background information
SADC Regional Drug Control Programme [Dr Strijdom]

Background to SADC
SADC comprises 14 member states having a combined population of approximately 200 million persons. In March 1999 the SADC Regional Drug Control Protocol (SRDCP) came into force.

SRDCP
Has the following objectives:

• To establish appropriate and well functioning national and regional frameworks.
• To develop and enhance basic capacities.
• To further analyse the drug control situation in the SADC region.

Its main areas of intervention are as follows:

• Regional capacity building and coordination.
• National capacity building and coordination.
• Legal development.
• Supply reduction.
• Demand reduction.
• Illicit drugs and HIV/AIDS.

Various activities are indicated in the demand reduction area, including:

• Development of integrated drug abuse prevention education and curriculum development.
• Establishment of SADC Epidemiological Network on Drug Use (SENDU).
• Training of treatment and rehabilitation professionals.
• Development of outreach programmes for vulnerable groups.
• Awareness raising and prevention through mass media.
• Coordination and support to NGOs.
• Research on topics such as drug abuse and irresponsible sexual behaviour.

The 5-year budget of SRDCP is approximately ,3.99 million from the European Commission (EDF and EPRD-South Africa).

SADC Drug Control Database
The main foci of this database are data on national contact points, the drug control situation in different countries (seizures, production, trafficking routes, trends, effects, mode of abuse, and treatment and rehabilitation) and projects and programmes.

The main problems with this database to date are that (i) data are often not available, (ii) the data that is available is not always relevant, (iii) too many authorities are involved in data collection, and (iv) the questionnaire used is too complicated.

What is required is better coordination with similar efforts by the OAU and UNDCP, development of a simplified questionnaire, and greater involvement of SADC Drug Control Committee (SDCC) members in the collection and compilation of data.

Key findings from the 1997 database are:

• Alcohol is by far the most abused drug, and is by far the drug that causes the most problems.
• Cannabis is the 2nd most abused drug and is the 2nd most damaging drug. Cannabis abuse is stable or on the increase in all states except among adult females in Zimbabwe. The area being cultivated with cannabis is more than 2 158 hectares.
• Heroin is seen as a particularly serious problem in Mauritius, Botswana, Swaziland, Tanzania, and Zambia.
• Namibia, Zambia, and Zimbabwe report an increase in the abuse of opiates in almost all age groups.
• When reported, hallucinogens and synthetics are either stable or on the increase.
• Hypnotics and sedatives are stable or increasing in all countries except Zimbabwe.
• All countries report intravenous abuse of at least one or more illicit drugs.

The intention is to link SENDU with the SADC Drug Control Database.

• Methaqualone (Mandrax) is mentioned only as a problem in Namibia and South Africa.
• Data regarding the number of abusers receiving treatment is insufficient.
• 29 drug control projects are being implemented.

Overview of SENDU [Dr Parry]

Scientific background
Three issues were mentioned as being major factors contributing to the SENDU initiative:

• The burden of harm from AOD use in Southern Africa is likely to increase with development.
• Various factors (globally, regionally and locally) have highlighted the need for monitoring substance misuse in Southern Africa at this time.
• The SADC Protocol (1996) highlights the importance of information and research to inform interdiction and demand reduction activities. Article 6 (Law Enforcement, Point 2) states that Member States shall 'establish a regional drug database' and Article 7 (Drug Demand Reduction: Point E) states that Member States shall provide and share systematic information and research data on drug abuse, drug trafficking and demand reduction programmes to facilitate regional cooperation and coordination.

The need for accurate information on substance abuse trends is also important as SADC member states seek to develop or modify existing drug control strategies/master plans, and in particular as they seek to develop and evaluate short term action plans (often at a local level) to address substance abuse.

SENDU Aims and Objectives
This is an observational epidemiology study.

Its purpose is to develop, establish and evaluate a substance abuse sentinel surveillance system in one or more sites in each of the 14 SADC member states - building on the SACENDU model operational in 3 cities and 2 provinces in South Africa.

The overall goal is to improve the information base for policy makers and practitioners in SADC member states to address the health and socio-economic burden caused by the misuse of AODs.

Specific objectives include:

1. Establishing a network of key stakeholders in one or more sites (especially major cities) in each of the 14 SADC member states, including persons from the health, welfare, research, law enforcement and education sectors.
2. Reaching agreement on a set of indicators for measuring the nature, extent and effect of AOD use.
3. Collecting data on the AOD indicators at each of the sites.
4. Sharing and validating the information collected on an annual basis at each site by running workshops involving key stakeholders.
5. Preparing reports on the nature, extent and effect of AOD use and changes over time for each site, and an integrated report across sites.
6. Disseminating information to policy-makers and the general public to guide programming and policy, and actively lobbying key decision makers to use the information provided by this surveillance system and to support its ongoing development.
7. Evaluating the project (externally).

Methods
Training (capacity building) - through exposure to the SACENDU model and 3-4 day intensive training (Consultation Meeting), as well as through provision of written materials, site visits and attendance at report back meetings.

Establishment of site specific networks and implementation of a 'basic'surveillance system in each and, if possible, additional components in some sites. Site convenors will involve members of the networks in collecting information on treatment demand (e.g. from specialist treatment centres, if available, psychiatric hospitals, PHC clinics) and on arrests/seizures. Where possible assistance will be given to implementing more advanced surveillance methods, such as high school surveys, emergency room studies, mortuary studies, studies of AOD use among arrestees, and qualitative research on drug users (e.g. sex workers and street children) and other key informants. The project is to be phased-in in two or more countries every 6 months.

Validate and collate data. Validation is to largely take place though discussions at (bi-) annual meetings that will take place at each site. Collation will comprise the preparation of site reports and their presentation at (bi) annual meetings. The site reports will then be combined into regional reports by the MRC.

Disseminate findings. Findings will be reported annually to the SDCC and written reports made available in paper format and via the internet.

Evaluation. Evaluation will be outsourced and will focus on both process and outcome issues in terms of the following criteria: level of participation of stakeholders, completeness and quality of the information obtained, usefulness of the process and the information obtained to network participants and policy-makers, and appropriateness of indicators.