Author: Volodymyr Kuzminskyi, PhD; Irina Malanchiuk; Peter Evans
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This report was written by consultants Dr. Volodymyr Kuzminskyi, Irina Malanchiuk and Peter Evans within the framework of the UNICEF project “Family and Child Support Services in Uzbekistan”. The report covers the key findings during an evaluation visit to Uzbekistan from September 9th – 26th 2009. The purpose of the evaluation was to evaluate the impact, effectiveness, efficiency, sustainability and relevance of the piloted Family & Child Support Service in Uzbekistan.
The Child Protection system in Uzbekistan remains unchanged, closely resembling the one that was founded during the Soviet Union. This is a fragmented system and many governmental structures are responsible for child protection. In addition there are complexities in the decision-making mechanisms at local levels.
UNICEF Uzbekistan has been involved since 2004 in child care system reforms. UNICEF together with the Republican Centre for Social Adaptation of Children conducted two studies in 2006. The research identified gaps in the current child care system and led to the development of practical concepts to test the potential for the introduction of various services for children with disabilities and children without parental care at the local level. One of these concepts led to the pilot project - Family and Child Support Services (FCSS) beginning in 2007.
The aim of the Project was to develop and expand the model of effective childcare system and family and child support services by creation of Family and Children Support Services. The overall goal of the pilot aimed at preventing children from being admitted to institutions, reintegrating children already living in institutions with their biological parents or extended family, or arranging substitute family care for children unable to live with their biological family.
At the same time that FCSS services were established, the social work profession was given government approval with the recognition of social work as an official occupation and the establishment of undergraduate, graduate and in-service courses in social work taught in centres of higher education.
The evaluation was carried out using qualitative and quantitative research methods. In addition to conducting a desk-top review of background documents, the evaluators held wide-ranging interviews and focus-group discussions with stakeholders at national and local levels in Uzbekistan. At the same time, the evaluators endeavoured to collect quantitative data about decisions made by authorised bodies in pilot and non-pilot regions to place children in institutions or substitute families. During the course of the evaluation field work it became apparent that such data was exceedingly difficult to obtain as placement decisions were made by many authorised bodies at many levels of local government and none of which was collated at regional or national level. The evaluators collected as much quantitative data as they were able but it is acknowledged to be incomplete for the non-pilot regions. As a consequence there are limitations to the conclusions that can be drawn from the data.
The data appears to show that FCSS have reduced the proportion of children placed in institutions in pilot districts of Tashkent compared with the non-pilot Tashkent district though that reduction does not show in the other pilot regions. This is probably because each region is different in terms of demographics, employment and health indicators, factors that are known to impact on rates of placement in institutions. However, according to figures provided by the FCSS teams themselves the vast majority (96%) of out-of-biological family placements made by them were in substitute families such as adoptive families, guardianship or patronage (foster care).
One pilot region (Samarkand) appears to show an increasing capacity to reintegrate children from institutions back to their families though the same capacity was not observed in other pilot regions.
The evaluators observed that most FCSS teams were using internationally recognised case management processes when working with children and families though because staffs were only working part-time for FCSS while continuing to work in their "regular" jobs, the number of child and family cases they worked with was limited to ten cases per worker. Other potential cases were referred on to SPON inspectors.
Individual interviews and focus group discussions with stakeholders in pilot regions indicated general satisfaction with FCSS services. Fewer persons in non-pilot regions knew very much about FCSS and were unable to express an informed opinion. Some staff of children‟s homes rejected the proposition that children were better off in poor families saying that children‟s homes provided a better environment.
The biggest difference in approach to vulnerable children and families observed by the evaluators in pilot and non-pilot regions was that FCSS staff adopted a non-judgemental attitude to families and tried to assess the individual needs of children and families. In non-pilot regions the approach appeared to be more administrative, dependent on the production of required documents and certificates following which a child was placed in an institution.
FCSS services were successful in preventing the admission to institutions of almost all children they worked with, either by supporting the child in its biological family or by arranging care in a substitute family. However, the overall impact of FCSS interventions on reducing the number of children placed in institutions was limited because many more children from the pilot regions; children lacking parental care, children from poor families, children with severe and less severe disabilities, young children under three years, children in conflict with the law, were placed in institutions by the many authorised bodies at several levels of local government. This situation reinforces the conclusion that a scaling up of FCSS services would succeed in preventing many more avoidable admissions to institutions, especially once FCSS service became more widely known by potential sources of referrals and by families themselves.
The evaluators conclude that FCSS teams were responding to referrals efficiently though they noted that the average time spent on a prevention case was longer than that spent on a reintegration case. The evaluators thought that situation would reverse itself as the teams became more confident and experienced. The evaluators did not attempt to directly compare the cost-efficiency of care in an institution with the cost of supporting a child at home though they made some calculations of the cost of FCSS care packages. Reference is also made to studies of comparative costs of institutional and family support in other CIS countries.
The evaluators conclude that FCSS organised at oblast level is not the most effective model for a national scaling up of services. FCSS pilots that were organised at District level are closer to the communities they serve, meaning that the workers themselves had better knowledge of local resources, and that local government officials are more likely to refer families in difficulties to the FCSS. Similarly, self-referrals by families themselves are more likely when FCSS are seen as local resources. The evaluators agree with several stakeholders who expressed support for locating FCSS at rayon and city levels and for strengthening the capacity of key people at makhalla level to respond to vulnerable children and families.
The evaluators conclude that the project had implicitly adopted a human rights-based approach to programming with its focus on supporting children to live in families. The evaluators were less certain that a results-based approach had been adopted to manage the project.
The evaluators make a number of recommendations; principally that consideration is given to developing a broad-based, high-level national strategy to protect vulnerable children at risk of admission to institutions. The assessment and family support services of FCSS would be a key feature of the strategy, which would also aim to streamline decision-making procedures to ensure that all children at risk of admission to institutions are first assessed to see if they could be supported in their own or a substitute family. The strategy would also aim to reduce the bed capacity of institutions and redirect the savings in government expenditure towards community-based support services such as day care, after-school care, education and support for children with special needs and financial support for substitute families, etc.
Recognizing that a strategic review and strategy development will probably take at least 18 months, the evaluators make a number of shorter term recommendations to enhance the effectiveness of the FCSS teams.
Uzbekistan faces the exciting challenge of reducing its reliance on expensive care in institutions and increasing its support for less expensive and more effective family based care.
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