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

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. Description of the context & project Impact Evaluation Seminar 2 to 6 Decembre, Phnom Penh

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 multistackholders approch 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 Description of the tool/study Impact Evaluation Seminar 2 to 6 Decembre, Phnom Penh

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. Most of strategies aim to: Impact Evaluation Seminar 2 to 6 Decembre, Phnom Penh

levels of intervention Micro level Meso level Macro level

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

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

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

What does it mean in Access? 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. 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. Macro level: Citizen Participation Policy reform Co-decision Participatory programme design. Participatory M&E Person centered regulatory mechanisms. Macro level: Citizen Participation Policy reform Co-decision Participatory programme design. Participatory M&E Person centered regulatory mechanisms.

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 Outcome or Impact that the tool/study was able to demonstrate? Impact Evaluation Seminar 2 to 6 Decembre, Phnom Penh

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

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

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

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 Next steps: Evaluate and Duplicate