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PROCESSES AND APPROACHES TO ENABLE SUSTAINABLE ACCESS TO QUALITY REHABILITATION SERVICES
Comparative study of HI programmes in Albania, Kosovo and Mozambique
2012
Khatmandu, 28 January 2013
COUNTRIES PROFILES
MOZAMBIQUE24 M HDI: 184
KOSOVO
1,7 mHDI N/A
ALBANIA 3,2 m
HDI: 70
•Structured health system•Lack of policies for rehabilitation•No specialized trained staff•Mine Victim Assistance
1986-2001Present during the civil war + in the long-term reconstruction
2000-2004; emergency and reconstruction 2006-
2011
SYSTEMIC ANALYSIS:
1. TO WHAT EXTENT HAVE THE PROGRAMME INTEGRATED A SYSTEMIC APPROACH?
2. WHICH PARTNERSHIP MODALITIES?
3. WHICH IMPACTS ON CRITICAL DIMENSIONS, INCLUDING SUSTAINABILITY ?
APPROACHES: -LEVELS OF INTERVENTION
-PROJECT DESIGN-RESOURCE ALLOCATION
APPROACHES (1)LEVELS OF INTERVENTION:
DONORS
iNGOS
All the interventions of HI prioritised:•The promotion of national policies in PMR •The training of professionals •The development or the strengthening of services, including in the community (except Albania)
The capacity building and support to the disability movement was implemented differently in the three countries and in parallel to the PMR strategy
THE CASE OF KOSOVO
Interventions were comprehensive ,though uncoordinated; interactions between actors remained poor.
Regulatory mechanisms such as territorial need assessment, gate keeping procedures, quality standards, referral system are still missing
APPROACHES ( 2)
RESSOURCE ALLOCATION:
-In Mozambique and Kosovo: high number of expatriate and local staff (from emergency)
-In Albania:few expatriate staff; short external technical experts,including regional resources
PROJECT DESIGNProject designs were all based on needs assessments , more systematic and comprehensive in Albania, including participation of DPOs; Their participation continued, to a much lesser extent , during the implementation phase
PARTNERSHIP MODALITIES
•Who’s the ownership •How decisions are made•Role of each stakeholder in planning, implementation, monitoring
THE CASE OF ALBANIA The demand for the development of rehabilitation
services came officially from DPOs A project steering commitee and a Physical
Medicine and Rehabilitation working group were set up
Written agreements for almost all actions Strong influence of local stakeholders in decision
making Full ownership of Albanian actors since the design
phase Technical support was assured by external experts ,
including from the region.
Weak participation of local stakeholders in monitoring
PARTERSHIP MODALITIES Lesson learned: securing the commitment of the public
support to develop PMR services and policies was essential to at least consider universal access, geographical coverage and affordability to PwDs (equity)
Challenges: -poor exit strategy, poor
consultation with stakeholders (funding constraints)
- missing strategies to maintain quality of services
PARTNERSHIP: ROLE OF HI
MOZAMBIQUE
KOSOVO ALBANIA
DIRECT SERVICE PROVISION
CAPACITY BUILDING
SUPPORT TO POLICY MAKING
OVERALL COORDINATION
IMPACT AND SUSTAINABILITY:
1 REHABILITATION OUTCOMES2 INSTITUTIONAL CAPACITIES AND POLICIES
3 TRAININGS OF PROFESSIONALS4 SERVICE PROVIDERS
5 COMMUNITY AND DPOS CAPACITIES
INSTITUTIONAL CAPACITIESThe case of Mozambique
Development of a national policy; rehabilitation centres are included at secondary and tertiary level
Services are managed by the governement and are free of charge for PwDs
Basic data collection procedures in place in the centers
2- INSTITUTIONAL CAPACITIES/POLICIES
ASSETS →National policies were
developed in the three countries -national action plans
→rehab services are included at secondary/tertiary level and free of charge in Moz and Kosovo
Capacity building on management in Moz.
CHALLENGES Poor policy
implementation: lack of financing, managerial and monitoring capacities
Poor links between communities and centers, rural areas are undersearved
Absence of regulatory mechanisms
3- PROFESSIONAL TRAINING PROGRAMMES
ASSETS
Innovative training in Albania for P&O
PT programme directly set up with the local training institute
In Kosovo and Moz., trainings were institutionalized following the crisis
CHALLENGES
Long-term quality of training and practice
Recognition of community level profiles
Retention and planning
4- SERVICESASSETS
All P&O workshops set up by HI are run by the government today
Number of PT clinics increased in urban areas –with a good coverage in Mozambique -including private clinics in Albania and Kosovo
CHALLENGES
Costs of materials for P&O workshops
Gaps in rural areas
Lack of central regulatory interventions
RH
COMMUNITIES AND DPOS CAPACITIES
Consultation/participation to policy making is very little
Advocacy and lobby: effective networking but only at local level in Kosovo and Albania
Participation in functioning and evaluation of services: poor, and very limited access to actual services
FROM PROJECT TO LOCAL PERSPECTIVE:
DESIGN
• Participatory design and agreement on roles and timeframe
• identification of roles and responsibilities of partners, both institutional and CSO;
• knowing the barriers to access to services in the local context
• Provide a cost analysis
IMPLEMENTATION
PHASING OUT
FROM PROJECT TO LOCAL PERSPECTIVE
DESIGN
IMPLEMENTATION
• Promote participation of PwDs in management;
• directly support the strenghtening of regulatory mechanisms;
• strenghten links with community actors;
• HR: promote competences and recognitions for non professionals and professionals
PHASING OUT
FROM PROJECT TO LOCAL PERSPECTIVE
DESIGN
PHASING OUT
IMPLEMENTATION
• special attention to monitoring mechanisms
• define long term partnerships for technical support in order to continue beyond the project
• anticipate to the implementation phase the transfer of knowledge
QUESTIONS: For an equitable and sustainable access
to REHABILITATION SERVICES for PWDs, who should contribute , and how, to:
1. The improvement of the quality of services ?
2. The development of regulatory mechanisms?
3. The design and monitoring of rehabilitation policies?