National Focal Points Research Articles

Cross-cutting integration of equity and diversity lens in public health: a novel approach of JACARDI

Abstract Issue/Problem Health inequities persist across European countries, impacting the distribution, prevention, and management of non-communicable diseases. With increasing population diversity and improved understanding of the intersectional nature of drivers of health inequities, narrowing inequities calls for systematic integration of diversity perspectives into equity-driven policy and practice. Description of the problem The EU-co-funded Joint Action on CVDs and diabetes (JACARDI, 11/2023-10/2027) project with 76 partners from 21 countries and 142 national-level projects (later pilots), applies a structured approach for integrating equity and diversity perspectives within all project structures. This is achieved through design of a common methodological framework and terminology glossary for all thematic work packages (WPs) and their pilots, which are further supported through capacity building sessions and consultations. Results The “4Cs” framework (Critical reflection; Context and data; Co-design; and inclusive and accessible Communications) for integrating equity and diversity principles in JACARDI was developed based on results of focus group interviews with WP leaders (n = 24) and review of previous literature. This framework was applied as a lens to be applied in the planned activities by WPs and pilots, elaborated in an equity and diversity maturity matrix aligned with the XV methodological steps for pilot implementation. Additionally, equity and diversity indicators were integrated into harmonized context analysis questionnaires for national focal points of each partner country, as well as into the methodology for pilot assessment and reporting. Lessons Equity and diversity perspectives should be integrated into the core structures of project implementation, supported by practical tools, trainings and practical consultations to improve adherence and collaborative understanding across project partners. Key messages • Equity and diversity integration into core structures are essential for tackling health inequities and the NCD-related social gradient in Europe. • Encouraging critical reflection among JACARDI partners is pivotal for initiating a paradigm shift towards equity and diversity inclusion.

Perspectives on the Regional Strategy for Implementation of National Action Plans on Antimicrobial Resistance in the WHO African Region.

Background: The WHO Regional Office for Africa developed a Member States (MS)-endorsed regional strategy to fast-track the implementation of MS' national action plans (NAP) on Antimicrobial resistance (AMR). This study explored the perspectives of AMR's national focal points in MS on the implementation of the priority interventions of the regional strategy in their countries. Methods: An online survey consisting of ratings and discussions covering the implementation of the six priority interventions was conducted. Sums of the scores per priority intervention were obtained, and their percentage to the total possible scores were calculated to categorize the implementation as inadequate (0-25%), basic (26-50%), intermediate (51-75%), or advanced (76-100%). Results: Thirty-six of the forty-seven national AMR focal points responded to the survey between 12 November 2023 and 8 January 2024. The implementations were rated as 37-62% (basic-to-intermediate), with the multisectoral coordination and collaboration committee receiving the highest overall rating (62%, 421/684), while the promotion of sustainable investment for the NAP on AMR received the least overall rating (37%, 257/700). The focal points mainly recommended awareness campaigns, capacity building, and regulations and guidelines to improve the implementation of the AMR strategy. Conclusions: The survey revealed a need to enhance awareness campaigns, support the establishment and functioning of AMR evaluation and monitoring systems, and build the capacity of AMR staff with cost-benefit analysis and budgeting skills. It also showed the necessity to improve awareness and conduct education on AMR, streamline evidence generation through One Health Surveillance systems, integrate initiatives to reduce hospital-acquired infections in the antimicrobial stewardship programs, and enhance regulations and guidelines to optimize the use of antimicrobials.

Availability of drugs for the treatment of multidrug-resistant/rifampicin-resistant tuberculosis in the World Health Organization European Region, October 2023.

The BPaLM regimen (bedaquiline, pretomanid, linezolid and moxifloxacin) recently recommended by the World Health Organization offers short, safe, and effective treatment for multidrug-resistant/rifampicin-resistant tuberculosis (TB). In a survey with national TB focal points in 18 central and western European countries to explore barriers for the implementation of BPaLM, only three reported full availability of pretomanid, a necessary component of this regimen. Implementation barriers included financing and procurement. Solutions on national and supranational level are needed to guarantee universal access.

UN Security Council Membership as a Litmus Test for Slovenia’s Commitment to R2P

ABSTRACT Slovenia, a small state, was actively involved in the formation of the Responsibility to protect (R2P) and continuously supports the principle through its own normative development (such as in the 2015 Declaration on Foreign Policy of the Republic of Slovenia and its Foreign Affairs Strategies) and by regular appointment of its R2P national focal points, which provide relevant domestic capacity to actively promote R2P’s operationalization domestically, regionally, and at the global level, most prominently within the UN. Several regional European R2P Focal Points Meetings and six biennial academic interdisciplinary conferences on R2P have been organized in Slovenia, providing opportunities to enhance its capacity to lead a well-informed active advocacy for R2P. Moreover, in July 2020 Slovenia supported the first standalone HRC Resolution on the Fifteenth anniversary of the R2P. In April 2022, Slovenia was among the 83 cosponsors of the UN General Assembly Resolution on Standing mandate for a General Assembly debate when a veto is cast in the Security Council. Now, with Slovenia’s election as a non-permanent UN Security Council member for the period 2024–25, an important opportunity has arisen to use accumulated knowledge and experience and strive for efficient operationalization of R2P, including through peace operations. The aim of this paper is to discuss Slovenia’s relationship with the R2P, including during Slovenia’s candidacy for the non-permanent seat at the UN Security Council, and to suggest possible future developments.

Enhancing the Lives of Older Adults in the WHO European Region: Assessing the Implementation of the UN Decade of Healthy Ageing

Abstract The WHO European Region has one of the world's highest median age with many countries having the longest life expectancies. However, the COVID-19 pandemic highlighted the challenges faced by older adults in Europe, leading to excess deaths and highlighting the need to improve their lives. The UN Decade of Healthy Ageing (2021-2030) aims to enhance the lives of older people, their families, and communities. The Decade focuses on four action areas to improve older people's health and wellbeing, combat ageism, ensure age-friendly environments, provide integrated care, and ensure access to long-term care. There are four enablers for the Decade: connecting stakeholders, strengthening research and innovation, engagement, and leadership. A process evaluation survey to assess the implementation of the Decade has been conducted with 48 out of the 53 Member States of the WHO European Region. The survey assessed countries’ policies, regulations, guidelines, strategies, and data on healthy ageing. Preliminary analysis shows that when compared to baseline data, there are more countries with national policy and strategy on ageing with more countries reporting national programme on age-friendly communities, policies to support comprehensive needs assessment of older people and national population-based survey on ageing. Analyses were also conducted based on indicators related to national focal points, multistakeholder forum and legislation on age-discrimination. The UN Decade of Healthy Ageing provides a framework to address the challenges faced by older adults. By focusing on the four action areas and enabling factors, we can enhance the health and wellbeing of older people, their families, and communities. This presentation highlights the importance of the Decade and provides evidence of its early impact, demonstrating the potential to create positive change for the ageing population in Europe.

Assessment of the Implementation of the International Health Regulations during the COVID-19 Pandemic: Portugal as a Case Study.

The International Health Regulations (IHR) were developed to prepare countries to deal with public health emergencies. The spread of SARS-CoV-2 underlined the need for international coordination, although few attempts were made to evaluate the integrated implementation of the IHR's core capacities in response to the COVID-19 pandemic. The aim of this study was to evaluate whether IHR shortcomings stem from non-compliance or regulatory issues, using Portugal as a European case study due to its size, organization, and previous discrepancies between self-reporting and peer assessment of the IHR's core capacities. Fifteen public health medical residents involved in contact tracing in mainland Portugal interpreted the effectiveness of the IHR's core capabilities by reviewing the publicly available evidence and reflecting on their own field experience, then grading each core capability according to the IHR Monitoring Framework. The assessment of IHR enforcement considered efforts made before and after the onset of the pandemic, covering the period up to July 2021. Four out of nine core IHR capacities (surveillance; response; risk communication; and human resource capacity) were classified as level 1, the lowest. Only two were graded level 3 (preparedness; and laboratory), the highest. The remaining three) (national legislation, policy & financing; coordination and national focal point communication; and points of entry) were classified as level 2. Portugal exemplifies the extent to which implementation of the IHR was not fully achieved, which has resulted in the underperformance of several core capacities. There is a need to improve preparedness and international cooperation in order to harmonize and strengthen the global response to public health emergencies, with better political, institutional, and financial support.

Alarming case of avian influenza A (H5) in humans: call for urgent action in Ecuador

Alarming case of avian influenza A (H5) in humans: call for urgent action in Ecuador

Livestock phenomics and genetic evaluation approaches in Africa: current state and future perspectives.

The African livestock sector plays a key role in improving the livelihoods of people through the supply of food, improved nutrition and consequently health. However, its impact on the economy of the people and contribution to national GDP is highly variable and generally below its potential. This study was conducted to assess the current state of livestock phenomics and genetic evaluation methods being used across the continent, the main challenges, and to demonstrate the effects of various genetic models on the accuracy and rate of genetic gain that could be achieved. An online survey of livestock experts, academics, scientists, national focal points for animal genetic resources, policymakers, extension agents and animal breeding industry was conducted in 38 African countries. The results revealed 1) limited national livestock identification and data recording systems, 2) limited data on livestock production and health traits and genomic information, 3) mass selection was the common method used for genetic improvement with very limited application of genetic and genomic-based selection and evaluation, 4) limited human capacity, infrastructure, and funding for livestock genetic improvement programmes, as well as enabling animal breeding policies. A joint genetic evaluation of Holstein-Friesian using pooled data from Kenya and South Africa was piloted. The pilot analysis yielded higher accuracy of prediction of breeding values, pointing to possibility of higher genetic gains that could be achieved and demonstrating the potential power of multi-country evaluations: Kenya benefited on the 305-days milk yield and the age at first calving and South Africa on the age at first calving and the first calving interval. The findings from this study will help in developing harmonized protocols for animal identification, livestock data recording, and genetic evaluations (both national and across-countries) as well as in designing subsequent capacity building and training programmes for animal breeders and livestock farmers in Africa. National governments need to put in place enabling policies, the necessary infrastructure and funding for national and across country collaborations for a joint genetic evaluation which will revolutionize the livestock genetic improvement in Africa.

Public health emergency operations centres in Africa: a cross-sectional study assessing the implementation status of core components and areas for improvement, December 2021

ObjectiveTo assess implementation status of public health emergency operations centres (PHEOCs) in all countries in Africa.DesignCross-sectional.SettingFifty-four national PHEOC focal points in Africa responded to an online survey between May and...

ASEAN Strategy for Enhancing Knowledge Management on Disaster Health Management

Introduction:ASEAN Leaders’ Declaration on Disaster Health Management (ALD on DHM) (2019-2025) was adopted by the ASEAN Summit in November 2017 to strengthen the DHM system at national and regional levels, and the Plan of Action (POA) to implement the ALD on DHM was endorsed by the ASEAN Health Ministers Meeting in August 2019. Knowledge Management (KM) is one of the five priority areas in the POA with the relevant targets including the regional academic network establishment, organization of regional academic conferences, publication of the ASEAN academic journal on DHM, and so forth. The ARCH Project Phase2 (ARCH2), which started in January 2022, focuses on aiming to support implementation of this POA.Method:The ARCH2 will support the establishment of the ASEAN Academic Network on DHM (AAN-DHM) and the ASEAN Institute for DHM (AIDHM). In addition, the ARCH2 will support the promotion of academic activities on DHM which shall be conducted under the AAN-DHM in collaboration with the AAN member institutes and AIDHM.Results:Terms of Reference (TOR) of AAN-DHM was endorsed by the 15th ASEAN Health Ministers Meeting in May 2022. Afterward, the National Focal Point (NFP) institutes for the AAN were nominated among all ASEAN Member States (AMS). The first meeting of representatives of the NFP was held in September 2022 to discuss several areas such as governance of the AAN-DHM, the organization plan for the ASEAN Academic Conference (AAC), and the publication plan of the ASEAN Journal. Simultaneously, the TOR of the AIDHM was prepared for further discussion of its establishment.Conclusion:The AAN has already been established to initiate the preparation of its academic activities. The AAC on DHM is scheduled to be held in November 2023 in Indonesia as the first regional event for accelerating academic activities toward enhancing KM on DHM in the region under the AAN-DHM.

Integrating Management and Operations of Rapid Response Teams and Emergency Medical Teams Programs Globally

Introduction:Health emergencies such as the COVID-19 pandemic, strain health systems and emergency response mechanisms. Identifying critical points during the response cycle where the emergency workforce and operational capacity can be improved can help break the protracted nature of responses. Global health emergency workforce, or health emergency and alert response teams such as multidisciplinary Public Health Rapid Response Teams (RRTs) and Emergency Medical Teams (EMTs), play critical roles in response to public health emergencies.The project aims to explore and understand how countries manage and operationalize their RRT and EMT programs. With anecdotal evidence of countries integrating the two historically disparate groups, we propose to examine how countries are jointly or separately addressing legal frameworks and policies; management practices, reporting processes and protocols, training, as well as program operations and standards.Method:Through existing global partnerships and networks, a convenience sample of national focal points responsible for the management of their RRT and EMT program are sent an online survey followed by participating in a one-on-one interview, and descriptive and thematic analyses.Results:Sixteen countries representing all six World Health Organization regions with both RRT and EMT programs have been selected for engagement.Conclusion:Factors contributing to/or against countries’ integration of RRT and EMT programs will be identified. Areas of divergence or synergy of plans and standard operating procedures will be mapped. Recommendations for strengthening global health emergency alert and response teams will be generated.

EU4Health Programme and the role of national focal points for 2023 and beyond.

EU4Health Programme and the role of national focal points for 2023 and beyond.

THE IMPACT OF DESERTIFICATION CONTROL AND GUM ARABICL IN NIGERIA

Nigeria simply due to consistency in high quality, Nigeria farmers should therefore maintain good reputation on their products and meet the highest standards. Food and agricultural organization (FAO) in 1996 made a review and discovered that the products taken into the market were adulterated because it was poorly produced, processed and so poor quality. This was attributed to lack of proper coordinating body to control the rate of competition amongst producers and to esure consistent production methodology and quality. The restructuring of the only existing association into national association of gum Arabic producers, processors, and exporters of Nigeria (NAGAPPEN) has been largely responsible for Nigeria’s position back on the ladder of production, (Okoro et al), generating foreign exchange of over US $6 billion within a period of 4 year needs to be further strengthened. Established same in the state which have the vehicle through which informal training can be conducted, should be encouraged, with financial institutions taking the lead. Proper supervision to ensure non tempering with the original quality which reduces its market value, creating had impression on the product must be put in place hearing in mind, every shipment is tested to ensure its optical rotation, solubility. Color and moisture content (5% moisture or less is considered stable). The inclusion of Nigeria in the second phase of acacia operation project (AOP) organized by the network for natural gums and resins in Africa (NGARA) with a national focal point and the national project coordinator domiciled in federal ministry of environment aimed at enhancing best practices in the production of gum Arabic is to be taken more serious by the government. There should be close relationship with the associations involved in its production and quality control (physical and physiochemical determination).

Tobacco advertising, promotion, and sponsorship ban adoption: A pilot study of the reporting challenges faced by low- and middle-income countries.

The WHO Framework Convention for Tobacco Control (FCTC) Secretariat has identified issues with Article 13 (Tobacco Advertising, Promotion and Sponsorship) Party policy progress reporting, whilst some researchers remain skeptical of the completeness and accuracy of the data collected as part of the required reporting questionnaire. Gaining a deeper understanding of the challenges encountered when completing these questionnaires could provide insights to improve WHO FCTC progress reporting. Qualitative semi-structured interviews were conducted between January and June 2021, with nine national tobacco control focal point (NFP) individuals (designates who report on WHO FCTC implementation on the Party's behalf) from low- and middle-income countries. The study analysis used a thematic framework approach involving data familiarization, thematic framework construction, indexing and refining, mapping and interpretation of the results. The analysis generated four themes: 1) use of different resources, 2) presence of compounding complexities, 3) use of supporting mechanisms employed for tackling the challenges, and 4) recommendations for refinements within the questionnaire and for those completing it. The WHO FCTC reporting questionnaire needs improvements that could be piloted and discussed between the Convention Secretariat and the Parties prior to wide scale implementation.

Are current warning and responses systems suitable to respond to emerging infectious diseases?

Abstract Socio-economic, environmental and ecological factors, as well as several natural hazards, have repeatedly been shown to drive emerging infectious-disease risk. However, these drivers are largely excluded from surveillance, warning and response systems. This paper identifies, analyses and categorises 64 warning and response systems for infectious diseases. It finds that 80% of them are “reactive” – they wait for disease outbreaks before issuing an alert and implementing mitigating strategies. Only 6% of the warning and response systems were “prevention-centred.” These both monitored and were linked to strategies that addressed drivers of disease emergence and re-emergence. This paper argues that warning systems’ failure to conceptualise emerging infectious diseases as part of an integrated human, animal and environmental system stems from inadequate multi-sectoral collaboration and governance, compounded by barriers to data sharing and integration. This paper reviews existing approaches and frameworks that could help to build and expand prevention-centred warning and response systems. It also makes recommendations to foster multi-sectoral collaboration in governance and warning systems for infectious diseases. This includes proposing solutions to address compartmentalisation in international agreements, developing One Health national focal points and expanding bottom-up initiatives.

Shadows of the Enlightenment: Tragic Drama during Europe's Age of Reason ed. by Blair Hoxby

Reviewed by: Shadows of the Enlightenment: Tragic Drama during Europe's Age of Reason ed. by Blair Hoxby Daniel Gustafson (bio) Blair Hoxby(ed). Shadows of the Enlightenment: Tragic Drama during Europe's Age of Reason. Columbus: Ohio State University Press, 2022. Pp. vii + 320. $99.95. The fate of eighteenth-century tragedy in the long sweep of Western theatre history is most often to get swept under the rug. Sandwiched between the early modern heights of Shakespeare or Racine and the twentieth century's revived interest in the tragic after Ibsen and Nietzsche, marked by philosophical optimism and the rise of the novel, the eighteenth century as a period is witness to "the decline of tragedy as a viable theatrical genre" (2). Such is a persistent narrative of theatre history that editor Blair Hoxby describes in the opening pages of Shadows of the Enlightenment and that the volume on the whole convincingly dispels. The eleven essays collected here unearth the assorted ways in which dramatic tragedy remained essential to European intellectual life between the late seventeenth century and Romanticism. Wide-ranging in locale and language (the featured scholars work in and sometimes across the English, Dutch, French, and German national traditions), discipline, and method, the essays render the long eighteenth century as a complex and exciting moment in the genre's history for the way it operated, as Hoxby argues, as "a period of transition in which dominant, residual, and emergent ideas of – and practical experiments in – tragedy coexist" (8). One of the book's strengths is how fruitfully it substantiates this claim, as it documents a lively cultural moment in which the inheritance of tragic models from classical antiquity sits side-by-side, both productively and uneasily, with fresh designs for the genre. The book's second strength lies in its account of how dramatic tragedy addresses issues on the vanguard of current eighteenth-century studies, particularly affect theory, form and history, and the role of theatre as a public institution. After clarifying the stakes of the volume's intervention in his introduction "Tragedy at the Crossroads of the Enlightenment and Counter-Enlightenment," Hoxby opts to proceed via a discussion of illuminating examples rather than pursue a more pointed line of argument. He outlines the neoclassical theories of the French l'abbe Batteux as a launching point to explore the diversity of Enlightenment thought on tragedy in a pan-European setting: from discussions of Aristotelianism and tragic pleasure to different contemporaries' takes on the form, history, and public function of the genre. On the one hand, the preference for multiplicity of example over more sustained critical synthesis of the field has its drawbacks. Perhaps the most notable of these is that Hoxby has a real command of the material (as evidenced in his own 2015 monograph What Was Tragedy?, which possessed a similarly impressive scope), but his authoritative voice is not always evident in this format. On the other hand, what emerges in the [End Page 418] introduction is an intriguing series of motifs that connect Enlightenment ideas of tragedy to classical and modern ones, depicting tragedy as the grounds in the period for a productive "collision between antiquity and modernity" (25). To take an example: if the 1960s debate between George Steiner and Raymond Williams on tragedy as universal or as historically contingent remains a flashpoint for studies of tragic theory still today, then Hoxby's readings uncover how eighteenth-century writers were already working through the same crux. The critical lineage of these two camps—with full awareness of inevitable slipperiness between them, Hoxby denotes them "Enlightened" and "Counter-Enlightened"—becomes one of the more fascinating throughlines of the volume (9-10). Shadows of the Enlightenment is judiciously divided into three sections with three distinctly thematic (rather than national) focal points. To resist the urge to group the essays by nation or by chronology is a nice touch, and the thematic categories do much to advance the volume's comparativist impulses. Part I, "Ancient Forms, Modern Affects," assembles four essays on Enlightenment theories of the passions, but takes readers from the early eighteenth-century she-tragedies of Nicholas Rowe through discussions of reason, enthusiasm, religion, and...

Establishing a National Emergency Medical Team (EMT) in the Federated States of Micronesia (FSM)

Background/Introduction:The Federated States of Micronesia (FSM) is a Pacific Island nation of just over 100,000 people, with 607 islands spread over an ocean territory of over 2.5 million square kilometers. The nation is regularly struck by disasters and outbreaks - most recently Typhoons Wutip and Maysak, which affected populations on hundreds of islands. To strengthen rapid response to future emergencies, the FSM Government, with support from WHO, Japan, and USAID, is now developing a national Emergency Medical Team.1Objectives:To describe the development of FSM’s national EMT.Method/Description:FSM’s EMT development began with a workshop facilitated by WHO in November 2019, with participants from the National Department of Health & Social Affairs (DHSA) and representatives from all four of FSM’s State Health Departments. A national EMT focal point was jointly hired by WHO and FSM’s DHSA, a Technical Working Group was established, and SOPs developed. WHO initiated procurement of a tailored Pacific EMT cache for FSM’s EMT, along with other Pacific EMTs. FSM’s EMT development has been slowed by COVID-19, but there are plans to train team members from the country’s four States to be ready for self-sufficient national deployments by early 2023.Results/Outcomes:With support from partners, FSM is developing a self-sufficient national EMT capable of rapid response across hundreds of islands spread over a vast ocean territory.Conclusion:FSM is strengthening readiness for future emergencies by developing a national EMT capable of rapid response to the most remote and austere post-disaster conditions, including throughout its remote outer islands.

Integrating Management and Operations of Rapid Response Teams and Emergency Medical Teams Globally

Background/Introduction:Health emergencies such as the COVID-19 pandemic strain health systems and emergency response mechanisms. Identifying critical points during the response cycle where emergency workforce and operational capacity can be improved can help break the protracted nature of responses. Global health emergency workforce, or health emergency and alert response teams such as multidisciplinary Public Health Rapid Response Teams (RRTs) and Emergency Medical Teams (EMTs), play critical roles in the response to public health emergencies.Objectives:The project aims to explore and understand how countries manage and operationalize their RRT and EMT programs. With anecdotal evidence of countries integrating the two historically disparate groups, we propose to examine how countries are jointly or separately addressing legal frameworks and policies; management practices; reporting processes and protocols; training; as well as program operations and standards.Method/Description:Through existing global partnerships and networks, a convenience sample of national focal points responsible for the management of their RRT and EMT program are sent an online survey followed by participating in a one-on-one interview. Quantitative and qualitative analyses will be conducted.Results/Outcomes:Twelve countries representing all six World Health Organization regions with both RRT and EMT programs have been selected for engagement.Conclusion:Factors contributing to or against countries integration of RRT and EMT programs will be identified. Areas of divergence or synergy of plans and standard operating procedures will be mapped. Recommendations for strengthening global health emergency alert and response teams will be generated.

PENICILLIN: A JOURNEY FROM A MAGIC BULLET TO A RESISTANT DRUG

PENICILLIN: A JOURNEY FROM A MAGIC BULLET TO A RESISTANT DRUG

Drug related harm reduction in the eu and candidate countries - success and gaps


 Background: Evaluation of the state of play of the 2003 Council Recommendation on the prevention and reduction of health-related harms, associated with drug dependence, in the EU and candidate countries and elaboration of proposals for new recommendations.
 Methods: Analysis of epidemiological data available at the European Monitoring Center for Drugs and Drug Addiction (EMCDDA) using statistical modeling, a general literature review on harm reduction measures, four systematic literature reviews (one on peer naloxone pro-grams) and surveys among decision makers in the field of drug policy and among harm reduc-tion providers (“stakeholders”) using online questionnaires and a gap survey among the na-tional focal points of EMCDDA in EU-countries and candidate countries.
 Results: It was possible to decrease the number of HIV-infections among drug users substan-tially in most EU countries and candidate countries during the last decade; unfortunately for the numbers of deaths due to overdoses this effect could not be reached. Stakeholders (harm reduction providers) name improvement of needle and syringe exchange and harm reduction in prison as main priorities in order to reduce drug related infectious diseases. Concerning re-duction of mortality they prioritise peer naloxone programs, drug consumption rooms and first aid training of drug users.
 Conclusions : The increase of coverage of substitution treatment and of the availability of nee-dle exchange programs in most countries can be seen as successes of harm reduction policy although the coverage especially of the latter still needs improvement. Peer naloxone pro-grams and improvement of harm reduction in (and after) prison are two of 13 recommended actions to improve the situation concerning mortality of opioid users. Continuous political strengthening of harm reduction is necessary.