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Failure To Fund: The continued crisis for harm reduction funding in low- and middle-income countries

This article features the 2021 HRI report on the global state of funding for harm reduction
A visualisation with a chart to illustrate the funding gap
© Harm Reduction International

As we heard in the previous video, funding harm reduction is a major challenge in many places. In this step we will look into this from a global perspective. It will hopefully help you contextualise your own setting.

Read the executive summary of this report (page 6-8). You can read the key findings directly below and for the full executive summary you can download a copy of this report below or follow the link.

As the COVID-19 pandemic has brought global health to centre stage, it has never been clearer that ensuring access to health care for all is paramount. People who use drugs are criminalised and marginalised in much of the world, resulting in greater barriers to accessing health services than for the rest of the population.
Harm reduction services such as needle and syringe programmes (NsPs) and opioid agonist therapy (OAT) are proven to be effective and cost-effective protection from blood-borne viruses. A comprehensive package of interventions has been endorsed at the highest political level. Insufficient financial support, both for services and the advocacy necessary to garner political will at the national level, remains the major barrier to implementing at scale.
Governments have committed to ending AIDS and tuberculosis, eliminating viral hepatitis and providing universal access to health care by 2030. We will not reach these goals without the leadership of people who use drugs and a fully funded harm reduction response.
Since Harm Reduction International commenced monitoring funding for harm reduction almost 15 years ago, the findings have been consistently dire. Available funding continues to be so far from meeting estimated need that the funding ‘gap’ is more accurately described as a failure to fund. The total number of international donors investing in harm reduction remains small, and the total funds invested by international donors appears to be shrinking. At national level, more data has become available on domestic funding for harm reduction.
However, spending on drug law enforcement and imprisonment continues to dwarf investment in harm reduction; with case studies showing over 600 times more spent on punitive policies.
This report explores the state of harm reduction funding in low- and middle-income countries, drawing upon existing public data on domestic funding and information collected from international harm reduction donors. The data shows that we are further away from meeting the needs of people who use drugs than ever before.


  1. Harm reduction funding is only 5% of the level required in low- and middle-income (LmI) countries. Overall, US$131 million harm reduction funding was identified for 2019, just 9% of the US$1.5 billion that UNAIDS estimated to be required annually by 2020. Considering funding levels in the context of UNAIDS’ new resource needs estimates, harm reduction is funded at just 5% of the US$2.7 billion annual requirement by 2025.
  2. The funding gap for harm reduction is widening. Despite the evidence of effectiveness of harm reduction interventions, high-level political support and staggering unmet need for services in low- and middle-income countries, identified overall funding for harm reduction in 2019 was one-third lower than in 2016.
  3. The split between donor and domestic funding for harm reduction is almost equal – half of the total identified funding for harm reduction in 2019 has been allocated from domestic sources. This could be in part due to more available data on domestic funding, but given the overall decrease in funding levels, it is also suggestive of donor funding decreases outpacing any domestic funding increases.
  4. Funding availability is not aligned with need – funding levels vary considerably within and across regions with these variations not fully aligned to the need for services. For example, while Eastern Europe and Central Asia is home to 38% of people who inject drugs in LMI countries, it accounts for only 27% of funding for harm reduction, from both domestic and donor sources.
  5. The global Fund to Fight AIDs, Tuberculosis and malaria remains the largest donor for harm reduction, but the mechanism must work harder for people who use drugs – while available data provide a partial picture, funding levels appear to have dropped; and forty-six countries where injecting drug use is reported do not include harm reduction in their HIV funding proposals.

© Harm Reduction International

© London School of Hygiene & Tropical Medicine
This article is from the free online

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