PhDr. Hana Janečková PhD. School of Public Health Institute of Postgraduate Medical Educatio n

1. National Action Plan of Social Inclusion for the years 2004 – 2006 from the point of view of the NGO PhDr. Hana Janečková PhD. School of Public Health Institute of Postgraduate Medical Education Diakonia ECCB Prague 2005

2. The Czech NAP • Approved by the Government of the Czech Republic in the • Resolution No. 730 from July 21, 2004 • It results from the Common Memorandum on Social Inclusion signed • by the Czech Minister of Labour and Social Affairs and the • European Commissioner for Employment and Social Affairs in • Brussels on 18 December 2003.

3. The Actors Governmental level: The Council of the Economic and Social Agreement Governmental Council for NGOs Governmental Council for the Roma Community Governmental Council for Disabled Citizens Governmental Council for Ethnic Minorities In NAP the specific goals and tasks for these actors have not been stated .

4. The Actors • The regional and local authorities and their associations: • Association of the Regions of the CR • Union of Municipalities and Communities • Both have regular dialogue with the Government. • Both establish commissions for various areas – also for the social inclusion: • - at the Regional level there are commissions for socialaffairs and for health care • in the Cities and Communities there are social commissions and commissions for disabled citizens. • Employment Agencies • - advisory boards to support the collaboration in the labour market

5. Social groups threatened by social exclusion according NAP CR 04-06 • Disabled people • Children and young people • Senior people • Ethnic minorities and migrants • Homeless people • Persons leaving institutional education and prisons

6. The most vulnerable groupsfrom the health poing of view • Homeless people • Migrants, specially illegal • Marginal social groups of population (socially and culturally • disadvantaged people, specially Roma) • Chronical drug addicts

7. The Role of NGO in social inclusion • NGOs often fillthe gaps caused by thefailure of the state. • In the area of extreme social exclusion NGOs are given the tasks that evidently (according to the Czech Constitution) belong to the public authorities. • NGOs expect to be invited as the equal and valued partners to the public authorities. On the contrary they are permanently treated as having been beard. • In the NAP NGOs are not perceived as official partners of the social commissions on the Regional level. Only on the level of the Union of Municipalities and Communities the experts of NGOs are invited • NAP underlines the personal contacts of the members of Social Commissions with the organizations of disabled people as the way to participation. But this principle creates barrier in accessibility for socially disadvantaged groups.

8. What does NAP offers in the areaof financing of social services • Responsibilities and the frame of financing are not described • No change in the system of financing is offerd like for example: - thepublic money follow the service users, not to the institutions - the private sources in the form of tax assignationcould be allowed This causes insecurity and doubts for all relevant actors, specially for NGOs

9. The NAP and the quality of social services • The NAP does not anticipate the role of the standards of quality as a pre-condition of the entry of the provider to the social services network - NGOs undergo voluntarily the process of consultations and simulated inspections ofquality to garantee the quality of care • Social Services Act Proposal count with the standards and inspections of quality - Absence of the act contributes to the unequal conditions for NGOs and state organizations

10. Ambitions contra reality • NAP introduces an innovative programme of the Ministry of Social Affairs • „Support for the development of the new forms of social services allowing life in the natural social environment“ • to enable development of social services aimed to the disadvantageous • social situation. • - to promote this kind of services by the publication of endowment programme for innovative projects. • - to help the transformation of the residential institutions intothe form of communitybased services

11. The reality • no specification of the goals and methods how to reach them • communities have little interest in the state moneyfor social living • no transformation of big social institutions into the form of community • services • little support for caring families (not only people in institutions are • excluded but also the caring families) • „The more they care, the less attention from the society they get, as if these people have disappeared from the world“ (H. Jeřábek, Agora seminar, April 2005)

12. The reality • no effective activities to preventthe segregation of locally isolated socially week communities (mostly Roma families) • the system of continuing and flexible services in community is not being created through community planning • NGOs are creative, flexible, community oriented. They do provide services directly in the user´s natural environment.

13. The reality • The comprehensive health and social care is still being underestimated in legislation and in the way of financing: • - mixed „social and health care“ in social and health institutions • comprehensive rehabilitation for people with severe disability to improve • their self sufficiency • - health care for homeless people, refugees and ethnical minorities • - help for non-insured young people, for drug addicted

14. Extreme exclusion NAP pays just marginal attention to the people affected by the homelessness. Until the access of the Czech Republic to the EU the homelessness was not acknowledged and solved as a public problem. Till recently there were no empiric data about the extent and the causes, about the quality of life ant about the health status of homeless people. The complex national strategy of prevention and of the fight with homelessness does not exist.

15. Extreme exclusion In 2004 first count of homeless people was organised by NGO Naděje and Salvation Army in collaboration with the City of Prague. According to the Census 2001 there are 45 000 people living in rough dwellings and shelters In 2004 in Praguemore than 3000 homeless people were counted. Out of them only 37% used accomodation facilities.

16. Extreme exclusion • Only NGO sector (specially Naděje, Salvation Army, Charita, Diakonie) has more than ten years experience with the care of the people without shelter: • provide social services in quite a wide network of facilities • (accommodation and asylum service, food delivery, medical care) • suffer from limited capacity, financial and subsistential insecurity • the lack of continuity of services • some local authorities ignore the work of NGOsand do not cooperate • sufficiently with them.

17. Health Care • The accessibility of the health care, specially the primary care is a problem: • the absence of the personal documents which is a condition for the social assistance(tied to the official place of living) • usually do not pay their health insurance, indebted to the HIC • there is a delay in the identification of the health problem (do not go to the physician), • the health care is not provided in time (question where does the persons belong) • the continuity of care is absent (specially in the situation of the discharge from acute hospital care) • The solution of the homelessness means collaboration of various sectors, which was done in NAP, but does not work in reality

18. Other vulnerable groups Roma population:high unemployment rate, lower education, dependence on social allowances, open or covered discrimination. There are disadvantaged localities cumulating several families with many social, economic and health problems (Roma gheta).Subjectively they feel useless and uprooted. We have lack of relevant information, that is why the NAP plans long term complex empirical research of Roma population (for 7 years). Field social work is recommended directly in isolated communities. Migrants: They usually work without permission, live in very bad conditions, in temporary accommodating facilities, in bad hygienic condition and physically weekend. They are not insured and solve their health problems illegally. They are threatened by TB, HIV, sexually transmitted diseases, abuse and violence. Even the health care for legal migrants is rather difficult.

19. Conclusions • Responsibility was yield to the NGOs, but they have not enough stuff, • equipment, space, and finances to cover all needs of the excluded people • Good praxis comes out more from the initiative of individuals or groups of • enthusiastic people without support of clearly definedgovernmental plan. • The State and the local authorities do not fulfil the goals of the NAP • as well as the goals of WHO programme Health 21. • The NAP is rather too ambicious and not concrete enough in defining • steps to the social inclusion of vulnerable groups in the Czech society.

20. Recommendations • In the field of health care the emphasis should be given to the primary care, to • the discharge of the risk patients from hospitals and to the continuity of care • Social services should have legal framework, the Act, which should define the • role of all actors, specially the role of communities in assuring dignity for all • their citizens. • Conditions of the accreditation and financingof social services should be given • by law to assure equal condition for all providers, and give the NGOs their • position in the system.

21. The End.