The C-EHRN Monitoring provides annual, city-level data on harm reduction services across Europe, based on input from a network of civil society organisations (Focal Points). It aims to identify gaps, barriers, and inequalities in service provision and to support evidence-based advocacy and policy development at local, national, and European levels. By capturing real-world service conditions and frontline perspectives, it complements existing national and European monitoring systems. Data are collected through a standardised survey and presented in aggregated form to ensure confidentiality. The monitoring follows a harm reduction and human rights approach and is co-developed with participating organisations, ensuring relevant, practice-based insights.

The monitoring focuses on the following core areas:

• Service availability: Whether essential harm reduction services (such as OAT, NSP, DCR, naloxone, and drug checking) are present in a city
• Service accessibility: How easy it is to access services, including barriers related to cost, eligibility, distance, or administrative requirements
• Service quality & comprehensiveness: The range and adequacy of interventions, materials, and treatment options available
• Continuum of care: How well services are connected, including pathways from testing to treatment and follow-up (e.g. for HCV and HIV)
• Equity & inclusiveness: Whether services are tailored to the needs of different populations, including people in prison and other underserved groups
• System integration: The level of coordination and cooperation between services, including referral systems and case management
• Human rights & acceptability: The extent to which services are respectful, non-discriminatory, and involve people who use drugs