In 2019, harm reduction funding across low- and middle-income countries totalled US$131 million, equating to 5% of the US$2.7 billion UNAIDS estimates to be required annually by 2025 and one-third lower than the amount available in 2016. While international donor and domestic funds were almost equally split, decreases in international donor funding are outpacing increases in domestic support, threatening the sustainability of harm reduction programmes. To inform and support national advocacy for domestic harm reduction funding, landscape analyses and consultations were carried out in Indonesia, Kenya, Nepal, Nigeria, South Africa and Uganda.

HRI developed a tool for community and civil society advocates to identify challenges and opportunities for increasing domestic financing for harm reduction. The tool provides step-by-step guidance on conducting desk-based research and semi-structured interviews to assess the financial, legal and policy landscape and to map advocacy opportunities, targets and partners. The tool was used in six countries by local consultants, with support from HRI.

While each national context varied, key learnings emerged on the protective and challenging factors that influence the extent and direction of government investment in harm reduction. The findings also highlighted advocacy strategies which may also resonate beyond the six countries. In Indonesia, South Africa and Nepal, for example, targeting advocacy towards increasing budget allocations for harm reduction at the local/provincial level was more strategic than at the national level. Across all countries, increasing funding for community and civil society advocacy, as well as increasing budget advocacy capacity for harm reduction were highlighted as crucial underpinning factors.

As well as informing advocacy for increased domestic investment in harm reduction in the six counties, the research highlights the critical role of international donors in supporting community and civil society advocacy for increased harm reduction funding from national and local/provincial government.