Kathmandu: Nepal is a small country situated in southern Asia between India and China (Tibet). The population of Nepal is divided mainly between the plains or terai (47%) and the hill areas (46%) with only 7% of the population living in the mountainous regions (1). The main reasons for increase in migration from the hills to the terai are related to scarcity of fertile land and limited food production, under-employment, lack of accessible markets and transportation, and economic exploitation (2).
Nepal is one of the poorest countries in the world and its underdeveloped economy contributes to low literacy rates and poor health statistics. It is estimated that 61% of the entire adult population of Nepal is illiterate, while the female illiteracy rate is 82% (3). Only 4.9% of Nepal’s budget (fiscal year 1995/96) is allocated for health care. Little current information on disability is available, since no national surveys have been conducted since the International Year of Disabled Persons (1980), when the disability rate in Nepal was estimated at 3% (4,5).
This may be a conservative estimate and, if compared to other countries in South Asia, the actual number of persons with disabilities could be more than 5% of the population if those with minor impairments and the fragile elderly are included. Data on rehabilitation programmes and services in Nepal are incomplete, however, most disabled persons in Nepal have little or no access to rehabilitation.
Since little financial assistance is available for rehabilitation in Nepal, many persons with disabilities have come to rely on Community Based Rehabilitation (CBR) programmes to provide rehabilitation services and advocacy for public services. CBR attempts to utilise resources provided by the community and emphasises family involvement in rehabilitation. Terre des Hommes (TdH), a Swiss based international children’s organisation, has supported a programme for disabled children in Nepal since 1985. Of the total population of disabled persons in Nepal, 27.8% are reported to be children below the age of 15 years (5).
TdH and a local non-government organisation called Friends of the Disabled (FoD) joined forces in 1992 to support the development of the Hospital and Rehabilitation Centre for Disabled Children (HRDC) in Kathmandu (6). HRDC provides medical and surgical treatment to physically disabled children under the age of fifteen years. The objective of the HRDC programme is to formulate and implement an individual rehabilitation plan for each disabled child served through its in-patient and out-patient CBR programmes (7).
Although physiotherapy is provided as needed to disabled children at the Kathmandu hospital site, there is also a great deal of follow-up work accomplished by the HRDC field department through CBR activities and initiatives. Eventually, children are discharged from HRDC when they have achieved their functional rehabilitation goals, when they are referred to adult rehabilitation programmes, when they move and cannot be traced, or when families decide not to continue in the programme. Even when a child is discharged, a field worker may visit the family periodically to determine if new concerns have arisen (8). This type of discharge monitoring function is necessary to promote family independence, yet at the same time provides necessary contact as the child grows and develops, especially in the adolescent years.
HRDC which works in a difficult geographical and socio-economic environment, wanted to gain information about the physical and social status of disabled children who had completed their rehabilitation programme. By examining their functional status, rehabilitated children could be compared to the general Nepalese population and some conclusions could be drawn about the suitability and limitations of the HRDC approach to rehabilitation. This study was not intended to be an exhaustive evaluation of HRDC’s programs, but was undertaken to provide insights into its CBR efforts and to provide a basis for future programme planning for disabled children in Nepal.
Reference DNIF