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.