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Transcript of Handicap International – Cambodia Programme © Éric Martin / Le Figaro / Handicap International...
Handicap International – Cambodia Programme
© Éric Martin / Le Figaro / Handicap International
Study on Sustainability in the Physical
Rehabilitation Sector: Cambodia Perspective
Nepal, 24-29 January 2013
Dr. Vivath Chou
Outline of the presentation
• Context
• Participation in the study
• Inputs from the study
• Limitations
• How Handicap International made use of the study’s findings
• Key questions
Country context
• Population: 15,3 million (IMF 2012)
• Surface Area: 181,035 Km2
• Population density: 81.8 p./Km2
• Sub-devisions: 24 provinces
• Average income: US$1.5/day
• HDI: 0.523
Rehabilitation sector context
• Physical rehabilitation centres (PRCs) supported from the 1990s by a variety of INGOs
• More than 50% of disabled population are children. Evolution of the PRC patients profile overtime.
• Research implemented in 2006 with EU support estimates 150,000 persons are at need of assistive device, 90% located in rural areas
• End 2011, more than 64,000 landmine casualties. Around 50% of PRC clients in the country gets amputation
• Absence of sector policy resulting in no standardisation of management and monitoring tools
Context : Handicap International (HI) history & coverage
• HI involved in the rehabilitation sector since 1992 supporting
5/16 PRCs established
• Rehabilitation network created following major humanitarian
crisis= Khmer Rouge period, country highly affected by
landmines and cluster munitions
• Process of handover to the Government – formalised with a
MoU signed for the period of 2008-2010
• At the time of the study, HI France and HI Belgium were
managing 3 out of 11 PRCs
Participation in the study
– Initial research field missions organised in 2009
• Comparison studies on 3 HI PRCs completed
• 1 day workshop conducted to understand what sustainable PRCs meant to different actors, to further explore the handover process and to identify the main actors of the rehabilitation sector
– In 2010 a workshop was organised with all the actors to define sustainability and identify common core sustainability indicators.
Inputs from the study
• Opportunity for all stakeholders to understand the sustainability concept
• Opportunity to define the different dimensions of sustainability
• Opportunity to reflect PRC (centre based) into the national context (sector based)
Limitations
• MoSVY was not involved into the process
• The indicators were not designed to serve as a monitoring matrix and support a system of control from national level that should come along the principle of delegation
• Too many indicators, some beyond the scope of the rehabilitation sector with little input for improving the piloting of the sector
• Some indicators are hardly manageable into the political context / unrealistic
Limitations
• Some indicators were embedded into standardised procedures that at the time of the study did not exist / feasibility
• The notion of quality of services is too broad and is questionable. Supposes that agreed references are set / affordability, acceptability
• The impact of rehabilitation upon the clients not considered
Limitations
• Technical / operational / administrative / financial requirements for implementation not addressed
• Indicators addressing health outcomes (number of clients) and outputs of health service delivery (productivity) were included into routine M&E; other indicators developed under quality assurance system remained outside this frame
• Indicators were not operationalized
• Responsibilities for data collection & analysis were not identified
How Handicap International made use of the study’s findings
• To input into the quality assurance system deployed
at Kampong Cham PRC overtime
• To advocate for needs vs coverage study
• To develop the framework of a study assessing the impact of the handover in one PRC managed by HI
• Main indicators used reflect management of the PRC vs sector
Rehabilitation services analysis
02468
10
Legal framework, nationalstrategies, actions plans.
Regulatory mechanisms forservices
Services & types (ordinary,support, specific)
Professional profiles andformal training programs
Accessibil ity of existing services
Competent user organisations
Data on needs
Multi-stakeholder consultationmechanisms
Rehab
• How can we better consider users and community based organisations into sustainability framework ? – for measuring performance ? – For contributing to the sustainability of the system ?
• How can minimum standards for viable and affordable service delivery be established?
• What is the necessary pre-requisite for setting monitoring systems ?
• How can links between rehabilitation and health systems be developed to ensure continuum of care and better conditions for sustainability ?
Key questions