| 4. In which ways is the initiative creative and innovative?
|
|
● Realization of the Public-Private Partnership at the Local Level, a First in the Nation: Building an Integrated Rehabilitation Hospital for Disabled Children that Provides 'Medical + Education + Self-Reliance' Services
This project is significant in that it is Korea's first co-governance model to involve the central government, local government, civil society and businesses, as well as being the country's largest integrated rehabilitation hospital. As an integral aspect of national healthcare, the field of medical rehabilitation is one of the core responsibilities of the central government. However, the Korean government failed to address this field due to the heavy burden it imposed on the health budget. However, Mapo-gu made successful promotion of the initiative its top priority and selected the Purme Foundation as a counterpart for negotiations. In January 2014, the two parties signed a concession agreement composed of 60 articles and 175 clause. We established 'co-governance' to coordinate the multiple stakeholders' opinions and conflicts of interests. The construction of the hospital is innovative in that it is Korea's first disabled children’s rehabilitation hospital completed under the initiative of a local government, thus setting an example to follow in the realm of public medical services.
|
|
| 5. Who implemented the initiative and what is the size of the population affected by this initiative?
|
|
● The Major Player: Mapo-gu District Office
Mapo-gu, with its population of 380,000, is a major district in the mega city of Seoul. It promotes residents' welfare as one of its top priorities under the slogan of "Welfare Mapo Where All Residents Live Well Together" under the leadership of the major of the fifth popularly elected municipal government. In order to improve the quality of life for children with disabilities, Mapo-gu has materialized private sector-centered public healthcare offering 'medical + education + self-reliance' services, while showcasing the Korean model of child rehabilitation centers for the first time in Korea. Consequently, Mapo-gu has eliminated the blind spot in its rehabilitation welfare services for children with disabilities, improved the overall welfare of local residents in the district through other cultural, leisure and sports facilities, and provided unique medical services to disabled children with urgent rehabilitation needs across the nation.
● Size of Affected Population: 300,000 Children with Disabilities Nationwide
According to the Ministry of Health and Welfare, the registered number of children with disabilities nationwide is about 90,000, but the number of children who are not registered with the Ministry due to prejudice or a lack of information on disabilities is estimated to be about 300,000. Most notably, a large number of children with congenital disabilities or having acquired disabilities at a later stage of their development experience multiple disorders, and thus require integrated rehabilitation. In this regard, the new hospital provides an opportunity for approximately 300,000 children with disabilities across the country to be treated in a timely manner and become self-reliant in their daily life.
|
| 6. How was the strategy implemented and what resources were mobilized?
|
|
● Promotion of the Initiative
The construction of the Mapo-gu Children’s Rehabilitation Hospital was promoted in September 2011 following the execution of an MOU between Mapo-gu District Office and the Purme Foundation. After receiving a conditional approval for promotion at the investment/loan evaluation session of the SMG and the Ministry of the Interior, respectively, the district office completed the basic design of the hospital in August 2013. We held four town hall meetings between 2011 and 2014 to actively reflect the residents' opinions. The groundbreaking ceremony was held in March 2014 and the hospital was completed the following year. A core feature of this initiative is Mapo-gu’s encouragement of local residents and communities to participate in the construction process of the hospital, rather than relying on the traditional business model whereby a project is driven by government offices from start to finish. As a result of our efforts to reflect local residents' input, we successfully established the Disabled Children's Rehabilitation Hospital, which can be used by local residents and children with disabilities alike.
● Securing Stable Operating Funds through a Win-Win Public-Private Partnership Model between the Central and Local Governments, Civil Society and Businesses
Everyone agrees on the necessity of building hospitals to cure sick children. However, there are several reasons why local governments in Korea shied away from undertaking such an initiative. The construction of such a hospital requires a sizeable plot of land and entails considerable costs. Securing the budget for the construction costs was the most important factor in determining the success of the initiative. To overcome the limitations of public financial resources, Mapo-gu proposed a new co-governance model for the hospital between the central government, the municipality, civil society and businesses. Mapo-gu District Office offered 3,212.9㎡ of land, which it had purchased from SH Corporation for ￦9.2 billion, free of charge for the construction of the hospital. In September 2011, it signed an MOU with the Purme Foundation after selecting it as a preferential counterpart for negotiations. In January 2014, the two parties signed a contract of "the Rehabilitation Hospital for (Disabled) Children and a Social Welfare Facility."
In addition, Mapo-gu actively engaged in discussions with the central government and related organizations in order to resolve the burden of operating expenses. For example, the district office received ￦1.5 billion from the central government to purchase medical equipment for the special children's hospital after passing the government's rigorous funding evaluation. It secured a budget of ￦8.5 billion from the SMG for the construction work and purchase of equipment. In January 2015, the SMG and the Purme Foundation signed an MOU and, as a result, the district office receives an additional ￦900 million in operating expenses each year.
Members of the hospital’s medical staff have also participated in the realization of a win-win public-private partnership in the welfare sector. They offer high-quality rehabilitation services at 30% lower prices than those of large hospitals. Administrators have also joined forces by accepting salaries equivalent to only 80% of those of general hospitals. In addition, the hospital is working hard to help reduce income inequality by supporting ￦170 million in medical expenses (as of December 2016) to be paid by the poorest and most vulnerable groups, and providing assistive devices for use by the children. Despite starting from scratch without public funding or assistance of any form, the district’s passion and commitment to children with disabilities was eventually able to overcome the severe financial limitations thanks to the continuing interest of the central government, local government, civil society and businesses, steering the initiative at the district level to great success.
|
|
| 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
|
|
●1) Mapo-gu District
Mapo-gu decided that the problem of rehabilitation and care for children with disabilities should be resolved jointly by not only the families but also by the local community and the government. The district provided the site for the hospital and led the promotion of the initiative by offering administrative support.
●2) The Purme Foundation
The Purme Foundation is a nonprofit public benefit corporation established in 2005 with the aim of rehabilitating children with disabilities and establishing hospitals to that end. Since signing an MOU with Mapo-gu for the construction of a rehabilitation hospital for children in September 2011, the foundation has raised funds to build the hospital from citizens and businesses, and is in charge of managing and operating the initiative processes.
●3) Other Public Organizations
Other public institutions have promoted financial support for disabled children. The Ministry of Health and Welfare has offered subsidies for equipment purchase, while the SMG has provided financial assistance for the construction and operation of the hospital.
●4) Citizens and Businesses
A total of 9,695 citizens and 486 companies have participated in fund raising activities, raising a total of ￦32.8 billion for the hospital. Individual donators include writers who donated their royalty payments, entertainers who took the lead in making donations through participation in triathlon competitions for seven years, athletes, schoolchildren, housewives and kindergarten children. The amount corresponds to about 70% of the total project cost of ￦46.5 billion.
●5) Academia and Experts
A counseling group composed of experts on welfare for the disabled conducted 'a study on the establishment and operation of a rehabilitation hospital for children' and laid the groundwork for the establishment of an effective hospital capable of offering 'One-Stop-Service' from treatment to vocational rehabilitation from a life cycle point of view.
|
|
| 8. What were the most successful outputs and why was the initiative effective?
|
|
● Establishment of Appropriate Social Security Systems for the Poorest and Most Vulnerable (SDG 1-3)
Most households with children with disabilities belong to the middle and lower classes. Notably, the burden of expenditure on medical expenses is enormous. In order to alleviate their financial burden, Mapo-gu has expanded coverage of the lower income group by 200% and provides medical care for disabled family members who do not meet the eligibility criteria of the government’s guidelines. It also provides special programs designed for the siblings and other family members of disabled children.
● Contribution to Reducing Premature Birth Rate due to Illness (SDG 3-4)
Preterm infants are children who are born with insufficient physical and mental development, concentrating on the care of the acute phase directly linked to their lives while receiving treatment in the incubator. The Purme Children’s Rehabilitation Hospital is cooperating with the NICU wards of fourteen large hospitals in Seoul, Gyeonggi, and Incheon to monitor the occurrence of disabilities in premature infants and to prevent premature death and disability among infants.
● Contribution to Enhancing Gender Equality and Family Confidence(SDG 5-4)
When a child suffering from mental retardation is born, the mom runs around the country looking for treatment while the dad gets worn out at work. Therefore, the Children’s Rehabilitation Hospital has held a total of 1,000 sessions of special care programs for such families, including psychological counseling for the family and parent education focused on promoting the human rights of the mother, who usually shoulders the burden of taking care of a child with disabilities in the family. As a result, a mother who cares for a child with a disability is able to recover her own life by standing back from her child to some extent in order to concentrate on her social activities.
● Improving the Employment Rate of the Poorest and Most Vulnerable (SDG 8-5)
The Purme hospital’s vocational rehabilitation center is dedicated to developing the vocational ability of severely disabled persons with difficulties in employment and linking them to the job market. In cooperation with the Korea Employment Agency for the Disabled, it contributes to the creation of jobs for people with disabilities in order to attract subsidiary-type standard workplaces for the disabled.
|
|
| 9. What were the main obstacles encountered and how were they overcome?
|
|
● Differences in Viewpoints between the Public (Mapo-gu) and Private (the Purme Foundation) Sectors
Although the vision pursued by Mapo-gu and the Purme Foundation was one and the same, namely, "the provision of integrated services for medical, vocational and social rehabilitation," the differences between public and private organizations became evident in the course of promoting the initiative. For example, opinions differed with regard to the contents of role sharing to be contained in the agreement, the allocation of facilities in the construction stage and so on. However, they have found solutions through the constant exchange of opinions and coordination, while also sharing the vision of building a hospital that develops hand in hand with the local community.
● Overcoming Local Residents' Aversion through Transparent Public Administration
There were some local residents who were opposed to the construction of the hospital due to vague prejudices. In order to reach a consensus with local residents, Mapo-gu discussed ways to improve the happiness index of local residents while conferring with people from all walks of life, including business people, citizens, and municipal councilors. Mapo-gu held four briefing sessions on the initiative, with the first in 2011, in a bid to highlight the need for the establishment of a children’s rehabilitation hospital, and shared all the details of the initiative with local residents in a transparent way. After carefully reviewing the 74 suggestions made by residents at the briefing sessions, Mapo-gu decided to install additional facilities for use by local residents, such as restaurants, rooftop gardens, children's libraries, cafes, and swimming pools within the hospital premises. In the process, the district office gained the residents' trust, drew consensus from some local residents who were initially opposed to the hospital due to social prejudice, and boosted the driving force behind the initiative.
|