DFID Option lesson learn 20161108 GM-1

Rehabilitation Support Services in Earthquake Affected Districts

Lesson Learned Workshop “Need and Services gap”

PresentationMahendra Bikram Shah

Project Coordinator, HI Nepal10 Nov 2016

Kathmandu, Nepal

Plan of the Presentation :1. Need of Rehabilitation services linked to the EQ 2. Pre existing need not linked to the EQ3. Rehabilitation Units development in District Hospital 4. Need derived from project achievement5. Need derived from growing burden of non-communicable

diseases (NCDs), the rising prevalence of disability and changing global population demographics

6. Need derived from Nepali Policies7. Integration of Rehabilitation services in the Health System8. Ways forward to develop and sustain rehabilitations services

1. Need of Rehabilitation services linked to the EQ

Estimation : 1,500 - 2,000 earthquake injured (EQI) will need ongoing nursing and rehabilitation support and will continue to have long-term rehabilitation needs.

But no rehabilitation services in Health System (no specific policy in MoH).

Setting up of rehabilitation centers planned in the Recovery and reconstruction Plan

2. Pre existing need not linked to the EQ

1.94% (N= 513321 ) of people with disability36%(N= 186457) of the total disabled is comprised with people with physical disabilities

83.8% service gap in medical rehabilitation

72.5% service gap in assistive device service

2. Pre existing need not linked to the EQ

Injuries due to RTA from 2008 to 2013 were more than injuries caused by earthquake. Accidents accounts for 8.3% of the total cause for disability in Nepal

New rehabilitation services in the District Hospital would address the need of Earthquake affected (EQA) people not directly injured during the disaster

3. Rehabilitation Units development in District Hospitals

An activity under rehabilitation plans made by Leprosy Control Division


4,617 clients including : - 1,127 EQI- 3290 EQA were provided rehabilitation and social protection support between Sep 2015 to July 2016

High unmet need of Rehab services in District hospitals


3,020 clients were treated in hospital of which 381 were earthquake injured

1,597 clients were treated in community of which 746 were earthquake Injured (EQI)


7,195 treatment sessions were provided along with 2,578 follow-up sessions

552 assistive devices were delivered to clients


4,428 Clients and 1,428 caregivers were oriented on rehabilitation


54%46%

Gender distribution of benefi-ciaries

FemaleMale

0-5 5-18 18-60 ≥60 0%

10%20%30%40%50%60%70%

2%11%

66%

21%

Distribution of beneficiaries according to age group

Charikot

Nuwakot

NTC

Chautara

Rasuwa

Jiri

Dhading

0% 5% 10% 15% 20% 25%

22%

22%

16%

14%

11%

9%

6%

Distribution of beneficiaries according to PT unit

n = 4617


Other Orthopaedic Conditions

Fracture

Cerebral Palsy & Other Paralytic Syndromes

Head Injury

Respiratory Problems

Spinal Cord Injury

Other Disabilities

Amputation

Others

0% 10% 20% 30% 40% 50% 60% 70%

62.8%

24.6%

2.1%

1.4%

1.3%

1.3%

1.3%

1.0%

4.1%

Type of Diagnosis/Impairment of Beneficiaries

4. Need derived from project achievement

According WHO DAS, 837 patients (296 EQI and 541 EQA) need long term rehabilitation care

4. Need derived from project achievement

0-5 5-18 18-60 ≥60 0%

10%20%30%40%50%60%70%

2%11%

66%

21%

Distribution of beneficiaries according to age group

38.3% and 33.6% of the disability causes due to diseases and congenital

The most (50.6%) of disability onset between 0 – 10 years

Need more time to focus on Children with Disabilities issues

5. Need derived from growing burden of non-communicable diseases (NCDs), the rising prevalence of disability and changing global population demographics

5. Need derived from growing burden of non-communicable diseases (NCDs), the rising prevalence of disability and changing global population demographics

People over 60 years of age already outnumber children under 5, with the fastest growth of the number of older persons occurring in Low and Medium Incomes Countries.The age structure of Nepal is changing in the same pattern. The proportion of the population 65 years and older will rise from 4.2%, in 2000, to 5.8% in 2025. The World Bank, South Asia Human Development, Health Nutrition, and Population. NCDs policy brief, Nepal, 2011.

6. Need derived from Nepali PoliciesPolicies of MoH related to the rehabilitation services and disability :• NHSS 2016-2021 mentioned physiotherapy in basic health package• 10 years action plan on Prevention and Rehabilitation of Didability is

under finalization• National childhood disability management and rehabilitation

strategy 2063 clearly appeals for the rehabilitation for children with disability

• Birth defect surveillance, prevention and control plan (2015 19) ‐ has rehabilitation as one of the intervention

• Prolapse uterus management guideline and national training manual defines the importance of physiotherapy exercises

• Nepal Health policy 2070 assures health service to people with disability

6. Need derived from Nepali PoliciesOther Nepal Policies on Rehabilitation :• Constitution of Nepal assures to ensure health right for

people with disability • National Policy and Plan of Action on Disability of the MWCSW

with a Health component

Need Integration of Rehabilitation services in Health System to implement those policies

7. Integration of Rehabilitation services in the Health System

HPs, PHCC & CHU

Prevention and detection• Birth defect • Disability due to NCD,s and due to Elderly• Childhood disability and Motherhood disability Long term follow up in collaboration with second level

District hospital

Assessment and CareLong term follow up in collaboration with first level and the third level

Tertiary hospital & Rehabilitation centres

Specialized care

Referral mechanism

Referral mechanism

• Allocate funding in health for disability and rehabilitation at all tiers: look at links with current health programmes ( MCH, NCDs) and implement a disability and rehabilitation-specific policy

• Utilize available human resources in rehabilitation in health system (1780 PTs trained in Nepal)

• Define public private partnerships with CBOs operated rehabilitation centre

• Coordination interdepartmental/interministerial for integrated care of impairments and to address disability issues

• Engage disable people organizations at all levels and CBR programmes • Seek support from non-state actors expert at this area

8. Ways forward to develop and sustain rehabilitations services

DFID Option lesson learn 20161108 GM-1

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