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Table 2 The summary of the identified barriers and facilitators in the four analysed countries

From: Needle exchange programmes in Visegrad countries: a comparative case study of structural factors in effective service delivery

Level Category Themes CZ PL SK HU
Macrosystem Morality Drug use as a sin NA − 1 − 1 − 2
Addiction as a life choice − 1 − 1 − 1 − 2
Criminal law Legal status of drug possession (decriminalisation–criminalisation) + 1 − 2 NA − 2
State politics Engagement (engagement–indifference) + 2 − 1 − 1 − 2
Consensus (consensus–opposing views) + 2 − 2 − 2 − 2
Attitudes (hostility–support) + 2 0 NA − 2
Policy in general Competition of drug policy with other policy fields NA − 2 NA − 2
Drug policy Competition with other pillars of drug policy (i.e. prevention, treatment) + 1 − 2 − 2 − 2
Coverage of demand reduction services in general + 1 − 2 − 2 − 2
Completeness of the demand reduction system − 1 − 2 −2 − 2
The framework of HR service delivery by NGOs Regulations/policies (reasonable–inadequate) − 1 − 1 − 1 −1
Resources Amount of funds (scarce–ample) + 2 − 2 − 2 − 2
Stability of funds (stability–instability) + 1 − 1 − 1 − 2
Donor-imposed limitations 0 − 2 − 2 − 2
Time-consuming procedures − 1 − 2 − 2 − 2
Embedment of harm reduction in policy documents and public tenders + 2 + 1 + 1 −2
Education/labour market Country-level shortage of professionals (e.g. nurses) − 1 − 2 − 2 NA
Low level of recognition/respect for social workers and outreach workers employed in harm reduction services NA − 2 − 2 NA
Exosystem Local politics Motivation (public good–self-interest) 0 − 2 − 2 − 2
Attitudes (hostility–support) 0 − 1 − 1 − 1
Scapegoating NA NA NA − 2
Mesosystem Community Not in my backyard attitudes 0 − 2 − 1 − 2
Conflicts NA − 1 − 1 − 1
Violence NA NA − 2 NA
Criminal underworld Direct contacts with the criminal underworld NA 0 NA NA