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In the implementation of the Community Oriented Primary Care (COPC) programme in the City of Tshwane, the extent and the complexity of harmful substance use and the impact on
the health and social functioning of individuals, families and communities, have become increasingly evident.
Professor Jannie Hugo and researchers in the Department of Family Health have emphasised
that the main focus needs to be on treatment and rehabilitation, and not on policing and a criminal justice response to the problem. Although widely recognised that drug and alcohol abuse contribute to the burden of disease in society – and to family and community conflict, crime and economic instability
− the dominant approaches have been largely ineffectual. Shaun Shelly, also in the Department
of Family Health, writes that although many South Africans are calling for harsher drug policies,
there is increasing recognition internationally that criminal justice approaches are not effective. He references Kofi Annan, former United Nations secretary general and commissioner on the Global Commission on Drug Policy, who commented that: “Drugs have destroyed many lives, but wrongheaded governmental policies have destroyed many more.
I think it’s obvious that, after 40 years of the war on drugs, it has not worked.”
Given the health risks of drug use in a TB and
HIV epidemic and the social need for an effective response, the Department of Family Medicine has partnered with the City of Tshwane to develop a community-oriented substance use programme (COSUP). It is a primary care programme that uses
a harm-reduction approach to prevent and manage substance abuse, to reduce and/or contain injecting drug-driven TB and HIV infection, and to improve the quality of life of individuals and families affected by substance abuse.
COSUP is a three-year collaboration that involves government, university departments and third sector organisations, among others, the City of Tshwane, the Gauteng Department of Health, the
UP Department of Social Work and Criminology,
the SEDIBA Hope Clinic, and OUT Wellbeing. The implementation of COSUP in the City of Tshwane
is also being researched as a community-based, multidisciplinary, multisectoral harm-reduction approach to substance use. It draws on data generated from screening processes, network development and service delivery information that are generated in the course of service development and implementation. In addition, specific qualitative and quantitative enquiries are being developed
and included as issues requiring further research emerge. Constant collection of data and programme observation for monitoring and evaluation are essential to determine outcomes and inform strategies for improvement which, if effective, could rapidly be scaled up.
Researchers in the Department of Family Health linked to COSUP: Professor Jannie Hugo, Professor Tessa Marcus, Dr Lindi Shange, Shaun Shelly, Dr Andrew Scheibe and Dr Lorinda Kroukamp.
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