A. Constraining factors

Administrative changes: China has been undergoing administrative reforms and far reaching changes began to be implemented in October 1998. Ministries at the central level in Beijing have been considerably downsized. (e.g. the Ministry of Health has only approximately 200 staff in Beijing). Very little funding is available from the central government for interventions though some small pilot projects are occasionally funded. Local provincial, prefecture and commune level have to obtain their own revenues and implement their own activities. China is a politically and administratively de-centralized country thus the implementation of laws and directives is largely dependent on the local situation and on local interest and budget.

Policy and strategy: The major responsibilities of ministries on the central level is policy and strategy development and the provision of guidelines for action to provincial and other local bodies. The role of the provincial authorities is tactical and strategic as they translate central government guidelines to local conditions. There is local flexibility in how the general guidelines are operated. It is important to note that local level activities depend largely on availability of resources and on the priorities set by top local officials. For the implementation of drug policy, much depends on the relationships between different sectors in the community e.g. health and the local narcotic control authorities. This decentralised system provides an opportunity for local community based actions although it is generally understood that once the central government favours a policy, the regions will generally comply.

Whose responsibility is Drug and HIV prevention? The NNCC believe that the responsibility for preventing the risk of HIV/AIDS among drug users is the responsibility of the Ministry of Health and that methadone could be part of detoxification if the Ministry of Health chooses to introduce this into the voluntary treatment system. However, the relevant department in the Health Ministry (now the State Drug Administration) notes that any change in drug treatment needs to be approved and sanctioned by the NNCC, which has the lead role in China in drug control. Asked whether they would like the sole responsibility for drug treatment the SDA retorted that they had no capacity to undertake such a role. Respondents within the health sector did not feel that the system of treatment as it stands needed immediate or radical change.

Evidence-based drug and HIV prevention policy: China has many research facilities and a long tradition in drug research but the focus of study has been on two major issues: the improvement of detoxification technologies, and on epidemiological surveys (e.g. determining HIV status among users). China has not yet conducted systematic post-treatment or rehabilitation follow-up studies so there is scant information on whether the very extensive rehabilitation efforts are having the desired benefits.

There do not seem to be mechanisms in place, which would facilitate policy, reviews in the drug field and very little inclination, to change course. The conviction that China must strive towards a drug-free society at all cost prevails. Very few are clear about how policy can in fact be changed or reviewed. Most of those working in the drug and HIV field have very little notion about how to bring about change in thinking though there is little doubt that the power to change lies firmly in the hands of senior personnel within the Ministry of Public Security.