Policy translation in global health governance: Localising harm reduction in Tajikistan

Abstract

This article analyses how global governance frameworks and knowledge claims are translated to fit local contexts. It specifically looks at harm reduction initiatives targeting injection drug users utilising the case of Tajikistan. In the 1990s, this post–Soviet Central Asian country became exposed to an inflow of cheap and easily available heroin from Afghanistan. While Tajikistan mainly became a transit country, some parts of the local population also became addicted. To tackle the negative consequences of heroin addiction, starting from the 1990s international donors proposed the country adopt a range of harm reduction measures, including providing access to opioid substitution therapy and establishing drop-in centres where single-use needles and syringes would be distributed. This article discusses how donor-promoted harm reduction initiatives were localised in Tajikistan, why and with what outcomes. It argues that instead of a full acceptance or rejection of knowledge promoted by international actors, a complex translation process can be observed on the ground. International norms are thus localised by taking into account societal attitudes towards injection drug users, the changing nature of legitimate expertise, evolving national legislation and everyday practices, against the background of other conflicting global governance regimes and local geopolitical priorities.