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“The greatest means of pressure are the problems themselves”

The former President of the Centre for Social Solidarity led the team that drafted the first Action Plan for Children, in 2008. Over ten years later, most of his proposals have not been implemented although “progress has been made”.

Panayiotis Altanis

Panayiotis Altanis

Courtesy: P. Altanis

How did the National Action Plan for Children come about?

The need to draw up a National Action Plan arose long before 2007. According to EU guidelines, Member States were urged to develop National Action Plans for different policy fields, such as healthcare, welfare, exclusion. The National Action Plan for Children was not a top priority at the time, despite our requests and pressing for a national policy for children to be formulated. We were working with a Committee under the General Secretariat for Youth, which was responsible for submitting evaluations on the implementation of the rights of the child in Greece to the UN. It had to submit reports at various intervals, had sent very few, so we were in breach of duty. Anyway, there were other Action Plans in the works. There was some money left over from the NSRF funds and following pressure exerted by The Smile of the Child, which had developed a good working relationship with the Ministry at the time, the plan was set in motion.

I believe there was institutional pressure from abroad, as well as from within Greece, from associations such as the Greek Association of Social Workers (SKLE) and The Smile of the Child. Media publicity also exerted pressure, news reports that shed light on numerous problems: the number of children piled up in institutions was rising, foster care placements in Greece were negligible, and foster care was not being supported as it should be. There was more support given to the adoption of healthy children and institutions accommodating children with special needs were filling up at the same time. The pressure being exerted was significant.

Why was The Smile of the Child chosen?

The Ministry’s Department of Child protection was short-staffed, and of the existing staff, the scientific personnel that could actually do something was limited. Moreover, it was drowning in bureaucracy, so it needed external assistance. The Smile of the Child, enjoying a high profile and exerting pressure, also played its part. That is why I think it was chosen, that and the fact that as a body it stood outside party politics.

Additionally, The Smile of the Child has always had a good working relationship with the various services. A meeting was held about whether The Smile could take on the plan, a budget was available, a very small budget, and I was asked to be in charge of scientific planning. Our communication was excellent, and we agreed on what the priorities for the children should be. I had been assisting them with several matters already. We had also run various activities together. We had trained some of its members.

So, I accepted to do it without remuneration. The Smile of the Child wished to recompense me, but I declined. I believe certain matters should be exempt from any kind of agenda, that nothing should be allowed to cast a shadow on them.

But why wasn’t another state body chosen to bear the responsibility for this?

That is a legitimate question, but which state child agency had the capacity to do so? The Institute of Child Health is one such legitimate state body. Although its staff is not vast, it could have acted as the contracting entity. However, being a public sector entity, the processes it must follow are complex and time-consuming. EU guidelines at the time encouraged the use of NGOs, which are more flexible.

An Institution could have been another option, but even Institutions were drowning in their own problems. Or a Research Institute, a university, but there were no Social Work departments at the university level, only at the level of Technological Educational institutes (TEI). The University of Athens could have taken over, it was producing some noteworthy work in the field of paediatrics at the time, but the work carried out was very specialised and they were not active in the field of welfare as a whole. They mainly focused on children’s mental health.

I think The Smile of the Child suited the state because the research cost more than the funds it received. If you add staff wages, time spent, how much work was done on a volunteer basis, how quickly, how little it cost, I think there was a lot of added value provided, which led to this result. 

My underlying conviction that NGOs should be evaluated and monitored rather than operate without accountability, especially in matters of financial operation and legitimacy and ethics, aside, The Smile has always been receptive to our feedback. I was impressed by the extent to which it incorporated the training we provided.  Even its President impressed me with how quickly he assimilated the information imparted and how much he respected ethics relating to the handling of various issues. As to the financial aspects, I was never involved in that regard, but the scope of its activities is vast. And The Smile of the Child has always been effective.

There is another issue, which I often raised in my lectures: to what extent can a non-social organisation expand in terms of work volume or structures? In the sense that it eventually becomes too unwieldy and complex. My only issue with The Smile was that the needs were both great and ever-increasing, which presented the risk of bureaucracy and centralisation. However, at least up to and including our collaboration, The Smile had managed to decentralise its decision-making and to dispense with the need for a bloated central organ. It appointed highly trained and capable managers who could operate effectively, be flexible, and who were prepared to go beyond the call of duty. It had cultivated an internal culture that encompassed not only professionalism but also volunteerism and high awareness of what the job entails – because child protection in Greece has always been non-existent, with a few bright exceptions.

Was The Smile of the Child suited to such a task?

The Smile of the Child was useful in that it had its own enclaves of decentralised structures throughout Greece, as well as a central scientific team which I could guide in taking decentralised actions.

It was an enormous task that had to be completed in a short time. We split Greece into Regions and set up scientific teams in each Region to supervise and guide the researchers carrying out the interviews. I drafted the questionnaire with the assistance of Mr Economou, Professor of Sociology at the Panteion University of Social and Political Sciences. We trained our managers at headquarters and they then trained the regional managers. Our researchers were all Social Science graduates who had been trained in the questionnaire and had been briefed which social welfare organisations to address.

It all happened within a carefully designed framework. They did not just go anywhere asking anything. It was simultaneously very structured and decentralised. We employed a greater number of researchers to speed things up because the questionnaire was long and required time and we also wanted to be able to monitor validity.

Who did your survey address?

It addressed all of the country’s social welfare organisations – state, NGOs and private. It addressed everyone who agreed to participate. We had also approached all the services registered with the Ministry in each Region and some others that our Network had recorded. Most of them responded. We obtained a very good sample, with a high response rate and degree of validity. I do not think many refused to participate, but not everyone was able to respond to all the questions, especially state organisations. Some of them might also not have had the requisite data, but I think that collectively they provided a wealth of material.

Is The Smile of the Child to be credited with this initiative?

Exclusively. But it is of little significance because the Ministry christens it a “Supervised Entity” and the initiative is funded by the NSRF. The Ministry would ultimately be judged by the extent to which it implemented the resulting proposals.

The study was published in February 2009.

Yes, but it had been completed earlier, in May 2008 if I am not mistaken. The study was delivered six months after its commission. The Smile of the Child was most helpful, a couple of its social workers and other personnel were close to us providing input, and it always paid the researchers and all the other staff on time. At the executive level, everyone worked for free.

What conclusions did you draw about child protection in our country during the preparation of this plan?

That it is non-existent. That there are a few shelters in a raging storm. And that the pre-existing network has no horizontal interconnection. The biggest issue facing Welfare Services is their horizontal cooperation and coordination because, in the absence of such a horizontal interconnection, there can be no effective cooperation. Even if I were to establish ten services in a region, provide plenty of funding and scientific personnel and start offering the services within their remit, their effectiveness would be cancelled out by the absence of cooperation with the other available service providers.

Let me give you an example. Let us take a mother and child who have been abused by the father and left the family home. The services the mother needs are provided by ten different bodies. The problem is that the remit of each service is limited. For example, one service says, “we can cover your rent”, another one says, “we can provide childcare”, another service offers accommodation in a refuge or job training, and so on. If all these services are not interconnected, then the timing of the aid offered can be off, meaning the mother will not be able to assimilate and use these services effectively. You could call and say, “We have found you a job”, but the mother responds, “I do not have childcare”. “This is now available”, “But I have no place to stay.”

How are things in the Healthcare sector?

The same issues face healthcare. We have specialists who attend to an individual, and everyone gives their diagnosis and prescribes medication, but no one attends to the patient as a whole, no one who can say for example, the anti-inflammatory drugs prescribed by the orthopaedic could cause this patient heart failure. This could only be seen by a family GP and a professional who can assess the risk not only to the individual concerned but the whole family. It is not just the individual who is ailing, but the whole system.

It is the same with welfare. The issue is not whether someone committed theft, or a man is being abusive, but that the whole system is ailing. We cannot just look at the symptoms and not identify the causes in order to address and overcome them. Yes, the emergency relief must be provided on the spot, but how do you help someone make the transition from victimhood to independence and self-sufficiency long-term. Without the horizontal interconnection of all welfare services, you cannot do anything.

Which is the decentralised body currently active in the field of welfare? The church. Right now, the church is present in every neighbourhood, is it not? There can even be two churches in each area, with Parish Boards, benevolence funds, women’s charity associations. Unfortunately, until I left Greece, they followed the tenet of ministerial rather than social work. They were providers of alms, which does not help someone escape a situation.

Therefore, churches need to be incorporated into the provision of welfare. Start with the care for the elderly; train them, explain what is going on, in a way that resources can be grouped and shared out. The elderly, too, need comforting, need companionship. These things are costly to the state, yet they could be accessed for free, right next door. Why should the person in question have to get up and go to the Region’s offices so that the Region then comes to the individual to assist in providing companionship? The same thing should apply to the Open Care Centres for the Elderly (KAPI). That horizontal interconnection is of the utmost importance. And it affects the family because child protection is linked to the family. Only in the family’s absence, when the family is missing or unsuitable, do we have some institutions in place.

Look at what is happening at “Paidon” Children’s Hospital now. Children are admitted following the intervention of the public prosecutor. What use is that admission? Is there someone consistently looking after the child, advocating for that child, addressing the child’s ailing network? During my presidency at the National Centre for Social Solidarity (EKKA), for example, we were charged with assisting abused women, domestic violence victims. We held counselling sessions with a psychoanalyst to provide psychological support, we provided legal aid, and we could and did ask to see the perpetrators too, to help the perpetrators. Because when someone commits an error, it does not follow that it is in their nature to always do so. Something has led to that act, there is a confluence of many factors.

They might have been victims of abuse themselves.

Certainly, and you help them, and after you have helped them, you can keep seeing them as a couple. In other words, we do not believe that removing children from their family and then hanging the family out to dry is the answer.  We need to counsel the family and assist it. When the Children’s House in Cyprus came into being, Mr Nikolaidis and I decided to establish one here too. Because the forensic evaluation of abuse is a difficult matter and you cannot take statements from minors in the way that the police does. Lawyers, too, in their attempts to help their client, are abusive to the children. The children must be protected.

I have also spoken with Minors Public Prosecutors, such as Xeni Dimitriou, who was one of the ablest prosecutors in this field. They are not many. Often the post is seen as a stepping stone towards promotion to another post. Minors Public Prosecutors also need to be part of a group fostering a different culture and be supported by doctors, psychologists, everybody else, because it is a complex matter.   

At present, children and adults are vilified on television during court trials and other instances of abuse. I can assure you, based on my own experience, that the truth is not what is being presented. It is not what the children say, nor the truth claimed by the adults. The truth is something else, something that cannot be detected by journalists. The Children’s House in Cyprus came into being because the NGO in charge was able to obtain and implement all the know-how from abroad. They also had access to EU funds, and they were able to set up a commendable Children’s House, which is exclusively run by scientists without the interference of any administrative players.

The state is a player, though.

The state is the supervisory body. The House belongs to it, but state officials act only in a supervisory capacity, they do not provide services. The services are provided by the House’s staff. But the NGO is in charge, they monitor them, they are updated weekly. Ongoing training is provided, it does not stop. They invite people from abroad, receive know-how, publicise, they do many, many things. That is why we initiated more actions. There are other NGOs in Cyprus, too, for example, ——– which addresses the abuse of women. The “Foni” National Strategy Implementation Council is another one. In other words, the failure of welfare to provide the services needed in this field have brought the organisations providing them to the forefront. And the citizens of Cyprus now show greater trust in them, because welfare lost credibility following the publication of articles on the issues concerning benefits and welfare staff.

Through the National Action Plan, you set some guidelines. Were they respected down the line?

I have not made an assessment, but I think the guidelines preoccupied many people. They have been extensively shared, and studies also mention that they have aided research and reflection. At the time, the proposals were subject to certain constraints. They had to be feasible. They had to be incorporable in the Ministry’s plan to receive funding and be implementable. So a number of these proposals is affected by feasibility and the need not to alienate everyone, by claiming that they have no idea what they are talking about and what they are requesting. At the same time, other proposals are more long-term and focus on culture and the general way forward. I do not think these were grasped by the political personnel and the bureaucrats, but they greatly influenced universities and academics. I was impressed by the Democritus University of Thrace Conference on Social Deprivation, Child Protection and Human Rights, focusing on the changes that needed to be made in child protection. An international conference was held, which I was unfortunately unable to attend as I was abroad, at the university’s Department of Social Work, whose President is Charalampos Poulopoulos, whom I had worked with at KETHEA (Therapy Centre for Dependent Individuals).

We do not dispute that the guidelines are a point of reference during conferences, or that they have assisted many scientists and academics. The effort was made, some guidelines were issued, a National Action Plan was formulated. But then, every subsequent government comes up with its own Action Plan.

During the following years, some of our proposals were announced, albeit selectively. They were moves in the right direction and can also be attributed to the influence of managers who read the proposal and whom we had the chance to train. What is missing is for them to say, “Yes, we want to reform the system. Come join us so that we can see what reforms are needed”, but this must be accompanied by a willingness to undertake administrative changes. Administrative changes are also needed, responsibilities need to be reshuffled, scientific protocols and standards must be drawn up and implemented.

When I worked in Healthcare, and we implemented the changes in hospitals, there were specifications, so many beds, so many doctors, so many social workers etc. The personnel of any kind of Service is subject to how many you serve, what services you provide, this affects how much staff you will need. If we copy what is happening at Lechaina, 40 to 50 children and a staff of ten or two, yes you might increase capacity, but still, people are being abused.

So, we need to see first what kind of reforms we seek and take it from there because the truth is that the Welfare Sector is loosely seen as not particularly desirable and the pre-existing models were always reciprocal models. We establish social security and then build a safety network leaving a hole in the middle down which thousands of suffering people fall and then we pretend not to see them and ask for the assistance of volunteers. I do not know if the time has come to see social welfare in conjunction with our social security system, because Greece still has some positive aspects that are absent in other countries. As we speak, state healthcare is free for all, whatever its quality may be. There are gradations, but even then, if you visit a state hospital you will see anyone and everyone, Roma, repatriates, refugees, they all go, wait for their turn and will at some point receive medical care. This is an approach missing in other countries. The same with medication. That is not the case with Welfare.

We have heard terrible reports. About minors with anal warts who simply received treatment and returned home, without any of the doctors administering care wondering how the child came to be infected in the first place. 

But where could they refer the child to? To another Service? In a hospital employing two social workers at most? Go to “Paidon” and talk to the children there. They do not want to receive assistance; they want to leave. The disorder is so serious that hospitals are not always the best place to provide treatment. Neither is an institution. It is as if we are training them to be delinquents and dependent forever.

But you spoke of a Service network.

In the context of redesigning all of these components, I mentioned the need for them to be connected to a single Centre acting as the supervisory or competent body, so that everyone can be aware of and record their needs, their deficiencies, what they require, what they do not require and know that they are solely responsible. Because if I am dealing with it, and you are dealing with it, at the end of the day no one is effectively dealing with it, and we could be spending large sums to no effect because our timing, as I already mentioned, could be off.

Moreover, how is it even possible to announce that Greece has a budget surplus, that a given sum is left over, and then distribute those funds to the uniformed services? By all means, let us allocate them, but the heart of the matter is which needs are you addressing? These are all things that happen, unfortunately. The fact is that, in Denmark for example, which has a comprehensive welfare system, the underpinning mentality is not the mentality we inherited from the Ottomans, namely dealing with things by paying out of your own pocket; the mentality is one of trust in the state. They give more than half their salary to the state and know that everything will be fine because it will respond both effectively and to a high standard. Here, even if you personally have the resources, you still cannot access social services.

I collaborate with therapists, and you have no idea how many prosperous citizens struggle to access services. In other words, it is not only certain social categories that are ailing. The problems are many, the situations are multiproblematic, the whole of society is ailing.

You were the President of the National Centre for Social Solidarity (EKKA) around ten years ago. At present, how do you assess its course?

EKKA should be the Ministry’s executive branch, meaning it should be monitoring everything. The Ministry could have charged EKKA to oversee everything in a scientific manner, without bureaucracy. EKKA could be playing a leading role, although it has not been reinforced with scientific personnel to the extent that it should be. We utilised several NSRF funds effectively and that is how we were able to achieve something, and I tried to emphasise its role as executor and coordinator during my tenure. We have two helplines for adults too, and we also tried to integrate anyone providing related services within Welfare, so that they could have access and their work included, and so that people could find them.

Why is there no political will for reform?

One reason is that the Ministries do not have the requisite scientific personnel. Most politicians are blinded by the short-sightedness of clientelism and are distrustful. They want to ensure they leave their mark in the short-term. That causes problems. Planning policy and implementing policy are two different things. Policies must be implemented by others, and that coordination could be effectuated by EKKA along with the whole infrastructure. We did try this with all thirteen existing Centres of Social Welfare, it is set up and could easily happen provided the Ministry is willing.

Another problem is funding. We need to secure stable funding and not allocate funds willy-nilly, hand them out as if they were alms. We need to have stable funding, and EKKA must be carrying out constant research: How many children are we responsible for, where are they, who cares for them, what resources do we have? We have the Hellenic Statistical Authority (ELSTAT), we have the indices, we have tools which, if allowed to be scientifically coordinated by someone, could work very effectively.

But that work is demonstrably not being carried out. How can anyone hope that the chaos reigning in the field of child protection in this country could possibly change?

As we speak, the greatest means of pressure are the problems themselves, unfortunately. It is not the pressure levied by the scientific community, nor the EU. The scientific and academic community, unfortunately, do not have that kind of influence. It does what it can, it records everything, but movements for change are weak. I attempted to coordinate the NGOs, to make them aware that they are ten bodies facing the same issues, that competing among themselves for visibility is a waste of resources, that we should coordinate by forming an Association, work together, etc. But right now, a single positive step has not been taken. For example, there is no obligation to join the register and elect a Committee that will collaborate with the Ministry so that we can coordinate our actions and receive information.

EKKA had a system under which only bodies that had been assessed could receive Ministerial funding. We had an evaluation system, which was not the most modern of its kind because its contents were determined by the Ministry, but at least we had a register of 200-300 different bodies that also needed the data to obtain the prerequisite approval to receive funds from the Ministry, otherwise the Ministry could not authorise funding because it was institutionally prevented from doing so. In the rest of the world, all bodies are submitted to such evaluations. Tomorrow morning, I could submit my articles of association, rent a flat in Patisia and start accommodating young girls facing various issues and I could be a paedophile and you would have no idea how many children are staying at the flat nor what I get up to.

Could this be happening in our country, Mr Altanis? Is no one checking?

It could be happening; I cannot exclude it.  Because we still live in a society that expresses interest and concern, it would come to light at some point, albeit too late. But it is something that could happen because the institutional framework allows it.

EKKA runs a national helpline for children. But if I were to see someone beating a child right now, who would I call? If we asked any of the people around us right now, they would say The Smile of the Child.

It is the best-known line, we agree on that, although the answer would have to be 112, which is the EU emergency number. There are specific reasons for it: The Smile has many volunteers producing its adverts and it has used the Law on Social Responsibility in Radio and Television effectively. Because EKKA is a state body it stumbled over certain issues: it would not run its adverts, not promote them, consider them competitive toward The Smile etc. There is no institutional framework allowing the state to ensure it is utilising its structures effectively, and I am not sure whether the financial brains of each government see this as a priority. In the sense that when the demand for a service becomes evident, it will swamp them. I had raised it at the Ministry once, said we need to get out there and inform people about a certain topic, and their response was, “And then what? Leave it as it is, we will be swamped.”

Moreover, consider the fact that welfare rights are not actionable. This means that if a service fails to provide me with welfare, I have no legal recourse. Our model suffers from such legal vacuums. And I should also inform you that even though it was the Ministry of Labour that maintained the financial allocation of welfare funds, there was greater scientific expertise at the Ministry of Health and greater understanding. The Ministry of Labour is still very social security centred and I do not know if they have since fostered the requisite culture. I think there is still some way to go, but there are also some very creative forces at play, such as the Municipalities or the thirteen Centres of Social Welfare in the Regions, but their responsibilities do not extend to that.  

We need to give them responsibility for regional coordination, and EKKA should be made responsible for coordinating the Regions. That could be a swift model bearing immediate results until a more comprehensive structure is set up. Are you aware of how many desperately needed welfare premises collapsed and closed due to lack of funds and personnel, and were then given to NGOs to run their programmes? PIKPA (Rehabilitation Centre for Disabled Children) used to own buildings all over Greece. Where have the buildings gone, the premises? Many premises, whose exact location we do not even know, are demolished, lost. They could not even maintain the Gerokomeion Retirement Home!

How relevant is your Action Plan today, ten years after its publication? Would it need a significant review?

It would certainly need to be updated. Many bodies have changed, some new institutions and organisations have entered the field, but we also need a different approach to the new data. I have already mentioned the creation of the thirteen Centres of Social Welfare in the Regions. The Municipalities have also expanded during that time through the Organisation provided for by the Kapodistrias reform, so we have that too. I don’t know if anything has changed for NGOs in terms of the governing institutional framework. EKKA has been entrusted with new responsibilities. I think that it could, if it wished, utilise them and move in some of the welfare directions indicated, but the bodies involved are different now.  State bodies have decreased, and the number of NGOs has risen.

Would you do it again?

You have caught me in a transitional phase. I stopped my academic activities a few months ago, and I am only interested in research now. The truth is that I have declined many meetings and some proposals to accept administrative-scientific posts because I think it is pointlessly soul-destroying and that once you are an academic, you cannot compromise too much with all the different agendas. But I would always be interested in research, in a study. I think research is the only way we can gain control and be able to say whether we are doing the right thing, but research does not suffice, you need to put assessment systems, evaluation mechanisms, in place. Creating something and leaving it to its own devices is not enough.

I feel very disappointed and frustrated, but I would do it again. If another study were to take place now, I would agree to become involved. But I would not act as the President, as a Consultant, any kind of relationship that encompasses dependence is not an option for me. I cannot accept such conditions anymore; they are too abusive.

Was your experience at EKKA abusive?

Yes, certainly, the political leadership and the Ministries behaved as if we were the enemy.

What kind of resistance did you meet there then?

Ignorance, lack of scholarship and scientific understanding, all kinds of agendas, bureaucracy, lack of empathy. All of it, unfortunately. There were many hardworking people, certainly. But when you are ignorant, you cannot help. Love is not enough; it is necessary but not enough. When I visited the PIKPA Pentelis, I found many volunteers there and asked them what they were doing. They were taking the children to play and when I asked them what exactly they were doing, if they knew the child, the child’s specific needs, all they knew was that the child was fair-haired and blue-eyed. They sat there and played. And I banned everyone, I said: “Go receive training in what you are exactly supposed to do.” Some reacted badly, others accepted. We all need to know what is required and how to do it and act in a coordinated manner. In Cyprus, we began to implement a few programmes during the crisis so we could see how many people were involved. We visited a few institutions and realised that it was the same people who went to two, three different parishes. That is the point, welfare should be aggressive, not defensive.

We have talked with many people active in the field of child protection. Some of them have confessed that there are times when they witness an incident and are at a loss as to who to address because they are aware of the system’s flaws.  But who else can you turn to?

The welfare model should be this: all residents should be registered with and have a general practitioner. It is unthinkable that a person should have a problem and not know who to first turn to, the teacher, a psychologist, a psychiatrist? Someone needs to manage this. I used to jest that in Greece you need a PhD just to figure out the service you should turn to. Without registration, there can be no scientific protocol… Surgeries, hospitals, they all follow a protocol. No one can act as they please. The same must apply to Welfare.

This interview was edited out of a conversation that took place in December 2019.