1. Thurs. 5 December 2013 Impact Assessment Seminar – Phnom Penh Local assessment of the situation and access to services in Gabès and Douz- Kebili

2. Population: 10.8 million (2012 source: Tunisian INS) Per capita GDP: €7,300 (2012) Territory divided into 24 administrative regions Regions where the assessment was implemented Focus on Tunisia

3. PRESENTATION OUTLINE ►PART 1: The VAPS assessment ►PART 2: Results analysis ►PART 3: Recommendations

4. PART 1 – The VAPS assessment ► a. The Vie Autonome et Participation Social (VAPS, self-reliance and social participation) project in the Gabès and Kebili governorates ► b. Goals of the assessment ► c. Methodology ► d. Survey and sample zone

5. PART 1 – The VAPS assessment ► a. The VAPS project in the Gabès and Kebili governorates ► b. Goals of the assessment ► c. Methodology ► d. Survey and sample zone

6. ► Purpose of the project ► Expected results in the two governorates: ► a. The VAPS project Improve the quality of life, self-reliance and social participation of people with disabilities R1: Increased participation of emerging self-advocacy movements of PWD and their families in local development processes R2: Improved quality of services via concerted initiatives involving public structures, associations and self-advocacy movements R3: Enhanced quality of services for PWD via the implementation of PSS (personalised social support) principles and tools 3 years (2012-2015) ► Budget €525,000 (75% European Union + 25% HI) ► Duration

7. ► Beneficiaries ► Primary activities ► a. The VAPS project in the Gabès and Kebili governorates ► a. The VAPS project - People with disabilities - Local associations of people with disabilities - Service professionals, local administrators of decentralised national services and local officials -Participatory assessment of the situation of PWD, current status of the identified structures -Support and capacity-building for self-advocacy groups in the two governorates -Development of a space for member collaboration and training -Training of professionals in personalised social support (PSS) for PWD and introduction of PSS in the two governorates -Support for implementation of local initiatives -Leverage of activities and sharing of best practices

8. PART 1 – The VAPS assessment ► a. The Vie Autonome et Participation Social (VAPS, self-reliance and social participation) project in the Gabès and Kebili governorates ► b. Goals of the assessment ► c. Methodology ► d. Survey and sample zone

9.  Know the social and economic characteristics of people with disabilities in the two governorates;  Compare the use and needs for various services of people with disabilities with the general population;  Determine the level of accessibility to services and identify existing barriers;  Analyse the system of actors and know the professionals’ practices;  Formulate a series of recommendations for local agents in the assessed territory by domain and sector of intervention. ► projet Vie Au ► b. Goals of the assessment

10. PART 1 – The VAPS assessment ► a. The Vie Autonome et Participation Social (VAPS, self-reliance and social participation) project in the Gabès and Kebili governorates. ► b. Goals of the assessment ► c. Methodology ► d. Survey and sample zone

11. 1 The method is global 2 The method is operational 3 The method is participatory 4 The method is dynamic The assessment involves, informs and mobilises local agents in identifying, comparing and reporting data. Consultative approach Enables joint reflection on: o Practices o Needs of people with disabilities o Attitudes of actors o Solutions to the problems Approach by: service sectors / professional profiles. An accessible, succinct and operational discussion document. Quantitative and qualitative elements for a global intervention strategy. Full status report on the situation and access to services. ► c. Methodology IMPLEMENTATION OF 4 KEY PRINCIPLES

12. ► c. Methodology FIVE IMPLEMENTATION PHASES Design of methodology framework Exploratory research Phase 1: Preparation of the assessment Designation and training of survey administrators and tandems Presentation of the assessment process to field agents Phase 2: Launch of the assessment Quantitative study of the situation and access to services of people with disabilities Service accessibility audit (audit checklist) Examination of the needs analysis and needs solutions (focus groups) Interviews with the region’s dedicated associations and stakeholders (in-depth interviews) Phase 3: Field surveys Statistical analysis of the data collected (EPSOS, SPSS, Excel) Critical review and discussion groups Phase 4: Data analysis - Publication of a report and summary document - Seminar to present results and recommendations Phase 5: Data feedback

13. ► c. Methodology: participatory process VAPS project PARTNERSHIP UTAIM Gabès, AGIM Douz and Handicap International Steering committee + project team External consultant + polling agency Participatory approach Create a dialogue framework and organise a field team Understand the local context Capacity-building for actors Gabès 2UTAIM coordinators Self-representative group (5 interviewer pairs) Project actors and stakeholders Douz 2AGIM coordinators Autonomous representative group (5 surveyor pairs) Project actors and stakeholders

14. PART 1 – The VAPS assessment ► a. The Vie Autonome et Participation Social (VAPS, self-reliance and social participation) project in the Gabès and Kebili governorates. ► b. Goals of the assessment ► c. Methodology ► d. Survey and sample zone

15. Quantitative survey: Individuals surveyed 1000 People with disabilities 497 213 284 Control subjects 503 190 313 People who responded to the survey PWD sample Number of individuals surveyed Who responded Respondents with disabilities

16. ► d. Survey and sample zone 140 structures audited 21 interviews with dedicated associations 6 focus groups with professionals

17. PART 2 – Results analysis ► a. Quantitative approach: social perception and socio-economic situation of PWD ► b. Accessibility of services by activity sector ► c. Qualitative approach: professionals’ practices

18. PART 2 – Results analysis ► a. Quantitative approach: social perception and socio-economic situation of PWD ► b. Accessibility of services by activity sector ► c. Qualitative approach: professionals’ practices

19. ► a. Quantitative approach ► Method 1,000 individuals surveyed ► Outputs  Quantitative data on the profiles of people with disabilities: age, gender, family situation, education level, employment, disabilities  Comparative data on social participation ➔ Identification of collective perceptions of Disability (beliefs, attitudes) Relevance of the approachLimits to the approach -Almost no existing data on the situation of PWD -Initial situation indicators -Specific knowledge of the region -Leverage of results -Declarative -Filtering and eligibility of PWD via Washington Group questionnaire -External professional survey administrators

20. ► a. Quantitative approach ► Results Perception of disability and social participation Social and civic participation* Take part in a family event Visit family in Tunisia Travel abroad Take part in a cultural event Take part in a political or labour demonstration Member of a political party Member of a union Member of an association of people with disabilities *: over the past 12 months

21. ► a. Quantitative approach ► Results Perception of disability and social participation 43.4% of PWD voted in the last elections compared with 76.7% Ability to carry out activities of daily life (go to the pharmacy, bank, hairdresser, market, grocer, Hammam, Hammas, restaurant, etc.) Social and civic participation (participate in family, cultural, political, labour union, etc., event) Difficulty with personal and family responsibilities (able to make decisions for oneself, for family, and benefit from family support in daily life)

22. ► a. Quantitative approach ► Results Socio-economic situation of PWD  Relative income (TND) 327 547 Education level reached PWDNon-PWD University6%16.1% Secondary30%51.5% Primary43.1%29.2% No formal education19.7%2.4% Other1.2%0.8% Total100%

23. PART 2 – Results analysis ► a. Quantitative approach: social perception and socio-economic situation of PWD ► b. Accessibility of services by activity sector ► c. Qualitative approach: professionals’ practices

24. ► b. Accessibility ► Method -140 structures audited following mobility chain principle: Reach, Enter, Circulate, Use (RECU) + quantitative survey ► Outputs ➔ Accessibility measure using concrete indicators  Quantitative data on the level of knowledge, need and utilisation of the different services  Identification and categorisation of barriers to access to these services Relevance of the approachLimits to the approach -Real movement towards mobilisation of PWD -Indicators of initial accessibility situation -Rates of attendance and utilisation -Figures to support advocacy -Specific knowledge of barriers -Leverage of results -Mobilising and involving local architects and decision-makers in collecting data would be useful

25. ► b. Accessibility Results Health services: 1) Level of accessibility / RECU standards Reach Accessible exterior Enter Enter the buildings Circulate Circulate indoors without obstacles Use Accessible toilets Accessible information Reception of PWD 76%58%71%55% Scale Accessibility complies with regulationsRate between 70-100% Partially accessibleRate between 50-70% Non accessibleRate between 0-50%

26. ► b. Accessibility 2) Level of knowledge, need, utilisation expressed in number of individuals KnowledgeNeedUtilisation Services PWDNon-PWDPWDNon-PWDPWDNon-PWD Basic healthcare unit 438494409417399395 Physical rehabilitation service 183205128517819 Service providing technical assistance 1191537120355 Private physician’s office 272386170200105144 Regional rehabilitation unit 941285312265 Private clinic 2243311331442856 Psychological and psychiatric service 5812022590

27. ► b. Accessibility 3) Difficulty accessing services 4) Comparable satisfaction rate Difficulty in:PWDNon-PWD Receiving care from a service53.7%7.5% Paying medical costs69%13.5% Entering and circulating in the services56%6.6% Receiving information53%9% Getting a proper reception46.9%10.1%

28. PART 2 – Results analysis ► a. Quantitative approach: social perception and socio-economic situation of PWD ► b. Accessibility of services by activity sector ► c. Qualitative approach: professionals’ practices

29. ► c. Qualitative approach ► Method -6 focus groups, 52 individuals representing:  dedicated associations,  local administrative officials,  the various healthcare, education, vocational training, employment, recreation professions. ► Outputs  Identification of professionals’ perceptions of the needs of PWD  Problem tree chart: Identify needs and barriers by sector  Information about professionals’ practices Relevance of the approachLimits to the approach -Structure and organise the network of professionals -Inexpensive and motivating tools -Launch a process of change for practices -Summary and qualitative analysis are challenging -No quantitative data to measure the barriers named -Need to also involve the families in reflection

30. ► c. Qualitative approach Needs related to vocational training and employment Guidance and information on existing vocational and academic courses Recognition and legal status for diplomas from specialised institutions Strategic repositioning of professional workshops and production centre Personalised professional and social support: managing money, finding work Micro-project financing Advocacy for the right to work with local companies FG Results, vocational training and employment

31. ► c. Qualitative approach Needs of the dedicated associations: Human resources Operational effectiveness for better support of PWD (PSS) Financial resources Staff training Recruiting of care staff Involvement of families, network, etc. Financial resources targeting different governance: rules for good governance, professional practices More comprehensive case management Person-centred support (decision-making and involvement) Knowledge of funding bodies, drafting of grant requests Budget preparation and monitoring Logistics support and assistance via network development, etc.

32. PART 3 – RECOMMENDATIONS ► Recommendations by domain of intervention ► Recommendations by sector of intervention ► Towards the implementation of change indicators and monitoring tools

33. III – RECOMMENDATIONS ► Recommendations by domain of intervention For 9 intervention domains:

34. III – RECOMMENDATIONS By sector of intervention:  Healthcare  Social services and programmes  Education  Employment and vocational training  Recreation ► projet Vie Au

35. III – RECOMMENDATIONS ► Recommendations by domain of intervention Towards the implementation of change indicators and monitoring tools Current status: Description of local target population / Initial situation indicators Identification and analysis of system of actors Assessment Recommendations ImplementationInformation Evaluation READJUSTMENT

36. Workshop

37. O Indicators Method / Tools Goal / Purpose Standards Participatory approach Resources committed Actors involved Resistances What we want to find Obstacles/ What we want to avoid What we want to involve? How?

38. Workshop In order to increase our capacities to monitor and measure our indicators of the changes we want to achieve, when we develop baselines: 1.What we must stop; 2.What we already do but we need to improve; 3.What we don’t do but we should start to do; 3 to 4 people per group