NLR Nepal works together with Local Government to implement a package program called “Inclusive Development" aimed at holistic development in communities ultimately contributing to the well-being of people with disabilities due to leprosy. Clear instructions and conclusions presented from external evaluation of “Our Villages the model villages” in December 2017, has inspired replication of this package program not only in different Municipalities of Nepal but also in other NLR supported countries such as India, Indonesia, Brazil & Mozambique.
Applying a twin track approach, Inclusive Development consists of safeguarding that all marginalized and excluded groups (such as disabilities, gender, age, ethnicity, poverty) are stakeholders in development processes and at the same time ensures significant improvement in policy and practice so that the contributions of all stakeholders – including marginalized groups – in addressing mainstream development agendas are incorporated. It promotes transparency and accountability, and enhances development cooperation outcomes through collaboration between civil society, governments, I/NGOs and private sector actors.
This programme includes 7 components: Disability Prevention, Disability Management, Disability Inclusive Development, Leprosy Prevention, Leprosy Control, Comprehensive Water Sanitation and Hygiene and Organizational Strengthening of committees, disabled people’s organizations, and NGOs.
Disability Prevention: Inspire to Care (I2C) Project
Since 2015 NLR Nepal entered in a joint 5- year project ‘Inspire2Care’ with Karuna Foundation and Liliane Foundation in the area of disability prevention and Community Based Rehabilitation (CBR) for children and adults with disability. Inspire2Care is a program that focuses on prevention of disabilities (birth defects and secondary prevention) and Community Based Rehabilitation of children and adults with disabilities placing families in center. The former focuses on activities concerning improvement of maternal and child health i.e. promotion of registration of pregnancy in health institution, pregnancy care including nutrition, immunization and regular antenatal checkup, delivery planning and institutional delivery, awareness activities, screening at Early ChilDPHOod Development (ECD) centers and primary school etc. The later emphasizes on identifying children and adults with disabilities with their detail assessment and develop individual rehabilitation plan to provide intervention as per the plan for each child or adult based on the individual assessment. The plan sets out the social, medical and educational goals of each person with disability and entails ways to achieve the goals.
Objectives of the program:
• To decrease number of birth defects and developing disabilities by strengthening existing health system and educating communities with deepened focus to vulnerable groups
• To improve quality of life of children and adults with disabilities and their families
• To decrease violence against children at home, school and community
• To strengthen community support system to make local community capable to run the program continuously.
Components of Inspire2Careprogram:
There are four major components of Inspire2Care program to attain the above mentioned objectives of the organization.
• Disability prevention: awareness raising, quality and access to maternal and child health care through strengthening the Primary Healthcare services, and improved accountability and patient friendliness of health workers (ToP).
• Community Based Rehabilitation: Community Based Rehabilitation according to the WHO CBR Matrix: Health, Education, Livelihood, Social and Empowerment.
• Child Protection: Prevention of violence against children at home, school and community fall under the component. Measures include positive discipline, skillful parenting, among others.
• Strengthen community support system: Program supports to the community to strengthen their capacity and local structure. Different types of training, Inclusive planning, monitoring, review, exposure are the activities of this component.
NLR has been working in Nepal since the past 40 years with disability as one of the major issues. In the beginning NLR was engaged with disabilities caused by leprosy. Over the years. NLR has played a pivotal role in mainstreaming disabilities due to leprosy to general disability and linking general disability to overall development agenda. NLR has executed disability several inclusive development projects in the eastern and western development regions of Nepal reaching out to the total population of 8364072 (population of Eastern and Far western Development region, as per census 2011). Disability issues integrated into the overall development agenda as per the spirit of MDGs (Millennium Development Goals) and SDGs (Sustainable Development Goals) have availed intended results in the projects operated by NLR. NLR’s strong advocacy and lobbying to Government agencies for allocation of resources and taking of ownership of the program have always been instrumental in the campaign for disability rights. NLR’s experiences also reveal that rather than a solitary issue, the issue of disability when integrated and linked with other issues of development cast better results and yield success.
Expected Outcomes of Disability Management program are
• Improvement in the severity of disability
• Capacity building of persons with disability
• Changed perception of family members towards persons with disability
• Actual information collection of persons with disability
• Develop right based approach and modality
• Facilitation in formulation of local level Pan of Action
Disability Inclusive Development
The project envisions to create disability friendly model villages where communities, government agencies, and other relevant stakeholders through intensive discussions, each becomes responsible and accountable towards fulfilling the rights of persons with disabilities as provisioned in laws, policies and programs.
The main goal of the program is to enable persons with disabilities to enjoy equal rights, equal opportunities and barrier free environment which is adapted to fit the needs of people with disabilities for their independence, convenience and safety. This also involved integrating persons with disabilities into society so that they take an active part as development contributor in their societies and lead a normal life.
Expected Outcomes of this program are:
• Change in social perception towards disabilities
• Formulation of inclusive plan in local level and by stakeholders
• Human differences will be respected and ends discrimination
• Ensure equal rights and opportunities for everyone
• Policy Implementation and fully turn it in practice
• Ownership and representation of all deprived communities in developmental programs being conducted in local level
• Disability issues will be addressed in each step of development process
• Reconstruction of infrastructure to become more accessible and user friendly
• Create a basis on Inclusive Development
Leprosy Prevention and Control
Leprosy and other NTDs thrive under conditions of poverty, they tend to cluster where housing is substandard, drinking water is unsafe, sanitation is poor (“Leave no one out,” 2010), access to health care is limited or non-existent, and there are insect vectors. 1/3rd of people affected by leprosy attedning the TLMN clinic tested positive for helminths signalling that their access to clean water services was very limited and their immune system compromised.
According to studies on leprosy, cleanliness and hygiene prevent the spread of leprosy and other NTDs. All people lacking WASH facilities, and particularly those affected by leprosy are likely to have a lower immune system. Research on leprosy affected people seeking treatment at TLMN clinics revealed that 54 % out of 148 tested positive with helminths (a parasitic worm), showing that PAL need quality WASH services. Improved hygiene through behavior change and skin care for self-care is an essential focus for managing Leprosy and NTDs. PAL need to do self-care to clean their wounds and ulcers, therefore, clean water and accessible WASH facilities are mandatory. This will decrease the risk of infection, prevent further disability and reduce the time for healing. WASH plays a crucial role in the fight against leprosy and NTDs.
National Federation of the Disabled
Nepal (NFDN) and District Health office (DHO)
Model work Municipalities for Inclusive Development
Provincial Leprosy Referral Centre (PLRC)