Target-based Contract’ for Better Care Outcomes

Summary

AVIQ, a care regulator and funder, introduced ‘target-based contracts’ to break down funding barriers and encourage a more strategic approach focused on the continuous improvement of care for people with disabilities, while simplifying grant-use procedures. This allows service providers to develop their services through a six-year strategic plan funded by AVIQ, rather than receiving short-term, compartmentalised funding.

Organisation

Agency for Quality of Life (AVIQ) - Belgium

Context/ Social issues addressed

Before 2019, quality audits were carried out on the day-to-day operation and financial audits were carried out on a yearly basis. Any unused portion of the annual grants was required to be reimbursed to the public authority.

The “Target-based Contract” legislation now requires each service provider to define its strategic objectives over a six-year period to improve the quality of support provided to beneficiaries and to face future challenges. At the same time, this legislation gives service providers greater flexibility in the way they manage their grants and funding. They can spend more in one year and less in the following year. However, if not all grants are used during this six-year period, the remaining balance can be allocated to a strategic project approved under the target-based contract. One condition must be met: the amount set aside cannot exceed 5% of the annual grant. The aim is to ensure that at least 95% of the grant is used to guarantee adequate staffing levels and the day-to-day operation of the service.

The Target-based Contract encourage long-term planning while allowing organizations to adapt their resources to their strategic priorities and future challenges, such as: sustainable buildings, energy-related issues and the move towards deinstitutionalization, as encouraged by the UN Convention on the Rights of Persons with Disabilities (smaller living units, individual bedrooms, EVRAS, social inclusion through meaningful community activities).

Objectives

1. Strategic planning for the continuous improvement of care.
2. Stakeholder engagement (service users, families, staff, public authorities, etc.).
3. Performance agreement between the service provider and the public authority.

Activities

1. The Agency has set up a working group to discuss, together with the social partners, new legislation known as the ‘target-based contract’.  
2. AVIQ has amended existing regulations to break down barriers to funding and encourage a six-year strategic approach focused on the continuous improvement of care for people with disabilities.
3. The ‘target-based contract’ must be drawn up based on a strategic analysis of the organisation (strengths, weaknesses, opportunities and threats) and involve the relevant stakeholders (beneficiaries, families, staff members, etc.).
4. Operators must draw up a six-year strategic plan (targets-based contract) which will include: a. The service’s objectives for improving the care provided to service users; b. The means of implementation and; c. The monitoring and evaluation of results.
5. The grants awarded by the Agency are used over a six-year period. This enables providers to adopt a more efficient resource allocation strategy, thereby improving the quality of care. The various types of grants are combined, so there is no longer any compartmentalisation of funding. It’s a simplification of grant management. 
6. Finally, subject to the Agency’s approval, the service is permitted to set aside surplus grants, the maximum amount of which corresponds to 5% of the total grants allocated by the Agency during this six-year period. The operator can thus undertake more ambitious projects to address the sector’s challenges.

Outcomes

The review of the first six-year term has just begun. We note that numerous projects have been developed as part of this initiative: 356 Target-based contracts have been approved, and 178 contracts include a financial reserve, totalling €50 million to support strategic projects.

It represents the realisation of a working relationship developed between the Agency and service providers over many years now. It is a relationship based on trust and support for professionals who face on-the-ground situations daily.

It greatly simplified the procedures for using grants. The operator can undertake more ambitious projects to address the sector’s challenges

Principles of the European Pillar of Social Rights

Funding Source

Regional Government Funds

Links to supporting documents

Contrat d'objectifs | AVIQ

Comments and tips

This is a new approach based on strategic planning within each institution. Active participation and commitment of staff and managers across the sector are essential. We have organized training sessions and webinars, and jointly developed practical tools made available to the sector, including a quality framework for strategic assessments and a platform designed to support the management of six-year grant funding.