case study title: person centered approach country: iraq, opt specific thematic: access to services...

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


• 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


• 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:


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.


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


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.

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?


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


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).


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


•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


Next steps: Evaluate and Duplicate

case study title: person centered approach country: iraq, opt specific thematic: access to services...

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