Experiences from Skopje, Macedonia highlight that community monitoring and advocacy has improved the quality of treatment in the drug dependence treatment programs, arousing the spirit of activism in people.
Community Monitoring and Advocacy:
Community Monitoring and Advocacy methodology (CMA), in its broadest sense means an active involvement of a given community in the monitoring of the work public services of concern to the respective community. At the same time, it is expected that the data collected through the process of monitoring should instigate a process of social change among the monitored services.
Community monitoring is more than just a collection of research data. Its primary intent is to serve in the advocacy for social change, as a key strategy in protecting democracy, pushing the requirements of citizens in stepping up for their rights before the state bureaucracy. Community monitoring and advocacy was used for improvement of the quality of treatment in drug dependence treatment programs in Skopje (the capital of Macedonia), financed by the State Budget. The community monitoring and advocacy activities started in December 2011 and ended in June 2014. Social and Political Context The public ideological and moral perception about drugs and practices of the use of drug use in Macedonia is related to the political and institutional context. This has an extremely limiting influence on the political self-awareness of people in the treatment for drug dependence, on people who use or have used drugs as a whole. The exposure to permanent stigmatization, discrimination and police persecution because of drug using habits causes the feeling of shame among people who use or have used drugs, forcing them to con-form themselves to the marginal status posed by society and the laws.
Social and Political Context
The social and political context in which community monitoring and advocacy were carried out had an adverse effect on the success of activities. The consequences of social and political transitions have made Macedonia an ethnically and politically paralyzed state. This polarization is reflected in almost all social relations, including public institutions that are susceptible to corruption, nepotism and crony-ism. The judiciary is under the control of the Government of the Republic of Macedonia, and freedom of press is extremely limited. A similar polarization is evident in the civic sector. Political parties in their fight for power have destroyed almost every model of civic activism. In the lack of a supporting environment, people treated for drug dependence avoid public appearances as they suffer discrimination.
The Spirit of Activism in People Treated for Drug Dependence
The key barriers for the emergence of activism in people, in the treatment for drug dependence are stigmatization and discrimination, discouraging legal regulative, fear of Police, fear from sanctions in drug dependence treatment, imposed feelings of guilt and shame. To understand the spirit of activism in people who are on drug treatment; a comparison can be made by examining the spirit of activism the LGBT (lesbian, gay, bisexual, and transgender) community has garnered. A comparison of the circumstances for the development of activism in the LGBT community shows that the over-of drug using practice, the dependence on pharmacotherapy in drug treatment and the lack of serious anthropological and sociological studies limit the potential for activism even among those who show a certain initiative to advocate for the rights and needs of the community. Thus, stigmatization and discrimination cause resistance in the community.
These same limitations in the drug user’s community force people to live in the ascribed social status and become passive. Hence, coming out of the closet, facing and trying to overcome the stigma and shame, the feeling of belonging to their community are said to be the points where the two communities (LGBT and drug users) share key aspects for (de) motivation for activism.
Key Activities and Results
The applicability of the community monitoring and advocacy methodology reasserted towards initiating activism, motivating people on drug treatment to represent themselves and to affirm their rights and interests. Taking into consideration the existing social and political context, advocacy activities can be assessed as being successful. According to the plan, a team was formed for representation from which several more motivated individuals stood out, pre-pared to continue to advocate for the rights and interests of people treated in drug dependence treatment programs in Skopje. Though with varying dynamics and with frequent dips in motivation, the team carried out several activities
of advocacy, directed at the same time towards improving the quality
of programs for drug dependence treatment and towards animating the community for more active self-advocacy. Several team members of the advocacy team held a public appearance in the Macedonian media on 26 June 2014. They supported the “Support. Don’t Punish” (IDPC 2013) global campaign. This was an occasion to articulate their opinions about the policies where people who use drugs face criminal persecution. They expressed their condolences for all the drug users who had passed away, and used the opportunity to expose their demands for improving the quality of drug dependence treatment programs. Through community monitoring and advocacy, people in drug dependence treatment programs (financed by the state budget) in Skopje were accepted as equal negotiators by the programs staff members. In three of the five state programs community representatives had the chance to use a room for regular or thematic meetings and socializing, thus enabling better communication with and animating of other community members. Even though not meeting the expectations, it is fair to say that 70% of the members in the community know that there are people representing their rights and interest in the dependence treatment pro-grams, with more than half the members are able to identify the main advocacy activities. It can be concluded that monitoring and advocacy activities have provoked the spirit of activism in the people in drug dependence treatment. The dependence treatment programs have animated part of the community and have caused satisfactory changes in drug dependence treatment programs. With that, a good basis has been created for further action. The results and experiences described in this document shall be used for further improvement of advocacy drive to-wards bettering the quality of drug treatment programs in Skopje. We believe that this will also serve other communities who intend to advocate for the common objectives that is the foundation of human rights.
Recommendations
• To continue the activities to-wards improvement of the quality of drug dependence treatment programs in Skopje and to find a way to make advocacy sustainable.
• To provide strong and continued support to the advocacy team members who demonstrate motivation and initiative, without insisting on reciprocity in the inclusion of certain dependency treatment programs.
• To set realistic and easily achievable objectives.
• To direct advocacy in three directions:
– First, advocating within the community to strengthen civic awareness that will help harmonize community values and attitudes, consolidate efforts and strengthen the spirit of activism.
– Second, overcoming institutional stereotypes through community advocacy in policy-making institutions and to introduce humane drug policies and drug dependence treatment.
– Third, community advocacy in the public sphere, in order to initiate a debate for humanization of the people who use/have used drugs.
• To dedicate more attention to developing civil awareness among community advocacy team members.To enable further moral and professional support for the advocacy team/s, especially insisting on cooperation and exchange of experiences with other civic organizations and similar for groups/movements from Macedonia and abroad.
• To use successful advocacy stories to motivate other people on drug treatment to be-come pro-active, and thus cre-ate a critical mass for advocacy at higher political levels
The article has been authored by Dimitrievski, Vanja, Irena Cvetković and Vlatko Dekov. The article has been abridged from the document “Coming out of the closet? Assessment and evaluation of advocacy efforts for the improvement of quality of drug dependence treatment programs in Skopje. ‘Skopje: HOPS- Healthy’ Options Project Skopje, Coalition ‘Sexual and Health Rights of Marginalized Communities’, 2014
About the Authors
Vlatko Dekov is Manager at the Center for Education, Documentation and Research (CEDR), Department of Healthy Options Project Skopje (HOPS).
Irena Cvetkovic works as a Project Coordinator at the Coalition Sexual and Health Rights of Marginalized Communities. She is working on the research for her PhD thesis on the topics related to the marginalized communities i.e. sex workers, drug users and people living with HIV.
Vanja Dimitrievski works as a Programme Assistant for Research in the Center for Education, Documentation and Research (CEDR), a Department of Healthy Options Project Skopje (HOPS)
To learn more about Healthy Options Project Skopje (HOPS), please visit: http://www.hops.org