Croatia: Transition from Institutional to Community-Based Care for Children, Youth and Persons with Disabilities

1. What is the assignment that the World Bank recieved?

In Croatia, there are still over 6,000 children and adults with disabilities living in institutions. The institutional form of care has dramatic negative long-term effects on the lives of children, potentially causing delays in children’s physical, emotional, cognitive, and social development. As for persons with disabilities, the United Nations (UN) Convention on the Rights of Persons with Disabilities (CRPD) underlines the right of all persons with disabilities to live fully integrated in their communities, and to have the freedom to choose and be in control of their own lives. The Croatian government, led by the Ministry of Labor, Pension System, Family and Social Policy (the Ministry), has committed to accelerate the deinstitutionalization process and requested the World Bank’s support with this task.

In December 2022, the Ministry and the World Bank in Croatia began cooperating on a technical assistance project supporting the transition from institutional to community-based services for children, youth and persons with disabilities.

This project seeks to assist Croatia in moving toward the provision of family based or community-based services and away from Croatia’s current system of institutional care, ensuring a better quality of life and integration into society of a large number of Croatia's children with developmental disabilities and adults with disabilities, as well as children and youth with behavioral problems or without adequate parental care.

Successfully moving away from institutional care requires the development of alternative community-based services and the modification of existing services to make them more accessible and adaptable to all beneficiaries. This entails the provision of affordable housing in the community, access to public services, and personal assistance and peer support. It also requires significant changes in the staffing structure, work methods, and spatial conditions. Therefore, the project is supporting social welfare institutions, their residents and others using their services in the transition from institutions to the family environment, or independent supported living in the community.

The World Bank is supporting the Ministry with the preparation of individual transformation plans for 38 of 69 state social welfare institutions, whose individual plans are pending or that have not yet initiated the transformation process from institutional to community-based care. The project is also assisting with the establishment of an IT system for monitoring the deinstitutionalization process. This technical assistance is financed by the European Social Fund + (ESF+) of the European Union, using the World Bank’s Reimbursable Advisory Services (RAS) instrument, and is scheduled to last two years—until the end of 2024.

2. What is the role of the World Bank in promoting deinstitutionalization, prevention of institutionalization and development of extra-institutional community-based services in Croatia?

The World Bank is providing technical assistance to the Ministry in supporting and guiding social welfare institutions in their transformation and preparation of institutional transformation plans, and in deinstitutionalization of their residents, in line with the CRPD. The objective is to improve the quality of life for persons with disabilities, and children and youth, and to reduce the number of residents in social welfare institutions.

Transformation plans have been prepared for many years, but without systematic guidelines for crafting them that are embraced by all actors. The World Bank is also supporting the Ministry in drafting the Proposed Guidelines for the Preparation of Deinstitutionalization and Transformation Plans, for four types of institutions included in the deinstitutionalization process:

• Institutions for children without parental care,
• Institutions for children with behavioral problems,
• Institutions for children with developmental disabilities and persons with intellectual, physical and sensory impairments; and
• Institutions for adults with psychosocial difficulties.

These Guidelines will be complementary and could be used alongside the existing Common European Guidelines on the Transition from Institutional to Community-based Care and the pertaining Toolkit on the Use of European Funds for the Transition from Institutional to Community-based Care (2012, revised 2014). The proposed Guidelines will also include the training package to be used for training staff from institutions in the preapartion of transformation plans for individual institutions.

The activities also include capacity building of institutions' teams on key topics of the deinstitutionalization process, as well as access to cutting-edge national and international knowledge and expertise in the development of community-based services.

The technical assistance provided also includes an analysis of: key stakeholders and of the broader community influencing and being impacted by the transformation and deinstitutionalization process; main challenges in engaging and communicating with these groups; and recommendations for engaging and communicating with these groups at the level of individual institutions. This analysis seeks to advance the implementation of deinstitutionalization reform and promote a shared understanding of its benefits. The project is also developing the methodology for monitoring the deinstitutionalization and transition process, with measurable indicators of results achieved.

The World Bank's engagement is based on a participatory approach in order to support Croatia in advancing the deinstitutionalization policy and increasing the availability and quality of social services, and their regional consistency. The project is carried out in partnership and consultation with a number of key stakeholders: state authorities, local and regional governments, ombudpersons' offices, civil society organizations, academia, UNICEF, Croatian Institute for Social Work and its branches, family centers, social welfare institutions, rehabilitation centers, community-based social services centers, as well as beneficiaries and their families.

3. What are the expected benefits of this engagement for Croatia?

Deinstitutionalization is a social policy priority in Croatia, and is recognized as an essential prerequisite for the realization of certain basic human rights of all groups of beneficiaries and their full inclusion in society. Active implementation of the deinstitutionalization policy contributes to and is closely related to the reduction of social exclusion as one of the general goals of social policy.

Institutional care is characterized by depersonalization, rigidity of routine, group treatment and social distancing. All this speaks in favor of the deinstitutionalization process as a better alternative to the institutional environment for most of the mentioned vulnerable groups, especially for children.

The experiences of people with disabilities and children and youth who live in a family environment, or use community-based support programs, have shown that living in the community, while receiving needed services can strengthen learning and skills, increase chances of employment, improve health conditions, and boost resilience. Perhaps most compelling is that both the people receiving services and the communities they reside in continuously report overall improvements in quality of life.

By implementing this project, Croatia continues the deinstitutionalization process started in 1997 and thus contributes to the implementation of the goals set in the new Operational plan for deinstitutionalization, prevention of institutionalization and transformation of social service providers in the Republic of Croatia 2022-2027.

Croatia: Transition from Institutional to Community-Based Care for Children, Youth and Persons with Disabilities

All documents listed below are prepared within the technical assistance to the Ministry of Labor, Pension System, Family and Social Policy on deinstitutionalization provided by the World Bank between 2023-25, and are made available with the approval of the Ministry of Labor, Pension System, Family and Social Policy.