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 PROVISIONCAPACITY BUILDING SUPPORT TO POLICY MAKINGOVERALL COORDINATION

IMPACT AND SUSTAINABILITY:1 REHABILITATION OUTCOMES

2 INSTITUTIONAL CAPACITIES AND POLICIES3 TRAININGS OF PROFESSIONALS

4 SERVICE PROVIDERS5 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?