development and NGOs.  We have seen consensus reached in many instances where police who would ordinarily arrest those with “illegal paraphernalia” (needles, syringe etc) would provide security and escort drug users to receive their services despite the inconsistency between the security and public health laws.  Thus while advocacy at the policy level continues, practical application at the lower service delivery levels are in turn taken back to the steering committee and influencing the development of appropriate policies.

Another objective of the framework regards the provision of alternatives to custodial sanctioning in order to decongest prisons and prevent reoffending. What kind of alternatives does this involve?

Various different ones, depending on the country. One alternative used by almost all countries and this is at the discretion of the magistrates, are probation orders and community service orders. It works and we are promoting its continued use. The problem with probation and community service orders is that they may not necessarily provide a treatment option. So, we have merely diverted drug users from the prison setting but not reduced their drug use.

We therefore say that in addition to community work and to probation, people have to be sent to treatment centres - only willingly of course, as we cannot force people into treatment. However, while the demand for treatment is generally high in Africa, only 1 out of 18 drug users who need treatment services actually get it. Compared to the global level, whereby 1 out of 6 people receive treatment, this is critical. Hence, while working with the criminal justice system we are also continually pushing for the social development and public health sector to offer more accessible, and adequate treatment and reintegration options.

The Action Plan declares to target “grower communities in the agricultural sector with specific focus on Technical, Vocational Education and Training (TVET)”. Can you give us some insights into what this entails in practice?

The framework is not solely being implemented by the Department of Social Affairs, it feeds into so many other Plans of Action of the AU Commission. When it comes to AD, there are links with other departments. In particular, the Department of Agriculture’s Comprehensive Africa Agriculture Development Programme (CAADP). Synergies and linkages between departments are important because often people, who have left treatment and or people who have stopped trafficking drugs don’t know what to do anymore. So, through national coordinating groups, we work on having systems in place that provide training and income for these people. Some of the institutions in our member states enrol agricultural extension workers to target drug crop cultivating communities. In fact, the biggest challenge we have is finding better and licit sustainable income alternatives for drug traffickers and drug crop cultivators. AD is an option and we do link it to our agricultural program but I think we still need to do a lot of exploration and research regarding what works before we can invest resources into specific AD programs.

How significant in terms of importance is the role of civil society actors in the implementation of this new strategic framework?

CSOs are part of national implementation frameworks. One of the structures recommended in the AUPA is presence of multi sectorial National Drug coordinating Councils/committees that bring on board all players. We believe this partnership is happening in many countries for indeed a large part of drug prevention, treatment and harm reduction services are provided by NGOS and other non-state actors.

If you think about treatment and service, who are the outreach workers? Who is at the drop-in centres? It is really the NGOs. They can reach those most difficult to reach. Even in terms of sustainable livelihoods, agriculture and trade, while governments provide the policy framework, it is mostly non-government agencies on the ground.  Hence, they have a huge role and it needs to be promoted. Civil society can gather data quickly from the ground regarding evidence on what works. For many countries where harm reduction services were illegal, NGOs and other service providers at the community level were able to generate evidence of workable public health approaches even in the absence of a legal basis. Thus, they have the ability to develop and generate evidence to provide services much faster.

Do you see any limitations regarding the new strategic framework and how do you think these shortcomings (if there are any) could be addressed in the future?

No framework is perfect, and I don’t think any will ever achieve that. There is always room for improvement and that is why we revise the framework every 5 years.

Having said that, it is hardly one year since the adoption of the framework. We have not conducted any evaluation to determine limitations that may need to be addressed.  The framework is a statement of intent with many of its objectives broadly stated to be able to capture any new thinking, emerging trends or ideas deemed necessary by member states and supported by evidence to be working in addressing the world drug problem as it affects the continent.