© Cleveland Clinic

‘Riding the Waves’ of Psychological Impacts: How Public Services are Responding & Adapting to COVID-19

FROM: Arbër Kadia , Valbona Karakaçi , Jacques Merat , Zenebe B. Uraguchi – 13. May 2020
© Cleveland Clinic

If you feel stressed about the impacts of the COVID-19 pandemic, you aren’t alone. COVID-19 appears to cause relatively mild symptoms in many children. However, the impact of the outbreak and its anxiety-inducing spread may be far more stressful for children and their parents. How can then education systems minimize the impacts now and build a more resilient social service beyond the pandemic?

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All impacts are serious, but…

‘What are you doing Gledi?’

‘I'm playing by myself.’

‘But why are you playing alone?’

 ‘Because I have no friends.’

‘Do you miss your friends?’

‘Yes, a lot.’

‘What else do you miss?

‘I miss the games, the teacher's voice, the kindergarten… I miss everything.’

That was a conversation between a parent and Gledi, a pupil at a kindergarten in Albania. Like in many countries, schools and kindergartens have been suspended in Albania to contain the spread of the COVID-19 pandemic. Imagine what disruptions to daily routines mean to the mental status of children – depression, aggression (hyperactivity), sleep disorder, and loneliness.

‘The impact of the COVID-19 pandemic is a serious psychological and social burden on children in Albania,’ says Denisa Basha, who is the Vice Mayor of Dibra municipality. Not every parent can afford more space, toys, and learning opportunities to their children who are confined at home. Added to this is the lack of support for other social services.

In such a situation, a more fundamental question then is: how can public services contribute to minimizing the psychological impacts during the pandemic? What implications do current measures have for the long-term emotional wellbeing of children?

To answer these questions, we use the experience of Bashki të Forta (BtF), a project of the Swiss Agency for Development and Cooperation (SDC) implemented by Helvetas in Albania. The project supports preschool education management by municipalities.

Is the education system prepared for the test of time?

Preschool education is among the latest functions decentralized to municipalities in Albania. Since December 2019, Albanian municipalities exercise greater managerial control over the function of preschool education. They have also started financing it from their general revenues.

The function is implemented – funding as well as operations – with responsibilities divided between the national and the local levels.

Municipalities need to comply with many standards and requirements in all relevant areas of the preschool education function set by the national government. Some municipalities comply with most of the standards while others lag.

Out of 61 municipalities, 22 don’t have psychologists. For others, 34 out of 58 municipalities have employed at least one social worker. At the moment, the service isn’t offered at kindergartens, which aren’t part of the primary school buildings. Also, the standard ratio pupil/psychologists is reduced at the primary level and therefore there are little chances that the existing psychologists will be used for the preschool system.

Added to the above challenge is the demand for psychologist service in pre-school remains low due to the perception of parents that this is a service for ‘sick children’. Such a perception is stronger in rural areas. Even if there is a demand, most parents are reluctant to recognize signs of ‘unusual children behaviors’. The lockdown and quarantine of some people have also made it difficult to reach and engage parents.

Responding & adapting in action: Our roles

With the lockdown and closure of schools, ‘the time has come for the trio of parents-kindergarten- teachers-psychologists to not only work but to work in the best way possible,’ says Lira Gjika, a pediatrician in Tirana, the capital of Albania.

Before the COVID-19 pandemic, a survey prepared by the Bashki të Forta (BtF) project showed that there were only 23 municipalities that provided psychological-social service for preschool children. This shows that decentralization in Albania is still a work in progress.

Three key factors influence the success of social services to preschools in Albania.

Case 1: The role of coordination

Addressing the challenge requires better coordination. This is where Bashki të Forta (BtF) comes in. On the one hand, this needs to happen between branches of the national government that are key to providing services to school-age children and municipalities. On the other hand, it’s also crucial that municipalities work with civil society organizations and specialized institutions to provide volunteer support during the COVID-19 pandemic in 5 municipalities (e.g., Lezhe, Kurbin, Kukes, Vlore, and Elbasan).  

The support of Bashki të Forta (BtF) has made it clear that establishing preschool education as a de facto shared role has created many frictions and overlapping responsibilities. For this, the project has been supporting stakeholders in two ways.

First, it’s about designating a responsible authority that can provide the services at the most immediate (or local) level. This simply means that the national government should be doing only those tasks which cannot be performed at a more local level (i.e. the principle of subsidiarity).

Second, it’s also important to make the roles and responsibilities of the various institutions clearer among local authorities and local education offices and regional directorates. This happens by setting broadly accepted administrative standards.

Case 2: Not everything comes for free

The services have a price tag – they need to be financed! Municipalities used their limited resources to provide the service. Bashki të Forta (BtF) has been working to raise awareness through policy briefs and organizing conferences with key stakeholders, such as the Ministry of Interior, the Ministry of Education Sport and Youth, the Ministry of Health and Social Protection, as well as the Ministry of Finance and Economy.

There are several ways of addressing the financing issue.

The most obvious one is increasing funding – the COVID-19 pandemic shows that there is money as long as there is a political will. This is also necessary given standards and legal requirements for preschool education.

Another way is setting a financial baseline for each requirement based on preschool education standards as well as for contribution from its revenues that local self- government units should provide for this service. It involves identifying and aggregating all related to pre-university education by different line ministries or different municipal budget programs that should be a priority.

On top of all, municipalities need to prepare and develop cost-effective service improvement plans by optimizing existing resources.

Case 3: Delivery matters

For Zurie Lita, who is the Director of the Preschool Education Department at Kukes municipality, the role of a psychologist is critical. ‘Children like to hear the reassuring voice of a psychologist,’ says Zurie.

That is why strategies like coordination, financing, and having in place professional service providers are important areas. Yet, ‘culture can eat all these strategies for breakfast’ (!) if we don’t pay attention to other barriers to delivering the services.

A good example is the traditional way of offering psychological services mainly for clinical cases that fails to overcome cultural barriers. The collective counseling proved to be effective during the COVID-19 pandemic, but the psychologists weren’t well prepared to provide the services.

‘We need to understand the concerns of parents and explain to them why it’s necessary to get the support of professionals,’ says Oliana Moriseni, who is the Vice Mayor of Lezha municipality.

Bashki të Forta (BtF) has played a role in making demands match well with supply through different channels of delivery. One way has been using municipal web applications in which parents apply for psychologist services by filling in an online request (e.g. in Durres municipality).

A second one is for teachers to address parents through the regular exchange using different online tools like WhatsApp/phone. Parents report their observations and jointly they decide to go for psychologist advice which is offered through video and WhatsApp/phone (e.g. Shijak municipality).

A third way is through face-to-face service. Specialized organizations, in cooperation with municipalities, provide the service for already recognized clinical cases or based on demands from municipalities or another agency (e.g. Lezha and Diber municipalities).

The way forward: transformation

‘At the moment, being close to people today is the best service you can provide. But, being close to children is the best investment you can do for the future,’ says Genta Drabo, who is the Director of ZVAP Maliq, an agency responsible for education at the local level.

Kindergartens will start opening on 1st June 2020 in Albania. Young people sense the anxiety of their parents and worry about their health and that of other family members. Children need to be reassured in an age-appropriate way.

Our examples above illustrate shifts in three areas:

(a) from a case-based approach (mainly clinical) into a group/collective mentorship by professional psychologists; (b) service targeting both parents and children; and (c) the role of teachers as active observers to assure emotional well-being of children.

Along with these shifts, technology has helped bring this ‘new’ service more to the forefront. The pandemic is an opportunity that has allowed people to reach the municipality more easily than before via technology.

Ideally, psychologists and social workers should be hired by municipalities. Bashki të Forta (BtF) is working with municipalities towards the formulation of service improvement plans that take the need for psycho-social assistance into account. It’s, therefore, crucial to invest and stimulate transformations of a service delivery model along with the above shifts. The main role of Bashki të Forta (BtF) has been to facilitate the response and adaptation to the pandemic and prepare the ground for the transformation of services beyond the pandemic.

Social services, like the psychological support to preschool children and their parents in the light of the current crisis, is the best example of how timely transformation of public services can be critical for the resilience and long-term performance of the services.  A more resilient service means a less affected and above all healthy citizens!

Related readings

Arbër Kadia responsible for Communications and Monitoring and Results Measurement for the Bashki të Forta project. During the COVID-19 emergency, he produces a weekly report on the Albanian municipalities' response to the crisis. He is a new addition to the team after having worked as a consultant for the Swiss bases energy project Trans Adriatic Pipeline AG and with a wealth of experience as director of National Heritage at the Ministry of Culture in Albania, mainstream TV media and other engagements in the private sector as a communications consultant.
Valbona Karakaçi is a Regional Advisor for the Western Balkans at Helvetas and Strategic Advisor of Bashki të Forta (BtF), a project of the Swiss Agency for Development and Cooperation (SDC). She has been a key managerial and go-to person for over 20 years in various international development interventions, mainly with Swiss Cooperation, aimed at decentralization and democratic local governance in Albania. She has vast experience and a demonstrated track record of excellence in strategic analysis and steering, stakeholder and partnership management, evidence-based policy dialogue, knowledge management, capacity and organizational development, process facilitation, and project cycle management. She holds the academic title of Doctors of Philosophy, and apart from her international development duties, she is also a lecturer and researcher for the University of Shkodra and the European University of Tirana in the field of cultural studies.
Jacques Merat is the Project Manager of Bashki të Forta (BtF). Involved in the project from its inception phase, Jacques makes sure activities are implemented on time and allow reaching targets. He also makes his wide governance expertise available to team members and partners. Jacques has been working on local governance and decentralization since his early years in development cooperation in 1998. He has advised civil society organizations, local and central governments in many countries in Latin America, Africa, Eastern Europe, and Asia. Economist and Sociologist by training, he specialized in 2001 in governance through a master's degree and attended postgraduate courses later on in public finances and public law.
Programme Coordinator, East and Southeast Europe, Senior Advisor, Sustainable & Inclusive Economies