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Cost-effectiveness of a Community-based Rehabilitation Programme in Nepal

Vaughan, Kelsey
Thapa, Aradhana
2016

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Purpose: This study aimed to estimate the cost-effectiveness of a community- based rehabilitation (CBR) programme known as Inspire2Care (I2C), implemented in Nepal by Karuna Foundation Nepal. In the absence of any gold standard methodology to measure cost-effectiveness, the authors developed a new methodology to estimate the programme’s achievements and cost-effectiveness.

 

Methods: Financial records were reviewed to determine total expenditure during the period August 2011 - December 2013. Programme records which documented the physical, mental and social status of children and adults with a disability qualitatively before, during and after the intervention were used to determine a starting disability weight and improvement score, which was then converted into a change in disability weight. The disability weight and expected remaining lifespan of each person were used to estimate disability-adjusted life years (DALYs) averted by the intervention. The cost per DALY averted was estimated by dividing the total programme expenditure by the sum of DALYs averted over that same period.

 

Results: I2C cost 204,823 Euros to implement over the period August 2011- December 2013. In total, an estimated 1,065 DALYs were averted from the treatment and rehabilitation components. The cost per DALY averted was 192.34 Euros.

 

Conclusions and Implications: The methodology devised for the study was able to successfully estimate the cost-effectiveness of the I2C programme. Using WHO benchmarks, this programme can be considered highly cost-effective. Other organisations can assess the cost-effectiveness of their programmes by using the assessment improvement score and subsequent conversion to DALYs averted. However, while mental, physical and social gains have been captured, other benefits from I2C cannot be captured in the cost per DALY averted statistic. Further research is needed to develop methods for incorporating these harder-to- measure gains in cost-effectiveness studies with a single outcome measure like the DALY.

Inclusive disaster risk management : a framework and toolkit

FERRETTI, Silva
KHAMIS, Marion
2014

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This framework and toolkit have been designed to support practitioners in challenging and deepening inclusiveness in their work. They have been designed in simple language, so the resource should be easy to adapt for the use of field staff as a complement to existing manuals and operational resources on DRM. The practical framework contains the following sections:introduction, framework for inclusive DRM, levels of achievements, and assessing inclusiveness, using the framework for,  annexes and Q&A. Throughout the resource, related resources and checklists are provided and the toolbox features cartoons, tools catalogue, learning pills, case studies, poster and 4D lenses. These resources are useful for practitioners who want to develop an understanding of inclusive DRM framework and to learn how to practically assess inclusiveness in in ongoing DRM situations

Empowerment and participation : good practices from South & South-East Asia in disability inclusive disaster risk management

BOLTE, Patrick
MARR, Samadhi
SITOMPU, Dewi
et al
2014

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This report presents good practices showing examples of inclusion and active participation of persons with disabilities in disaster risk management. The paper is structured in three sections that illustrate general recommendations towards greater participation of persons with disabilities.

Section A provides the background on disability inclusive disaster risk management and reviews existing guidelines as to how the participation of people with disabilities in disaster risk management can be facilitated. 

Section B contains the actual good practices, structured in three separate chapters that illustrate general recommendations towards greater participation of persons with disabilities. Each practice highlights the involvement of individual persons as well as groups, describes the initial setting, the achievements, and the lessons learned from the practice. Each practice concludes with a box with key insights.

The final section C presents the key recommendations that can be drawn from the good practices and that are geared to inform future programming

Sustainability and equity aspects of total sanitation programmes : a study of recent WaterAid supported programmes in three countries global synthesis report

EVANS, Barbara
et al
2009

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This report is a synthesis of three individual country studies on Community-led Total Sanitation (CLTS) activities in WaterAid programmes in Bangladesh, Nepal and Nigeria. The studies examined whether CLTS had led to sustainable and equitable sanitation behaviour change. The study explored whether achieving open-defecation-free (ODF) status is a necessary but not sufficient condition for the entire community to use and maintain hygienic latrines in the long-term. Also, where possible, the study explored the additional factors that enhance the probability that ODF status will translate into entrenched behaviour change, as well as the capacity of communities to move onwards up the ‘sanitation ladder’

Ancient roots, new shoots : endogenous development in practice

HAVERKORT, Bertus
VAN T' HOOFT, Katrien
HIEMSTRA, Wim
Eds
2003

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This book describes the approach of COMPAS, a network of partners that supports 'development from within', based on local knowledge and practices. The body of the book consists of case studies which illustrate how development can be based on locally available resources, knowledge, values and leadership institutions; how there can be genuinely local determination of development options; and how the benefits of development within local areas and communities can be fostered

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