• When a community takes on the war on drugs

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    RICHARD R. LAPRES

    RICHARD R. LAPRES

    President Rodrigo Duterte is not the first sovereign leader to grapple with the problem of illegal drugs. Many before him, some with an even bigger epidemic of drug addiction in their backyards, have waged a similar war, with much the same immediate results as we’re seeing now in the Philippines.

    Brazil, Colombia and Mexico are just some of the countries that took on prohibitionist drug policies, which involved the criminalization of drug use and aggressive police operations to stop production and disrupt drug flows.

    In Brazil alone, the number of people incarcerated for drug trafficking between 2007 and 2012 increased by 123 percent – from 60,000 to 134,000, according to a paper from the Brookings Institution. This jump was largely credited to incarcerating first-time offenders caught with small quantities of drugs but with no links to organized crime. Colombia’s own President, Juan Manuel Santos, said that new approaches to the war on drugs need to be discussed, including possibly legalizing some substances.

    For these three countries, the idea of abandoning prohibitionist drug policies took on a more concrete shape when in 2009, their former Presidents banded together to convene the Latin American Commission on Drugs and Democracy in an effort to evaluate the impact that the war on drugs had had on their respective nations. The Commission unequivocally called the conflict ‘a failed war,’ and recommended ‘safer, more efficient and humane drug policies’ moving forward.

    If the experiences of these countries are anything to go by, it is safe to say that a hardline anti-drug campaign is not the only way – and may not even be the best way – to combat illegal drugs.

    The Deloitte Center for Government Insights recently released a report that, although specifically addresses the United States’ (US) own drug problem, puts forth possible solutions that are worth considering for the Philippines.

    “Fighting the opioid crisis: An ecosystem approach to a wicked problem” proffers a widespread, integrated solution to the drug problem that involves all affected sectors. The concept of an “ecosystem” – a localized community of people who interact with one another and with their particular environment – suggests the kind of collaboration needed in order to address a problem that the current administration says has reached “epidemic proportions.”

    The team at the Deloitte Center for Government Insights studied several other solution ecosystems, and it noted that those that have made the most progress in addressing societal problems often have five elements in common. They:

    Engage a broad community of “wavemakers” to innovate, convene and fund its own solutions.

    In the US, stakeholders in the opioid crisis are coming together to analyze the root causes of the problem, highlight successful solutions, and make recommendations for government agencies. The parties involved aren’t limited to health and criminal justice stakeholders. Deloitte recommends engaging new and unusual partners – people who are in recovery, innovators, technologists – to get a broad perspective on possible solutions.

    Here in the Philippines, we may already be seeing this in a new partnership between the government and the private sector. The Department of Interior and Local Government (DILG) recently announced that it will partner with 13 business leaders for the improvement of newly organized drug-rehabilitation centers. While this agreement is limited to funding on the part of the business leaders, more involved and out-of-the-box approaches may be explored in the future.

    Establish an ecosystem integrator to “hold the whole” and create the space for aligned action by others.

    Considering the number of parties involved in an ecosystem approach, it is important that one organization take on the integrator role to oversee coordination and alignment of strategies. Again, this doesn’t have to be limited to the government. Foundations or companies that specialize in public health may be better-positioned to drive collaboration across the ecosystem and tailor efforts to the unique needs of a community or region.

    Attack the problem with a portfolio of interventions.

    There’s a reason why “An ounce of prevention is worth a pound of cure” is a popular truism. In recent years, the US’ anti-opioid initiatives have focused on education: state agencies and medical colleges have been updating their educational materials to better arm physicians with information about the risks of opioid abuse and addiction. This has prompted pain clinics and emergency rooms to stop, or drastically reduce, the use of opioids for chronic conditions.

    Trend data from the Dangerous Drugs Board reveals this general profile of Filipinos who seek treatment for drug abuse: 30 years old, male, single, unemployed, living in an urban area, and usually hooked on metamphetamine or cannabis. Armed with this information, stakeholders can design programs that will get to this at-risk demographic before they even try an illegal substance. The employment status of these rehab seekers is particularly telling. Perhaps instead of deploying police officers en masse to urban areas, the government’s ‘war on drugs’ can focus on findining gainful employment for Filipinos, especially those in the productive age.

    Create an innovation engine to drive ideas for solutions that upend the problem.

    One of the advantages of an ecosystem approach is that stakeholders are likely to attack the problem from every possible angle. New solutions emerge when partners with diverse backgrounds and expertise interact cooperatively and even competitively.

    Deloitte cites the Pay for Success (PFS) model that some governments have been using to address social problems. Instead of paying an organization for each service rendered, the government pays based on performance. For example, the PFS model can be used to motivate rehabilitation centers to make sure none of their recovering patients relapse.

    Develop solutions embedded in well-functioning markets.

    The current chief of police has said that it is possible to win the war on drugs in six months. Just the same, stakeholders may want to look into interventions that are sustainable in the context of real-world markets, in case this war stretches on indefinitely. For example, the ongoing battle against dengue depends on a widespread information campaign, the availability of insect repellents, and now the availability of the vaccine.

    One such solution the US has put into practice is “value-based care,” which is similar to the PFS model. Payments to healthcare providers are linked to patient outcomes rather than volume of services. Imagine if here in the Philippines, payment to a doctor or a treatment program were linked directly to patient outcomes.

    This is just one approach that stakeholders in this war on drugs may want to consider. As I said, President Duterte isn’t the first leader to try to solve a nationwide drug problem. Many before him have tried, are still continuing their own battles, and have learned so much and made adjustments in the process. The President would do well to consider their insights and what they are doing now to correct the errors of the past.

    The author is a Partner at Navarro Amper & Co., the local member firm of Deloitte Southeast Asia Ltd. – a member firm of Deloitte Touche Tohmatsu Limited – comprising Deloitte practices operating in Brunei, Cambodia, Guam, Indonesia, Lao PDR, Malaysia, Myanmar, Philippines, Singapore, Thailand, and Vietnam.

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