This document discusses the need for rehabilitation services in earthquake affected districts in Nepal. It notes that an estimated 1,500-2,000 people will need ongoing rehabilitation support due to earthquake injuries, but there are currently no rehabilitation services in the health system. It also outlines pre-existing rehabilitation needs not related to the earthquake, including 1.94% of the population living with disabilities. The document then details the development of rehabilitation units in district hospitals that have served over 4,600 clients. It argues that policies support integrating rehabilitation services into the health system to address the growing needs of non-communicable diseases and an aging population. Ways forward are proposed to develop and sustain rehabilitation services.

1. Rehabilitation Support Services in Earthquake Affected Districts
Lesson Learned Workshop
“Need and Services gap”
Presentation
Mahendra Bikram Shah
Project Coordinator, HI Nepal
10 Nov 2016
Kathmandu, Nepal

2. Plan of the Presentation :
1. Need of Rehabilitation services linked to the EQ
2. Pre existing need not linked to the EQ
3. Rehabilitation Units development in District Hospital
4. Need derived from project achievement
5. Need derived from growing burden of non-communicable
diseases (NCDs), the rising prevalence of disability and
changing global population demographics
6. Need derived from Nepali Policies
7. Integration of Rehabilitation services in the Health System
8. Ways forward to develop and sustain rehabilitations services

3. 1. Need of Rehabilitation services linked to the EQ
Estimation : 1,500 - 2,000 earthquake
injured (EQI) will need ongoing
nursing and rehabilitation support and
will continue to have long-term
rehabilitation needs.
But no rehabilitation services in Health
System (no specific policy in MoH).
Setting up of
rehabilitation centers
planned in the Recovery
and reconstruction Plan

4. 2. Pre existing need not linked to the EQ
1.94% (N= 513321 ) of people with
disability
36%(N= 186457) of the total disabled
is comprised with people with physical
disabilities
83.8% service gap in
medical rehabilitation
72.5% service gap in
assistive device service

5. 2. Pre existing need not linked to the EQ
Injuries due to RTA from 2008 to 2013
were more than injuries caused by
earthquake.
Accidents accounts for 8.3% of the
total cause for disability in Nepal
New rehabilitation services in the District Hospital would
address the need of Earthquake affected (EQA) people not
directly injured during the disaster

6. 3. Rehabilitation Units development in District Hospitals
An activity under rehabilitation plans made by Leprosy
Control Division

7. 3. Rehabilitation Units development in District Hospitals
4,617 clients
including :
- 1,127 EQI
- 3290 EQA
were provided
rehabilitation and
social protection
support between
Sep 2015 to July
2016
High unmet need of Rehab services in District hospitals

8. 3. Rehabilitation Units development in District Hospitals
3,020 clients were
treated in hospital of
which 381 were
earthquake injured
1,597 clients were treated in
community of which 746
were earthquake
Injured (EQI)

9. 3. Rehabilitation Units development in District Hospitals
7,195 treatment sessions
were provided along with
2,578 follow-up sessions
552 assistive devices were
delivered to clients

10. 3. Rehabilitation Units development in District Hospitals
4,428 Clients and 1,428 caregivers were
oriented on rehabilitation

11. 3. Rehabilitation Units development in District Hospitals
54%
46%
Gender distribution of
beneficiaries
Female
Male
2%
11%
66%
21%
0%
20%
40%
60%
80%
0-5 5-18 18-60 ≥60
Distribution of beneficiaries
according to age group
22%
22%
16%
14%
11%
9%
6%
0% 5% 10% 15% 20% 25%
Charikot
Nuwakot
NTC
Chautara
Rasuwa
Jiri
Dhading
Distribution of beneficiaries
according to PT unit
n = 4617

12. 3. Rehabilitation Units development in District Hospitals
62.8%
24.6%
2.1%
1.4%
1.3%
1.3%
1.3%
1.0%
4.1%
0% 10% 20% 30% 40% 50% 60% 70%
Other Orthopaedic Conditions
Fracture
Cerebral Palsy & Other Paralytic Syndromes
Head Injury
Respiratory Problems
Spinal Cord Injury
Other Disabilities
Amputation
Others
Type of Diagnosis/Impairment of Beneficiaries

13. 4. Need derived from project achievement
According WHO DAS, 837 patients (296 EQI and 541
EQA) need long term rehabilitation care

14. 4. Need derived from project achievement
2%
11%
66%
21%
0%
20%
40%
60%
80%
0-5 5-18 18-60 ≥60
Distribution of beneficiaries
according to age group
38.3% and 33.6% of the disability
causes due to diseases and congenital
The most (50.6%) of disability onset
between 0 – 10 years
Need more time to focus on Children with Disabilities issues

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

16. 5. Need derived from growing burden of non-communicable
diseases (NCDs), the rising prevalence of disability and changing
global population demographics
People over 60 years of age already outnumber children under 5, with the
fastest growth of the number of older persons occurring in Low and Medium
Incomes Countries.
The age structure of Nepal is changing in the same pattern. The proportion of
the population 65 years and older will rise from 4.2%, in 2000, to 5.8% in 2025.
The World Bank, South Asia Human Development, Health Nutrition, and Population. NCDs policy brief, Nepal, 2011.

17. 6. Need derived from Nepali Policies
Policies of MoH related to the rehabilitation services and
disability :
• NHSS 2016-2021 mentioned physiotherapy in basic health package
• 10 years action plan on Prevention and Rehabilitation of Didability is
under finalization
• National childhood disability management and rehabilitation
strategy 2063 clearly appeals for the rehabilitation for children with
disability
• Birth defect surveillance, prevention and control plan (2015‐19) has
rehabilitation as one of the intervention
• Prolapse uterus management guideline and national training manual
defines the importance of physiotherapy exercises
• Nepal Health policy 2070 assures health service to people with
disability

18. 6. Need derived from Nepali Policies
Other Nepal Policies on Rehabilitation :
• Constitution of Nepal assures to ensure health right for
people with disability
• National Policy and Plan of Action on Disability of the MWCSW
with a Health component
Need Integration of Rehabilitation services in Health
System to implement those policies

19. 7. Integration of Rehabilitation services in the Health System
HPs, PHCC & CHU
Prevention and detection
• Birth defect
• Disability due to NCD,s and due to Elderly
• Childhood disability and Motherhood disability
Long term follow up in collaboration with second level
District hospital
Assessment and Care
Long term follow up in collaboration with first level
and the third level
Tertiary hospital &
Rehabilitation centres
Specialized care
Referral mechanism
Referral mechanism

20. • Allocate funding in health for disability and rehabilitation at all
tiers: look at links with current health programmes ( MCH, NCDs) and
implement a disability and rehabilitation-specific policy
• Utilize available human resources in rehabilitation in health system
(1780 PTs trained in Nepal)
• Define public private partnerships with CBOs operated rehabilitation
centre
• Coordination interdepartmental/interministerial for integrated care of
impairments and to address disability issues
• Engage disable people organizations at all levels and CBR programmes
• Seek support from non-state actors expert at this area
8. Ways forward to develop and sustain rehabilitations
services