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This situational analysis (SITAN) addresses the question: “what is the current situation for persons with disabilities in Nepal?”. It has been prepared for the Disability Inclusive Development programme (which works on access to education, jobs, healthcare, and reduced stigma and discrimination for persons with disabilities in Bangladesh, Jordan, Kenya, Nepal, Nigeria, and Tanzania), to better understand the current context, including COVID-19, and available evidence in Nepal. It will be helpful for anyone interested in disability inclusion in Nepal, especially in relation to stigma, employment, education, health, and humanitarian issues. This SITAN has been briefly updated from the April 2019 SITAN.

The aim of this study was to identify key governance issues that need to be addressed to facilitate the integration of mental health services into general health care in the six participating "Emerald" countries (Ethiopia, India, Nepal, Nigeria, South Africa, and Uganda).  The study adopted a descriptive qualitative approach, using framework analysis. Purposive sampling was used to recruit a range of key informants, to ensure views were elicited on all the governance issues within the expanded framework. Key informants across the six countries included policy makers at the national level in the Department/Ministry of Health; provincial coordinators and planners in primary health care and mental health; and district-level managers of primary and mental health care services. A total of 141 key informants were interviewed across the six countries. Data were transcribed (and where necessary, translated into English) and analysed thematically using framework analysis, first at the country level, then synthesised at a cross-country level.

"Mental illnesses are the largest contributors to the global burden of non-communicable diseases. However, there is extremely limited access to high quality, culturally-sensitive, and contextually-appropriate mental healthcare services. This situation persists despite the availability of interventions with proven efficacy to improve patient outcomes. A partnerships network is necessary for successful program adaptation and implementation."

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.

Persons with disabilities remain one of the most vulnerable and socially excluded groups in any displaced community. Barriers to accessing humanitarian assistance programs increase their protection risks, including risk of violence, abuse and exploitation. Women’s Refugee Commission has been supporting the United Nations High Commissioner for Refugees and implementing partners to translate guidance on disability inclusion into practice at field levels through the provision of technical support to eight country operations. In the course of the project, WRC has consulted with over 600 persons with disabilities and care-givers and over 130 humanitarian actors in displacement contexts. Key protection concerns identified include a lack of participation in community decision making; stigma and discrimination of children and young persons with disabilities by their non-disabled peers; violence against persons with disabilities, including gender-based violence; lack of access to disabilityspecific health care; and unmet basic needs among families of persons with multiple impairments. Suggested strategies to further advance disability inclusion in humanitarian programming include: strengthening identification of protection risks and case management services for persons with disabilities; facilitating contextspecific action planning around key guidelines; and engaging the disability movement in advocacy on refugee issues.

Disability and the Global South (DGS), 2015, Vol. 2 No. 1

This report “documents positive practices and ongoing challenges to promote disability inclusion across UNHCR’s and its partners’ work in multiple countries and multiple displacement contexts. The report provides lessons and recommendations for other organizations and the wider humanitarian community on engaging persons with disabilities at all levels of humanitarian work. It draws on consultations with over 700 displaced persons, including persons with disabilities, their families, and humanitarian staff, in eight countries”

Note: This report is also offered in plain text format

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

"This report is the result of an external and independent evaluation of the Norwe¬gian Support to Promote the Rights of Persons with Disabilities in the last 11 years. The intention of the evaluation is to analyse the results of targeted and mainstreamed initiatives towards achieving the rights of persons with disabilities...The methodology included field visits in the four case countries: Malawi, Nepal, the Palestinian territory and Uganda to obtain a deeper understanding of how the rights of persons with disabilities have been promoted, and estimate the possible contributions of the Norwegian support. Afghanistan was included as a desk study"
Note: The report is available electronically and in printed version. A braille copy can be downloaded from the web. The four country reports, written in English, are available electronically. The summaries of the country studies are made available electronically, with translations to the relevant local languages Nepali, Arabic and Chewa. In addition an easy-read version in English and Norwegian of the main report is available electronically

Purpose: This quasi-experimental field study examines the prosocial influences of a children’s entertainment-education television programme, Khushi Ko Sansar, on children’s beliefs and intended behaviour towards people with disabilities in Nepal.

Method: Pre-test and post-test survey data were gathered from 357 Nepali children from nine communities that took part in the study. The children were shown two television episodes in which the star of the programmes, a dog named Khush, befriends and visits people with disabilities.

Results: Post-test results show that children developed strong identification with Khush and adopted his prosocial beliefs and behaviour towards people with disabilities.

Conclusions: The authors conclude that the entertainment-education television programme, Khushi Ko Sansar, provided a positive role model for children who encounter people with disabilities. Implications of these findings suggest that entertainment- education media can improve the treatment of people with disabilities and can promote beneficial health beliefs and practices.