Substance Use Monitoring and Surveillance: Challenges faced by LMICs

Substance use surveillance has emerged as a crucial public health strategy across Africa, particularly in light of the alarming rise in substance use among adolescents (1). This trend poses significant health risks that require a comprehensive understanding of the underlying dynamics. Substance use surveillance plays a pivotal role in developing a thorough understanding of the underlying dynamics of substance use across various populations, particularly in Africa. By systematically collecting and analyzing data on substance use trends, prevalence, and associated health risks, surveillance efforts can illuminate the complex interplay of factors that contribute to substance use disorders (SUDs). This understanding is crucial for designing effective interventions, policies resource needs, and resource allocations tailored to the unique contexts of different communities (2).

The data gathered through surveillance can reveal critical insights into the demographics most affected by substance use, including age, gender, patterns of use, and socioeconomic status. For instance, studies have shown that substance use is particularly prevalent among youth in sub-Saharan Africa, where social and economic challenges often exacerbate vulnerability to substance use. By identifying these trends, public health officials can prioritize resources and interventions for at-risk groups, ensuring that prevention and treatment efforts are both targeted and effective12. Furthermore, surveillance can also contribute to understanding the broader social determinants of health that influence substance use patterns. Factors such as poverty, unemployment, and social instability can drive individuals toward substance use as a coping mechanism. Moreover, surveillance can identify the presence of comorbidities among substance users. By integrating surveillance data with information on these socioeconomic and other factors, stakeholders can develop multifaceted strategies that address not only the symptoms of substance use but also its root causes (3).

Surveillance efforts are however reliant on fostering good collaborations with various stakeholders, including government agencies, non-governmental organizations, healthcare providers, and community members. Such collaboration is vital for creating a comprehensive response to substance use challenges. By sharing data and insights from surveillance activities, stakeholders can align their efforts towards common goals, ultimately enhancing the effectiveness of prevention, treatment and harm reduction initiatives (4).

To date, significant challenges hinder the establishment and maintenance of effective surveillance systems for substance use in low to middle-income countries (LMICs). Resource constraints are a primary barrier; many countries lack the financial and human resources necessary for comprehensive data collection and analysis. This includes not only inadequate funding for research initiatives but also a shortage of trained personnel in relevant fields such as epidemiology and public health. Additionally, the fragmentation of data systems presents another obstacle; there is often a lack of coordination between various governmental and non-governmental organizations involved in drug monitoring, resulting in disjointed data that is challenging to analyze comprehensively (1).

To address these challenges, several strategies could enhance substance use surveillance in LMICs. For instance, strengthening national networks through robust national drug observatories can improve data consistency and availability. Building capacity is also essential; investing in training programs for healthcare professionals and researchers will enhance local capabilities for data collection and analysis. Collaborations with international organizations can facilitate knowledge transfer and resource sharing, creating a more robust framework for surveillance.

Reflecting on these challenges and potential solutions underscores the necessity for coordinated efforts at both national, regional, and global levels. By comprehensively addressing these issues, LMIC countries can significantly enhance their capacity for monitoring substance use, ultimately leading to improved health outcomes. The journey towards effective substance use surveillance might be fraught with challenges but holds immense potential for fostering healthier communities.

1. Basutu A, Ongolo JMO. Prioritising Research and Data Collection in Africa’s Drug Control Policy. Journal of Illicit Economies and Development. 2024.
2. Harker N, Lucas WC, Laubscher R, Dada S, Myers B, Parry CD. Is South Africa being spared the global opioid crisis? A review of trends in drug treatment demand for heroin, nyaope and codeine-related medicines in South Africa (2012-2017). Int J Drug Policy. 2020;83:102839.
3. Nsubuga P, White ME, Thacker SB, et al. Public Health Surveillance: A Tool for Targeting and Monitoring Interventions. In: Jamison DT, Breman JG, Measham AR, et al., editors. Disease Control Priorities in Developing Countries. 2nd edition. Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2006. Chapter 53. Available from: https://www.ncbi.nlm.nih.gov/books/NBK11770/ Co-published by Oxford University Press, New York.
4. Dada S, Harker Burnhams N, Erasmus J, Parry CDH, Bhana A, Timol F, et al. Monitoring alcohol, tobacco and other drug abuse treatment admissions in South Africa: July 1996 - December 2016 (Phase 41). Cape Town: Medical Research Council; 2017.