Through an inclusive education project in Nepal, Rabina finally has the chance to learn alongside other students.
Rabina, 19, was born with cerebral palsy. As a girl with disabilities from a low-income family, she was unable to go to school. Her parents were unaware children with disabilities could access education. Disability is stigmatized in communities like hers, where there are no inclusive schools. As a result, Rabina lacked both mobility and education for years.
That’s changing since she met a community officer working with the Empowering a New Generation of Adolescent Girls with Education (ENGAGE) project, managed by Humanity & Inclusion and Voluntary Service Overseas along with local partners in Nepal. The project seeks to empower more than 2,000 girls who are not enrolled in school—including those with disabilities—through education across three districts in Nepal’s Terai region. It is supported by UK Aid’s Girls Education Challenge Fund.
“I think that many people with disabilities in our community are still deprived of their rights and the support they need to gain their independence,” Rabina explains. “They need to be involved in projects like ENGAGE, which can be life-changing for them.”
Rabina’s opportunity to learn
In a medical camp organized by the ENGAGE, teams assessed Rabina’s needs and provided her with a wheelchair and toilet chair along with training in how to use them correctly. Soon, she will receive another, custom-made wheelchair that will help her move around even more easily.
A community officer also paid regular visits to her home to meet with her family. After a series of discussions and counseling, Rabina’s parents agreed to let Rabina join an intermediate class to prepare her to attend school. ENGAGE supplied her with the necessary learning materials.
“Thanks for supporting me with a wheelchair and a toilet chair; they really made a difference to my life,” Rabina says. “Thank you for providing counseling to my parents. They started to see me as their daughter with a future and have helped me learn.”
Rabina has completed her intermediate class, learning basic literacy skills and developing a strong interest in drawing and art. She is gaining self-confidence and wants to go to school to take her learning a step further. She will soon join a classroom where children with and without disabilities learn and play together.
“Rabina’s life has changed a lot since she joined the ENGAGE project,” explains Suman Buda, a community officer who works with Rabina. “She had never been to school and was totally illiterate. Now I feel very happy for her because she can read her lessons and write.”
Rabina’s parents are pleased with the progress she has made in her studies, and they are participating in a training program to learn how to better support their daughter. Now, they see her as a woman with ambitious plans for the future. Rabina’s neighbors are more welcoming, too, inviting her to social activities and rituals. This means Rabina is more involved in her local community, and she feels more confident than ever.
A new Nepali sign language learning app will support Deaf children develop pre-literacy, reading and basic sign language skills. The free app launched on Sept. 23, in recognition of International Day of Sign Languages.
Called Mero Sanket, the app is the first of its kind for Nepal, can also help teachers, parents, and caregivers to learn basic Nepali sign language, and will be available as an offline platform.
The app was developed as part of the USAID-supported Reading for All program, which is implemented by Humanity & Inclusion in partnership with World Education, the National Federation of the Deaf Nepal (NDFN), the Center for Education and Human Resource Development (CEHRD) and other local partners. In Nepal, children with disabilities face unique challenges in accessing meaningful and inclusive education. They experience a lack of proper learning infrastructure and accessible instruction materials adapted to their needs. In Nepal, 15,000 Deaf students attend 24 specialized schools with 174 resource classrooms. Nepali sign language was developed in 1998 and has rapidly progressed, helping students who are deaf excel in their education and communication. However, Nepali sign language is not accessible in all parts of the country, which has resulted in disproportionate high school dropout rates for Deaf students.
“Inclusion is at the heart of Humanity & Inclusion’s core values and accessibility in communication is our mandate," explains Reiza Dejito, director of Humanity & Inclusion's activities in Nepal, India and Sri Lanka. "When children’s access to education is curtailed due to Covid-19 containment measures, and when children are confined to their homes, this ingenious app helps Deaf children to continue learning. The starting point was creating a tailor-made mobile app for learning Nepali sign language, and making it fun and on demand to anyone, anytime, anywhere."
In a statement, the National Federation of the Deaf Nepal wrote, “This app puts Nepali Sign Language into the hands of anyone with an interest in learning it. In creating this mobile app, we appreciate the support provided by the Government of Nepal, USAID, Humanity & Inclusion, World Education, and all technical teams involved. In the days to come, we wish to take more initiatives to promote inclusive education by developing an additional learning material together with everyone involved in such activities and to lay the groundwork for the education of Deaf children.”
The free app is already available for download on Android devices in the Google Play Store. It includes six lessons on vowels, consonants, words, punctuation marks and other exercises in Nepali sign language. The app can be accessed offline once it is installed on a device.
“It has been a pleasure sharing that the Mero Sanket application has been developed, targeting students who are deaf or hard of hearing from grades one to three," says Dr. Divya Dawadi, Director of Inclusive Education at CEHRD. "The mobile application does not only support pre-literacy, reading and basic sign language skills, but this also helps teachers, parents, caregivers and other stakeholders learn basic sign language. The government of Nepal is committed to providing access to education for children, including those with disabilities. Together with the partners, we have developed lessons in sign language to catch up from the learning loss resulting from the Covid-19 pandemic."
Studies on educational outcomes in Nepal point to high drop-out rates and comparatively low achievement rates for children with disabilities, particularly in rural areas. USAID’s Reading for All program aims to improve reading outcomes for students with disabilities, through improving data quality on students with disabilities, early screening, building technical capacity, and testing disability inclusive education instructional models. The project will screen an estimated 277,418 children from grades 1-3 for any disabilities. Early screening helps teachers and schools to adapt students’ individualized education plans and the learning environment. Likewise, Reading for All will train more than 9,400 primary school teachers and 46 educators in resource classrooms to use inclusive teaching instruction to adapt to different needs of students.
"USAID is committed to ensuring all children have access to learning, especially children who are most marginalized," says Shannon Taylor, USAID/Nepal’s Education Office Director. "This is even more pressing during the Covid-19 pandemic where so many children are out of school and children with disabilities are disproportionately affected. We hope that this will be one more tool parents and teachers can use to support children who are deaf or hard of hearing in learning to read."
Covid-19 has presented numerous challenges, changing the way Humanity & Inclusion teams around the world work with the communities we serve. One of those challenges was figuring out how to safely continue providing rehabilitation to people with disabilities. The answer in many places? Telehealth.
For instance, take Priti, a 3-year-old girl living with cerebral palsy in Nepal. Doctors suggest she do regular physical therapy sessions to improve her condition, but her parents find it difficult to afford treatment on top of other living expenses.
A community member and former patient referred Priti to Community Based Rehabilitation Biratnagar (CBRB), a local partner organization of Humanity & Inclusion, for physical therapy and assistive devices.
Priti completed three physical therapy sessions at the center and received a specialized chair that helps stabilize her body and maintain upright sitting posture. She can also use the chair during daily activities like playing and eating.
Then, as the second wave of Covid -19 swept through Nepal reinstating travel restrictions, Priti completed four telerehabilitation sessions by video. Physical therapists gave Priti’s family advice on continuing home exercise to help Priti grow stronger and checked on the condition of her chair.
“It was difficult for me to continue regular exercises on my own during this pandemic as I could not remember techniques taught by the physical therapist,” says Priti’s mother. “With regular video calls, I am satisfied and happy with the services that helped me to continue exercises."
After three months of regular rehabilitation services, specialists have noticed that Priti’s neck is growing stronger and that her arms and legs are more flexible.
Many people living with disabilities, like Priti, lack access to regular follow-up services that they need because of Covid-19 safety measures and travel restrictions.
“Through the provision of telerehabilitation, another easy way of reaching out to the individuals who need such services, we tried better at our level,” explains Rinki Adhikari, CBRB physical therapist. She added that telerehabilitation can be an alternative way of making rehabilitation services accessible for people in the future.
Humanity & Inclusion’s Covid-19 response in Nepal
These physical rehabilitation activities are supported by USAID and managed by Humanity & Inclusion. The program supports the establishment of a sustainable, integrated, public-private rehabilitation system in order to improve the mobility and functional independence of victims of conflict as well as other adults and children in need of rehabilitation services in Nepal.
With Covid-19, the program has adapted to offer telehealth services and distribute information to prevent the spread of coronavirus. So far:
- 922 audio messages have been broadcast in four different languages on the radio
- 257 accessible video messages have been broadcast in four different languages on television
- 10,726 posters and leaflets have been delivered to government and rehabilitation stakeholders
- Health workers have received 275 sets of personal protective equipment; 16,750 pairs of gloves; 32,500 masks; 62 gallons of disinfectant; and 19 gallons of hand sanitizer
- 7,067 physical therapy sessions have been conducted, including 3,390 telerehabilitation sessions
- 483 assistive devices have been provided to people with disabilities or injuries
- 678 people received essential medical items
- Specialists have offered guidance to government officials related to inclusive health and rehabilitation and to rehabilitation care for people with Covid-19
Header images: Priti sits in her special chair to help her posture while eating and playing. At center, her mother helps her with exercises during a telerehabilitation session. Inline image: A CBRB Prosthetist and Orthotist teaches a woman to re-learn to walk, gain balance, strength and mobility with their new prosthetic device in a parallel bar at the rehabilitation center. Copyright: CBRB/HI
Resources are proving insufficient as Nepal faces a surge in Covid-19 outbreaks. Humanity & Inclusion teams in the country are responding with vital supplies and accessible risk education.
A second wave of Covid-19 continues to overpower Nepal’s population and resources. Hospitals are ill-equipped and understaffed, with insufficient space and materials to meet the heightened demand for care.
Providing the essentials
In an urgent response, Humanity & Inclusion’s team in Nepal is preparing to support government hospitals with the most vital supplies at this time, such as personal protective equipment, oxygen monitors, and masks among other medical items. Staff will continue the Covid-19 intervention projects that have been in place since the initial 2020 wave, including the distribution of hygiene kits, promotion of sanitary practices and assisting partner organizations with food aid for people with limited access. These initiatives have already benefited nearly 90,000 people in Nepal.
According to the World Health Organization (WHO), the country has reported more than 566,000 confirmed cases and over 7,000 Covid-related deaths since January 2020. Strict government restrictions are in place to curb the most recent wave. After an alarming peak a few short weeks ago saw more than 1,200 deaths in a single week, the number of Covid-19 positive cases is finally starting to fall. However, experts stress that the situation remains dire, as the infection rate hovers above 34%.
“People with disabilities and elderly people are more likely to be affected,” says Reiza Dejito, Humanity & Inclusion’s director for Nepal. “They are often the first to be isolated when Covid restrictions are in place, and therefore don’t have access to essential goods or care.”
Making information accessible
While rates may be decreasing in Nepal's urban areas, this is not the case in rural regions, where the number of infections is likely even higher than reports indicate. Lack of access to information and the stigma associated with Covid-19 has deterred people in these areas from being tested, and often people hide their symptoms or deny them. This leads many to seek hospital care only once symptoms become severe, in part causing an increased need for medical oxygen despite a decrease in infections.
In an effort to raise awareness and increase information accessibility, Humanity & Inclusion is implementing risk education initiatives. Along with a partner organization, Humanity & Inclusion has developed Covid-19 prevention messages to reach people with disabilities. One such message is a video broadcast to 75% of Nepal’s population, explaining virus prevention protocol and care in both the local language and sign language.
Continuing our mission
Amidst the health crisis, Humanity & Inclusion specialists continue to provide vital rehabilitation care for people with disabilities in physical therapy units and alongside local partners. This is increasingly important, as overworked medical facilities and government restrictions limit access to other care services. Teams are also providing mental health and psychosocial support to assist frontline healthcare workers, people with disabilities, vulnerable people and their families.
Humanity & Inclusion teams around the world have been responding to the Covid-19 pandemic since March 2020. Donors helped launch more than 170 Covid-19 projects in dozens of countries to protect and care for the people that others overlook. Between March and August 2020, staff have reached 2.2 million people with care and aid to keep Covid-19 at bay.
Image: A young boy and his mother attend a rehabilitation session in Nepal in November 2020. Copyright: HI
The Covid-19 pandemic has plunged Nepal into a public health disaster. One of the poorest nations in Asia, it does not have the resources to cope. Humanity & Inclusion is ready to assist the most vulnerable people.
As the international community focuses its attention on India, a similar crisis is unfolding in neighboring Nepal. Public hospitals are overwhelmed. In Nepal's capital of Kathmandu, the best private hospitals are turning away patients for lack of beds, supplies, and equipment. Patients are dying at home and outside hospitals as they await admission. In rural areas, where there are no hospitals, people are dying at home without ever being diagnosed or treated.
Nearly 50% of Covid-19 tests are coming back positive as cases continue to rise above 455,000, with more than 5,000 Covid-19-related deaths reported. Experts predict 40,000 deaths by the beginning of July, a projected per-capital toll worse than any other country in South or Southeast Asia. Only 1.27% of the country's nearly 30 million residents are fully vaccinated.
The surge of patients coming to health facilities has increased the demand for medical oxygen, ventilators, test kits, and personal protective equipment (PPE) for front line workers, with most facilities facing a critical shortage of supplies, as well as sickness and deaths of medical staff and patients.
Vulnerable people more at risk
“Imagine what this sort of crisis means for older people and people with disabilities, who are more likely to get infected and suffer more severe symptoms and complications from Covid-19," says Reiza Dejito, Humanity & Inclusion's director for Nepal. “It impacts them in two ways because they find it difficult to move or find help. Strict lockdown measures also very often result in a loss of income and limited access to health and social welfare services. Vulnerable people are therefore more at risk.”
Need for accessible information
As the pandemic worsens, needs are growing. The lack of accessible and accurate information for families means people are unaware of Covid-19 risks and the need to protect themselves, get tested and vaccinated. People living in rural areas and urban slums do not have access to clean water, soap or masks. Mental health risks are also very high. The crisis, illness, death and isolation have increased the vulnerability of the population as a whole.
During the first wave of Covid-19 in 2020, Humanity & Inclusion provided more than 15,000 families—or nearly 90,000 people—in Nepal with support. In response to this latest wave, Humanity & Inclusion again plans to improve access to communication by developing and sharing information on Covid-19 risks, prevention and response. This will include information in accessible formats such as Braille, and the use of local languages.
Teams also plan to distribute hygiene kits and promote hygiene practices to new isolation and quarantine facilities, isolated communities, and vulnerable individuals. Humanity & Inclusion plans to distribute food and provide care to older people, people suffering chronic diseases, pregnant people, people with disabilities, and others. Teams are also expected to provide mental health and psychosocial support to assist frontline healthcare workers, people with disabilities, vulnerable people and their families. Humanity & Inclusion is referring at-risk people to services provided by government agencies and partners, and may help them get to and from health facilities for testing, treatment and vaccinations.
Humanity & Inclusion's Covid-19 response
Humanity & Inclusion teams around the world have been responding to the Covid-19 pandemic since March 2020. Donors helped launch more than 170 Covid-19 projects in dozens of countries to protect and care for the people that others overlook. Between March and August 2020, staff have reached 2.2 million people with care and aid to keep Covid-19 at bay.
Image: Rajina, a physical therapist for Humanity & Inclusion, provides instructions on different exercises to a rehabilitation patient in Nepal in June 2020. Copyright: HI Archives
To mark International Women's Day on March 8, we talked to Reiza Dejito, a strong woman who is deeply committed to both her family and her role at Humanity & Inclusion. Currently serving as the Program Director for Nepal, India and Sri Lanka, Reiza has worked in numerous countries affected by humanitarian crises for two decades.
Why did you decide to join Humanity & Inclusion?
I graduated in science and physical therapy, and I earned diplomas in teaching and then management. I also completed several volunteer missions in the Philippines (my home country) and Ethiopia. And then, three months after leaving Ethiopia, I joined Humanity & Inclusion as a victim assistance project manager in Bor, South Sudan. Since then, I have worked in Kenya, Bangladesh, the Philippines and now Nepal.
Is there one experience that really stands out?
Working with Rohingya refugees in Bangladesh. They’ve suffered so much. One woman told me how she watched helpless as her husband was murdered and her house was burned down. A 9-year-old child, who was injured in the arm by a bullet after being caught in the crossfire, told me he’d forgiven the attacker for hitting the wrong target. Men, women and children walked for days and days to cross the border with little food and water. Awful.
As a director in the Philippines, I joined the emergency team to help the victims of Super Typhoon Goni. I was extremely impressed by the resilience and generosity of Filipinos. And the commitment of my team and partner organizations to provide assistance to those who needed it most.
What’s the hardest part of your job?
As Program Director, I’m responsible for the security and protection of my teams and ensuring they are safe and sound, and in good health, especially during emergencies, crises and conflicts. In 2016, I had to manage the evacuation of Humanity & Inclusion’s teams in South Sudan following a series of deadly clashes between armed groups. It was the most trying experience of my career.
What's really important when it comes to working with your team?
Trust. Transparency. Empathy. And being able to laugh together.
Humanitarian and mother: how do you strike the right balance?
For many women, achieving this balance is a huge challenge and often prevents them from taking on more responsible positions. I’m extremely fortunate to have a supportive family and a husband who takes care of our child when I’m working. Thanks to their support, I can do the job I do. My family is my biggest incentive. They really inspire me to do better every day.
Is gender equity a challenge in the humanitarian sector?
I’ve been personally fortunate to work with male colleagues and team leaders who are advocates for women's leadership. But while many women work in the humanitarian sector, there are still too few in senior positions. Many organizations have made a lot of progress, but not enough. There is a great deal of work to do before we achieve greater equity. It’s not an easy task, because these inequalities run deep. They’ve been entrenched in cultural, social, financial and political life for generations. It’s not simply a question of empowering women and advancing their rights, but of changing corporate cultures. Men also have a role to play here. I want to see women access positions of responsibility just like men. I think we'll get there...slowly but surely.
Header image: A Filipino woman named Reiza (wearing the blue visor) and another woman carry a tub of supplies after Typhoon Goni in the Philippines. Copyright: HI
Inline image: Reiza squats down to talk with a girl who has an artificial leg at a refugee camp in Kakuma, Kenya, in 2015. Copyright: Xavier Bourgois/HI
When Covid-19 was declared a global pandemic in March 2020, Humanity & Inclusion mobilized its teams to help the most vulnerable people affected by the crisis. Providing emergency response in almost all the countries where Humanity & Inclusion works has been a major challenge, especially since its emergency teams are normally able to focus their efforts on a handful of countries or regions. Humanity & Inclusion therefore provided emergency response and adapted its routine projects to help all those in need.
As of December 2020, more than 65 million people worldwide have been infected with Covid-19 and more than 1.5 million people have died.
While the epidemic has hit Western countries extremely hard, it is also affecting many countries in Asia, the Middle East, South and Central America and Africa, which are already affected by violent conflicts, political and socio-economic crises, frequent natural disasters, and significant climate change. Thousands of people need assistance.
In response to the Covid-19 crisis, Humanity & Inclusion has:
- Provided response in 46 of the 50 countries where it works;
- Implemented more than 160 projects in aid of people affected by the Covid-19 crisis;
- Given assistance to more than 2 million people between March and August 2020 alone;
- Provided more than 1.6 million people with information on Covid-19 prevention measures;
- Distributed more than 138,000 hygiene kits containing hand sanitizer, soaps, and other items;
- Distributed more than 800,000 masks;
- Provided food to more than 6,800 vulnerable families;
- Organized thousands of psychosocial support sessions for people who feel insecure or traumatized as a result of the crisis;
- Conducted thousands of tele-rehabilitation sessions in countries where a strict lockdown has been imposed to continue providing its routine services to people in need.
Beyond its impact on health, Covid-19 has had a considerable effect on children’s education. According to a Unesco report, some 1.6 billion children and teenagers have been deprived of school education in 190 countries as a result of the pandemic. The situation is even more worrying for children with disabilities, who find it harder to access education.
This pandemic has also considerably increased poverty and food insecurity. People in 25 countries are expected to face devastating levels of hunger in the coming months due to the fallout from the Covid-19 pandemic. The number of acute food insecure people could increase from 149 million before the pandemic to 270 million.
Identifying the needs of the most vulnerable people
Humanity & Inclusion's teams and volunteers trained by the organization have identified the needs of the most vulnerable people including older people, single women with children, people with disabilities, migrant populations, and refugees. Those with the greatest needs are receiving direct assistance such as awareness sessions, distribution of hygiene kits, food assistance, cash transfers, and psychosocial support, or referrals to an organization that can offer them appropriate care, including healthcare for those infected with Covid-19.
Leading awareness-raising sessions
More than 1.6 million people affected by the pandemic have taken part in awareness sessions in villages and communities in Africa, Asia, the Middle East, South America and the Caribbean, and at home. Humanity & Inclusion has provided people with information on Covid-19, including the risk of transmission and prevention measures, through group meetings in villages, refugee camps, and the like; one-on-one sessions; and awareness campaigns based on leaflets, posters, and other materials. The organization has also aired programs on radio and TV. For example, in Nepal, Humanity & Inclusion has produced videos with subtitles and in sign language adapted to people with hearing difficulties, in partnership with the World Health Organization, which have been aired on Nepalese television.
Offering psychosocial support
Humanity & Inclusion has provided psychosocial support to people affected by the pandemic and the trauma it has caused, from economic hardships to loss of family and friends. More than 225,000 people received psychosocial support, including by telephone, from Humanity & Inclusion. The organization has also provided support to medical staff who are on the front line.
Distributing hygiene items, food, and cash
Humanity & Inclusion has distributed more than 138,000 hygiene kits composed of hand sanitizer, soaps, cleaning supplies, and the like. More than 800,000 masks have also been provided to people who need them.
In many countries, the food supply chain has been disrupted by border closures and lockdown measures. In Bolivia, especially, it is more complicated to access food in cities. Price inflation has soared and many people, who have lost their jobs, have found it more difficult to access food. Humanity & Inclusion has provided food assistance to more than 6,800 families by distributing goods, cash transfers, non-perishable foods, fresh produce from partner organizations, and so on.
Humanity & Inclusion has also identified people living in situations of extreme vulnerability, including refugees and families living in extreme poverty, and provided them with cash transfers to access basic services and meet their basic needs such as paying rent, buying food, and going to the doctor. So far, 7,565 families have received cash transfers from Humanity & Inclusion.
Transporting humanitarian supplies
The measures put in place to combat the spread of Covid-19 have entrenched humanitarian crises and made it harder to implement humanitarian aid projects. Faced with the difficulties of transporting humanitarian supplies and mobility issues caused by lockdowns, quarantines and other restrictions, Humanity & Inclusion, through its logistics department, has shifted the focus of its operations in Central African Republic, Bangladesh and Mali. News projects were also implemented in the Democratic Republic of the Congo and Haiti for the transport and shared storage of health and humanitarian equipment, the repair of airport runways and roads to isolated health centers, and the like.
Humanity & Inclusion has also mobilized three experts from the Réseau Logistique Humanitaire (RLH) to coordinate airlifts to 12 countries. More than 141,000 cubic feet of emergency supplies and 1,200 humanitarian and medical staff were transported as part of this operation.
Conducting tele-rehabilitation sessions
Humanity & Inclusion continued providing rehabilitation care to patients who need it by adapting its working methods to the Covid-19 pandemic. Where the situation allowed, physical therapists continued to provide care in rehabilitation centers in compliance with safety rules such as social distancing and mask-wearing.
In countries where lockdowns were imposed, online tele-rehabilitation sessions have enabled thousands of patients to continue doing their physical therapy exercises at home by watching videos or receiving instructions via telephone, WhatsApp, and other technology. Humanity & Inclusion has organized thousands of tele-rehabilitation sessions in Nepal, for example, and developed virtual rehabilitation apps in Rwanda and Vietnam.
Promoting safety and inclusion
Humanity & Inclusion referred more than 470 people with the greatest protection needs, such as single women, isolated children, and refugees to specialized organizations able to offer them appropriate support.
Lastly, Humanity & Inclusion’s teams trained 201 staff from partner humanitarian organizations to include the most vulnerable people such as people with disabilities, isolated women, and older people in activities organized for victims of the Covid-19 crisis. The aim is to ensure that no one is left behind.
Humanity & Inclusion has adapted its activities to the Covid-19 pandemic in Nepal, where more than 202,000 people have contracted the coronavirus (as of Nov. 11, 2020)Read more
When a couple in Jajarkot, Nepal welcomed their first baby boy, Pascal, they couldn’t have been happier. Like most new parents, they experienced their fair share of worries. When they started noticing that their baby’s feet had some kind of abnormalities, they became increasingly concerned and worried that he may never be able to walk.
Neighbors and relatives would show sympathy to Pascal’s parents. But at times, they would blame his mother for his disability, stating that it was due to something bad she may have done in her previous life.
Pascal’s parents belong to a marginalized community who make clothes as a way to earn a daily living. When Pascal was two or three months old, he caught a viral flu and was taken to the nearby health post for treatment. While there, a health worker noticed that his feet did not look like they typically would at that age, but didn’t know what exactly was wrong. With a lack of knowledge on clubfoot, the health worker hesitated for proper counseling and sent the baby home after receiving treatment for the flu. Pascal’s parents thought that his feet might self-correct as he grew.
One day, a female community health volunteer met Pascal while visiting the community. When she noticed his feet, she recalled learning about clubfoot in an early detection training provided by Humanity & Inclusion, with support from USAID.
Shortly after, she identified Pascal as having bilateral clubfoot and helped counsel his parents, sharing with them, what she had learned from her training. That was the ray of hope Pascal’s parents needed.
With her expertise, she is helping them understand the importance of early detection, and referred him to a nearby health post where the trained health worker confirmed the case to be bilateral club foot.. “Thanks to early detection training, I was provided with the knowledge about clubfoot and when identified at an early and timely matter, a child’s feet can be corrected, ensuring a better quality of life,” the trained health worker says.
The child was then referred to the specialized center for intervention.
After getting to the specialized center, Pascal’s father saw many other children with clubfoot who were also undergoing treatment. Being able to talk with other parents gave him a better understanding of clubfoot and the importance of early intervention. After six-month-old Pascal was assessed by the specialist, he was fitted with a specialized plaster cast to help move the feet into proper alignment. After his cast was removed, his parents took him home.
Recently, Pascal has been provided with a brace to help ensure that his feet don’t revert back--protocol in managing cases like Pascal’s. Frequent check ins are also important factors during the rehabilitation phase. Parents are counseled to visit the center within three months after the final session of cast has been removed.
Pascal’s parents are very grateful for the early detection training that the Humanity & Inclusion health worker and female community health volunteers participated in. The skills that she and other staff learned from the training help ensure that more children like Pascal can live full, independent lives.
Through this pilot project funded by USAID, Humanity & Inclusion trained 159 health workers and 205 female community health volunteers to detect different types of disabilities on children five years old and younger.
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.”