Learning through exchange: Tunisian Health Delegation study visit to Switzerland

30th June 2019 - Geneva, Switzerland

Aiming to strengthen the knowledge and capacities of medical doctors directly involved in drug dependence and blood-borne infections, UNODC organized a study visit for Tunisian doctors to Switzerland. Learning through direct exchange, discussions, and interaction helps in sharing the best practices and tools towards effective capacity building. The visit also aimed to spark a conversation on the possible ways to integrate the experience gained into the doctors' daily practice to improve health services in Tunisian prison settings.

The visit was a collaboration between UNODC and the Federal Office of Public Health (FOPH) and the Groupement Romand d'Etudes des Addictions (GREA), and included meetings with International and Swiss Federal Organizations, Civil Society Organizations, University Hospitals and Swiss prison authorities.

 Some of the key exchanges covered:

    • The efficiency of comprehensive public health and harm reduction policies: scientific evidence, and cost effectiveness of the response.
    • Exploring innovative approaches implemented in Switzerland: experimental Heroin Prescription Program (PEP), Needle Exchange in Prisons, Opioid agonist treatment centers, and supervised injection sites.
    • Drug policy in Switzerland: the 4 pillars policy and its implementation challenges.
    • The need for a strong focus on effective harm reduction services in prison.

To initiate the conversations, Ruth Dreifuss, former president of Switzerland, presented the Global Commission on Drug Policy's mission and history to. This provided an opportunity to discuss drug policy reform in Switzerland and exchange views related to drug policies from a human rights and public health perspective. The Tunisian delegation explained the health situation in the Tunisian prisons and related future challenges. Also, discussions centered on drug policies and harm reduction strategies in Tunisia, as well as opioid substitution therapy programs implementation in the country and the improvement of drugs-related data quality. "Prejudices and fears surrounding drugs are expressed in stigmatizing language, stigmatization leads to social discrimination and repressive laws, and prohibition validates fears and prejudices. This vicious cycle must be broken," Dreifuss had explained when discussing the work that needs to be done.

As the visit moved forward, the Tunisian delegation had the chance to explore the Department of Community Health and Primary care at Geneva University Hospitals (Hôpitaux Universitaires de Genève, HUG). The delegation received an introduction about drug policy in Switzerland, which is called the 4 pillars policy (prevention, treatment, harm reduction, and repression).  One of the participants had commented that "during this study tour, we were impressed by the results obtained from the "four pillars" policy, which is a valuable and inspiring experience that should be implemented in Tunisia." While another added that such visits helped to "understand better the Swiss drugs policy, including the four-pillar model."

In addition, the participants visited the department of Addictology at Geneva University Hospitals and were familiarized with the used protocols for their experimental heroin-prescription program (PEPS) at the addictology department, as well as for methadone-based opioid substitution therapy (OST).

The visit of the PEPS and OST center was followed by an exchange between the Swiss health professionals from the University Hospitals of Geneva and the Tunisian participants regarding how PEPS and OST are accepted by the community of drug users, the impact of these drug treatment program on overdose mortality decrease in Geneva, how patients are maintained in the drug treatment programs, protocols used for treatment resistant drug users, limits and future challenges of the PEPS program.

The Tunisian participants visited a supervised drug consumption room named Quai 9, where they met with social workers, nurses, and members of the Civil Society Organization "Première Ligne" in Geneva. With the Quai 9 staff, the participants reviewed the available harm reduction services and tools and inquired about the ongoing prevention and treatment projects for drug users implemented.  This visit was followed by a meeting with Mr Serge Longère, President of Première Ligne, Mr Jacques André Romand, Geneva's chief medical officer, and Mr Jean-Félix Savary, Secretary General of GREA.

This meeting was an opportunity to explore the strong community-based commitment of Civil Society Organizations and Geneva's political institution towards comprehensive public health and human rights approach regarding drug use. Community-based projects and interventions was presented to the participants, especially the supervised injection site of Quai 9 and how high-quality harm reduction and prevention services were provided for drugs users.

The day continued with the visit of Champ-Dollon Prison, one of Switzerland's biggest prison facilities. Mr Philippe Bretschy, Deputy Director of Champ-Dollon prison welcomed the delegation by presenting data related to the prison and explaining the applied procedures while visiting different sections of the prison. Then, a meeting with Dr Hans Wolff doctor chief of the Division of Correctional Medicine and Psychiatry, Geneva University Hospitals, was organized. Following the visit of the health facilities available at the prison, a presentation was to explain how Opioid Substitution Therapy and Needle and Syringe Exchange programs are implemented in prison settings.

For the fourth day of the study tour, the participants visited the Federal Office of Public Health (FOPH) in Berne, Switzerland. During the meeting, Mr Stefan Enggist, Deputy Head of Section, Department of Communicable Diseases, presented the drug policies led by the FOPH in Switzerland from a strong public health and Human rights perspective. In addition, Mr Dominique Schori from the Swiss Office for the Coordination of Addiction Facilities (infodrog) explained how Infodrog supports the FPOPH in the development and the implementation of the 4-pillar addiction policy, and how quality and accessibility of various prevention, counselling, treatment and harm reduction services are promoted in Switzerland.

The visit was part of UNODC's project,  "HIV and AIDS Prevention, Treatment, Care and Support in Prison Settings in the Middle East and North Africa;" supported by the Drosos foundation.