Processes and approaches to enable sustainable access to quality rehabilitation services

1. 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

2. Countries profiles • Structuredhealth system • Lack of policies for rehabilitation • No specializedtrained staff • Mine VictimAssistance MOZAMBIQUE 24 M HDI: 184 1986-2001 Presentduring the civil war + in the long-term reconstruction ALBANIA 3,2 m HDI: 70 2000-2004; emergency and reconstruction KOSOVO 1,7 m HDI N/A 2006-2011

3. Systemicanalysis: • TO WHAT EXTENT HAVE THE PROGRAMME INTEGRATED A SYSTEMIC APPROACH? • WHICH PARTNERSHIP MODALITIES? • WHICH IMPACTS ON CRITICAL DIMENSIONS, INCLUDING SUSTAINABILITY ?

4. APPROACHES:-LEVELS OF INTERVENTION-PROJECT DESIGN-RESOURCE ALLOCATION

5. Approaches (1) LEVELS OF INTERVENTION: iNGOS DONORS

6. 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

7. THE CASE OF KOSOVO Interventions werecomprehensive , thoughuncoordinated; interactions betweenactorsremainedpoor. Regulatorymechanismssuch as territorial needassessment, gatekeepingprocedures, quality standards, referral system are stillmissing

8. ApproachES ( 2) PROJECT DESIGN Project designs were all based on needsassessments , more systematic and comprehensive in Albania, including participation of DPOs; Their participation continued, to a muchlesserextent , during the implementation phase RESSOURCE ALLOCATION: -In Mozambique and Kosovo: highnumber of expatriate and local staff (from emergency) -In Albania:fewexpatriate staff; short externaltechnicalexperts,includingregionalresources

9. Partnershipmodalities • Who’s the ownership • How decisions are made • Role of each stakeholder in planning, implementation, monitoring

10. THE CASE OF ALBANIA • The demand for the development of rehabilitation services came officiallyfromDPOs • A projectsteeringcommitee and a PhysicalMedicine and Rehabilitationworking group wereset up • Writtenagreementsfor almost all actions • Strong influence of local stakeholders in decisionmaking • Full ownership of Albanianactorssince the design phase • Technical support wasassured by external experts , includingfrom the region. • Weak participation of local stakeholders in monitoring

11. Partershipmodalities • 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) - missingstrategies to maintainquality of services

12. Partnership: role of HI

13. Impact and sustainability:1 REHABILITATION OUTCOMES2 INSTITUTIONAL CAPACITIES AND POLICIES3 TRAININGS OF PROFESSIONALS4 SERVICE PROVIDERS5 COMMUNITY AND DPOS CAPACITIES

14. institutionalCapacities The case of Mozambique • Development of a national policy; rehabilitation centres are includedatsecondary and tertiarylevel • Services are managed by the governement and are free of charge for PwDs • Basic data collection procedures in place in the centers

15. 2- Institutionalcapacities/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

16. 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 wereinstitutionalizedfollowing the crisis CHALLENGES • Long-term quality of training and practice • Recognition of community level profiles • Retention and planning

17. 4- Services ASSETS • 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

18. Communities and DPOscapacities • Consultation/participation to policy making is very little • Advocacy and lobby: effective networkingbut only at local level in Kosovo and Albania • Participation in functioning and evaluation of services: poor, and very limited access to actual services

19. fromproject to local perspective:

20. Fromproject to local perspective

21. Fromproject to local perspective

22. Questions: • For an equitable and sustainableaccess to REHABILITATION SERVICES for PWDs, whoshouldcontribute , and how, to: • The improvement of the quality of services ? • The development of regulatorymechanisms? • The design and monitoring of rehabilitationpolicies?