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Project Code and Sector
Project Background and Justification
Project objectives and outcomes
Execution modality and implementation arrangements

Community-Based Treatment for Drug Users in Cambodia (KHM K51)

1. Project Code and Sector

No. and Title: Community-Based Treatment for Drug Users in Cambodia (KHM K51)
Duration: 5 Years
Start Date: 1 Jan 2012
Status: Ongoing
Location: Cambodia
Link to Regional Programme outcomes : Outcome 4.2 - More effective treatment of drug users and their dependents
Outcome 5.1 - Universal access goals (for HIV services) achieved among drug users
Executing Agency: UNODC
Partner Organizations: MOSALVY, Service delivery NGOs, Research Institutions, and others


2. Project Background and Justification

The amount of drug users in Cambodia is reported to be increasing. Estimates of the number of people who use drugs range from the official Government estimates of between 5,896 and 23,108 people, up to a maximum of approximately 75,000 people. The large majority of these are young people. The current response to drug addiction in Cambodia is to place drug users in compulsory treatment centres; a response which has been shown to be ineffective in treating and rehabilitating drug users.

A joint Royal Government of Cambodia and UN Country Team programme, led by UNODC with specific support from WHO, UNAIDS and UNICEF will support the further development and roll-out of community-based treatment and care services (inclusive of HIV prevention, and increased access to HIV/AIDS treatment and care) for drug users in Cambodia. It aims to help provide the people of Cambodia with a cost-effective alternative to the current use of compulsory centres for drug users. The programme has been prepared at the express request of the Deputy Prime Minister of Cambodia.

The programme will build on the results and lessons learned from implementing the current UNODC Treatnet II project, which is testing a model of community-based drug treatment in Banteay Meanchey Province in north west of Cambodia. It will apply principles of international good practice regarding how to effectively address drug dependency and drug related problems and reduce the harm it causes, i.e. HIV, STI. The programme will specifically promote understanding of drug dependence as a health disorder, requiring a health and social sector response, undertaken within the community as part of the Commune Competitive Plan of the NACD.


3. Project objectives and outcomes

End results to which this programme will contribute are expected to include: (i) reduced morbidity and mortality among current and recovering drug users; (ii) reduction in relapse rates among those with drug dependence problems; (iii) improved access to health and social services for people with drug related problems, including drug dependence; and, (iv) enhanced community safety, including through drug use prevention and re-integration programmes. If successful, this programme may also provide a model for replication in the region where the use of compulsory centres for drug users is currently the norm.

The programme has four main components: (i) Policy and Coordination; (ii) Compulsory Drug Treatment Centres; (iii) Methadone Maintenance Therapy; and (iv) Community Based Treatment Service Delivery. The main government implementing partners are the National Authority for Combating Drugs (NACD), the Ministry of Health (MOH) and the Ministry of Social Affairs, Veterans and Youth Rehabilitation (MOSALVY), together with non-governmental service delivery organizations.

The 5 year programme of support is expected to commence in mid-2011. It will be implemented in 3 main phases: (i) Phase 1 - inception and expansion to cover up to 10 Operational Districts (18 months); (ii) Phase 2 - starting early 2013, expansion to another 20 Operational Districts; and, (iii) Phase 3 - starting early 2014, expansion to another 20 Operational Districts. In total, some 50 Operational Districts (each operational district covers a population of 100,000-200,000 and comprises 10-20 health centres) will therefore be supported. These phases may overlap, and their duration is indicative only.


4. Execution modality and implementation arrangements

The programme will support work at both national and sub-national levels and will contribute to the Decentralisation and Deconcentration (D&D) strategy of the Rectangular Strategy of the RGC. At the National level, the main focus for support will be with policy and coordination issues, as well as strengthening the capacity of the recently established Centre for Mental Health and Drug Dependence within the MOH. At sub-national level, the health system's Operational Districts (ODs) will be a primary focus for support, given that this is where referral hospitals are located. Provincial Health Departments and the Provincial Drug Control Committees (PDCCs) will take a lead role in operational coordination and planning issues. A key role of the NACD and their PDCCs will be to help ensure that law enforcement agencies understand and support the programme's objectives and facilitate its implementation.

Importantly, the development and testing of the community-based treatment system for drug users will be integrated into the national health system, within the framework of the RGC's Mental Health and Substance Use Strategic Plan (2011-2015). This will help ensure integration with other related initiatives being implemented or planned by the RGC (including, for example, the pilot methadone maintenance therapy programme currently being implemented), and promote prospects for the sustainability of service delivery in the long term.