1. How to improve the availability and quality of community-based services? Zagreb,23 November 2010 Dr.Vasilka Dimoska Specialist in social medicine and health management Consultant for social services Board member of EASPD

2. What is disability?  Definition  complex and controversial  Approach: - Medical model - Social model - Inclusion

3. It is human rights issue!!!! Persons with disability have rights to be equal members of the society!!!  Human rights approach  Awareness  New initiatives

4. International frame for improvement of rights and equal opportunity for persons with disability in the society  UN Convention on the rights of persons with disabilities  Council of Europe Action Plan 2006/2015 The European Disability Strategy 2010-2020  International development goals: - economic, human and social development; - Prevention + rehabilitation= integrative approach

5. National frame for improvement of the rights of persons with disabilities  Macro level - National strategy  Micro level - Local Action Disability Plans Need for collaboration!!! - Regional level - European level - International level

6. Key words in the reform of the system  Decentralization  De-institutionalization  New system of opportunity  Social services on the local level/community based service  European social model

7. Reform of the system  Institutional care  Community based services  Decentralization  De-institutionalization

8. Society for all  Regular services - Kindergarten - Primary school (inclusive program) - Occupational therapy - Employment  Specialized services  person centered approach

9. Community – based services for persons with disabilities  System of new opportunity  Driving force for changes  Development of the capacity and capability of the person  Support to the families  4A rules for community based services (Accessibility, Availability, Affordability, Accountability)

10. Steps in the process Deming wheel PDCA (plan-do-check-act)  Planning  Provision  Monitoring/Evaluation  Improvement

11. Regulatory mechanisms  Operative instruments for control, coordination and improvement of the process of service provision on macro and micro level  Opportunity for different service providers  Balance between demand and offer/supply  Create rules in the system of service provision

12. THE GATE-KEEPING MECHANISMS (Referral, information and direct access to social services) At the level of the general system of social service (macro):  Needs assessment (which types of services are needed)  Elaboration of territorial maps of needs and services  Defining national access criteria to social services At individual level (micro):  Assessment of the individual situation  Decision making and orientation to community services

13. Quality mechanisms (principle/standards)  General principles (rights based, values and basic standards)  ‘Technical’ standards, taking into account more specific quality requirements for different categories of services

14. CONTRACTING AND FUNDING MECHANISMS  Call for offers/tenders/project applications for social services at local/national level  Licensing/authorisation of social service providers  Purchasing and contracting of social services at community level  Funding of social services at community level

15. THE INTERNAL REGULATORY MECHANISMS  Manuals of policies and procedures;  Internal regulations (human resources, relations with users, safety regulations etc.)  Quality management and improvement procedures;  Strategic planning procedures and follow up;  Internal and external communication procedures ;  Evidence-based decisions and measures etc.

16. MONITORING AND EVALUATION MECHANISMS  At macro level (the system of social services at local level)  Monitoring of social service provision at local level  Periodic evaluations and articulation with the gate- keeping system at macro level ;  At the level of service providers (micro)  Internal evaluation of service providers (self- evaluations)  External evaluations of the social service  Auditing and control procedures  Regular monitoring of service delivery.

17. THE OVERALL SYSTEM OF INFORMATION AND FEEDBACK  Data collection and flow of information that ensures the transparency of the system at all levels, and facilitates decision making and planning

18. Functions covered by the regulatory mechanisms of services for persons with disabilities  Normative function  Corrective function  Promotion and continuous improvement of service delivery

19. What we are looking for ? Quality Services :  Respect human dignity and fundamental rights  Achieve results  Tailor-made to each individual  Ensure security to all users, including the most vulnerable  Participative and empower users to take decisions on their own  Holistic and continuous  Provided in partnership with communities and other actors  Provided by skilled professionals working under good employment and working conditions  Managed in a transparent way and are accountable

20. European Quality of Life Principles EASPD - Values - Quality of life for all Dignity Emotional well-being Equal opportunitiesInterpersonal relations Independent livingPersonal development Participation in the society Self-determination Contribution to the society Social inclusion/equal rights

21. European Requirements for Quality in Social Services of General Interest  1. Rights  2. Person centred  3. Comprehensiveness  4. Participation  5. Partnership  6. Result Orientation  7. Good Governance Source: Positioning Paper Disability High Level Group June 2007

22. Improvement initiatives  Service improvement  Proof of effectives and efficiency  Support concept  Addressing needs/consumer satisfaction  Involvement of persons with disability in the process respecting the principle “Nothing about us without us”