This operational guide provides practical, evidence-based guidance to support countries in planning, implementing and scaling up needle and syringe programmes for people who inject drugs as part of comprehensive harm reduction responses. It translates WHO's recommendations into actionable steps for programme managers, implementers, donors and community-led organizations.

The guide presents a structured framework covering assessment and planning, service delivery models, integration with broader health and social services, monitoring, and sustainability. It emphasizes community leadership, human rights, equitable access and adaptation to local contexts, including closed settings. Practical tools are included to support implementation and accelerate progress towards global targets for controlling HIV and eliminating viral hepatitis epidemics.