Nepal

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In Nepal, Handicap International works on disability issues at three complementary levels:

1. At beneficiary level (disabled people): reinforcement of specialised services (e.g.: orthopaedic workshops) in order to improve the quality and availability of services provided to patients
2. At community level (families, associations, social workers): awareness-raising, training and assistance for prevention of disability and changing of people’s attitude towards disabled people
3. At national level (government, administrations, national structures): promotion of basic rights for disabled people, improvement of the population’s knowledge about disability-related issues and advocating for rights and inclusion of disabled people.

CONTEXT
Nepal is a land-locked country that lies between China and India and stretches 800 km from east to west and 90 to 230 km from north to south.  With a population of 25 million inhabitants, this is one of the poorest countries in the world. While income per capita is around $240 per year (1), 42% of the population live under the national poverty line (2) with the great majority living in rural areas where conditions are extremely harsh. 

Nepal has experienced serious political instability with frequent changes of government. In addition, the Maoist conflict, which has claimed over 12,000 lives to date, has hampered economic development. Recent events however, have changed the political landscape giving hope for long-term stability and development. The current monarch, who had assumed executive powers at the beginning of 2005, capitulated in April 2006 after mass public protests demanding democracy and the restoration of parliament. A serious peace process has been initiated and a ceasefire has been called. There are plans to form an interim government that will include Maoists soon to be followed by elections for the Constituent Assembly.  

Disabled people remain one of the most vulnerable and marginalized groups in Nepal. They are faced with the challenge of being disabled in a country where poverty rates are extremely high and where access to essential and specialised rehabilitation services is extremely limited.  Along with this, there are many negative religious and cultural beliefs that lead to considerable discrimination towards people with disabilities who are often isolated and rejected from their communities. For many, access to health and social services as well as educational and economic opportunities is not a reality. 

BACKGROUND
1996: Start of a regional project “India, Nepal, Bangladesh” to share expertise in the field of disability and development, based in Kathmandu.
2000: Opening of Handicap International office in Nepal.
2001: Start up of activities in 12 districts by providing support to 40 development organizations in disability-related issues, for example, awareness about disability in the community, and integration and inclusion of disabled people in the development process.
2004: Continuation of current activities and exploration of potential activities in the fields of disability prevention, physical and social rehabilitation, support to war victims, mine risk education, inter alia.
2005: Start of a new project entitled ‘Access to Physical Rehabilitation Services for Disabled People affected by the Conflict in Nepal’. The project aims to reduce the vulnerability and isolation of disabled people by ensuring they have access to quality rehabilitation services.
2006: Phase II of the Rehabilitation Project is launched with plans to open a new rehabilitation centre in the far western region of Nepal as well as two new satellite units in the conflict affected hilly areas. A new rights-based approach project ‘Empowerment and Social Change for Inclusion of People with Disabilities in Nepal’ is developed; fundraising for this exciting project is ongoing. A study of Community Based Rehabilitation activities and projects in Nepal will be conducted at the request of the Government. This study will provide recommendations on future governmental policies, the recognition of a legal career path for rehabilitation community workers and the creation of a centralised information system.

ACTIVITIES
All our activities are implemented in partnership with national development organisations. Three projects are presently being implemented.

1. Access to rehabilitation services for disabled people affected by the conflict in Nepal

• Global support to rehabilitation centres: At present, the rehabilitation project is supporting four rehabilitation centres and one satellite unit in the production of orthopaedic and assistive devices and the provision of physiotherapy treatment. The centres also offer follow-up, social counselling as well as a repair service for appliances. They are based all throughout Nepal.
• Improved access to rehabilitation services: Mobile camps and the presence of field workers who identify and refer clients to the centre ensure a decentralized approach. Economic support is also provided to the most destitute to allow them full access to rehabilitation services. 
  

2. Small-scale actions in continuation of efforts initiated through the Community Approach to Handicap in Development (CAHD) project

• Physical rehabilitation of people with disabilities
• Awareness-raising about disability-related issues within the community
• Promotion of the “Rights and inclusion” concept in order to improve the integration and rights of people with disabilities.
• Reinforcement of Nepali partner organisations (development or training organisations, governmental agencies, disabled people organisations, etc.) through technical training, continuous support and capacity building

3. Provision of specialised services

• Development of adapted orthopaedic devices (local components, innovative construction methods) through support to and technical training of local organisations.
• Improve accessibility of specialised services to the patients through decentralisation, networking, mobile camps, referral systems and patients transportation, etc.

BENEFICIARIES (2005/2006)

• Over 4,000 people received physiotherapy.
• Almost 40,000 rehabilitation therapy sessions were provided to disabled people in their own homes.
• 1,486 orthopaedic devices were produced (including prostheses, orthoses and mobility aids).
• Over 37,000 people attended 1,451 social communication events raising awareness on disability issues, rights, mainstreaming and prevention of disability.
• 456 disabled children were integrated into schools or non formal education.
• 165 disabled children were integrated into child clubs.
• 130 disabled people received vocational training, while 248 were included in savings/credit groups.
• Handicap International leads, trains and provides support to a network of 47 local NGOs, 2 training organisations, 2 governmental agencies and 4 disabled people’s organisations, with the assistance of 5 major international development NGOs.

CONTACTS
Jean-Bertrand Lebrun, field programme director
Tel: + 977 1 4371845
E-mail: director@hi-nepal.org

(1) Nepal Country Assistance Strategy, The World Bank, November 2003, Annex 2.
(2) Human Development Report 2005, UNDP, New York, 2005.  The report also notes that 37.7% of the population live under US$ 1 per day while 82.5% live under US$ 2 per day.