26 February 2026
A new report has been released following the INHSU 2025 Policy Day, held alongside the INHSU Conference in Cape Town, South Africa. The Policy Day focused on increasing access to harm reduction services across the African region and brought together 67 participants from government, community-led networks of people who use drugs, civil society, UN agencies, donors and research institutions, with a strong emphasis on government leadership and community representation from across Africa and other regions.
The new report outlines the key discussions, findings and recommendations from the day.
Download full report Key recommendations
Common barriers, shared challenges
Across two structured roundtable discussions, participants identified a set of recurring barriers that continue to limit harm reduction scale-up across countries.
Stigma and the criminalisation of drug use remain central challenges, undermining political will and reinforcing punitive responses over health-led approaches. Limited understanding of harm reduction among policymakers and regulators continues to result in restrictive policies and delayed implementation. Participants also highlighted fragmented procurement systems, unreliable supply of essential commodities, and the ongoing vulnerability created by heavy reliance on external donor funding.
Community-led organisations of people who use drugs were consistently recognised as essential to effective harm reduction, yet remain under-resourced and often excluded from sustained policy engagement. Without stable funding and formal recognition, their ability to advocate, monitor rights violations and influence decision-making remains constrained.
Cross-country learning
Country case studies from Egypt, Kenya, Nigeria and South Africa (outlined in the report) grounded discussions in real-world experience. These examples demonstrated that progress is possible even in challenging legal and political contexts when harm reduction is supported by strong leadership, multisector collaboration and meaningful community involvement.
Through these case studies, participants heard how sustained engagement with law enforcement can reduce interference with service delivery, how legal reform and national coordination mechanisms can accelerate scale-up, and how domestic financing and local manufacturing can improve sustainability. And across all case studies, community leadership emerged as a consistent driver of trust, service uptake and policy change.
Key recommendations
For donors and funders
- Provide multi-year, predictable funding: Enable governments, implementers and community organisations to plan, scale and sustain services without disruption
- Invest in market shaping and price reduction: Support pooled procurement, regulatory harmonisation and engagement with manufacturers to reduce prices and stabilise the supply of essential harm reduction commodities
Promote sustainability through systems strengthening: Fund supply chains, regulatory capacity, monitoring systems and investment cases that integrate harm reduction into national health infrastructure - Prioritise community-led organisations: Allocate dedicated resources for advocacy, governance, peer-led outreach and rights monitoring, including core operating costs.
- Coordinate effectively: Align donor investments and transition planning with governments to prevent duplication, supply gaps and service interruptions
For community-led organisations of people who use drugs
- Build unified advocacy coalitions: Coordinate evidence-based messaging across civil society, public health and human rights orgs to strengthen political influence, support legal reform, and secure financing
- Monitor and document barriers: Systematically document rights violations, service disruptions, harassment and discrimination to generate evidence that supports engagement with police, justice actors and policymakers
- Prioritise organisational and leadership development: Invest in governance, financial management, monitoring and evaluation, and strategic planning to strengthen credibility, sustainability and policy influence
- Continue driving community-led service models: Expand peer outreach, harm reduction education, overdose response, adherence support and navigation across health and justice systems to improve access and continuity of care.
- Build constructive relationships: Strengthen relationships with police, local authorities and health providers through dialogue, joint workshops and peer-led training to reduce interference and improve service access
For governments
- Institutionalise harm reduction within national strategies: Embed harm reduction within HIV, hepatitis, TB, Universal Health Coverage and national drug strategies to strengthen legitimacy, coordination and accountability across sectors
- Advance legal and regulatory reform: Review and reform laws, policing practices and regulatory frameworks that criminalise drug use or restrict access to essential harm reduction tools
- Prioritise domestic financing: Reduce reliance on donors by allocating national and sub-national budgets for OAT, NSPs, naloxone and community-led activities
- Invest in capacity-building: Support ongoing training for policymakers, regulators, police and frontline officials to promote consistent, health- and rights-based implementation
For implementing partners
- Adopt a systems-strengthening approach: Support integration of NSPs and OAT into public facilities, strengthen supply chains, and assist with forecasting and quality assurance
- Prioritise evidence-informed program design: Use regional data, implementation research and strong monitoring systems to demonstrate impact and inform advocacy
- Keep human rights and community leadership central: Work in partnership with community-led networks to co-design, deliver and evaluate services that reflect lived realities
- Train and sensitise frontline workers: Deliver stigma-reducing training for health workers, social services and police, and support practical tools such as SOPs, referral pathways and legal guidance
Our Policy Days are designed to be highly practical: to bring government, community and funders together to work through challenges, share responsibility and agree on realistic next steps. The result is concrete actions across political, legal and operational barriers that can drive real progress across the African region.
