Home » Side event. The efforts of Ghana towards placing health and human rights at the heart of national drug policy: lessons learned and future opportunities

Side event. The efforts of Ghana towards placing health and human rights at the heart of national drug policy: lessons learned and future opportunities

Organized by Ghana with the support of Czechia, Germany, Nigeria, South Africa, Switzerland, the African Union Commission, the Office of the United Nations High Commissioner for Human Rights, the International Centre for Human Rights and Drug Policy and the International Drug Policy Consortium

Moderator: Mary Wangui Mugwanja, Permanent Representative of Kenya to the United Nations (Vienna)

Amb. Raphael Nägeli, Permanent Representative of Switzerland to the OSCE, the United Nations and other International Organizations in Vienna: the Ghanaian process of drug reform is an inspiration model for the rest of west Africa and the continent. Covid-19 did not deter the authorities from advancing health and human rights in drug policy. In face of challenges related to trafficking and consumption in west Africa, Ghana’s efforts to address this through prioritising health through prevention, treatment, harm reduction and. Our countries share the concern of respecting human rights, proportional policies, to reduce demand for drugs, and to find most cost effective policies. We hope Ghana will inspire its neighbours and beyond. Drug policy is not static – it is an evolving process involving lots of different stakeholders. There are no one size fits all policies but the need for local policies. Ghana’s first response to the crisis of controlled medicines which are critically needed for pain relief, mental health etc. There has been a development of a double crisis related to opioids in west Africa with a lack of availability of substances who need them, as well as the highly potent tramadol and synthetic opioids in the illegal market. By choosing to prioritise health and rights, Ghana chooses also a clearer path to address this issue. Swiss health foreign policy focuses on treating addiction and looks forward to collaborating with Ghana both in the CND and in future.

Hon Seth Kwame Acheampong, Minister of State, Ghana: Ghana’s journey to drug policy reform was influenced by three decades of running purely on supply and demand reduction mechanisms. We realised that the fight was never being won, the war on drugs lep`t waging on. As a people, based on all the outcomes we had signed within the framework of the UN, we needed to get our act together. Our PNDC law 235, enacted in 1990, was super outdated by the time we enacted the new law. Purely focused on demand and supply reduction. We all know that the fundamentals of drug policy should be health, safety, security and socio economic wellbeing. These were missing in the previous law. The review o the law was to address the policy gaps of that law. Why was it necessary? Drug use was still in ascendance despite the law. We wanted to do something that was evidence based, provide services for people who use drugs and especially harm reduction. Removing custodial sentences for people who use drugs to decongest our prisons to humanise our drug law. Medical advantages, therapeutic benefits, medicinal and for industrial uses. How was the process managed? We are a democratic state. Civic engagement through consultations: academics, civil society… It’s not a perfect law but it sets the pace for better things to happen in the subregion. We converted the prison term of personal use into a fine of between 200-500 penalty units. This means instead of sending people to prison, they will offer alternatives to incarceration, decongesting our prisons. The new law also allows for the first time the implementation of harm reduction services for people who use drugs to reduce the transmission of bloodborne diseases, overdose deaths and drug dependence. We came with Section 43 to sort out the cultivation of cannabis for medical and industrial purposes, seeking to regulate the activity of farmers who were already doing this illegally. We hit a roadblock because of the Supreme Court negative response —but we hope we will move on. Ghana sought a dialogue on engagement in drug policy reform. I must share some of the lessons: Science and evidence should direct our policies (without moral and religious sentiments guiding our policies) —we’re a secular country. Engage in an open and honest debate. Appreciate various perspectives and engage widely in discussion. Open the doors to civil society organisations, who are champions back home in Ghana. Reform is a continuous process and it can be very long because of our political environment. The national dialogue on drug policy and human rights that we carried out led to the following outcomes: Drug policy understood as a health issue —which is why it must be addressed like other health conditions. We need to put in place opioid agonist treatment, learning from neighbouring countries’ positive experiences in this regard. And integrating human rights issues into the curriculum in schools as well as drug prevention in schools. We trust these reforms will enable Ghana to fully comply with international human rights norms and standards. There should be advocacy for the retroactive application of the new law. Drug Policy and development: Participants also called for the participation of small farmers in the cannabis industrial/medicinal industry. Illegal cultivation of cannabis is highly lucrative, so alternative development needs to offer similarly lucrative options. And we need to resolve food security issues as part of our alternative development. Finally, alternative development beyond farming. Also developing gender-sensitive drug policy: standardised, regulated, and gender sensitive drug services. In sum, we need an open and honest debate on the drug situation in the region: there is no one size fits all. We  cannot arrest our way through the problem. The drugs issues is not just a security issue but a health and human rights and developing issue. We need to ensure solutions are people and community centre, with human rights at the centre. There must be cross party engagement as much as possible.

Dr Olubusayo Akinola, Principal Programme Officer, Drug Control and Crime Prevention, Africa Union: The African Union plan of action on drug control and crime prevention has currently been implemented from 2019-2023 and has been extended by heads of states to 2025. Overarching objective is to improve the health, security and socio economic wellbeing of the people of Africa by addressing drug trafficking and problematic drug use in all its forms and manifestations. It follows a balanced and integrated approach to drug control and provides a framework to address demand and supply reduction. Is anchored in 9 different policy areas. Today I will talk about only 4 pillars. The 8 policy pillars have 4 different sections. 1st = measures to tackle drug demand reduction and health issues with drug use. 2nd = ensuring that member states have availability and access to controlled substances for medical and scientific purposes. 3rd = alternative development and alternative means of livelihood targeting the agricultural sector. 4th = cross cutting issues on drugs and human rights pertaining to all vulnerable groups. This pillar provides for law enforcement authorities to be well oriented on human rights for health and safety. The nexus between AUPA and the reforms in Ghana – the 1st is the recalibration of the role of the narcotics control commission which was formerly NCC. NCC now acts as an autonomous body. NCC has a mandate to have various committees – a multi-stakeholder approach to drug related issues. It ensures that substance use disorders are treated as a public health issue and this is in line with the UN general assembly session in 2016 and in line with the African Union plan of action. 2nd nexus is an alternative to incarceration for people who use drugs. Ghana had a minimum 5 year imprisonment for possession of drugs – now this has been moved to penalty units. This talks to pillar 1, objective A4 plan of action which talks about alternatives to punishment for drug use. Last pillar relates to cannabis and hemp for scientific and medical purposes. There is a limit of 0.3% THC for medical and scientific purposes which talks directly to Pillar 2, obj. B1 to address barriers that suppress availability to controlled substances. So now we have the SUD treatment in Ghana. After this reform we have been seeing considerable increase in individuals from Ghana in treatment. There were only 4 treatment facilities reporting from Ghana but immediately from 2020 we had 19 facilities. People cannot afford treatment, stigma, no information, no services all constituted barriers to access drug treatment and support. This has been addressed in Ghana. Referral to treatment also improved considerably – 1 in every 25 people in 2021 was referred to treatment by the court and correctional services. The reforms in Ghana are evidence based and they are in line with the SDGs. Member states of the African union are encouraged to implement these best practices. We encourage states to show increased political will. We envisage an Africa of good governance and respect for human rights.

Mr Abdoul Thioye, Chief, Rule of Law, Equality and Non-Discrimination Branch, OHCHR:  In line with the international drug control framework all states are obliged to pursue a holistic approach in approaching drug control and that respect and protect human rights. I am pleased to see that Ghana is one of the key countries that is leading the world in pursuing this approach. The current law and policy reforms in Ghana clearly demonstrate it. I am equally pleased that in 2022 our office cooperated with the gov of Ghana and UN partners, civil society and other stakeholders to organise the first ever national dialogues on international guidance on HR and drug policy. The discussion highlighted that human rights approaches to drug policy are crucial to achieve the SDG goals. We discussed how the guidelines could be used to implement Ghana’s 2020 drug law reform and related measures in line with international commitment. The outcome document of 2016 UNGASS is an agreed global framework for balance, gender sensitive and human rights based drug policies. In the UNGASS outcome document, all states committed to respect, protect and promote human rights. To uphold the rule of law and development and implementation of drug policies, as well as the inherent dignities of all individuals. States agreed to many commitments related to human rights, allow me to highlight 3. States agreed to implement age appropriate practical measures tailored to the specific needs of children and youth. As stated in int. Guidelines on human rights and drug policy, children have the right to protection from drugs and exploitation in the drug trade, the right to be heard in matters concerning them and they shall be a primary consideration in drug laws, policies and practices. The guidelines follow this approach and all states should take appropriate measures. Appropriate measures should be evidence based and compliant with human rights norms. 2: Gender equality in human rights. On various occasions UN human rights experts have recommended that states take concrete measures to ensure women’s rights in drug policies and programs, to make drug policies effective we must address the root causes. Marginalisation of women, poverty, GBV and lack of job opportunities and absence of social protection from the state together with the need to support their family can drive women into committing drug related offences. Last year Ghana recommended gender sensitive measures including adequate measures for health care, GBV etc. to assess the needs of women who use drugs. I hope the authorities inGhana will provide full lattention to these measures. 3: Another critical recommendation is to address stigma and discrimination. For too long,we have relied excessively on incarceration which has caused tremendous suffering and limited access to treatment and harm reduction. In this regard, the guidelines recommend that states work towards decriminalisation. I am pleased to see that in line with int. Guidelines, the new drug law of Ghana provide provision for healthcare and harm reduction services for people who use drugs instead of incarcerating them in mass. To conclude, I hope that the ongoing drug policy reform efforts in Ghana will continue effectively to address complex drug issues while upholding the human rights of all, including youth and people who use drugs. Thank you.

Prof Pelmos Mashabela, South Africa: South Africa post apartheid seeks to adopt a human rights approach and social development approach. The protection of human rights is not only intrinsically important and necessary to improve the health of people who use drugs. South Africa adopted a national policy in the shape of the Master Plan of 20 19-2024 —integrating the principle of respect, protection and promotion of human rights. These principles are enshrined in the constitution of the republic. South Africa also established a community epidemiology network on drug use which is an alcohol and other drug sentinel surveillance system operational in all 8 provinces of the country. The network was contributed to the Pan-African epidemiological network. One of the responsibilities is monitoring and reporting on human gifts violations on a regular basis. In terms of human rights, during the covid-19 pandemic the country attended to the rights of the homeless, people who use and inject drugs, seeking to protect their dignity. Implementing regulations to establish shelters of homeless people and people who use and inject drugs. Distributing food and public health care services. In major cities of the country, there was also provision of health services to 2300 homeless people in shelters. Also provided OST clients with weekly take home doses. 1,200 people were initiated in methadone. Our country also experienced a policy shift in understanding addiction: away from understanding people addicted to drugs as morally flawed and lacking willpower. The physiology of addiction tell us it’s a brain disease, so imprisoning is ineffective. South Africa implements the Bangkok rules and started a project on the question of women in conflict with the law and gender responsive correctional centres. In developing the policy itself, we involved people who use drugs too. In terms of standardised terminology, we also found that if we didn’t standardise terminology, we would give in to stigmatisation. The focus on people was key (i.e. people with substance use disorders, instead of ‘addicts). With regard to treatment, we have 13 public treatment centres (and 50 private ones) providing inpatient treatment for substance use disorders. The public centres are managed by the government and offer free services. And we welcome civil society and multi stakeholder engagement. With regard to alternatives to incarceration, we also have options but they’re not used. So the Master Plan encourages the development, adoption and implementation of alternative measures such as committal to an institution, fines, community service orders, cautions and discharge, suspended sentences. In terms of opportunities: We can increase our use of empirical and scientific knowledge to inform interventions at all levels, we can promote research and data collection systems, we can encourage greater involvement of civil society in our work, engage the media in improving understanding on these issues, and ensuring services received by substance use disorder patients are of high quality.

Maria-Goretti Ane, Consultant: Africa, IDPC: When we talk about reform, it is not possible if we don’t create  space for that interaction. Ghana tried to create that space and I must acknowledge the fact that. It is important that states recognize that space created in terms of civil society involvement in all that process. That is what led Ghana to be able to bring the issues to the table. Now in terms of civil society’s role in this whole process, I must acknowledge the fact that we couldn’t have done this at all. We encourage broad consultation in terms of all these processes. As civil society we did not just narrow our engagement to specific stakeholders. We engaged broadly with media, religious leaders, policy makers in all other areas and that helped us to reach where we are today. In terms of our role, we wanted to contribute and bring evidence to the table. Without this it is very difficult to create policies, we went the extra mile. One other key thing that we did as civil society, we have always forgotten as policy makers the critical stakeholders who are mostly impacted and that is community members. We made sure that critical voice was brought into the room for us to be able to engage and make sure whatever we are doing is going to impact these people and they have a voice. In this process apart from all the evidence there are quite a number of lessons we have learnt – one is that reform is a process. It takes time and it needs commitment and it needs space to be able to do that and that is what we have meant as civil society. You need to ensure there is broader consultation – even people that don’t agree with your message. True dialogues are able to come to a conclusion of agree or disagree. One other lesson we have learnt is that maybe by engaging with legislators, the tendency to always focus on the incumbent in terms of the process is high. When this happens it becomes difficult. When the bill started in 2015, in 2016 there was a change of government so everything came to a halt. But civil society made sure there was broad consultation with both parties in parliament. So when the new administration came they were already up to date with the current conversation. That is how we were able to get the law passed otherwise we would have to start the whole process again. I want to share with policymakers especially that we need to open the space – we cannot have the conversation when we close the space. We cannot have the right issues addressed on the ground without the space. This allows for continuous dialogue to arrive at the right issues.

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