Case study

1. Case study Title: Person Centered Approach Country:Iraq , oPt Specific thematic: Access to services Presented by: Ahmed Ghanem, regional technical coordinator on access to services, Middle East programme Impact Evaluation Seminar 2 to 6 Decembre, Phnom Penh

2. Description of the context & project • PCA has been implemented for • Improving access to rehabilitation services in occupied Palestinian Territories • A multi-stakeholder dynamic towards a person centred rehabilitation in Northern Iraq • Program aim to improve access to rehabilitation services and applying the main principals of multistakeholder approach to insure comprehensive and sustainable solutions • Major lesson learned showed that real participation of person with disabilities and their families was a big challenge. Impact Evaluation Seminar 2 to 6 Decembre, Phnom Penh

3. Description of the tool/study • An approach to practice that embraces a philosophy of respect for, and partnership with, person receiving the services • Involves advocacy, empowerment, and respecting person´ autonomy, voice, self-determination, and participation in decision-making. • Three level: • Micro-level: at the level between the clinician providing direct treatment and the individual person/ persons • Meso-level: at the level within unit, within the facility/ place of employment • Macro-level: broader community, government/ legislation, policy development • Within the framwork of multistackholdersapproch strategies and practical actions to promote person centered services with: • Group 1: Services provider (as organization) • Group 2: Specialists and practitioners • Group 3: Persons and families (and persons organizations) • Monitor and evaluate every strategy of promoting PCA Impact Evaluation Seminar 2 to 6 Decembre, Phnom Penh

4. Most of strategies aim to: • Diffusion of best practice: i.e. increasing the uptake of PCA tools or practices • Diffusion of the ideology of PCA: i.e. developing amongst managers and professionals a culture where PCA is valued and sought as part of routine of the services. • Diffusion of organisational innovations: i.e. the dissemination of those organisational structures, processes and strategies, which encourage PCA. Impact Evaluation Seminar 2 to 6 Decembre, Phnom Penh

5. levels of intervention Macro level Meso level Micro level

6. Séminaire Evaluation d'impact du 2 au 6 décembre, Phnom Penh

7. PCA practices, oPt • Steering committee :9 rehabilitation centers and two DPOs. • ToR: facilitate and promote the implementation of PCA among members • Action plan and assessment tool : • User focus. • Process focus. • Staffs focus. • Quality focus. • Management focus. Séminaire Evaluation d'impact du 2 au 6 décembre, Phnom Penh

8. PCA practices, Iraq • Macro level: DPO, public authorities and service providers jointly monitor access to rehabilitation services in KRG including PCA • Meso and micro level: (3 Centers) • Capacity building in technical rehabilitation and PCA • Provide tools for PCA • Committee/Self evaluation • -Improvement plan Séminaire Evaluation d'impact du 2 au 6 décembre, Phnom Penh

9. What does it mean in Access? • Macro level: • Citizen Participation • Policy reform Co-decision • Participatory programme design. • Participatory M&E • Person centered regulatory mechanisms. • Meso & Micro level: • Puts the person first and partnership. • Service designed to meet the person’s needs and wishes. What is important to the person. • Removes any barriers within existing structures to inclusion. • Builds on mainstream, avoids what is separate. • Is measured against personal outcomes.

10. Outcome or Impact that the tool/study was able to demonstrate? • PCA help the translation of abstract concepts (participation, self determination, nothing about us without us, …) into applicable concepts in service provision. • For Authorities: • Ensure that the services are provided on good quality criteria by involving clients in the rehabilitation process. • Providing better transparency of service delivery, efficacy and common standards • For Service provider: • Building on respect of client’s dignity, enabling autonomy, behaviors, needs and offering choices • Access to accurate information on the service user’s situation, abilities and needs for better service provision • For Person with disability: • Increased proactive initiative and empowerment of service user and families • Improve participation of persons with disabilities in informative choices • Facilitated clients’ autonomy and independence Impact Evaluation Seminar 2 to 6 Decembre, Phnom Penh

11. Facilitating factors and obstacles • What in the context helped the implementation? • Better awareness of importance of PWD participation • Willingness of authorities to improve services provision • Existence of Multistakeholder initiative • Motivation of PWD/families to engage • Basic understanding of access to services principals • Main Challenges: • Culture • Absent of efficient accountability mechanisms • Different delivery sitting (center based, outreach,..) • Financial and time resources at services level Impact Evaluation Seminar 2 to 6 Decembre, Phnom Penh

12. Success and challenges oPt • Challenges at Meso level • Successes at micro level: • The teamwork protocols improved : multidisciplinary teams including users/families. • The intervention planning shard and discussed with the users/ families. • Documentation systems improved: including users/ families’ opinion. • Active and effective dialogue starts between DPOs and SP (user/parents committee). Séminaire Evaluation d'impact du 2 au 6 décembre, Phnom Penh

13. Success and challenges Iraq • Challenges at Micro/Meso level • Successes at Macro level: • Putting the PCA on policy agenda: MOH of Kurdistan issued a statement, officially requesting all the governmental rehabilitation centres to adopt PCA Séminaire Evaluation d'impact du 2 au 6 décembre, Phnom Penh

14. Next steps: Evaluate and Duplicate • Think globally ( PCA is complementary with other approach especially multistakeholder approach) • Satellite document (lesson learned/Guideline) • Integrate PCA in the PCM • assess needs at different levels (micro, meso, macro) from a PCA point of view • design activities accordingly, with PCA as included component. • Redesign the activity to be more PCA sensitive • Transfer the knowledge to partners (ownership) • Research and linking practice and knowledge: • Support the research about PCA effectiveness • Produce multi-cultural research on national basis • Create a pool of trainers on PCA • Identify centers of excellence for PCA and organize exposure visits Impact Evaluation Seminar 2 to 6 Decembre, Phnom Penh