In early 2026, the World Health Organization (WHO) released revised global guidance on needle and syringe programmes, informed by discussions from the INHSU 2024 Policy Day. The impact showcases INHSU’s powerful approach to convening, bringing together lived experience, research, and policy to create real sustainable solutions.
The challenge
Despite strong evidence that needle and syringe programmes (NSPs) reduce HIV and hepatitis C (HCV) transmission, among many other important health interventions, global scale-up has remained uneven. Many countries continue to rely on rigid targets, outdated procurement assumptions, and limited engagement with people who use drugs when designing services. Alongside increasingly limited funding, these gaps have restricted access and reduced the effectiveness of NSP delivery worldwide.
The intervention
In October 2024, INHSU convened the annual Policy Day adjacent to the INHSU Conference in Athens, bringing together implementers, researchers, community-led networks of people who use drugs, global funders, and multilateral agencies. Each year, the INHSU Policy Day focuses on a different priority issue; in 2024, attention turned to addressing health system and policy barriers to needle and syringe programme scale-up.
The Policy Day was intentionally structured using an implementation science framework, a discipline focused on closing the gap between evidence and real-world practice. Participants worked systematically to identify priority barriers to NSP scale-up across three domains – Global Policy, National Policy, and Procurement – and co-designed feasible solutions.
Nat Taylor, director of the Implementation to Impact (i2i) Program at UNSW Sydney and Guillaume Fontaine, who leads the RISE³ Implementation Science Lab at McGill University, co-collaborated with INHSU to organise the day.
Implementation science looks at solving the evidence-to-practice gap. We know what works, but the question is how to bring those interventions to the people who need them most. It allows us to systematically identify barriers and design solutions that are tailored to the real problem.
This rigorous, evidence-based approach grounded discussions in implementation realities rather than aspirational targets.
The findings
Key findings from the day, were later published in a report titled ‘Addressing Health System and Policy Barriers to Needle and Syringe Program Scale-Up’ and included:
- Community engagement is essential: People who inject drugs should be involved in selecting injecting equipment offered at NSP services and estimating need. Their input leads to services that are more relevant and more effective
- Implementation science strengthens strategies to support change: Structured, evidence-informed frameworks help identify priority barriers and design practical solutions, clarifying what works, in which settings, and at what cost
- Political will and sustained investment are non-negotiable: Scaling up NSPs depends on long-term funding commitments and consistent policy support at national and global levels
- NSP commodities must match user needs: Procurement should reflect the quality and product preferences of local communities, with suppliers aligned on standards and fair pricing
- Coordination accelerates progress: Shared goals and coordinated messaging across stakeholder groups can support governments to adopt and scale NSPs, alongside targeted education and technical assistance
The impact
Among the 54 delegates at the Policy Day was Ernst Wisse, harm reduction lead at Médecins du Monde, who – at the time – was leading the revision of the WHO Operational Guide on NSPs.
The Policy Days at INHSU are quite unique because it’s not often you find yourself in a room with all these different stakeholders – implementers, the community, decision-makers – all looking at the same subject together from different perspectives.
Two persistent challenges stood out to Ernst that went on to directly inform the revised guidance:
- Fixed numerical targets for syringe distribution were being misinterpreted and misapplied, often limiting access rather than expanding it
- NSP planning and procurement frequently failed to reflect the values, preferences, and real-world practices of people who use drugs
It [the policy day] was really a catalysing moment that helped crystallise which issues needed to be improved globally and helped frame the new guidance. One change we’re all really proud of, which came directly out of the conversations on the day, is that WHO now includes the values and preferences as one essential component of how to set up an NSP.
Ernst Wisse
The outcome
In early 2026, the World Health Organization released its revised Operational Guide: Needle and Syringe Programmes for People Who Inject Drugs.
Download WHO’s revised NSP Operational Guide
Key changes in the new guidance reflect priorities that emerged through the INHSU Policy Day process:
- Assessing the values and preferences of people who use drugs on injection equipment, are now included as an essential component of NSP design and implementation
- The guidance clarifies that 300 syringes/needles per person per year is a global coverage target. At the programme level, services should aim to provide clean equipment for every injection, meaning actual provision typically will – and should – well exceed this benchmark
- Countries are encouraged to act using the best available estimates rather than delaying implementation while waiting for costly or complex data collection
People talk about the 200 syringes per person or the 300 syringes per person. This new guideline really tries to explain that these are population level targets. You need to have enough syringes for everybody that every injection can be covered with sterile syringe.
Published in the Lancet Global Health
As well as influencing the new WHO guidelines, findings from the Policy Day and the resulting report were published in The Lancet Global Health. “Addressing policy barriers to scaling up needle and syringe programmes: a global call to action“, which was written following the Policy Day and calls for urgent global, national, and procurement-level reforms to address persistent policy barriers limiting access to NSPs.
Why this matters
Other delegates, including Susie McLean (who attended the event in a previous role with Global Fund), also commented on the impact of the day, calling it a ‘credit to INHSU’s convening power’.
This impact shows how convening the right people, using the right methods, at the right moment can influence global policy.
When INHSU convenes, we do more than simply host a discussion; we aim to create a shared problem definition and forge practical solutions. The revised WHO NSP guide will shape funding requests, procurement decisions, and service delivery across diverse settings globally. We’re very proud of the role we were able to play.