13 April 2023


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In 2022, HRI partnered with Apurva Rai, who used an HRI tool to assess the landscape for increasing domestic financing for harm reduction in Nepal. This report outlines the process used and the findings that emerged, covering the operational landscape for community-led, community-based and civil society organisations and the financial landscape for harm reduction. It maps advocacy opportunities and partnerships and makes key recommendations for increasing the domestic harm reduction financing.

Key Findings

  • Supportive policies and plans for harm reduction include the Drug Control Policy (2006, 2010) and the National Strategic Plan on HIV. However, the Narcotic Drugs (Control) Act 2033 (1976) contradicts these supportive policies and hinders implementation of comprehensive harm reduction programmes.
  • There is currently no policy framework or mechanism for social contracting of community-led organisations (CLOs), community-based organisations (CBOs), and civil society organisations (CSOs) for harm reduction in Nepal.
  • The Government of Nepal’s current investment in health is not sufficient to achieve Universal Health Coverage or the health-related sustainable development goal targets by 2030. A large majority of the health budget is held at the federal level.
  • The Global Fund and ViiV Healthcare UK are the only two international donors financing harm reduction services. There is limited domestic funding through conditional grants from the Government of Nepal, supporting 8 out of 12 opioid agonist therapy (OAT) sites which operate within public hospitals. The remaining 4 OAT sites are provided by community-led organisations and supported by the Global Fund grant.
  • There are no legal and/or policy barriers in place for domestic funding. However, there is currently no domestic funding available for CLOs, CBOs and CSOs implementing harm reduction programmes in Nepal.

Recommendations for actions to improve the domestic funding for harm reduction in Nepal

  • Increase advocacy and technical competency of CLOs, CBOs and CSOs at the national and provincial level.
  • Develop position papers on the efficacy of harm reduction for different provinces as per their local context for leaders, policy makers, and stakeholders.
  • Conduct stakeholder mapping for budget advocacy.
  • Conduct training for representatives of CLOs, CBOs, and CSOs on social contracting mechanisms and budget advocacy at federal, provincial, and local level.
  • Conduct advocacy for a social contracting mechanism and budget at federal, provincial, and local levels.
  • Sensitise key government officials on harm reduction at central, provincial, and local levels.
  • Sensitise parliamentarians and key policy makers.
  • Create policy champions at different levels of the government system.
  • Convene meetings bringing together the National Coordinating Committee (led by the Ministry of Home Affairs) and Executive Committee (chaired by the Secretary of Home Affairs) at the central level; and the Planning Committee (chaired by the head of the planning division) at the provincial and local levels to discuss legal issues pertaining to drug use and importance of harm reduction.
  • Convene meetings bringing together the Ministry of Health and Population, Ministry of Home Affairs, Human Rights Commission, National Planning Commission, and External Development Partners to discuss funding for harm reduction.

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