Understanding the Determinants of Policy Performance in Collaborative Context: The Case of Drug Harm Reduction Services in Central-Eastern Europe

Kivonat, rövid leírás

The dissertation focused on identifying circumstances contributing to the policy's poor versus high performance, focusing on different aspects of policymaking, namely, policy framing, collaborative governance regimes, and structural factors affecting effective service delivery. Together, the results of the three articles making up the dissertation provide a holistic, complex picture of the performance of harm reduction policy in the region. The work contains the following contributions: The first paper: • The results confirm the association between using a morality frame to shape drug policy and poor harm reduction policy performance, and between a strong health-social framing and high policy performance; • The level of the data quality was characterised by significant variance between countries, which may be considered an indicator of the entire policy system's capacity. The second paper: • Novel conceptualisation of collaborative governance regimes and the development of their conceptual classification including operationalisation of each of categories along with a range of observable dimensions; • Identification of a relatively strong presence of a pro-collaborative regime in Czechia, a mix of pro-collaborative and neutral regimes' features in Poland and Slovakia, and a strongly anti-collaborative regime in Hungary. Inductive conceptualisation and operationalisation of the anti-collaborative governance regime; • Conclusion arguing that anti-collaborative governance regimes do not appear uniformly across various policy fields, and their materialisation in different policy areas may vary in space in time. The third paper: • The results confirm the relationship between the number and severity of identified barriers and poor policy performance on the one hand, and between the number and scope of identified facilitators, on the other. The study also confirms that structural factors are interrelated and affect one another, creating a complex system of relationships. Overall: • The great extent of the use of criminal law as a policy instrument in drug policy field seems to be related to the general societal consensus regarding the morally evil status of drugs and people who are engaged in their use, sales, production, etc.; • The situation one can see in many countries with respect to drug policy resembles the concept of moral panic; • Drug policy, and especially its harm reduction element, is still a very controversial policy field where deep beliefs are strongly involved, and ideology often dominates over the evidence; The main consequence is that harm reduction organisations have to overcome not only barriers resulting strictly from policy and politics but also those emerging, for example, in local communities; • The data shows that the contradictions between different policy priorities (e.g., incarceration of people who use drugs and harm reduction) are not addressed at the system level but need to be dealt with by the frontline policy implementers; • Policy goals formulated in policy documents have a limited impact on what the policy effects will be; • There are significant differences between the range of harm reduction services operating in countries with otherwise similar legal frameworks in terms of the criminalisation of drug use and/or possession for personal use. The reasons behind the availability of specific interventions in some countries and not in others cannot be placed within the legislation or general policy frameworks – other policy aspects need to be explored to shed some light on this phenomenon.