Opinion Paper - Special Collection: COPC-based Integrated District Health System

Harm reduction in practice – The Community Oriented Substance Use Programme in Tshwane

Andrew Scheibe, Shaun Shelly, Johannes Hugo, Matilda Mohale, Sasha Lalla, Wayne Renkin, Natasha Gloeck, Senzo Khambule, Lorinda Kroukamp, Urvisha Bhoora, Tessa S. Marcus
African Journal of Primary Health Care & Family Medicine | Vol 12, No 1 | a2285 | DOI: https://doi.org/10.4102/phcfm.v12i1.2285 | © 2020 Andrew Scheibe, Shaun Shelly, Johannes Hugo, Matilda Mohale, Sasha Lalla, Wayne Renkin, Natasha Gloeck, Senzo Khambule, Lorinda Kroucamp, Urvisha Bhoora, Tessa S. Marcus | This work is licensed under CC Attribution 4.0
Submitted: 28 October 2019 | Published: 06 May 2020

About the author(s)

Andrew Scheibe, COPC Research Unit, Department of Family Medicine, School of Medicine, Faculty of Health Sciences, University of Pretoria, Tshwane, South Africa
Shaun Shelly, COPC Research Unit, Department of Family Medicine, School of Medicine, Faculty of Health Sciences, University of Pretoria, Tshwane, South Africa
Johannes Hugo, COPC Research Unit, Department of Family Medicine, School of Medicine, Faculty of Health Sciences, University of Pretoria, Tshwane, South Africa
Matilda Mohale, COPC Research Unit, Department of Family Medicine, School of Medicine, Faculty of Health Sciences, University of Pretoria, Tshwane, South Africa
Sasha Lalla, COPC Research Unit, Department of Family Medicine, School of Medicine, Faculty of Health Sciences, University of Pretoria, Tshwane, South Africa
Wayne Renkin, COPC Research Unit, Department of Family Medicine, School of Medicine, Faculty of Health Sciences, University of Pretoria, Tshwane, Tshwane Leadership Foundation, University of Pretoria, Tshwane, South Africa, South Africa
Natasha Gloeck, COPC Research Unit, Department of Family Medicine, School of Medicine, Faculty of Health Sciences, University of Pretoria, Tshwane, South Africa
Senzo Khambule, COPC Research Unit, Department of Family Medicine, School of Medicine, Faculty of Health Sciences, University of Pretoria, Tshwane, South Africa
Lorinda Kroukamp, COPC Research Unit, Department of Family Medicine, School of Medicine, Faculty of Health Sciences, University of Pretoria, Tshwane, South Africa
Urvisha Bhoora, COPC Research Unit, Department of Family Medicine, School of Medicine, Faculty of Health Sciences, University of Pretoria, Tshwane, South Africa
Tessa S. Marcus, COPC Research Unit, Department of Family Medicine, School of Medicine, Faculty of Health Sciences, University of Pretoria, Tshwane, South Africa


Share this article

Bookmark and Share

Abstract

Background: The Community Oriented Substance Use Programme (COSUP) is the first publicly funded, community-based programmatic response to the use of illegal substances in South Africa. It is founded on a systems thinking, public health and clinical care harm reduction approach.

Aim: To describe the critical components, key issues and accomplishments in the initiation and delivery of evidence-based, community-oriented, substance-use health and care services.

Setting: The Community Oriented Substance Use Programme is implemented by the University of Pretoria in four of seven Tshwane Metropolitan Municipality regions.

Methods: Quantitative and qualitative data were extracted and triangulated from plans, reports, minutes and other documents.

Results: Between 2016 and 2019, COSUP engaged in national and local policy and guidelines development. In Tshwane, it created practical working relations with 169 organisations and institutions and set up 17 service sites. These provide counselling, linkage to care and opioid substitution therapy services to 1513 adults (median age of 30 years), most of whom are male (90%), with similar proportions of clients who smoke (51%) or inject (49%) heroin. It also offers needle and syringe services (approximately 17 000 needles distributed/month) and has built human resource capacity in harm reduction among staff, clients and personnel in partner organisations.

Conclusion: The Community Oriented Substance Use Programme offers an evidence-based, public-health informed, feasible alternative to an abstinence-based approach to substance use. However, to translate the programme’s achievements into sustainable outcomes at scale requires health system integration; generalist, patient-centred care; affordable medication in a comprehensive package of harm reduction services; multisectoral partnerships; systematic, continuous capacity development; financial investment; and sustained political commitment.


Keywords

Harm reduction; Substance use; Community oriented primary care; Behavioural health management; Family medicine; Primary healthcare; Public health

Metrics

Total abstract views: 522
Total article views: 430


Crossref Citations

No related citations found.