Handicap International – Nepal Programme © Éric Martin / Le Figaro / Handicap International Study on Sustainability in the Physical Rehabilitation Sector: Nepal Perspective Nepal, January 2013 Raju Palanchoke

Outline of the presentation Context Nepal’s participation in the research How the research helped/contributed in strengthening the physical rehabilitation services in Nepal What was learned Constraining factors Enabling factors Conclusion

Key Stakeholders of the PR Sector in Nepal Government of Nepal : – 5 Ministries involved 13+ Service Providers : – 3 centres are managed by Government – 4 centres managed by local NGOs – 2 centres by private organizations – 4 centres by hospitals Professional Associations Disabled People Organizations : – National Federation of Disabled Nepal – NFDN – Nepal Association of Physical Disabled -NAPD International stakeholders Funding agencies

Nepal’s participation in the research Initial field trip by a Searcher from LSHTM workshop was organised by LSHTM and HI Assessment of physical rehabilitation sector organised by consultants 2nd workshop was jointly organised by LSHTM and HI to follow-up progress

How the research helped/contributed An increased the understanding of rehabilitation among actors Underliend the requirement of common vision for sustainability of rehabilitation services. The sectorial concept for physical rehabilitation has been emerging with increasing interactions among service providers, DPOs and government authorities. Support to NASPIR (National Association of Service Providers in Rehabilitation) for the development of National Strategic Direction on the Physical Rehabilitation Sector. Opening the avenue with authorities (MOWCSW, MOHP, MOPR and NPC) for financing the rehabilitation services.

What was learned Developing a common vision amongst the actors for the rehabilitation sector is a first step towards the building of sustainability in the sector Maintaining regular communication and interaction with the Government authorities remains essential to promote decisions on policies and resource allocation for the physical rehabilitation services. The sustainability indicators that were jointly defined during the sustainability study in 2010 and 2012 can be promoted as a part of the progress monitoring tools of the rehabilitation sector.

Constraining factors Three Government authorities (MWCSW, MOPR, MOHP) have emerged as the key public actors for disability rehabilitation. However, the multiplicity of public actors in the rehabilitation sector appears more as a constraint than as a support due to absence of a coherent vision and leading authority for the sector in Nepal. Frequent turnover of government officials, resulting in the lack of institutional memory and the need to restart coordination from the beginning, impacts making decisions for rehabilitation policies/programmes. There is as yet no comprehensive updated data on disability as well as on rehabilitation service provisions in Nepal.

Enabling factors In Nepal, the sectorial concept for physical rehabilitation is new, however, rapidly evolving. Increasing interest of the national public authorities in the physical rehabilitation services: –MWCSW, the main line-ministry for disability, has committed to earmark funds for 3 rehabilitation centres –The MOPR has funded NDF rehabilitation centre for the rehabilitation of the conflict victims –The MOHP, appearing as a new actor, has recently allocated some funds for the provision of physical rehabilitation services. Nepal, being a state party of the UN CRPD, is developing endeavors to meet the obligations of CRPD; including provision of rehabilitation services to persons with disabilities.

Who is in-charge of the general management and coordination of the rehabilitation sector? Who will the future rehabilitation service providers be? Local NGOs or private organisations or public services? How will the rehabilitation services be financed? If service providers are NGOs and private organisations. These questions are key to determine the sustainability of the sector. Conclusions Questions