Pubdate: Thu, 13 Dec 2012
Source: Victoria Times-Colonist (CN BC)
Copyright: 2012 Times Colonist
Contact: http://www2.canada.com/victoriatimescolonist/letters.html
Website: http://www.timescolonist.com/
Details: http://www.mapinc.org/media/481
Author: Mark Willson
Note: Mark Willson is a PhD candidate in political science, researching
VIHA's institutional effectiveness using freedom-of-information requests.

FIVE YEARS FOR HARM-REDUCTION SERVICES TOO LONG

The Vancouver Island Health Authority's announcement of the return of
fixed-site needle-exchange services ("service hubs") to Victoria,
after five years of false starts and delays, raises some important
questions.

Why is VIHA taking so long to reintroduce this basic harm-reduction
service? Can Victoria residents be confident we won't see similar
implementation failures when it comes to other components of health
policy, such as supervised consumption services or drug and alcohol
maintenance programs?

Five years is a long time for a health authority to fail to provide
services mandated by the province.

As early as 2009, a VIHA briefing note to the board of directors
pointed out that "without a fixed site NEX [needle exchange] the
health authority is not consistent with either its own or with
provincial policy," and acknowledged that "failing to establish a
fixed site NEX as part of a distributed harm-reduction model puts the
health authority at risk for spread of HIV, hepatitis C and other
blood-borne diseases."

Five years is also a long time to wait for a basic health service,
particularly for people who lack the financial resources to find
support elsewhere. When it comes to fixed-site needle-exchange
services, it's not just access to clean supplies, but access to health
care and referrals for people who would not otherwise have contact
with these services.

So these five years can be measured, not only in terms of infections
and diseases that could have been prevented, but also in terms of
improvements to people's health and well-being that could have been
provided and encouraged.

Policy implementation sometimes moves slowly, but there are reasonable
grounds to question whether VIHA has exercised due diligence in
implementing these services in a timely and appropriate manner.

A scant two months following the policy brief above, VIHA disbanded
its needle-exchange advisory committee and stopped speaking publicly
about needle-exchange services, making an abrupt shift toward a
"distributed model" of supplying needles through existing
service-providers.

In a letter to VIHA dated Nov. 19, 2009, the advisory committee
expressed its concern about a policy it believed "hamper[ed] the
successful search for a needle exchange site" and re-stated VIHA's own
findings that a distributed model could not replace the range of
services provide by a fixed site.

On what grounds were decisions to disband the needle-exchange advisory
committee and to shift toward a distributed model made? This remains
unclear.

More than a year later, the City of Victoria passed motions urging
VIHA to form a working group to ensure fixed-site needle-exchange
services would be reintroduced. In a letter dated March 4, 2011, VIHA
agreed to form such a group as long as there was agreement "between
the city, the police and VIHA on the benefits of harm-reduction
services based on best practices, including the reduction of public
consumption of drugs and improving public order."

Why was the city forced to prompt the provision of services VIHA
recognizes as part of its provincial health mandate? What
considerations led VIHA to prioritize public order and other policing
issues as conditions for meeting this mandate? This also remains unclear.

The reintroduction of fixed-site needle exchanges is an important step
forward for health services in Victoria. There are reasonable grounds
to be concerned, though, about VIHA's track record on implementing
such services. What changes are needed to prevent similar
implementation failures when it comes to other components of health
policy, such as supervised consumption services or drug and alcohol
maintenance programs?

It is in the public interest to hold VIHA accountable in addressing
these concerns. Effective implementation of public-health policy
requires an assessment of past mistakes, and we haven't seen this yet
at VIHA.

Mark Willson is a PhD candidate in political science, researching
VIHA's institutional effectiveness using freedom-of-information requests. 
- ---
MAP posted-by: Jo-D