NLR in Nepal is increasingly focussing its efforts on innovative approaches for leprosy control and the promotion of disability inclusive development.
The Leprosy Post-Exposure Prophylaxis project is running well, with over 31,000 contacts of more than 1,200 leprosy cases (called “index cases”) enrolled and given a single dose of rifampicin since its start in 2015. This newly introduced method of leprosy prevention through chemoprophylaxis continued to be a major focus, and further expansion in other districts has been prepared.
The Disability Inclusive Relief and Rehabilitation project funded by Samenwerkende Hulporganisaties (SHO) (also known as Giro555) continued in 2016 with support for persons with disabilities to restore their lives after the 2015 earthquakes and to enhance accessibility to humanitarian aid for persons with disabilities (PWDs).
PWDs were aided with emergency shelter, assistive devices, medical treatments, vocational training support and other income generating activities, such as membership of cooperatives. In addition, the project has led to a significant increase in the number of persons with disabilities (more than 90%) with a disability ID card in the project area. This number was below 40% before implementation of the project. With the ID card they are now obtaining government provisions such as public transport and pensions.
The Inspire2Care project continued in cooperation with the Karuna Foundation. The project focuses on disability prevention and community-based rehabilitation for people with a disability, with children as the focal point.
In addition to the abovementioned new approaches, the need for capacity building and service delivery also remained. In the capacity development area, over 1,670 health workers and volunteers received leprosy training. In service delivery 380 people with leprosy and disabilities were provided with some sort of livelihood support and over 500 received medical and surgical assistance.
To enhance the planning, monitoring and evaluation of results of our work in Nepal, a major change was made in project and program planning in 2016. NLR Nepal was one of the first organizations in Nepal to fully adopt Outcome Mapping (OM) as a Planning, Monitoring and Evaluation (PM&E) tool, and introduced the OM method with all its implementing partner organizations (called ‘boundary partners’).
Attention for the rights and needs of persons with disabilities is created in 12 communities spread over 8 districts, which are step by step being developed into disability inclusive model villages.
Number of new cases detected 3,054*
Proportion of new cases with grade-2 disabilities 3.57%*
Number of new cases detected in the area where we work 934*
Number of people receiving leprosy-training 1,669
Number of people informed/educated (awareness raising) about leprosy 14,127
Number of people from communities informed/educated (awareness raising) about general disabilities 360
Number of self-care groups supported/formed:
a) Number of existing groups (formed before 2016) supported in 2016 173
b) Number of new groups formed and supported in 2016 0
* The reporting year in Nepal is from July 16 2015 till July 15 2016
Number of people disabled by leprosy and other diseases trained in self-care 64
Number of Disabled Peoples Organizations (DPOs) receiving assistance from NLR 61
Number of people provided with reconstructive surgery 27
Number of people provided with assistive devices (wheelchairs + crutches + sunglasses + protective/ orthopaedic footwear + prostheses) 402
Number of people provided with microcredit 35
Number of people receiving vocational training 13
Number of direct contacts of new patients given preventive SDR (single dose of rifampicin) 14,036
Number of persons with disabilities acquainted with their rights 360
Number of people who received leadership training 53
Information on how to take care of the needs of persons with disabilities (PWDs) during disaster situations is limited in Nepal. During the Human Rights Summit organized by the National Federation of Disabled Nepal, NLR launched an information leaflet on how to include PWDs in relief and rehabilitation after a disaster, which has been widely distributed among communities, government departments and organizations working for persons with disabilities.
In cooperation with Karuna Foundation, the development of a community model for the prevention of disability and the rehabilitation and inclusion of children and adults with disability in the community yielded good results. In the 4 villages where NLR executes the project, a total of 64 children and adults with disabilities were physically rehabilitated through physiotherapy, treatments and assistive devices. 48 PWDs obtained their disability ID cards, which is a basic need for PWDs to receive government provisions and facilities. 43 children with disabilities were included in schools, and 38 adults could increase their income through vocational training and other income generating support.
Lobby and advocacy is one of the major strategies for NLR in Nepal to enhance disability inclusive development. The formation and strengthening of Disabled People’s Organisations (DPOs) and facilitation of lobby and advocacy activities has resulted in increased resource allocation for PWDs by local government offices. While NLR provided the initial financial support, DPOs in 9 communities are now implementing the activities (such as their group meetings and awareness raising activities in the community) from the allocated Village Development Committee (VDC) budget, ensuring sustainability.
NLR is involved in a 2-year action study (2016-2017) to explore how the access of PWDs to resources would help them improve their livelihood and inclusion in society. It also investigates opportunities and challenges to include people with physical disabilities (especially disabilities due to leprosy) in agriculture and livelihoods in Nepal.
In 2016 the project provided orientations on 3R (Recharge, Retention and Reuse of water) and installed 3R tools with selected farmers and their neighbors (both with and without disabilities) at 4 pilot sites (Chhoprak, Dus Kilo in Gorkha; and Urlabari and Patthari-Sanischare of Morang district) with emphasis on producing cash crops. The research is ongoing and in 2017 the results will be analyzed.
NLR supported the government in 2 leprosy referral clinics of the eastern and far western region, by providing manpower and utilities. In 2016, the following number of people received help with NLR support in Seti Zonal Hospital and Koshi Zonal Hospital:
Patient Data Total
Total New Cases Detected 374
Management of complications 622
Reaction Management 246
Ulcer Management 376
Admitted to hospital 37
Surgeries performed 27
From burden to successful businessman
‘My name is Hari Kumal. I am a man of 32 with a physical disability due to Poliomyelitis at the age of 7. Both my feet are affected and I use my hands for walking and riding my tricycle. In 2012, I was diagnosed with leprosy upon examination at the NLR-run leprosy clinic. One of my friends, who was affected by leprosy, had taken me to the clinic. During the two year long treatment, I developed reactions, which were properly managed in the clinic.
NLR encouraged me to become a member of a self-help group formed by NLR. I actively participated in awareness activities in my locality to impart health education to newly detected patients.
I live in Peepal Tole, Dhangadhi-6, Kailali district in Nepal with my wife, 2 children and unemployed brother. I used to work as a helper in a small tailor’s shop in my village. But I earned too little to support my family. Caring for my dedication to leprosy work and considering the huge responsibility towards my family, NLR decided to provide financial support to buy me a sewing machine.
With NLR’s support, I started my own tailor’s shop in my village. Thanks to my hard work, I have been able to move my shop to the city. Now I have 3 sewing machines with 3 staff members. I also train people in my shop and have trained 40 more so far. My family is happy and I have enrolled my daughter in a local English middle school. I now have a handsome sum in my account. ‘If I had not got proper treatment and support from NLR, I would have become dependent and a burden to my family and community. I am very thankful to NLR for curing me, preventing further disabilities and providing seed money to start my own business.’
I am very thankful to NLR for curing me, preventing further disabilities and providing seed money to start my own business
The LPEP pilot started in 2015 in 3 districts, with NLR Nepal as one of the main initiators. The approach has been well accepted by the people as well as the health system and policy makers. The government of Nepal decided to expand the approach in 3 more districts on its own initiative in 2016 and an additional 3 districts are planned for 2017. Due to the encouraging results, NLR plans to support 5 more districts based on the 2016 experiences.
A new approach to livelihood started in 2016 proved very successful as well. NLR started to promote the membership of persons with disabilities (PWDs) in village cooperatives, thereby enhancing their access to microcredit. 380 PWDs are now full members in cooperatives and were able to obtain a loan. It also helped to increase the recognition for PWDs among community members. The method will be continued in other areas.
For several years now, NLR has been trying to reduce its support to the leprosy referral clinics, based on the conviction that the government should fully support these clinics. However, in actual practice it remains difficult to withdraw completely. The clinics are running but quality of services remains an issue of concern for NLR and the Leprosy Control Division. Although training by NLR has improved quality, NLR does not yet consider a full withdrawal of support possible for 2017.
Three out of 4 village development committees (VDCs) in Jhapa are at the stage of phasing out the Inspire2Care project. This means that as of next year the local government should cover the support and budget allocation for persons with disabilities in their locality. In 2017, NLR support will be limited to technical support and monitoring to establish if government allocation takes place. In 2017 NLR Nepal will attempt to seek additional funds for the expansion of this project to other VDCs in Nepal.
Promotion of inclusion of persons with disabilities in mainstream development shall remain a focus in 2017. Advocacy & lobbying at policy level, networking, empowerment and capacity building are the major strategies to develop ‘disability-friendly model villages’ in our working area, where there is attention for persons with disabilities, understanding of their rights, and where they are included in local government development activities, local committees and groups. All work shall be organized based on the outcome mapping method, which means that development challenges and progress markers are defined in conjunction with the partner organizations to monitor for their own development.