This report, prepared for the Social Transition Team of the USAID Bureau for Europe and Eurasia (E&E), is the result of a study of promising practices in community-based care for vulnerable groups conducted in five countries (Armenia, Azerbaijan, Bosnia, Romania, and Russia) in the E&E Region between September 2004 and March 2005. Of particular interest is how these countries are moving from residential care to family-focused, community care models utilizing internationally recognized standards for children and youth, elderly, disabled, and minority groups (with an emphasis on Roma).
This report presents the specific findings for each country organized around a four-pillar framework of analysis of promising practices in community-based services, and it highlights the progress each country has made compared to the necessary elements of best practices in the four-pillar model. While the countries in the study vary widely in their approaches to and progress toward community-based care, they all demonstrate practices that can be built upon to continue the movement toward community care models. The specific findings and promising practices detailed in Parts Three and Four of this report support some general conclusions regarding the transition to community care in these countries. Some of these conclusions are listed below, grouped by the four-pillar framework:
Pillar 1: Policy and Legal Framework
- Policy design, often done with external assistance, is not followed by sufficient strategic planning that includes implementation planning.
- International standards have become the basis for knowledge and skills transfer in model programs in all countries, with strong influence from Western professional schools and associations, governments, and donor groups.
- Each country’s definition of priority vulnerable groups results from a combination of political, economic, and social factors. Overall, definitions tend to emphasize more concrete factors such as income rather than overall well-being.
Pillar 2: Structure and Types of Programs and Services
- All countries increasingly have examples, primarily through NGOs, of vocational programs for disabled persons, Roma, and youth aging out of institutional care.
- The non-profit sector is emerging as the primary provider of social services in the region; however, there is limited information about services and the effectiveness of their work.
- Lack of financial resources is a major contributor to child and family problems. Programs are being developed that increase self-reliance by incorporating income generation initiatives such as vocational training and retraining, small business development, and micro-finance for small businesses in rural communities.
Pillar 3: Human Capacity
- All countries have emphasized human capacity-building through transfer of technical knowledge and skills for transforming systems of care.
- There is recognition that a qualified workforce that represents a range of human service professionals is critical for quality service.
- Social work development has emerged as a primary agent of change for social services reform.
Pillar 4: Performance Outcomes and Measures
- There is recognition that the development of client and service monitoring and tracking systems is critical for determining the impact of programs and services, although this area has not received equal attention in all five countries.
- Monitoring is no longer seen as a method of “control” but rather as a way to ensure program quality and safety.
- The public services and civil society organizations, including professional and consumer associations, provide key mechanisms for ensuring that standards of care and standards of practice are developed and enforced.
The transformation of systems of care in Europe and Eurasia is multi-faceted and complex, involving “dismantling the old system” while designing and implementing new structures and financing mechanisms. While there are variations in how governments and stakeholders transform systems of care, the consensus in the region is that basic services are a fundamental right.
©USAID
