Presented by : Deepak Raj Sapkota; deesapkota@karunafoundation.com

Fellow colleagues here : Betteke de Gaay Fortman & Yogendra Giri

www.karunafoundation.com

Change comes from the community people! CBID practices in Nepal

Karuna foundation Nepal

Devastating earthquake in April 2015

Within 24 hrs Karuna Foundation Nepal transformed

into a lean & mean emergency relief organisation KarunafoundationNepal

Effective Disability Inclusive Disaster Relief

1. Knowledge of the local context , (in the field of marginalized groups that include children/ adults with disabilities and their families, pregnant women, infants and elderly )

2. A decade long hands on experience working closely with the local communities

3. Working with government system in the central, district and villages

4. Most importantly, districts where Karuna is working were severely affected by the earthquake

5. Strong network: Within country and at the international level

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Impact Relief:

• 15,000 families (100,000 people)

reached with Food, Shelter and

Medical Support

• Including 3,000 Persons with

Disabilities

• 1,500 patients directly with

medical teams/camps and more

through support to hospitals

• 3,000 safe shelters for the

monsoon

• Partnership with UNICEF to

reach all children with disabilities

in 14 districts-5000 Children and

families; immediate support

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Karuna Foundation Nepal

An entrepreneurial development organization committed to work on:

• Prevention of Childhood Disabilities

• Quality of life of children with a disability through Community Based Rehabilitation

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KarunafoundationNepal

Legal provisions/policies

• UNCRPD ratified by Nepal in 2010 (with optional Protocol)

• Disability Protection and Welfare Act, 1982 – amendment in the process of approval

• Education Act is being reviewed in consultation with DPOs and organizations working in the field of disability.

• Several Guidelines on accessibility, assistive devices, CBR, personal assistance.

• National Policy and Plan of Action on Disability, 2006- in the process of revision

Most importantly the upcoming constitution of Nepal is incorporating rights of Persons With Disabilities as Fundamental Rights and ensure Political Rights and positive reservation in many clauses.

Situation on Disability in Nepal

Population:

1.94 percent of total population has a disability Nepal i.e. around 513,000 (of

26 million population) [*National Census, 2011]

Karuna Foundation’s Nepal baseline census in about 40 VDCs: 3-5 percent

An experience of Karuna Foundation Nepal on promoting Community Based

Inclusive Development focusing on children/adults with disabilities and their

families

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2 community models developed and piloted (2008-2014)

Share & Care A community based health insurance model including prevention and CBR

- 9 villages (10000 HHs)

Inspire2Care Community model embedding prevention and CBR within local structures and resources

- 7 villages (7000HHs)

• Reaching in total

• 134.000 people

• 2500 persons with disabilities including 800 children

• Entrepreneurial approach

• Local Responsibility and ownership:

o Managed by local committee (chairman of the village, people with disabilities, parents, local leaders)

• In partnership with government

• Cost sharing budget allocation from

Municipality and District • 3 year financial support from KFN and • 2 more years technical support

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Principles of the Karuna Foundation models

Inspire2Care

Primary & secondary

prevention of child disability

Community Based Rehabilitation

Secondary and tertiary care for

disability

Leaderschap, Capacity

development & mobilisation of local resources

Lobby & advocacy for equal rigths

and opportunities for persons with

disability

Postive attitude change and

enabling environment for

disability

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Structure for effective CBID and CBR

Village Disability

Rehabilitation Committee

Health workers

CBR facilitator

Village Development Committee (VDC)

District Development Committee,

District Health Office

Ministry of Women, Children and Social Welfare

National government

District government

Local Government

VDC Chairman

Karuna

Community

People with disabilities and their families

Teachers

Local leaders

Marginalized groups

CBR Prevention-

Maternal child health

3 yrs

Village Disability Rehabilitation

Committee

CBR facilitator

CBR

Self Help Groups

Inclusive child clubs

ID card and entitlements

Capacity Building

Train a CBR Facilitator in each VDC

Activate and build capacity of VDRC

Identification Identify the Children with Disability

Detail Assessment of the Children

Female Community

Health Volunteers

Health Education Social Livelihood Empowerment

Health workers Self Help

Groups

Inclusive, special and vocationa education

Social participat

ion

Disabilty friendly

teaching & learning

environment

Enterprenuership and employment

Cooperatives

cultural, religious

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Inclusion of persons with disability in Karuna's work

Need Identification

Project design

Project Implementatio

n

Resource Mobilization

Monitoring and Evaluation

Feedback

Persons with Disabilities and their families

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National Level

• Lobby, Advocacy& Policy for equal rights and opportunities for persons with disabilities

• Lobby for political support and resources for scaling up Inspire2Care and community based health Insurance

• Coordination with Ministries, (I)NGOs, private sector

• Networking and linkage

District Level

• Lobby & Advocacy for equal rights and opportunities for persons with disabilities

• Coordination with CBR DCC

• Specialized Services (Health, Education & Others) by Public sector, NGOs (CP center, HRDC, SIRC), Private sector etc.

• Local Resource Mobilization

• DDC,

• Capacity building

• Networking and linkage

VDC Level

• Implementing body: HFOMC & VDRC

• Focus:

• Community Based Rehabilitation

• Prevention & Primary Health Care

• Leadership Development & Capacity Building

• Referral system to secondary/special services& tertiary care

• Local Resource Mobilization-VDC, families

• Coordination with DPO’s, VDCs and political leaders

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Sustainability

For KFN, sustainability has three major domains which are:

•Financial Sustainability is related to all about financial resource mobilization and its proper management based on the cost sharing principles.

•Structural Sustainability deals the management issues of the program including mobilization of all the stakeholders, networks, lobbying and creating positive environment. Timely and accurate recording and reporting in a transparent manner.

•Quality Sustainability covers the areas of providing best possible quality services through improvement/strengthening of service providers, needful linkages and/or referrals to secondary and tertiary care and assistive/supportive devices.

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Impact on people

• 70% of the village sustainable both financial and social

• 25% of community is member of the health insurance

• 35,000 people improved access to quality health care

• 700 children with disabilities improved quality of life

• 750 babies prevented from birth defects

• 500 families with a person with a disability increased their income

• Community empowerment and ownership of inclusion of persons with disabilities

• Ownership of the program by the community and district authorities

• Joint Venture to scale up the program to one district with Liliane Foundation and Netherlands Leprosy Relief

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Major achievements

• Cost-effectiveness and efficiency assessment of the Inspire2Care program, 2011-2013 by the Royal Tropical Institute (KIT), The Netherlands;

• Fund allocation for the expansion of the project by the Ministry of Women, Children and Social welfare of Nepal;

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• CBR program has been organized effectively and at a lower cost by involving wide range of stakeholders;

• CBR approach can create immense impact in the lives of children with disabilities and their families;

• Community people are focusing to include person with disability and their families in every community development activities and also starting to create surrounding environment inclusive and friendly;

CBID Impact on CBR

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CBID impact on Persons With Disabilities • Increased Recognition and Acceptance from family and community. Growing

Participating in indoor and outdoor activities;

• Getting equal access to right to education, health care, social participation. Are able to go to school, participating in social events;

• Increased economic status of the family through livelihood program;

• Empowerment of community people, leaders; together with the parents of children with disability and ownership on program by local community;

• Focus on inclusion of person with disability and their families in development process by creating inclusive and disability friendly environment;

• Identification of all children and adults with disabilities of the project areas with individual profile; and Increased access to Government Provisions / Schemes i.e. cash allowances, scholarship etc.;

• Local resource mobilization and proper utilization;

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What works and what to improve

Program is sustainable and successful if following 5 conditions are met:

• Local financial resources

• Quality primary Health Service

• Leadership: Local management with transparency and accountability towards the consumers and community

• One CBR worker in every village contracted by the local committee

• Inclusion of persons with disabilities at all levels

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Key Lessons

Community people themselves are the change

agents !

Awareness raising on disability to politicians, bureaucracy, media people, teachers and the health workers is the key;

Once people are aware they are positive and committed to support;

Disability related programs are not as expensive as considered if started from the very beginning and in an organized way;

Changing mindset of both persons with disabilities and the community crucial for change;

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Challenges in implementing CBID

Lack of government emphasis on inclusive development though many policies/ guidelines have been developed;

Meaningful participation of Persons of Disabilities is still a challenge in many cases. It requires special approaches;

Management of severe cases of disability in local setting;

Raising hope of Persons with Disabilities has also been a problem;

Infrastructures and geography in Nepal;

Community initially attracted towards tangible results such as buildings and equipment rather than services and quality;

Where are we heading?

The work could be easily started in any part of the globe if there are some committed people, thinking out of box;

Disability is developmental agenda thus is a political agenda. If the political system do not recognize and accept it, it can't be well organized;

Start from the bottom, identifying the disabled population, assessing their situation and most importantly involving family as a key player so that the ripple gets larger;

Technology has greater role to play to improve the quality of life of Persons With Disabilities. Rich and developed countries have to transform the technologies and make it accessible to the poor countries;

Disability cannot be dealt in isolation. Everybody has to be involved and must be sensitive;

Replicability of the models

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1. Currently Scaling up Inspire2Care to two districts in Nepal (50 villages) (2015-2019) reaching 300,000 people in joint venture with Liliane Foundation and Netherlands Leprosy Relief

2. Creating a disability movement in Nepal and influencing Government to implement the program throughout the country;

3. Post-earthquake Disability Inclusive Disaster Relief in Rasuwa district Nepal, reaching 15,000 people, including 1,500 people with disabilities;

4. Possibility for new ventures in other countries, contexts and in collaboration with others Join us!

Current work

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Together we can make it happen. We are ready. Lets collaborate!

Thank you