Sundari, 11, has an intellectual disability that creates memory and learning difficulties. With the support of Humanity & Inclusion in Nepal, she’s enrolled in a class adapted to her needs.

A fifth grader, Sundari lives in a dormitory at the school, which is more than 60 miles away from her home. Her favorite subject is science. She recently made a presentation to her classmates in which she drew an animal cell on the whiteboard and talked about its different parts.

“I want to become a doctor one day to save people’s lives and help the elderly,” Sundari explains.

Sundari spends most of her time with her best friend, Bipana. Together, they play Ludo, a strategy board game that is Sundari’s favorite.

"Sundari is very open and friendly,” Bipana says. “She sometimes gets angry, but I can calm her down really quickly."

Inclusive education resources

The resource class in Sundari’s school caters to 30 students with disabilities. Children learn the Nepali and English alphabets, numbers, words, body parts, as well as hygiene and self-care. When they’re ready, students join their classmates for inclusive lessons.

“Sundari was enrolled in the resource class – a class where children with intellectual disabilities study together - when she was 5 years old,” explains her teacher, Bhupendra Khadka. “She was enrolled during her early childhood development years and has since progressed to mainstream classes. She is now second in her class.”

Children in resources classes range in age from 7 to 17, with some even in their 20s. Like Sundari, some transition to mainstream classes after a few years in a resource class.

Over the past four years, the school’s resource class has been supported by Humanity & Inclusion and its local partner HUSADEC (Human Rights, Social Awareness and Development Center). Resource classes welcome children with a range of disabilities, including sensory and intellectual disabilities.

Only 380 of Nepal's 30,000 schools have resource classes, and Humanity & Inclusion supports a 50 of them. Teams provide educational materials adapted to the needs of children with disabilities, including braille books or sign language learning mobile applications. Other support materials include foam letters, word cards, toy balls, storybooks in local languages and stationery. Educators are also trained to adapt their teaching methods to the needs of children with disabilities.

Last school year, Humanity & Inclusion also provided hygiene kits and school bags to 500 students with disabilities in 46 resource classes across 10 districts to help them continue to learn during the Covid-19 pandemic.

Promoting disability inclusion

Uttam Prasad Bhattarai, the headmaster of Sundari’s school, explains that in rural villages, acceptance of children with disabilities can be challenging.

“There is a social stigma associated with disability,” Bhattarai says. “When children with disabilities, especially intellectual disabilities, enter a mainstream class after their entrance examination, some parents of children without disabilities are reluctant to send their children to the school. Children with disabilities tend to enroll in school at later ages than their peers and so they are older than their classmates."

Humanity & Inclusion and its local partners continue to fight for access to education for children with disabilities.

The resource classes have been supported by Humanity & Inclusion and its local partner since May 2018 as part of the Reading for All program, which is made possible by the generous support of the American people through the United States Agency for International Development (USAID).

Nisha Rai and Reshma Shrestha agree that love and patience are essential in understanding and supporting the learning needs of children with disabilities. The two women work as learning facilitators for the USAID-funded Reading for All program in Nepal.

Rai, who has a master's degree in social science, learned about the vacancy of a learning facilitator in Dhankuta from her brother when she was looking to start her career. So, she applied and began working in April 2021 to support children with intellectual disabilities in the resource classroom.

Rai, pictured above, completed a brief orientation provided by Reading For All staff on the types of disabilities and children she would support. Rai explains that she never had any friends, neighbors or family members living with a disability, so the training she received about disability, functional limitations, learning materials, and behavioral skills have made it easier for her to support the students.

"Initially, I was not sure if I would be able to continue to support the children with intellectual disability, but eventually I have learned to engage with them and love my work," Rai says.

Rai works regularly at the Shree Aadharbhut School's Intellectual Resource Class, where she engages with children using functional toys like balls and sponge letters, as well as electronic tablets. She is proud to see the children welcoming her with smiling faces and gestures every day. 

Similar to Rai, Shrestha is a learning facilitator in the Bhaktapur district. She supports children who are blind or have low vision in their studies and beams when describing the value she has found in working with children. Shrestha’s desire to better assist students with low vision motivated her to learn basic braille.

Before becoming a learning facilitator, Shrestha’s experience working with people with disabilities was limited to an internship at a community-based rehabilitation organization. In April 2021, she joined the Reading For All program with the goal of bringing positive change to the lives of children with disabilities.

Shrestha’s loving and caring nature has helped her quickly bond with children and build trust with students’ family members.

Sanju Adhikari, a Reading For All learning facilitator, supports a student who has a disability at a school in Dhankuta.

Barriers to inclusive education

Children with disabilities face challenging barriers to education. Nearly 50% of children with disabilities do not attend school. For every child to learn and develop the skills they need to succeed, they need an inclusive education. According to a study by Humanity & Inclusion, 83% of parents and caregivers of children with disabilities worried that their children would fall further behind in school because of Covid-19.

During the pandemic, the Reading For All program supported 35 resource classrooms with 62 learning facilitators, like Rai and Shrestha, to bridge the learning. Most of the learning facilitators were newly introduced to disability-inclusive education and are continuing careers in the field. These learning facilitators supported children by developing individualized education plans.

“In order to ensure we Leave No One Behind and to meet SDG4, inclusive education goes beyond enrollment in the classroom and requires trained teachers, adequate learning resources, adapted school infrastructure, and engaged parents,” adds Sanju Nepali, Inclusive Education Specialist for Humanity & Inclusion in Nepal.

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In the Democratic Republic of the Congo, Humanity & Inclusion is working alongside local farmers to help communities cope with the threat of a food crisis.

More than 35% of the population in the Kasaï-Central province in the Democratic Republic of Congo is severely food insecure, leading to increasing levels of malnutrition. Action Against Hunger, Humanity & Inclusion and other partners are implementing agricultural recovery and food aid activities, funded by USAID, in the Dibaya area that will reach more than 32,500 people.

In March 2022, Humanity & Inclusion distributed vegetable growing kits to 4,700 households. These kits contained a spade, hoes, a rake, a watering can and seeds for vegetables including cabbage, okra, eggplant and tomato.

Supported by state technical services, Humanity & Inclusion teams have trained 63 “relay” farmers in vegetable-growing practices. The training is designed to strengthen the farmers’ skills while teaching them eco-friendly farming techniques, such as growing crops without the use of chemical pesticides and producing natural fertilizer. These farmers then relay their newly acquired knowledge to their communities, transferring their skills to more people.

Agnès Nkaya, pictured above, lives in Kabenguelé and completed the training.

“This is the first time we have had this kind of training in the village,” she explains. “It’s very useful because we have problems making our farmland fertile enough, and protecting our crops from pests and diseases. As part of the training, the Humanity & Inclusion teams taught us how to prepare a vegetable garden, how to recognize soil suitable for vegetable production, how to make the beds and how to plant the seeds.”

One goal of this training is to make agricultural activities sustainable by encouraging the use of fertilizer made from locally available products, such as plant debris, ash and manure.

“For me, the most interesting module was the one on natural fertilizers, especially the 7-day compost,” Nkaya continues. “This is the kind of knowledge we are looking for to improve our practices and production. We have all the raw materials we need in our villages, but, until now, we didn't know how to use them. Thanks to this training, I won’t have problems with my production anymore because I’ll make my own natural fertilizers."

Nkaya looks forward to sharing these new techniques with her neighbors.

“I’m well-equipped now and ready to pass on what I’ve learned to other people in my village,” Nkaya adds. “This will also be an opportunity for me to improve my own grasp of these techniques. As well as sharing knowledge with us, Humanity & Inclusion has provided us with equipment—waterproofs, rubber boots, rope and logbooks—to help us when we train other people. I will make good use of it!"

GREEN Initiative: Humanity & Inclusion is committed to reducing the adverse effects of climate change on populations worldwide. We help communities prepare for and adapt to climate shocks and stresses, and we respond to crises magnified by environmental factors. Applying a disability, gender and age (DGA) inclusion lens across all our actions, we advocate for practitioners and policy-makers to embed DGA in their climate work as well. Humanity & Inclusion is also determined to reduce its own ecological footprint by adapting and implementing environmentally conscious approaches to humanitarian action.

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Humanity & Inclusion recently organized a consortium project review and planning for the USAID-funded “Reading for All-R4A” Program in Nepal with its colleagues from USAID Nepal, World Education and 10 other partners.

The consortium celebrated the outstanding performance of the inclusive education project, and discussed the challenges faced by the project participants, partners, and key stakeholders to better plan for the future: centering solutions to strengthen the government education system that support children with disabilities inside and outside the classrooms. The partners also developed a comprehensive implementation plan for the next six months of the project.

Achievements include:

• 5,071 head teachers and database focal persons from 3,094 schools trained on Early Screening and Integrated Educational Management Information System (EMIS).
• 103,268 children from early child development (ECD) to grade three completed early screening interventions at schools that identifies functional challenges of screened children and makes them available via a central EMIS sub-system managed by Center for Education and Human Resource Development.
• 86 learning facilitators trained to help children with disabilities through remedial and outreach learning support.
• 360 students received support by learning facilitators.
• 186 digital learning tablets and 892 hygiene kits distributed to children with disabilities.
• 8,544 sets of supplementary teaching-learning materials provided to 257 schools from four core municipalities, and to 46 resource classes in 10 districts.
• 9 Inclusive Education training packages designed and tested to ensure long-term intervention for children with disabilities.

“Happy to see all the progress made and great teamwork over the past few months- you all should be proud of your achievement,” said USAID Nepal’s Laura Parrott in her reflection note during the event. “We must continue the spirit and focus on the quality of interventions, working together to bring the change in children’s reading outcome.”

“As we have completed our strategic interventions, which often took longer time to coordinate with the authorities than we had anticipated, and entered at the full swing with field intervention in the schools and communities, we will achieve all target and objectives on time,” said Khindra Adhikari of HUSADEC, a local partner of Humanity & Inclusion for implementing the program in the district of Dhankuta.

“The leveling interventions of past six months helped the project to clear a huge backlog of the past few years. Now, we are in a comfortable position to plan our targets for next six months,” summarized Govind Phulara, Project Coordinator, at DEC-Nepal, Banke.

“The program has reached this milestone due to every single effort made by the members of the R4A consortium,” acknowledged Shaurabh Sharma, Chief of Party for the program. “For example, 94% of planned financial resources used, 48% of total revised project target of screening children performed using an early screening tool for the review period because of the excellent planning and execution.”

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Humanity & Inclusion’s Telerehabilitation Project Manager, Martin Jacobs, answers common questions about a new telerehabilitation software developed by the organization and being launched in Vietnam.

Q: What inspired Humanity & Inclusion to develop OpenTeleRehab?

OpenTeleRehab was inspired by the need to improve access to rehabilitation services in communities and strengthen discharge procedures. Many people have the mindset that there are rehabilitation professionals just around the corner at any given time, and that these services are easy to access. We need to realize that the context is different in different countries. People often need to travel to receive care. It’s costly for them to spend the money to travel, to pay for their consultation, and they miss out on earning income while they’re away from work.

The software aims to avoid multiple trips back and forth, increase our capacity to provide services over a distance, and increase the ability to follow-up with patients. We have seen how useful telerehabilitation can be in situations like the Covid-19 pandemic, where physical services are closed, or in emergency settings where rehabilitation needs surge and hospitals must quickly discharge patients without a way to follow-up afterward. With OpenTeleRehab, access can be improved because it reduces some of the current barriers to rehabilitation services.

Q: How is telerehabilitation software different from simply watching online videos or using internet resources?

It is important to rely on the expertise of rehabilitation professionals, who are trained to design individual treatment plans for optimal functioning. This helps prevent the possibility of further damage, which could be caused by following inappropriate practices or advice we may find online. Following a treatment plan remotely does not mean you are on your own. With OpenTeleRehab, even while you are remote, you are getting individualized care that is designed and adapted for you by a professional. Plus, users receive regular follow-up from their providers. Humanity & Inclusion’s approach is not only to facilitate service delivery, but to provide quality services. Our ‘Do No Harm’ mandate would not be fully respected if we allowed people to self-provide rehabilitation services.

Q: How will people use the software?

In upper-low and middle-income countries, actually a large portion of the population has access to smartphones. For example, I was surprised to see how many people in rural parts of Vietnam actually have smartphones and how common internet connection is. In some countries, this may be less true, but we can rely on hybrid approaches where we have tablets in local health community centers or schools, for example. This means people will not need to have a device at home, and rehabilitation professionals will not have to travel all the way to the community.

OpenTeleRehab is specifically designed to use very little data and allow access to content even when offline, so it is ideal for low-connectivity settings or contexts where internet may come and go. Reports show that internet access is increasing every year, so it will become even more relevant for more regions over time. 

Q: What inclusive considerations were taken in designing the software?

OpenTeleRehab is patient-centered and has been designed for a wide range of users. The patient mobile app is really simple to use. Users will land on a homepage and it will immediately tell them what to do. There is also a child-friendly version, made specifically for younger users. We followed web content accessibility guidelines to ensure that the software is accessible to users of differing abilities, and we selected what we believed were the most relevant accessibility features for users. One of these is the ability to read the exercises aloud, for users with low vision.

We have also designed OpenTeleRehab to be culturally appropriate. After monitoring other software in various countries, we found that the illustrations were rarely appropriate or representative of the users. Our illustrations are gender-balanced, mostly age-neutral (with the exception of infants), and wearing loose-fitted, full coverage clothing.

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Humanity & Inclusion has launched OpenTeleRehab, a new innovative software specifically designed by its experts to provide quality rehabilitation services for isolated populations. The software opens first in Vietnam, with plans to expand to other countries.

In Vietnam, more than 64% of the population live in rural areas, significantly limiting access to rehabilitation care. This is particularly true for people with disabilities for whom traveling long distances can be challenging. There are fewer than one physical therapist per 10,000 people in Vietnam, and only 2% of Vietnamese children receive rehabilitation care when needed.

By contrast, 80% of the population uses a smartphone and 4G coverage is at 95%. Even families with low incomes typically have access to a mobile device. With its background in innovative humanitarian response and rehabilitation expertise, Humanity & Inclusion designed the OpenTeleRehab software as an adaptive solution to ensure both access to and quality of care for patients who need rehabilitation.

The software with developed in partnership with hospitals in Vietnam and JAMK University. Its development was funded by USAID and the Botnar Foundation.

Custom care, accessible to all

“The application will provide remote rehabilitation services, increasing access to care in contexts where the rehabilitation workforce is limited,” says Martin Jacobs, Humanity & Inclusion rehabilitation technical advisor and OpenTeleRehab project manager. “Patients are taught in service by their therapist how to use the patient mobile application, then, once they are home, they can access their custom treatment plan by smartphone. The treatment plan can include exercises, information, educational material and questionnaires. Therapists can organize regular follow-up audio or video calls and track patient progress and adherence to the plan.” Read a full Q&A with Jacobs about this software launch.

OpenTeleRehab aims to increase access to rehabilitation services by strengthening hospital discharge, transition of care and community-based follow-up. It should help prevent repeat hospital stays for people with long-term needs, lower patient costs, optimize functioning and reduce obstacles for individuals with disabilities in central Vietnam. Its offline features ensure that it can easily be used in contexts with limited internet access, and a child-friendly version of the patient mobile app increases engagement among young users.

Implementation and next steps

The initial OpenTeleRehab launch will be piloted in two provinces of Vietnam, serving 550 direct patients and their families. Tablets will be distributed to families if they are unable to access a mobile device. After its initial release, Humanity & Inclusion plans to further develop its services and eventually expand its use.

“The next steps will be to increase the number of exercises in the library, and to translate it to different languages,” Jacobs explains. “We will then be able to deploy the software in different countries and different contexts.”

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In the Central African Republic, persistent armed conflict and annual flooding have caused mass internal displacement and food insecurity. As humanitarian access remains limited, Humanity & Inclusion is delivering goods to isolated areas by boat.

An estimated 1.4 million people—representing almost one-third of the country’s entire population—have been displaced by ongoing conflict. Over 2 million people are facing severe food insecurity due to a lack of safety, which is only expected to worsen in the lean season when less food is produced. Under constant threat of danger, civilians are forced to go without basic needs such as food, medicine and hygiene items to avoid risking their lives.

‘Access is one of our greatest concerns’

“A massive humanitarian crisis is growing and we have to prepare for it,” says Yamina Issad, Humanity & Inclusion’s operations officer for the Central African Republic. “As soon as conflict arises, all humanitarian access is completely blocked. There is only one route that connects Bambari to Bangasou, and it is now inaccessible. This isolates the population in those areas and worsens the hardships people are already experiencing. Right now, access is one of our greatest concerns.”

To overcome inaccessibility by road, Humanity & Inclusion has begun shipping goods such as fuel, building materials, oil and essential non-food items by boat along high-water rivers during the rainy season.  

“Access to communities along the river is particularly difficult by road,” explains Damien Volland, Humanity & Inclusion’s head of logistics and transport. “There is a lack of security and damaged infrastructure, which is accentuated during the rainy season. But, when the water is high, boats are easier to navigate. Transport by boat on the Oubangui River allows us to bypass these obstacles and reach more populations in need of humanitarian assistance.”

Delivering tons of aid

For years, local organizations have used boats to transport goods during rainy season, but the method is rarely used among international NGOs. Humanity & Inclusion’s logistics team is able to deliver between 50 and 60 tons of humanitarian goods per boat for partner organizations such as Solidarités International, ACTED and Action Against Hunger to reach people in some of the most isolated parts of the country.

These activities are funded in part by USAID's Bureau for Humanitarian Assistance and are carried out in partnership with Premiere Urgence Internationale.

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After the 2010 earthquake introduced her to the field, Humanity & Inclusion rehabilitation graduate Guetchly-Nise now finds herself treating those affected by the most recent disaster.

This week, Humanity & Inclusion teams in Haiti are training physical therapists and rehabilitation specialists in emergency rehabilitation to reinforce overwhelmed medical centers in Les Cayes. On Wednesday, one of the new recruits, Guetchly-Nise, started her first day responding to those who were injured in the earthquake. 

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.

History

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:

1. Governance and leadership
2. Health and rehabilitation human resources
3. Rehabilitation information system development
4. Medical and product technologies, including assistive products
5. Finance, including health insurance and budgeting rehabilitation activities
6. 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.”