|Responding to Drug and Alcohol Problems in the Community (WHO, 1991, 109 p.)|
|3. Organizing primary health care services to combat drug and alcohol abuse|
To ensure coordination between the various sectors involved, it will be useful to form a community action team (CAT) with representatives from health and other sectors. The members of these teams should be drawn from sectors and groups with a stake in community development. CAT members should be in close contact with members of the community, seeking answers to questions such as:
· What does the community identify as its drug and alcohol problems?
· Who is vulnerable in the community?
· What does the community believe should be done?
The CAT should collect background information on social definitions, perceptions, and responses connected with drug and alcohol problems, as well as on attitudes and the degree of awareness regarding drinking habits and drug use.
It is important that, in all of this, the PHC workers should not see themselves as lone individuals seeking to involve the community. Partnership between health workers, government agencies, social services, and voluntary groups is vital in dealing with drug- and alcohol-related problems in the community. Such problems can never be adequately managed by one person, or sector, working in isolation.
The CAT should coordinate the actions of various interested parties, including health professionals and associations, researchers, law-makers, law-enforcement agents, educators, and community groups, such as women's and youth organizations and churches. Strategies and decisions to develop drug and alcohol programmes should be negotiated by the CAT, or other community committees, which should function at all levels of the health system.
Intersectoral collaboration might also be established using the "gatekeeper" approach; this involves, first, finding out from other sector personnel what they need to know in order to decide whether to collaborate with a health programme. This step stimulates the initial interest. The next move is to find the information they require and pass it on to the other sector, which will then be more likely to act.
Government agencies are usually organized vertically, with representation at all levels but, because of their bureaucratic structure, they often do not develop horizontal collaboration. On the other hand, nongovernmental organizations may be preoccupied with managing their budgets and are often reluctant to develop a partnership for fear of losing their freedom of action. Despite these barriers, the potential of other sectors should be tapped, using the "gatekeeper" technique or another approach, to support drug and alcohol programmes at the community level. Negative attitudes need to be changed across all sectors.
Intersectoral collaboration should be a constant process that must be kept alive by the CAT; the team should organize regular meetings, interactions, and task assignments with community representatives, anticipating as far as possible any likely obstacles and problems.