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

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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