Evaluation Report - Final CBRs

8/6/2019 Evaluation Report - Final CBRs

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Community Based Rehabilitation Service

External Evaluation

CBRS

P.O. Box: 293

Nayabazaar, Pokhara, Nepal

Tel: 00977 - 061 - 528250/537326

Fax: 00977 - 061 - 521523

E_mail: [email protected]

Final December 2003

By Irada Gautam BSc, BcoM, MPA, (independent consultant)

and

Alastair Seaman BSc, MSc, MICFOR (International Nepal Fellowship)


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Table of Contents

Summary .................................................................................................................................................. 3Introduction .............................................................................................................................................. 4

1.1 Project Description ........................................................................................................................................ 41.2 Evaluation Objectives .................................................................................................................................... 51.3 Evaluation Methods ....................................................................................................................................... 51.4 Evaluation Approach ..................................................................................................................................... 5

Evaluating the Programme .................................................................................................................... 72.1 Project Logic .................................................................................................................................................. 72.2 Home Visits .................................................................................................................................................... 82.3 Referrals ....................................................................................................................................................... 102.4 Weekly Counselling Days (WCD). ............................................................................................................. 112.5 Raising Professional Awareness ................................................................................................................ 112.6 Appliances and equipment ......................................................................................................................... 12

2.7 Training ........................................................................................................................................................ 132.8 School Awareness Programme (SAP) ...................................................................................................... 142.9 Local Awareness Programme (LAP) ......................................................................................................... 162.10 Parents Group (PG) .................................................................................................................................... 162.11 Income Generation (IG) .............................................................................................................................. 182.12 Networking ................................................................................................................................................... 182.13 Education ..................................................................................................................................................... 192.14 Vocational Training (VT) ............................................................................................................................. 20

Evaluating the Organisation ................................................................................................................ 223.1 Rehabilitation Facilitators ............................................................................................................................ 223.2 Support Staff ................................................................................................................................................ 233.3 Advisory Group (AG) ................................................................................................................................... 233.4 Management Team (MT) ........................................................................................................................... 24

3.5 NGO Committee (NGOC) ........................................................................................................................... 253.6 CBRS Consultant ........................................................................................................................................ 263.7 Monitoring and Reporting ........................................................................................................................... 273.8 Planning ....................................................................................................................................................... 293.10 Community Involvement ............................................................................................................................. 293.11 Financial Management ................................................................................................................................ 313.12 Teamwork .................................................................................................................................................... 32

Appendices ............................................................................................................................................ 334.1 Outline Programme Log Frame .................................................................................................................. 334.2 Home Visit Case Studies ............................................................................................................................ 344.3 Evaluation Terms of Reference .................................................................................................................. 354.4 List of Stakeholders Consulted in Evaluation ............................................................................................ 394.6 Acronyms ..................................................................................................................................................... 40


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Summary

Activity

CBRS makes a very significant impact on the lives of the clients that it reaches. As we report later on Some childrenhave learned vital skills such as how to walk, feed themselves, go to the toilet, speak and read. Some children have beengiven the confidence to go to school. Attitudes of family members and neighbours have been changed as they havewitnessed the achievements of clients. The impact of delivery activities such as home visits, weekly counselling daysand appliances is particularly powerful and we make suggestions on how CBRS might increase the number of clientswho benefit from these services.

Awareness raising activities, such as LAP & SAP, are recognised as important by CBRS and form an important part ofprogramme activities. These are well intentioned but we believe that their impact could be significantly improved andmake suggestions as to how this might be achieved.

Other activities, such as income generation and vocational training have been rightly identified as important. However, wesuggest that these may be more effective if led by other partners with more experience in these fields. This would notonly increase their impact but also free up CBRS staff to spend more time working in their core areas of expertise.

Organisation

CBRS benefits from having an enthusiastic and competent staff. But CBRS is more than just staff. Clients, their familiesand the NGO committee are also involved in the wider CBRS family and demonstrate similar degrees of enthusiasmand commitment. There is a tangible sense of team and mutual respect. This report recommends a number of ways inwhich organisational aspects of CBRS could be strengthened. Key themes in this regard include:

A shifting focus for RFs from doing to facilitating

MT and NGOC moving from reactive administration to more proactive management and setting of strategy More clarity about what CBRS objectives are and how activities deliver these objectives

A shift in the focus of monitoring from activity to impact

More active annual planning

Strengthening of community involvement

Conclusion

As evaluators we have been impressed by what CBRS is doing. In an age when many organisations focus onawareness and advocacy (which is obviously important) it is encouraging to see an organisation that, in addition, deliverssuch a life-changing service to its clients. Without CBRS, the future for young PWD in Kaski and Syangja (and beyond)

would be bleak indeed.

We believe that there are opportunities for CBRS to significantly increase its impact and hope that the suggestions madein this report will help the organisations leadership as they seek to make CBRS even more effective. It is our hope toothat CBRS funding partners will continue to support this valuable work, through which the lives of clients are transformedand the attitudes of society are challenged.


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Part

1

Introduction

1.1 Project Description

CBRS aims to improve the quality of life of young people (up to the age of 25) with physical and mental

disability. It has been doing this since 1995, primarily in the districts of Kaski and Syangja in the Western Region

of Nepal. It has grown rapidly since its beginning and is now a key player in the disability sector in Nepal. A

summary of the projects aim, objectives and activities is given in a semi - Logical Framework format in table 1below.

Table 1: CBRS aim, objectives and activities

Aim improved quality of life for young people with disability

Objectives 1. clients achievephysical and mentalpotential

1. clients have supportiveand knowledgeablefamilies

1. clients are integratedinto their communitiesand supported by

society

1. clients have livelihoodopportunities

Activities home visit therapy

weekly counselling daytherapy

appliances

home visit advice

weekly counselling dayadvice

parents group

income generation forparents

skill training for parents

school awarenessprogramme

local awarenessprogramme

raising professionalawareness

home visit awarenessraising

education of clients inlocal schools

some basic education ofclients during homevisits.

vocational training ofclients

training

networking and partnership

CBRS is staffed by a team of 36, 25 of whom are based in the main Kaski office in Pokhara and 11 of whom are

based in the Syangja office in Syangja Bazaar. Last year it had a budget of approximately 7.3 million Nepali


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Rupees (equivalent roughly to 100,000 US$ or 87,000 Euros). It is funded by a range of organisational and

private donors, the largest of which, ICCO, Netherlands, accounts for about 50% of income.

1.2 Evaluation Objectives

The objectives of this evaluation are:

To assess the impact and effectiveness of the CBRS programme.

To consider ways in which the effectiveness of CBRS could be improved. This also includes

consideration of ways in which the sustainability of CBRS and its work could be improved.

1.3 Evaluation Methods

The evaluation was carried out by the authors over a period of two months between September and November2003 and involved five main stages as follows.

Stage No. Days Activity

Planning 1 Evaluation planning and review of project documents

Meetings with stakeholders inKaski and Syangja districts.

9 A full description of our itinerary and details of those we met is given in appendix 1.Most of these meetings took the form of structured interviews with individuals orstructured discussions with groups, as well as simply observing activities in action,such as SAP, LAP, PG and home visits.

Writing draft report 3 Office-based

Discussion of draft report 1 Meeting with CBRS Management Team and discussions with CBRS consultant

Finalising report 1 Office-based

1.4 Evaluation Approach

This evaluation addresses 2 key aspects of CBRS; its programme

(i.e. its aim, objectives and activities) and its organisation (staffing

and management practices and structures). These are addressed

by parts 2 and 3 of this report respectively. The report addresses

each aspect of CBRS in the same way. Each aspect beingevaluated is firstly described in brief. Its impact and effectiveness is

then considered and finally, recommendations for improving impact

are made. Throughout the report, recommendations are highlighted

in shaded boxes.


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Many of the recommendations we make are suggestions for further consideration by CBRS leadership (and

other stakeholders). Some need further development and planning and some may be considered to be

inappropriate. It will also be important to prioritise which of these recommendations are the most important and

which should be implemented first.

Our first recommendation is that CBRSs leadership (Management Team, Committee and consultant) consider

our recommendations during the current year and produces within 12 months a short 5-year strategy paper that

outlines in detail which of these recommendations will be taken forward, when these will happen and who will be

responsible.


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Part

2

Evaluating the Programme

2.1 Project Logic

Before looking at the detail of CBRS activity, it is useful to look at how this activity contributes to the

organisations different objectives and its overall aim. We found that, although CBRS is clear about what its

activity is, it needs to clarify and further develop what its objectives are and to identify how its activities meet

these objectives.

For example, the annual reports focus on activity and there is little discussion of whether this activity is really

helping to achieve CBRS objectives. There is a 10 page logical framework but this is very complex and not very

helpful in clarifying what the project is about. It is not surprising that this framework is not used in planning and

reporting! The 10 objectives specified in the LF are different from the 7 specified in the Terms of Reference. In

both documents, some of the objectives that are stated are not really objectives. For example the 3rd

objective in

the LF is to provide support to at least 50% of potential clients by 2002. This is really a target.

The reason we put together the summary LF in table 1 was to help ourselves as evaluators understand more

about why CBRS does the things that it does. The benefits of clarifying objectives and the way that activities

help to meet them is:

Clarity about what is really important in a project. For example, table 1 shows that home visits help to

contribute towards meeting all 4 of the objectives that we specified. This suggests that a key challenge in the

future for CBRS is to increase the number of clients that receive home visits.

Showing where the organisations main focus lies. For example, it is clear that CBRS has a stronger focus

on physical and mental rehabilitation, some focus on social rehabilitation and currently a fairly low focus on

economic rehabilitation. It is helpful to clarify this balance as it forms a good basis for discussions on how

CBRS might want to change that balance in future.


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Helping an organisation assess possible new activities. There are many things that CBRS could do. Being

more clear about what it is trying to do (i.e. having clear and simple objectives) makes it much easier to

decide on which possible future new activities are appropriate and which are not.

It helps an organisation to assess its impact rather than just its activity (see 3.7).

We recommend that CBRS clarifies its objectives and develops a simple logical framework to show how

activities, objectives and aim all relate to each other. Table 1 may be a helpful starting point for this. The LF

should be one page only. Later in the report (3.7) we suggest that impact indicators should be chosen for each

activity and objective so that CBRS can better assess its impact and progress towards its objectives.

2.2 Home Visits

Descript ion

Home visits are a primary activity of CBRS and a powerful way of providing

therapy (physiotherapy, mental therapy and speech therapy) for clients,

supporting families and raising community awareness. Visit frequency varies from

weekly to 6-monthly, depending on family and RF assessments of what is

needed. 45% of clients are visited at least every 2 weeks. RFs currently visit

clients within a 3-hour travel radius of the 2 offices. Last year over 3,000 home

visits were made to 402 clients. Under the current regime of home visits, RFs are

more or less 100% busy i.e. it will not be possible to continue to provide manymore home visits in the current way with the existing resources.

64% of clients are male and 48% are from the so-called higher castes (it would be interesting to know what the

percentage population of these castes is in order to know better how representative CBRS clients are of the

whole population). Visits that we made suggested that the burden of care for clients falls mostly with women and

that these women are sometimes also blamed by their husbands for the condition of the child. Naturally, male

RFs tend to interact more with fathers while female RFs interact more with mothers.

Evaluat ion

Parents whom we met expressed good levels of satisfaction with levels of service. It was obvious from the visits

we made that home visits have a very high impact. Some children have learned vital skills such as how to walk,

feed themselves, go to the toilet, speak and read. Some children have been given the confidence to go to

school. Attitudes of family members and neighbours have been changed as they have witnessed the

Rukhmaya signs her name on theCBRS home visit register


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achievements of clients. All of this has a huge impact on CBRS aim of improving the quality of life for young

PWD. Two case studies are given for illustration in appendix 2.

However, there are several aspects of home visits that would benefit from change. Data show the common

Nepali story that it is easier for males and members of higher castes to access services. It also appears that in

some cases there is a strong dependency of the family on the RF with RFs generally happier in a role as expert

provider rather than facilitator. There is a lack of clarity as to how responsibility for client care can be properly

handed back to parents. There is little in the way of exit planning that makes clear to families how long CBRS

support will be maintained and how it can be withdrawn in a constructive way.

Recommendat ions

The focus of home visits needs to change from doing physiotherapy to transferring skills. This means that,

after an initial intensive phase, a greater reduction in visits should be planned and that these visits should

concentrate on assessing client performance and parent care and in changing the recommended exercises

accordingly.

CBRS should set targets for the increased number of clients that it can service in this way over the next 3

years (assuming no change in staffing resources).

Impact can be increased by visiting clients beyond the current 3-hour boundary. This can be achieved by

allowing RFs to go directly to the field and home again without having to go through the office at the

beginning and end of every day, as is current practice. CBRS should also consider allowing staff to stay in

the field overnight if it is safe and efficient for them to do so.

CBRS should consider how to use community volunteers to help with home visits. This issue is considered

in more detail in section 3.10.

CBRS should develop a plan for how it can increase its coverage of girls and lower caste clients. At its

simplest level this could involve setting targets and more proactively trying to identify potential clients in these

groups.

RFs should consider how they could increase the involvement of fathers in caring for and providing

physiotherapy for their children. This is particularly a challenge for female RFs. It would be good to assess

levels of paternal care and set appropriate targets for this.


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2.3 Referrals

Descript ion

Chart 1: Referrals to CBRS

CBRS data show a range of different referral routes. It is

interesting to note the relatively low percentage of referrals

from the medical profession, both government and private

(see 2.4). It is also important to note that, with RFs more or

less 100% busy, there is little incentive for CBRS to actively

seek significantly more clients at present.

Evaluat ion

If referral rates were being improved then we might expect to see a decline in the average age of clients at

referral. CBRS data show that this is not happening. A key weakness of the organisation is the lack of baseline

information on the incidence of disability in its working area. Although estimates of the possible number of

clients were made at the start of the project, CBRS does not have recent data on this and therefore does not

know what percentage of potential clients it is reaching. Without this it is difficult to know how effective it is being

in reaching its target groups. The Nepal Census 2001 estimates the national incidence of disability (excluding

blindness and deafness) as 0.27%. CBRS should be able to use this figure and district census data to estimate

the number of potential clients in Kaski and Syangja. This figure is likely to be in excess of 2,000.

Recommendat ions

CBRS should estimate the number of potential clients in a) its current working area, b) the districts of Kaski

and Syangja and c) Western Region. This will allow a better assessment of the extent to which it is

effectively reaching its target population.

Section 2.2 already suggests the need to set targets for the number of new clients that CBRS hopes to work

with in future using its current level of resources.

Section 2.4 considers ways of improving referrals from HMG health system.

Many parents described how they had initially visited traditional healers in the search for a cure for their

children. These people could become very useful referrers and CBRS should consider providing some basic

training to them in order to encourage this.

health

service

27%

others

21%

clients &

parents

15%

SAP / LAP

& staff

24%

neighbours

13%


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2.4 Weekly Counselling Days (WCD).

Descript ion

139 clients have received support through WCDs. Around one third of these clients live within the core CBRS

working area. The rest come from beyond the 3 hour radius. In Syangja the normal pattern is for regular

attendance at WCD whereas in Kaski it tends to be less regular.

Evaluat ion

WCDs are a good way of extending the reach and impact of CBRS without significant additional resources.

Recommendat ions

CBRS should consider making more use of counselling in order to increase impact. There are different ways

that this could be done. For example:

Selecting health posts (or other suitable community centres) near the '3 hour' border and running monthly

CDs there in rotation, perhaps one per week in 4 different health posts in each district. Appropriate locations,

frequencies and staffing need to be considered further. This idea could potentially extend CBRS services to

a much greater percentage of the 2 districts.

Consider running the current WCDs in WRH and Syangja hospitals. If HMG staff are involved, this is a good

way to transfer skills and mainstream CBR. The NGO committee treasurer could help progress this idea at

WRH.

These 'outreach' CDs offer good potential to increase the involvement of community volunteers, parents and

HMG health staff.

2.5 Raising Professional Awareness

Descript ion

Few referrals (27%) come from hospitals, doctors and health posts. Speaking to parents we hear many

examples of the failure of doctors to recommend appropriate rehabilitation or refer to CBRS. Many families have

wasted significant amounts of time and money on needless tests, drugs, vitamins and operations. In some

cases, failure to refer early on has meant the loss of opportunities for physical and mental rehabilitation (as well

as other possible benefits such as education, family support and community awareness raising etc.)


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CBRS provides regular short disability orientation to students from Manipal Medical college and the

Government Nursing Campus. So far, about 120 students, nurses and teachers have attended. Teaching is

classroom based rather than field based.

Evaluat ion

This work is important and maybe needs to be given developed further.

Recommendat ions

Students should be taken on home visits to see the practice and results of CBR in practice and to talk with

families and clients.

Regional DHO meetings take place annually in Pokhara and are a good forum raising professional

awareness. CBRS should seek to be involved in these and to use them to explain issues of disability and

appropriate activities and services for addressing these. The effectiveness of these approaches could also

be demonstrated through use of case studies.

2.6 Appliances and equipment

Descript ion

401 of CBRS' clients (77%) have received appliances and equippment from CBRS. These include splints,gaiters, beds, special chairs and tables, walkers of different types, wedges, crutches, footwear, standing frames,

wheelchairs, prone boards and cycles. The impact of these appliances on clients is huge. They assist with tasks

such as walking, eating and toilet. They are used in strengthening and exercising. They can reduce the risk of

accidents. They facilitate improved social contact and make the job of caring easier for families.

Home visit clients pay a deposit for their appliances which is repaid on return of the item. Poorer families pay a

deposit of 25% of the material cost. Other families pay 50%. RFs follow up the use of the appliance in the field to

ensure that it is properly used and that any necessary modifications are made. The 2 CBRS appliance

technicians also frequently visit clients at home to make measurements and carry out maintenance. CBRS has

a good relationship with the orthopaedic unit of Green Pastures Hospital in Pokhara, from whom it purchases

specialist footwear and prosthetic devices.


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Evaluat ion

This work makes a great contribution towards CBRS' aim of improving the quality of life for young PWD. It is

particularly significant because no-one else in the region is doing it.

Recommendat ions

CBRS should aim to transfer these valuable skills to other organisations and people in the region.

Some kind of plan for how to do this needs to be developed. Which organisations have staff who could be

trained? How many people could we train per year? How could this be done? Do our staff need any training

in how to teach others?

Workshop staff should receive annual technical training. One way of doing this would be to arrange a short-

term placement in with an appropriate CBR organisation, perhaps in Kathmandu or India.

The charging structure should be revised so that richer families pay more for appliances.

2.7 Training

Descript ion

RF training involves a month of basic training, followed by 3 months of home visits with more experienced RFs.

This works well and is a good way of transferring basic skills. RFs also receive regular ongoing training input, for

example during the annual training week between Dassain and Tihar. Almost all CBR organisations in Nepalhave been visited by RFs over the years.

In addition, the other main training is carried out as a partner organisation of Handicap International as part of an

international pilot of a new approach to disability and development. This strategy, CAHD (Community

Approaches to Handicap in Development) is based on the negative attitudes and exclusion facing people with

disability and their families, and also on the links between disability and poverty. In CAHD, 'ordinary' community

development organisations are motivated and trained to include people with disabilities and their families in the

regular community development activities, and also to provide local basic rehabilitation. Also in the CAHD

network, disabled people's organisations and disability/rehabilitation organisations act as resource and training

organisations.

This approach is being piloted in Asia by two organisations, one of which is HI, and CBRS is one of two training

organisations for Nepal. CBRS provides training of two types, for managers of NGOs and community based

organisations, and also for field level staff, who carry out some basic rehabilitation and particularly awareness

raising work. The hope is that this kind of training can help to mainstream disability issues so that they cease to


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become a specialist subject tackled by a few organisations but instead are taken on board by a broader range

of organisations. This approach has the potential to radically improve the situation for PWD in Nepal. It will be

important for CBRS and HI to monitor the effectiveness of this approach, following up the participants to

discover the extent to which they are putting their new learning into practice.

Training is a significant income earner for CBRS. Last year 7% of the programme budget was raised through

providing training to external organisations.

Evaluat ion

Training is a very significant way in which CBRS has impact beyond its project area. There is a need for more

follow up of participants in order to assess better the impact of training and to learn lessons that will help to

make training more effective in future. The recent appointment of a training supervisor should make this easier.

Recommendat ions

Training for external organisations needs to be more actively followed up to assess how new knowledge is

being implemented. In particular, it is important that CBRS, HI and the other training organisation monitor the

effectiveness of the CAHD approach and follow up participants to discover the extent to which they are

putting their new learning into practice. Follow up of this nature can also further support implementation.

In the long term it would be good for CBRS to be a little more proactive in its training, i.e. to identify the

organisations and individuals, particularly in Western Region, who would benefit from appropriate training indisability issues, and to consider how best this training could be provided.

Other parts of this report also make recommendations for specific types of training, for example teacher /

resource person training, government health staff training, appliances training, medical student training etc.

2.8 School Awareness Programme (SAP)

Descript ion

SAPs have taken place in over 90% of schools attended by CBRS clients, as well as in a number of other

schools. Classes are mostly aimed at students in grades 8, 9 & 10 and there are usually 50 70 students in

each class. The materials used for these (and LAP) have been developed by CBRS to cover a range of different

disability issues. Use is also made of Handicap International materials. The focus of SAPs is on defining

disability and on the causes of and prevention of disability. Little attention is given to discussing or challenging

attitudes towards PWD. Methods of teaching are not very participatory. For example, a questionnaire was given


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for groups to fill in but there was no time given for feedback from this and only 3 or 4 students per class were

able to participate. SAPs are normally taken by 2 or 3 RFs. As such, they are quite intensive on staff time. The

teacher was not present during the SAP that we attended. There is currently no formal or systematic monitoring

of the impact of SAPs on the experiences of clients.

Evaluat ion

The objective of changing attitudes and behaviours of school pupils and staff in client schools in important. The

idea behind SAPs is good. However, the practice needs to change significantly if they are to become effective in

meeting this objective.

Recommendat ions

Content should change to focus more on challenging attitudes and discussing rights. More use should be

made of stories that illustrate how people have overcome challenges of disability. Local disabled adults

should be involved in this. They can tell their stories and answer questions. CBRS should further develop its

existing pool of disabled resource people for this (and pay them). Their involvement should also free up more

RF time to do home visits.

Methods should be more participate. For example, letting groups discuss issues together and feed back.

Seating arrangements could be temporarily changed to help facilitate this.

SAPs could have more of an action focus. For example, classes could develop their own plans which might

include: carrying out a survey of attitudes in their school, assessing physical infrastructure for disabled pupils,

survey of their community to find numbers of disabled children who could be in school but who arent and

action to encourage them to attend. Pupils should be encouraged to analyse the situation of PWD in their

own communities: where do they live, what challenges do they face, what role can local schools play in

dealing with these challenges etc.

Teachers should be encouraged to attend SAPs.

SAPs are resource intensive and should focus only on schools and classes where CBRS has clients. For

raising awareness in the wider education system, CBRS should focus on training school resource people

from district resource centres, who can then equip teachers to teach the subject better (in our discussions

with the DEO he expressed a willingness to pursue this). The school curriculum covers disability so there is a

big opportunity for influence here. Again, the focus should be on attitudes rather than technical aspects of

disability.

The impact of SAPs should be monitored by asking clients if they see any change of attitudes after the SAP

(and if so, what these changes are).


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2.9 Local Awareness Programme (LAP)

Descript ion

Around 250 clients have had a LAP in their area. The

content and style of these programmes is almost identical

to the SAP. Because of its focus on ante-natal and birth

issues, it is also quite similar to the teaching provided by the

Nepal Safer Motherhood Programme (NSMP). By the end

of the programme, some of the participants thought that

CBRS was an antenatal care provider and were asking RFs

to visit pregnant relatives. As per the SAP, groups were

given a list of questions to answer at the end of the

programme. Many of those present could not read and

write and were therefore not able to participate in this.

Evaluat ion

As per SAPs, the idea behind LAP is good but it is not very effective and needs significant change.

Recommendat ions

Most of the recommendations for SAPs are also relevant here. In addition, the following should also be

considered:

Discussion during LAPs should consider how the rights of PWD in that community can be protected.

There are opportunities to use LAPs to promote volunteering and the involvement of other community

groups in disability issues (see 3.10).

CBRS should make more use of local jatra and festivals to promote their work and raise awareness. These

could provide good opportunities to meet with influential community members, answer questions and find

new clients. As with SAP, PWD and parents should be involved in all these activities.

2.10 Parents Group (PG)

Descript ion

PGs meet in each of the 2 districts approximately every 2 months. An average of around 60 parents (and

sometimes other family or community members) attend each day time meeting, meaning that on average, each

Discussing a possible new client contact after a LAP


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client has a parent or other contact who attends roughly 1.5 times per year. On average, about two thirds of

participants are female and one third male. PGs discuss arrange of issues of concern to parents such as health

issues, childcare, micro credit etc. They also have a chance to share their own stories and to identify issues of

concern (through the Advisory Groups) which they would like to see CBRS address.

Parents appreciate being able to share their problems with others who understand their situation. They can feel

isolated, particularly in a village setting, and the PG is a valuable means of mutual support.

Evaluat ion

Parents appreciate these groups although their format could encourage more participation and sharing. There

seems to be good participation across caste divisions although, not surprisingly, most participants are women.

Recommendat ions

PG should become more participative and allow more opportunities for discussion and sharing. There are

many ways in which PG could be changed but it is really for parents to evaluate the effectiveness of PG and

suggest how they would like to see it develop. This year, PG meetings should carry out this kind of

evaluation and outline their own vision and plan for the future. Some options might be:

Small groups with a geographic focus e.g. at the VDC level (this would allow significantly improved

participation in Syangja). It would also allow parents to tackle local issues, such as lobbying VDCs, schools,

dealing with problem/ people in the local community etc.

Parents could identify important advocacy issues and carry out a lobbying campaign to seek change.

'Fathers' meetings could be held occasionally as a way of encouraging men to participate. These could look

at issues of fathering PWD and encourage men to take a more active role in caring for their children.

Small groups with a disability focus (e.g. for parents of children with muscular dystrophy) to discuss issues

specific to that condition.

More client social events, such as an annual picnic. These events would be good media events and

opportunities for awareness raising.

Ideally, PG should take more responsibility for organising and running the childrens clubs that are being

planned.


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2.11 Income Generation (IG)

Descript ion

IG activities were initiated by the AG. There are 4 main activities that fall under this heading. Firstly, IG loans are

given to parents using funds generated by RF visits, VDCs and other donors. These are used for small

enterprises such as shops, vegetable gardening and livestock rearing. 51 families (10%) have taken loans so

far. Secondly, 11 families are involved in a buffalo scheme that involves the gift of an in-calf milk buffalo and the

subsequent re-payment of a buffalo once the calf has been born and grown. Thirdly, CBRS has provided

sewing training (and the gift of sewing machines) to parents from 18 families. Fourthly, 10 clients have received

tailor-made training in skills that give them an opportunity to earn their own livelihood.

Evaluat ion

The impact of IG activities is mixed. The buffalo scheme is generally working well. Some IG loans are beingsuccessfully repaid but other enterprises have run into trouble. One family that we visited had started a pig-

raising enterprise but all the pigs had died. They are now left with a debt and are worse off than before. Less

than half of the loans have been paid off so far and PGs have halted new loans until the situation is resolved in

some way. Globally, successful IG schemes involve small groups where there is strong social pressure on

people to repay. PGs are too large to exert this kind of pressure. IG is outside CBRS core activities and there is

a danger that problems with PG money could lead to wider problems with the PG and a breakdown in trust.

Recommendat ions

If present problems with PG loans continue, CBRS should look for a competent partner to advise on and

administer IG activities.

PGs are wise to continue the current policy of no new loans until trouble with existing loans is dealt with.

The buffalo scheme could be extended, perhaps in partnership with Heifer International who already have a

buffalo scheme in Western Region.

IG activities were not reported in the last annual report and should be in future reports.

2.12 Networking

Descript ion

There are networks of organisations working in disability in both Kaski and Syangja districts, although this is

larger is Kaski. CBRS participates in both of these as well as in the district NGO Co-ordination Committees.


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Evaluat ion

These links give CBRS good informal relationships with many organisations. Most networking activity involves

CBRS acting as a resource provider to help other organisations (e.g. orientation to medical student, training to

development managers etc.) There are fewer examples of practical partnerships in which CBRS has benefited

from the input or resources of other organisations. There appear to be opportunities for greater networking

within government, particularly within health and education but also within local government generally. For

example, the District Education Office (DEO) shared that the district has funds to help pay for schooling for 50

PWD but that this scheme is under-subscribed in Kaski.

Recommendat ions

Set up a core group of agencies to take on advocacy work (the existing Kaski disability network seems to be

too large and inactive), agree what the main advocacy priorities are and how to best advocate for these

issues. Advocacy issues are likely to include education and health care, access to government employmentand access to employment in the private sector.

Identify partners who can take over income generation aspects of CBRS work (see 2.11)

Identify partners who can provide appropriate vocational training for CBRS clients (see 2.14)

Develop relationships with regional government structures (particularly in education and health) in order to

extend CBRS influence throughout region.

2.13 Education

Descript ion

CBRS data show that 24% of clients attend school. 61% of these are boys. It is interesting that, despite easier

physical access to schooling in Kaski, there is no significant difference in the incidence of schooling between the

2 districts. We met a client who had been excluded from school because he was unable to write with a pen. This

is a shame as he was obviously intelligent and could learn a lot from school. The UK's most famous physicist

(Dr Stephen Hawkins) is as PWD and unable to write with a pen.

Evaluat ion

CBRS has been responsible for getting many clients to school (it would be interesting to know what percentage

of clients were in school before the involvement of CBRS). However, it appears that more clients (particularly

girls) could be in school. In order to know more about the impact of schooling on CBRS clients, the organisation

needs to assess:


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how satisfied clients are with their schooling.

how successful they academically

the level of acceptance and integration of clients in their school.

the number of CBRS clients who could be in school but who are not, either because of parents attitudes or

attitudes of the school.

Recommendat ions

The questions outlined above need to be answered.

CBRS should review its records to find out how many of its clients in school were not in school before CBRS

involvement.

Each RF should be asked to develop a plan for getting more of their clients to school and should be given

some kind of target for numbers who should be in school.

Options should be developed for providing informal schooling to those who are unable to attend school (e.g.

using parents, siblings, neighbours etc as volunteer teachers). Local schools and education resource

centres could be involved in developing these ideas further.

Recommendations given for SAPs (2.8) are relevant here.

Pupils with disability could be given the opportunity to meet (once or twice per year) to discuss issues

relating to their own education and to identify how more PWD could be included in schooling.

Explore with PABSON (through the NGOC contact) opportunities for increasing the involvement of pupils

with disability in private schooling (for example through quotas, scholarships etc.)

2.14 Vocational Training (VT)

Descript ion

To date there has been some limited vocational training of parents and clients (see section 2.11) although there

has been little monitoring of how many of those trained have been able to earn an income from their new skills.With the recent raising of the age of clients to 25, the provision of VT will become much more important in the

near future.

Evaluat ion

VT will become a crucial part of CBRS work in future and needs to be planned and developed now.


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Recommendat ions

CBRS should study existing VT for PWD in Nepal (and India) and plan a vocational training strategy for CBRS

that includes the following:

Estimated number of clients (and gender balance) who will need VT over the next 5 years in each district.

Existing vocational training provided by others that CBRS clients could be involved in.

Is this existing provision adequate or is there a need for new VT opportunities for CBRS clients. If so, why

and what is needed? Could other partners provide new types of VT or should CBRS get involved?

What are the funding implications for CBRS of increasing VT provision?

How can the advocacy group (see 2.12) encourage local businesses and government organisations to

employ and train PWD?

Increasing the proportion of CBRS clients in school now (see 2.13) is an important aspect of improving

employment opportunities.


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Part

3

Evaluating the Organisation

3.1 Rehabilitation Facilitators

Descript ion

Rehabilitation facilitators are the engine of CBRS. They carry out the home visits, run the WCDs and the

awareness programmes, help with training and facilitate the Parents Group. They are a group of committed and

competent (mostly young) people. Although their title reflects their primary role as facilitators, they still generally

view themselves as technical experts.

Evaluat ion

RFs are excellent doers but need to become better facilitators. It is hard for technical people (RFs) to stand

back and let others (parents, community members etc.) take over, particularly when they may not do the job as

well as RFs. However, the only way that CBRS can increase its impact with its present level of resourcing is for

facilitators to pass on their skills to a larger team of volunteers, family members and community groups.

Recommendat ions

RFs need to refocus and move from being doers to enablers.

This might be encouraged by appropriate annual targets, for example the number of clients who should be

successfully handed back to their families, except for infrequent advisory visits. Other useful targets may

include the number of family or community members who RFs can teach basic physio and rehab skills to.

Team supervisors and leaders are key people in this regard. They need to clearly understand the

importance of being facilitators rather than technical experts and help their teams to work this out in practice.

If this is to happen, then some existing clients and parents who have become overly dependent on RFs may

be unhappy. The reasons for this change of approach will need to be explained carefully to parents, during

home visits, PG meetings and with the AG.

Consideration should be given to providing RFs with more training in facilitation and training skills.


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3.2 Support Staff

Descript ion

Support staff provide services in computing, administration, equipment making, office security, transport and

food. They are the oil for the CBRS engine. In addition to these service roles, they are important ambassadors

for CBRS and PWD. As an example, during our LAP visit, the driver sat outside the building, explaining to

passers by what was happening inside and explaining the work of CBRS.

Evaluat ion

We were impressed by the enthusiasm, professionalism and commitment to the vision of CBRS of support staff.

It is clear that they are an important part of the team. This is recognised by MT and RFs who involve them

regularly in organisational planning.

Recommendat ions

Given their roles as ambassadors, support staff should receive more basic training and orientation in

disability issues.

RFs receive a lot of skill development training from CBRS. Support staff feel slightly neglected in this regard

and should also be given the opportunity for regular training in their particular fields.

3.3 Advisory Group (AG)

Descript ion

AG meets every 3 months (with 2 members of MT) and consists of 4 representatives from the Parents Group, 2

disabled adults and 2 CBRS schooling clients. Its purpose is to give clients and their families an opportunity to

comment on and influence the work of CBRS. They also have a role in monitoring, for example, the use of PG

funds.

Evaluat ion

The AG is an excellent idea and it seems to work well in practice. AG members that we spoke felt that they were

listened to and genuinely able to input into the work of CBRS. They gave several examples of how their

suggestions were implemented (e.g. the provision of sewing training and the buffalo-raising enterprise for

parents). Likewise MT seemed to genuinely appreciate the opportunity of consulting AG when making important


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decisions. The main point that AG made to us was the need for CBRS to focus more on attitudes, advocacy and

livelihood issues (objectives 3 & 4 in table 1).

Recommendat ions

We have no recommendations for changing the way that AG operates. However, as we mention elsewhere,

we agree with AG that CBRS should increase its focus on social and economic rehabilitation.

One PWD resource person (not an AG member) expressed the need for CBRS to update its terminology in

line with current thinking on disability. For example, he mentioned the way in which the term disabled

people carries unhelpful meanings and suggested that the term people with disability be used instead.

3.4 Management Team (MT)

Descript ion

The 4 staff in MT are responsible for the day to day running of the project including personnel management,

administration and financial management. With the departure of the project founder in June 2002, MT members

have recently taken on much more responsibility and shown themselves capable of administering the project

well. They have an open and inclusive management style that is appreciated by CBRS staff. They are trusted

and respected by the NGO committee. Presently, MT members are all male, high class and not disabled. No

MT members are based in the Synagja office. One MT member is the father of a CBRS client.

Evaluat ion

MT has shown itself to be competent in administration, i.e. in running the organisation in the way that it has been

set up. It now needs to now move beyond administration to management. This means focusing more on

thinking about the future and planning strategically for that future. They have been good at holding the steering

wheel of CBRS steadily. They now need to become more confident and skilled in steering the organisation

around the challenges and towards the opportunities of the future. Without this there is a danger that CBRS may

not reach its full potential.

Recommendat ions

MT needs to improve its ability to think strategically about the work of CBRS i.e. about how the impact of the

organisation can be increased.

This evaluation and the proposed strategy plan provide a framework for doing this.


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It will be important for MT to be able to access support in this task. In addition to input from NGOC and the

CBRS consultant, it would also be helpful if one of the evaluators was also available as a source of future

advice or to help facilitate the process. Short training in strategic planning may also be helpful.

The field team expressed a desire to see MT spending more time in the field so that they could better

monitor and support existing work as well as plan for future work. Monitoring and support are the roles of

team leaders and supervisors rather than MT. However, continued infrequent visits to the field by MT will be

valuable in helping them to provide good leadership and policy direction.

If MT have too much administration to do to give time to policy and strategy then perhaps more

administrative capacity is needed and further staff could be hired. However, our feeling is that it is more a

matter of attitude and confidence rather than available time.

In the long term, CBRS should aim to include women, other castes and disabled people in MT. It should also

include at least one member of the Syangja team. If this is to happen then MT need to outline now how they

see that process happening.

3.5 NGO Committee (NGOC)

Descript ion

The NGOC consists of 7 members from a range of backgrounds and experience including education, business,

health and the voluntary sector. Presently it has no Syangja representation, no disabled representation and no

representation from other disability groups. There are 2 female members although 1 lives in Kathmandu and is

not able to participate regularly. NGOC meets regularly every 2-3 months although it quite commonly meetsoutside this timetable as and when required.

NGOC has 3 main areas of responsibility; firstly as a means of ensuring the accountability of MT, thereby

helping to ensure the quality of CBRS work. Secondly, the committee helps MT to decide on issues of policy

and strategy. Thirdly it has responsibility for CBRS staff issues such as recruitment, discipline and employment

policy. The NGOC members who we were able to meet expressed a confidence in MT and a genuine

commitment to CBRS work and goals. They also appeared to be open and receptive to new ideas and possible

new directions for CBRS.

Evaluat ion

NGOC members are committed and competent people who are also busy with significant responsibility in their

own organisations. Their main input has been in the area of ensuring accountability and staff management

issues. Although they appreciate the importance of being involved in setting strategy and policy, this aspect of


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their work remains weak. Some members that we met explained that this is partly because they dont feel

professionally competent in the field of disability. However it is also a matter of time availability, confidence and

lack of experience (as board members of other organisations) as well as the current lack of significant strategic

thinking by MT.

Recommendat ions

NGOC needs to think more strategically about the work of CBRS i.e. about how the impact of the

organisation can be increased.

As part of this, NGOC needs to work through the recommendations of this evaluation with MT and input into

the proposed future strategy plan.

To do this well will need quite a significant time input. This will include homework such as reading and

thinking about this evaluation as well as time with MT. There would be benefit to organising a couple of

daylong meetings that are dedicated purely to strategic decision making.

CBRS should seek appropriate short training on board membership for members of NGOC, preferably from

individuals who are involved in successful NGO boards. This could be combined with meeting and learning

from NGO board members from other successful NGOs (possibly other CBR organisations).

There would be value in having a member from another respected CBR organisation. They may not be able

to participate in all meetings but would strengthen the committees understanding of CBR and be a useful

source of extra advice and support.

NGOC membership should aim to become more representative of women and disabled people. It should

also aim to recruit at least 1 member from Syangja District.

3.6 CBRS Consultant

Descript ion

One of CBRS former founders is now in the UK but acts from there as a part time consultant, offering advice

and support to the Management Team. She spends an average of two days monthly on CBRS related activities.

These include:

frequent correspondence with the MT in relation to issues as they arise and giving advice and comments to

help decision-making by the MT and AG

receiving and commenting on MT meeting minutes and GSM meeting minutes

dealing with administration and reporting for CBRS UK bank account

attending meetings and giving information about CBRS to supporters in person or by correspondence


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attending relevant conferences when possible, and using this information and that from current work context

to advise and inform CBRS

reading and commenting on / revising drafts of reports and other documents e.g. annual reports

giving advice and support for donor contacts

it is planned to set up a UK based and registered support organisation for CBRS in the next year.

Evaluat ion

The consultant is an excellent resource for CBRS, knowing the organisation and working context in great detail

and having the respect of MT and other staff members. Her views on the recommendations of this report and

input into the future strategy plan for CBRS will be invaluable.

Recommendat ions

The consultant needs to encourage MT and NGOC to develop CBRS further in ways that will increase its

impact. This will mean being willing to let the organisation change.

This consultants input into this change is crucial and she has a key role in both inputting into the preparation

of the proposed strategy plan as well as helping the organisation to work through the changes that the

strategy plan sets out.

3.7 Monitoring and Reporting

Descript ion

CBRS has a monthly reporting system that allows MT to regularly monitor the activity of the organisation. These

monthly reports are the main source of information for the annual report. When we asked for further information

on activity we found that this was usually quickly forthcoming, indicating that this data is well recorded and

stored.

Most of CBRS monitoring and reporting focuses on activity. For example, the annual reports mention the

number of clients, the number of home visits, the number of trainings held and the number of people attending

school and local awareness programmes. Although this is useful it overlooks the more important issue of

impact. Another way of saying this is that monitoring focuses on quantity rather than quality. There is some

monitoring of impact by RFs at the level of individual clients, which is used for managing client care and RF

input. However, this kind of information is not used by management in regularly evaluating the performance of

CBRS.


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Evaluat ion

The important questions include how does SAP/ LAP changes attitudes? To what extent are client families able

to provide proper care for clients? How are clients progressing towards the CBRS aim of improved quality of

life? CBRS monitoring and reporting does not currently try to answer these kinds of questions. Without knowing

the answers, it will be difficult for CBRS to achieve its aim.

Recommendat ions

Activity monitoring is good and should be continued. However, in addition to this, CBRS needs to identify

more indicators that measure its impact and then start to regularly monitor these. This information should

then be used regularly by MT to help the organisation develop in ways that increase its impact.

Ideally, impact indicators should be chosen for each of the activities and objectives that are specified in the

Logical Framework that we recommend in section 2.1. A number of possible impact indicators (for activity)

are given below as an example. Impact indicators for objectives should also be developed.

Table 2: some suggestions for impact indicators

Activity Possible impact indicators

Home visits changes in attitude of parents and neighbours

skill transfer to parents and neighbours

independence of family from CBRS RFs

WCD as aboveProfessional Awareness % and number of referrals from HMG (and private) health service

Appliances client satisfaction

impact of device on client and family

Training participant assessment of training

trainers assessment of impact after follow up

SAP changes in attitude towards clients (as assessed by the client)

changes in school practice, e.g. numbers of disable people in school, changes to infrastructure etc.

LAP changes in attitude towards clients (as assessed by the client)

Parents Group % of parents participating at least yearly

PG member satisfaction survey

PG action plans drawn up and carried through

Income Generation % loans successfully repaid% IG ventures still running after 3 years

Networking what resources from other organisations has CBRS been able to make use of? (time, skills, money etc)?

Education Caste and gender data

% of clients and possible clients in school

Client academic achievement

Client and family satisfaction with school

% non-school clients receiving some basic education from others.

Vocational Training number & % clients who have received VT who are successfully employed or generating income.


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3.8 Planning

Descript ion

Organisational planning takes place during the monthly or three-monthly planning meetings. It tends to focus on

agreeing the details of current activity (such as the timing of training, staffing of WCDs etc). It is notable that

there is no significant regular planning, of CBRSs core activity of home visits (for example, how many new

clients can CBRS accept this year or how can RFs manage an increasing workload?).

Evaluat ion

Planning is weak in that is primarily reactive rather than proactive and focuses on the relatively minor issues of

detail rather than more important issues of substance.

Recommendat ions

the proposed strategy plan should provide a framework for more appropriate planning for the next 3-5 years.

However, even after this has been done, MT and CBRS staff need to plan more proactively and avoid the

danger of planning the easy detail rather than the difficult substance.

one way of doing this would be to prepare a more detailed annual plan that looks at each CBRS activity in

turn, considers the impact indicators collected for the last year and sets appropriate targets and strategic

directions accordingly. At the end of the year, the annual report can then assess CBRS performance in the

light of what was planned and differences between plans and achievements can be analysed as a useful

source of learning.

3.10 Community Involvement

Descript ion

The importance of community in CBRS is reflected in its title and can be seen in various aspects of its work.

These include the importance of home visits, which deliver rehabilitation services (physical and social) in the

community rather than in an institution. CBRS also understands the importance of community attitudes and

works through LAP and SAP to change these.

The concept of CBR goes beyond working in the community to working with the community. CBRS does this to

some extent, for example through the input of its NGOC and AG and the use of adult PWDs as resource


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people. However community involvement is generally weak with little community participation in the

organisation beyond the attendance of family members at meetings.

Evaluat ion

More community involvement (in terms of time and financing) could and should be sought. Given the lack of

volunteering culture in Nepal, it would make sense to focus efforts on making more use of client family

members and PWD themselves. Greater community involvement has 2 main benefits. The first is that more

people are empowered to get involved in issues of disability, increasing the impact of CBRS and making a

bigger difference to the lives of PWD. This includes reaching clients beyond the 3 hour travel limit. The second

is that community attitudes towards PWD are more easily changed. These 2 things have a very significant

contribution to make in encouraging sustainability. If CBRS ceased to function then, as things stand now, most

of its benefits would be lost completely. With greater community involvement, much more of CBRS work could

continue in some form, even if CBRS as an organisation was no longer present.

Recommendat ions

CBRS needs to consider ways of increasing community involvement in its work although it is recognised that

this will be a challenging task. Three main themes for further consideration are outlined below. These should

be considered and developed further in the strategy plan.

CBRS should develop a plan to encourage volunteering in the organisation. There are a number of possible

options. For example, Syangja RFs generally do home visits in pairs because of the security situation.

Volunteers could be selected and trained to accompany them, thus freeing up RF time to allow more home

visits to be made. If mobile WCDs are developed (see section 2.3) then volunteers could be sought to help

RFs run these. Disabled adults should be more involved in SAPs and LAPs (sections 2.7 & 2.8). In time, RFs

could transfer many of these skills to local volunteers. Any plan to encourage volunteering should look at

how volunteers can be recruited, trained and managed. Some budget should be allocated to meeting their

costs, as well as paying an appropriate honorarium.

CBRS should develop a plan for making greater use of existing community groups in CBR work (e.g.

Mothers Groups, Youth Groups etc.) Many client parents will already be involved in these groups and CBRS

should consider ways in which parents can be empowered to use these groups as a forum for addressing

issues faced by PWD. One local organisation, National Disability Uplift Programme (NDUP) already has a

network of community volunteers (5 in each VDC in Kaski) which it has been using for the last year to

change attitudes and provide health screening for PWD. CBRS should consider working with NDUP to build

the capacity of these volunteers through training and accompanying RFs on home visits.

CBRS should develop a plan for increasing the level of community financial support for the programme.

Options include more realistic pricing of services (such as appliances) for wealthy families and regular fund-


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raising activities organised by the Parents Group. Current levels of community financial support should be

assessed and an appropriate target set for increasing this over the next 5 years. In the short and medium

term it is not realistic to expect that this will be a large percentage of CBRS costs. However the value of

community funding is greater than its financial value only.

3.11 Financial Management

Descript ion

CBRS has a budget this year of 98,00,000 NRS or $137,000. This is a 34% increase over last years figures. Of

this, the greatest portion (62%) is for staff salaries and allowances. Financial records show that reasonable

budgets are set and usually adhered to. The last 2 years have also seen quite high levels of carry forward which

provide some measure of stability to an organisation that is otherwise very vulnerable to changes in donor

policies and priorities. CBRS also benefits from a good diversity of donors, some of whom are personal donors

and very committed to the work of the organisation. MT feel that their Kaski building costs are rather high and

are keen to pursue the idea of constructing their own building as a way or reducing annual costs in the long

term.

Evaluat ion

The planned increase in expenditure this year is quite ambitious. Realistically, CBRS cannot expect to grow

significantly beyond this level of expenditure in the near future. Our general feeling is that the current level of

resourcing could be used to achieve more impact and that, in the medium term, the focus should be onincreasing impact rather than increasing resources.

Recommendat ions

When planning, for the next 3 5 years, CBRS should assume resourcing levels approximately in line with

current resourcing.

CBRS should work hard to maintain its current diversity of donors. This means that it should be continually

seeking to develop relationships with potential new donors.

Section 3.10 recommended that CBRS seek to increase the proportion of local financial support.

Having a fully owned CBRS building has its advantages. However, once the cost of repair and maintenance

is factored in, the possible savings are in the order of 3-5% of the annual budget. To achieve this saving will

require a large investment of time (and money) at a time when MT needs to be focussing its attention on

improving impact. If the building project proceeds then CBRS needs to be clear about how this can be done

without distracting the attention of managers from clients and the purpose of CBRS.


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3.12 Teamwork

Descript ion

The system of regular RF monthly meetings and 3-monthly whole team meetings ensures that there is a good

sense of team. Staff and parents feel that their ideas are valued and considered. There is a high level of staff

satisfaction.

Evaluat ion

Visitors to CBRS are aware of a family atmosphere that includes clients and their families too. There is a

genuine feeling of CBRS family. It is particularly encouraging that the team includes both PWD and family

members of PWD as staff and in other roles. This is a good example of inclusion in practice, as well as an

organisation putting into practice the ideals and philosophy it shares with others

Recommendat ions

Good teamwork needs to be continually nurtured. The whole CBRS family needs to be involved in

discussing the recommendations of this evaluation and in taking these forward into a strategy plan.


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Part

4

Appendices

4.1 Outline Programme Log Frame

Narrative Summary Indicators How will indicators be

measured or collected?

Assumptions

Goal

Aim improved quality of life for young disabled people

Objectives 1. clients achieve physical potential

2. clients have supportive and knowledgeable families

3. clients are integrated into their communities and

supported by society

4. clients have livelihood opportunities

Activities Objective 1

home visit physiotherapy

weekly counselling day physiotherapy

appliances

Output 2

home visit advice weekly counselling day advice

parents group

income generation for parents

skill training for parents

Output 3

school awareness programme

local awareness programme

raising professional awareness

Output 4

education of clients

vocational training of clients

This outline LF is based on table 1 in section 1.1. It should be further developed by CBRS, giving particular

attention to choosing indicators that measure impact rather than merely activity (section 3.7).


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4.2 Home Visit Case Studies

Rosan Shrestha = A Case of Muscular Dystrophy

Rosan is now 10 yrs old. He lives in Lamachaur Engineer campus area of Pokhara. His parents migratedfrom Shyanja district and run a tea shop. He has a mother, father and one younger brother. His brother is

studying in Lamachaur public school but he is not because of his physical problem.

While Rosan was 6 years old he had developed muscular dystrophy and could not walk. Before thisproblem he went to school at grade one. His parents tried many medical sources of help but he was notcured. Medical clinics gave lots of vitamins in the name of making strong muscle. His father also took himManipal medical college and was advised that he needed surgery. He decided not to follow their advice. Inthe end they went GP Hospital and were referred to CBRS Pokhara. It took almost 6 months to come inright place.

A year ago before they met CBRS, Rosan could not walk due to muscular dystrophy. But now Rosan iswalking and playing with friends - a good sign of progress expressed by parents. When we reached hishome, Rosan was not there he soon came to meet us from across the road. Rosan looks like a happychild. He does all exercises by himself in the morning and evening as per advice given by CBRS staff. Hisparents also encouraged him a lot to do exercises. He is also interested to do household activities such as

making bread [chapatti], wiping wall, and cleaning house.

His mother looks unhappy and did not talk much compare to his father, which is surprising. This might bedue to a male facilitator. His mother described that in the beginning of this problem, his father alwaysblamed her for not doing good massage with his son and that this problem has worsened because of this.But now his father understands the problems because he took his son at KTM, TUTH with support of CBRSstaff. This was greatly appreciated by them. His father is thinking to send him to school with his youngerson.

During our home visit other neighbours also came and observed what Rosan was doing. His two bestfriends also came and supported him. They are really helpful. An old man who has worked in India as Indianarmy and now retired appreciated the service at home and encouraged Rosan's parents to send him toschool. While asking what problems are faced by Rosan in relation to social discrimination then the old manexpressed " f he goes to school he might have lots of problems on the way or at school but now he does notface such problem and does not know such problems even exist. "

Tek Bdr Gurung = A Case of Cerebral Palsy:

Tek is 21 years old. He lives with his father, mother and two brothers i.e. one elder brother and one youngerbrother. His elder brother has joint recently in Indian Army. While Tek was crawling age, he could not sit,walk and not move anywhere. He passed stool and urine in bed for the last 18 years. They used to live in avillage which is 2 to 3 hrs distance from Shyanga Bazzar. 3 years ago they migrated to Shyanga Bazzarand found out about CBRS from a neighbour.

Tek's parents had taken him to various medical establishments and experts but with no benefit. Aftermeeting CBRS his parents feel that lots of progress has been made. After CBRS began their work, he cando urinate and defecate by himself with support of a toilet chair. He likes to maintain personal hygiene andtakes care of himself by washing his face, brushing teeth and is able to movie inside the house with supportof wheel chair. He also loves to provide grasses for rabbit. His quality of life has been transformed becauseof CBRS.

During home visit of CBRS staff; both father and mother were involved. Father is retired Ex Army. As perassigned by CBRS team he has been done all the exercises although Tek is still unable to control his body.As per his expression he loves all family members except his younger brother by whom he is sometimebeaten and from whom he does not receive love and care. Tek's parents expressed that if they had metearlier then there may have been more progress with physical rehabilitation.


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4.3 Evaluation Terms of ReferenceBackground/Development Objective (Goal)

The Community Based Rehabilitation Service (CBRS), Nepal is founded in 1995. Through various activities CBRS wantsto reintegrate disabled children and young adults (till the age of 25), socially and economically, in society. CBRS wants toachieve this by working together with the disability, their parents and families (by using the rights based approach) and byusing different awareness activities directed towards the local communities and society as a whole. ICCO has beenworking with CBRS since 2000.

Specific ObjectivesCBRS formulates several specific objectives:1 To enable disabled people and/or their careers to identify and tackle the factors that prevent them from taking full

participation in their family life and community activities. (This is done by raising their level of awareness and skills,through discussion, training, and practical and moral support).

2 To increase specific awareness about disabled people, their potential and the practical problems they fase in life, inthe direct neighborhood, and the wider community. (This is in order to enhance disabled people and their familiesfinding acceptance, integration, and participation within day to day community life).

3 To work towards the involvement of disabled people and their careers in the different levels of organisation andactivities of the project. (This is done through shared activities, organisational structures, and by the participatoryworking style.).

4 To provide information and resources for disabled people, their families, other individuals, organisations and thegenral community (Information, skills, and knowledge and technical materials are available in the Resource ReferralCentre).

5 To initiate and strenghten networking with other organisation, within the diability sector and within the communitybased development sector, especially at local and regional levels.

6 To maintain effective and efficient management and administration to all the programmes and resources for theabove, including monitoring and development (for example; of staff, programme contents and so on).

7 To work towards the continuation and sustainability of the organisation and project in terms of personnel, skills, andfinances.

Activities

The activities to achieve these aims can be broadly divided into social communication (awareness), rehabilitation, andpromotion of inclusion and rights, in addition to management, and training.

These activities are:

- Awareness and knowledge promotion directed towards the local community, the schools/teachers and theregion/society in general. This is done by posters, video, media , signboards, newsletter, website, teacherstraining and school awareness programmes.

- Parent groups. There is a parent group in each district and they meet every two months. The group is open toparents and family members of CBRS clients and interested people. Training, fundraising, lobby and advocacy,income generating projects, counselling between parents and, exchange between districts are main activities ofthe parent groups. The parent groups meetings are also a platform for new contacts being new potential clients.

- Advisory group. The advisory group consists out of four members, two parents and two clients. The group workswith the management team in formulating, prioritising, planning, implementation, and monitoring of projectactivities.

- Home visits and weekly counseling days. The rehabilitation facilitatiors conduct home visits for direct support tothe client and family. The main emphasis is on the clientss own daily life and on the practical and/or socialproblems faced by the disabled child/young adult and the family. The weekly counselling days are held on aweekly basis and are attended by clients outside the home visit area, by new contacts, or for clients requestedto come. Referrals are made for special equipements, treatment, advice etc. to the networking organisations,hospitals and institutions.

- Networking. Networking takes place formally with organized meetings at local and national levels, and informallyvia other contacts and visitors.

- Training. CBRS conducts several training courses for staff, disabled adults, parent groups, local networkorganisations, teachers etc. It is therefore an important activity. It is also one of the two national trainingorganizations for CAHD Approach.

- Management and administration. The organisation is constantly working towards improvement. Teamapproach to decision making, weekly meetings of the management team, momitoring and evaluation,staff/client participation, etc. are major contributions towards improvement

General objectives of the evaluation


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1. To measure the impact and effectiveness of the CBRS programmes and strategies. The evaluation will lead torecommendations (based on the findings) towards the different programmes/activities , the management andCBRS as a whole.

2. To give recommendations regarding the sustainability of CBRS and its future as a whole.

Important items to consider during the evaluation are: awareness, gender, rights based approach, poorest ofthe poor, position of the disabled, their parents and the local community.

Specific Objectives

Organisation:

Explain and describe the historical developments within CBRS and its activities.

Describe the present activities on headlines (like goals, vision, main objectives, target group and strategiesand their inherent strenghts and weaknesses).

Explore and assess the organisational strength and capacity in handling and building up effective relationswith donors, the government, other NGO's and relevant institutions. Also indicate further possibilities forlobbying and cooperation.

Describe the internal organisational structure and assess its strenghts and weaknesses in terms of itsoperation system (organisational structure and culture, checks and balances, management systems suchas finances, budgeting process, PME, communication and its decision making procedures). Assess therole and the degree of involvement of the beneficiaries in the decision making processes.

Assess the professionallity of CBRS staff.

Based on these objectives, provide recommendations for improvement and future development for CBRS as an

organisation and the different activities.

That the evaluation process is positive and constructive for CBRS and the report useful for CBRS and otherprojects.

Programme:

Assess the effectiveness and sustainability of all CBRS activities in relation to the objectives as set out, revisedor outlined. Assess the (unique) strategies and interventions. Quantitative and qualitative output of the activities.Review set criteria, performance indicators of these activities. Give special attention to the items mentionedabove with the general objectives.

Illustrate any positive changes and unintended benefits or negative effects from the individual activities. Assess the level of involvement and participation from the beneficiaries at the different activities. Assess the

strenght and weaknessess of the intervention from the different activities and the level of progress.

Assess to what extend the interventions follow a rights based approach i.e. have a gender perspective andwhether they are working towards social and economic empowerment.

Specific issues:

Parent groups

Describe how the groups are organised, how they work, their tasks and current emphasis, the participants(gender, economic/social position), decision making procedures, efforts involved from the participants(money/time/distance)

Documents

Evaluation Report - Final CBRs