Ensuring Quality Care: community-led monitoring of client satisfaction and accessibility of OAT programs

After 30 years since introduction of OAT program in CEECA its coverage reaches the WHO recommended 20% only in 6 out of 26 countries. Transition to state funding of OAT programmes and cost-cutting efforts have negatively affected the provision of psychosocial support as part of such OAT programmes.

In 2019 EHRA has supported the development of CLM methodology to assess client satisfaction and quality of life in OAT programmes. This approach was piloted in Ukraine and subsequently implemented in Belarus, Estonia, Georgia, Montenegro, and the Republic of Moldova. A joint team of community and professional researchers collected both qualitative and quantitative data from 2,113 participants across these six countries.

Respondents across all the countries reported high levels of psychological distress, anxiety, depression and the need for more support, including medication. Availability and satisfaction with social services varied, with some countries facing significant shortcomings. In Belarus, Georgia, and Ukraine, respondents expressed high satisfaction with the OAT programme overall, but low satisfaction with specific services or their own health. This suggests a perception that OAT is primarily about the dispensing of medication rather than a comprehensive set of services. Staff played a crucial role in treatment outcomes, but programmes were generally understaffed. Unemployment was a prevalent issue for respondents in all countries, impacting their quality of life. OAT programme policies and practices often hindered access to, and retention in, employment.

Based on the findings, the following recommendations are proposed:

·     Quality of life and client satisfaction should be frequently and routinely monitored as part of the M&E approach to OAT programming.

·     Community-led monitoring should be leveraged for the monitoring and evaluation of OAT programmes as such enabling collaboration with communities allows are more informed understanding on how best to improve quality of life and client satisfaction.

·     Referral systems should be strengthened between OAT programmes and HIV, hepatitis C virus (HCV), and tuberculosis (TB) related prevention, testing, treatment and support programmes.

·     Psychosocial support provided at OAT sites should be enhanced.

·     OAT service hours should be adjusted to enable OAT participants to more easily pursue employment.

·     Individual approaches to take-home doses should be enabled.

·     Decriminalisation would reduce imprisonment of OAT clients and until decriminalisation is instituted, continuity of access to OAT programming should be guaranteed for people experiencing detention.

·     Quality of life and client satisfaction studies can be leveraged to counter efforts to cut costs, or to “optimise” spending, which would otherwise push for the elimination of psychosocial support as a service that is too costly.