Manju was born in Dadeldhura, a hilly district in far west Nepal. Her foot and toes on her lower right leg were not fully grown, which prohibited her from walking. Things were so difficult for Manju that she couldn’t even attend infant school like other children.
However, in 2014, at the age of four, she received a warm welcome at a local rehabilitation center, as well as her first artificial limb. With it, she was able to walk; and she enrolled in the local school.
Manju is one of the 18,000 Nepalis who are standing taller—and climbing higher— thanks to the generosity of the American people through USAID. Since her very first fitting, she has grown a lot, and USAID’s Strengthening Rehabilitation in District Environs (STRIDE) Activity, implemented by partner Humanity & Inclusion (HI), has already provided her with two replacement prosthetic legs.
For more than a decade in Nepal, HI has worked to build, strengthen and expand access to rehabilitation. And, since June 2019, this critical work has continued with a brand new project.
USAID’s STRIDE activity, managed by Humanity & Inclusion, partnering with local organizations, ended on January, 31, 2019, with a long list of successes. Since STRIDE’s launch in 2010, staff provided rehabilitation services to more than 52,000 Nepali people. Among them, more than 18,000 people learned to walk again using locally-manufactured assistive devices, which were based on appropriate technology. STRIDE also prepared and supported more than 4,000 people with disabilities as they entered the workforce and began earning decent wages. Along the way, STRIDE created a skilled team of rehabilitation professionals—which did not exist in Nepal before the project launched. And at the end of the project, STRIDE handed over five rehabilitation centers to Nepali stakeholders.
“We are immensely proud of STRIDE, and eager to cement its successes,” said Willy Bergogne, Country Director for HI Nepal. “Thanks to USAID, we’ve been able to dramatically improve people’s access to a range of rehabilitation services. Nepal has more highly skilled rehabilitation professionals and well-positioned rehabilitation centers. But, we need to ensure that these services are sustainable—and successful—in the long-term. This is the challenge we’ve set.”
Needs and Gaps
Many of our beneficiaries are living near the poverty line and cannot afford services or the assistive technologies offered by rehabilitation centers. In addition to these gaps, we know that long-term follow-up in remote communities remains a challenge.
What’s more, Nepalis are living longer than ever, though they face more non-communicable diseases, such as diabetes and cancer. These diseases increase the prevalence of disabilities and the need for physical rehabilitation services throughout a person’s life.
While rehabilitation needs are growing in Nepal, the capacity to address these needs remains limited. Physical rehabilitation services are mainly provided by local organizations, including the rehabilitation centers that formerly worked with STRIDE. This results in inadequate coverage to meet local needs and puts pressure on sustainability.
The Ministry of Health and Population acknowledged the growing needs of the Nepali people and the usefulness and importance of rehabilitation services as part of the continuum of care. The ministry included physical therapy as an essential health service in the National Health Sector Strategy 2015 – 2020 and allocated a budget for physical therapy for the first time. However, the public health system only recognizes physical therapy as an essential service; and it is mainly available in urban areas in tertiary level hospitals. The Government of Nepal’s budget for rehabilitation services only partially covers the provision of assistive devices and rehabilitation services.
The new Leprosy Control Disability Management Section (LCDMS), which is responsible for coordinating the Department of Health Services’ strategies on disability prevention, is a promising step toward a more comprehensive response. However, planning, administration, technical capacities, availability of rehabilitation professionals and resources allocated to fulfill the need of growing rehabilitation services are limited. Mechanisms and guidelines for monitoring, equitable access and use of quality services are also currently lacking.
The Path Forward
To fill these gaps, USAID’s physical rehabilitation activity will help to establish a sustainable, integrated, public-private rehabilitation system. The goal of this is to improve the mobility and functional independence of victims of conflict and others in need of rehabilitation services. The activity aims to strengthen the quality of rehabilitation services, increase access to rehabilitation services and strengthen the sustainability of private physical rehabilitation centers. This critical work, which will be implemented by HI, is made possible due to a $4 million grant made possible due to the support of the American people through USAID.
USAID’s physical rehabilitation activity will run through the end of 2024. During this time, the activity will help to establish a sustainable rehabilitation services system using the WHO Rehabilitation 2030 strategy as well as the WHO health system strengthening approach, which targets six core areas:
- Governance and leadership
- Health and rehabilitation human resources
- Rehabilitation information system development
- Medical and product technologies, including assistive products
- Finance, including health insurance and budgeting rehabilitation activities
- Service delivery, including private-public partnership
The steering committee for USAID’s physical rehabilitation activity, under the leadership of LCDMS, will help guide the process. Institutional and private actors will be crucial partners to ensure that this activity and its services remain relevant and appropriate.
HI will work with six local partners—the National Federation of Disabled Nepal, an umbrella organization of over 200 Disabled People’s Organizations in Nepal who will coordinate advocacy activities through local networks, and five physical rehabilitation centers (PRCs) previously supported by STRIDE to further enhance local capacities and model practices towards high quality, efficient, and comprehensive coverage in remote communities.
USAID’s physical rehabilitation activity team will closely work with the broader network of physical rehabilitation service providers and rehabilitation professional associations to have a sustainable system of rehabilitation services.
“The roots of the project are strong,” Bergogne adds. “Thanks to ongoing partnerships, and a drive to solidify Nepal’s rehabilitation sector, we can look forward to more smiles and tree climbing from children like Manju.”