Table 2 Sustainability framework: dimensions, indicators and benchmarks

A. Policy & governance

Indicator A1

Indicator A2

Political commitment OAT is included in national drug control, HIV and/or hepatitis strategies and action plans, with a commitment to WHO-recommended targets

Legislation explicitly supports the provision of OAT

OAT is a core part of national policy for opioid dependence management

Law enforcement and justice systems support implementation and expansion, as needed, of OAT

Effective governance and coordination oversee the development of OAT in the country

Civil society, including OAT clients, are consulted in OAT governance and coordination at country level

Management of transition from donor to domestic systems

Country has adopted a plan which defines transition of OAT from donor to domestic funding including a timeline

There is a multi-year financial plan for the OAT transition to domestic sources, with unit costs developed, co-financing level, the (future) domestic funding sources for OAT identified and agreed among country representatives

Donor transition oversight in the country effectively supports implementation of the OAT transition to domestic systems

There is good progress in the implementation of the OAT-component in the transition plan

B. Finance & resources

Indicator B1: Medications

Indicator B2: Financial resources

Indicator B3: Human resources

Indicator B4:

Evidence and information systems

OAT medicine procurement is integrated into domestic PSM system and benefits from good capacity without interruptions

Both methadone and buprenorphine are registered and their quality assurance system is operational

Methadone and buprenorphine are secured at affordable prices

Methadone and buprenorphine are included in the state reimbursed medicine lists and are funded from public sources

OAT services are included in universal health coverage or state guaranteed package of healthcare including for people without health insurance

OAT services are paid through sustainable public funding sources which secure adequate funds to cover comprehensive services

In the countries with active HIV grants, OAT services are co-financed by the Government in accordance with the Global Fund Sustainability, Transition and Co-Financing Policy

OAT is included in the job description of main health staff and core functions of the state system for drug dependencies with relevant capacities to prescribe and dispense OAT to a required scale

Capacity building system is adequate for OAT implementation in a sustainable way

OAT monitoring system is in place and is used for managing the OAT program including program need, coverage and quality assurance

Evidence-base for OAT effectiveness and efficiency are regularly generated and inform policy and program planning

OAT client data are stored in a database; they are confidential, protected and not shared outside of the health system without a client’s consent

C. Services

Indicator C1:

Availability and coverage

Indicator C2:

Accessibility

Indicator C3:

Quality and integration

OAT is available in hospitals and primary care; take-home doses are allowed

Coverage of estimated number of opioid dependent people with OAT is high (in line with WHO guidance: 40% or above)

OAT is available in closed settings (including for initiation onto OAT), during pre-trial detention and for females

OAT is possible and available in the private and/or NGO sectors in addition to the state sector

There are no people on a waiting list for entering the service

Opening hours and days accommodate key needs

Geographic coverage is adequate

There are no user fees and barriers for people without insurance

OAT is available and, in general, accessible for populations with special needs (pregnant and other women, sex workers, underage users, ethnic groups)

Illicit drug consumption is tolerated (after dose induction phase)

Individual plans are produced and offered, with involvement of the service user

OAT inclusion criteria are supportive of groups with special needs and are not restrictive, i.e., failure in other treatment programs is not required prior to enrolling into the OAT program

Adequate dosages of methadone/buprenorphine are foreseen in national guidelines and practice in line with WHO guidance

OAT programs are based on the maintenance approach and have a high retention of users

A high proportion of OAT maintenance sites is integrated and/or cooperates with other services and support continuity of care for HIV, tuberculosis and drug dependency (in line with WHO guidance: 80% or more of the sites)

A high proportion of OAT clients receive psycho- and social support (in line with WHO guidance: 80% or more of the sites)