Developing the System of Drug Services in the Czech Republic

Abstract

This paper begins with a brief overview of the status of Czech services for alcohol and drug users as they existed before 1990 (during the communist era). Particular attention is directed to the prominent figure of Jaroslav Skála and the treatment and training systems he pioneered. The second section of the paper concentrates on how the system of services evolved during the 1990s, after the fall of communism, and identifies the main factors affecting this development (the ongoing reform of health care, formation of the nongovernmental nonprofit sector, emergence of a national drug policy, and the reform of social services). The paper also describes characteristics of the current system of services for legal and illegal drug users. Included here are descriptions of the types of care available (low threshold services, ambulatory and hospital care, therapeutic communities, aftercare, and substitution programs), and an overview of their utilization. Specific features and weak points in the present system are addressed in broad terms. Financing and costs are addressed, with particular attention being paid to public grants at governmental, regional, and municipal levels. The paper also pays attention to the infrastructure of the system of services (coordination, training and education, quality assurance, etc.) as well as to research needs, training and quality assurance, and the effectiveness and efficiency of services based on sound financing, in order to promote innovative programs of care and to adjust existing services to the actual needs of the target population.