Implementing treatment demand indicator in West Africa: challenges and lessons learnt
Drug information systems are now existing in most high income countries, encompassing varieties of surveys and tools to regularly monitor the drug situation and its consequences. The implementation of such comprehensive approaches to collect drug related information remains a challenge in most low resource countries. The West African region has been recently the focus of several international technical assistance projects addressing the challenges related to drug monitoring in the region, many supported by international (EU, UNODC, several NGOs) or regional organisations (ECOWAS).
How can drug-related information systems be implemented in West Africa without compromising international standards and best practices considering the diversity and limited capacity of the countries in the region?
To date, information available regarding the drug phenomenon in West Africa is scarce and rare are the countries that are complying with their international reporting obligations (ECOWAS, UNODC). Although the technical assistance in the region is run by different programmes the approach adopted is similar: supporting the establishment of a reporting mechanism through the creation of national data collection networks using internationally adopted tools and standards.
Albeit some drug law enforcement statistics are available as well as some anecdotal or geographically limited data from surveys or research studies, mechanisms to monitor drug-related issues in a systematic way are not in place and need to be created. In view of the current monitoring gaps, the creation, implementation and monitoring of the treatment demand indicator (TDI) was the path chosen by all.
Since 2015, TDI data collection has been initiated in some countries in West Africa including Nigeria, Senegal, Cote d’Ivoire, Liberia, Guinea and Cape Verde. In a region where there is limited access to drug treatment, and limited resources, building a treatment demand information system requires finding the right balance between international standards and local realities. Alcohol cannot be ignored as a primary drug whereas opioid maintenance treatment is uncommon. Data collection methods have to be adapted to local context while ensuring that minimum quality standards are maintained. Working with internet and excel is ideal but in fact pen and paper are the most widely used form of reporting. Identification of key informants, support of local policy makers, continuous training, assistance and follow up are essentials factors necessary to address daily challenges of implementation of such systems in the region. Developments and results are encouraging. Nigeria is the first West African country to collect information on drug treatment and this, for the 5thconsecutive year providing data comparable with EU countries, while Senegal, Guinea and Cape Verde have embarked on their first year of data collection.
West African countries have started to address the issue of drug monitoring. There is need for further support from the international community. While a momentum is there to implement international monitoring standards in the region, it will require more time, additional capacity building, institutional change as well as high level policy leadership to sustain current achievements.