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: cbrs@fewamail.com.np

Final December 2003

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

and

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

Table of Contents

Summary .................................................................................................................................................. 3
Introduction.............................................................................................................................................. 4
1.1 Project Description ........................................................................................................................................ 4
1.2 Evaluation Objectives.................................................................................................................................... 5
1.3 Evaluation Methods....................................................................................................................................... 5
1.4 Evaluation Approach ..................................................................................................................................... 5
Evaluating the Programme .................................................................................................................... 7
2.1 Project Logic .................................................................................................................................................. 7
2.2 Home Visits.................................................................................................................................................... 8
2.3 Referrals.......................................................................................................................................................10
2.4 Weekly Counselling Days (WCD). .............................................................................................................11
2.5 Raising Professional Awareness................................................................................................................11
2.6 Appliances and equipment .........................................................................................................................12
2.7 Training ........................................................................................................................................................13
2.8 School Awareness Programme (SAP) ......................................................................................................14
2.9 Local Awareness Programme (LAP) .........................................................................................................16
2.10 Parents Group (PG) ....................................................................................................................................16
2.11 Income Generation (IG) ..............................................................................................................................18
2.12 Networking ...................................................................................................................................................18
2.13 Education .....................................................................................................................................................19
2.14 Vocational Training (VT) .............................................................................................................................20
Evaluating the Organisation ................................................................................................................ 22
3.1 Rehabilitation Facilitators ............................................................................................................................22
3.2 Support Staff ................................................................................................................................................23
3.3 Advisory Group (AG) ...................................................................................................................................23
3.4 Management Team (MT) ...........................................................................................................................24
3.5 NGO Committee (NGOC)...........................................................................................................................25
3.6 CBRS Consultant ........................................................................................................................................26
3.7 Monitoring and Reporting ...........................................................................................................................27
3.8 Planning .......................................................................................................................................................29
3.10 Community Involvement .............................................................................................................................29
3.11 Financial Management................................................................................................................................31
3.12 Teamwork ....................................................................................................................................................32
Appendices ............................................................................................................................................ 33
4.1 Outline Programme Log Frame..................................................................................................................33
4.2 Home Visit Case Studies ............................................................................................................................34
4.3 Evaluation Terms of Reference ..................................................................................................................35
4.4 List of Stakeholders Consulted in Evaluation ............................................................................................39
4.6 Acronyms .....................................................................................................................................................40

2
Summary

Activity
CBRS makes a very significant impact on the lives of the clients that it reaches. As we report later on ‘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 achievements of clients.’ The impact of ‘delivery’ activities such as home visits, weekly counselling days
and appliances is particularly powerful and we make suggestions on how CBRS might increase the number of clients
who benefit from these services.
Awareness raising activities, such as LAP & SAP, are recognised as important by CBRS and form an important part of
programme activities. These are well intentioned but we believe that their impact could be significantly improved and
make suggestions as to how this might be achieved.
Other activities, such as income generation and vocational training have been rightly identified as important. However, we
suggest that these may be more effective if led by other partners with more experience in these fields. This would not
only 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 families
and the NGO committee are also involved in the wider ‘CBRS family’ and demonstrate similar degrees of enthusiasm
and commitment. There is a tangible sense of team and mutual respect. This report recommends a number of ways in
which 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 on
awareness and advocacy (which is obviously important) it is encouraging to see an organisation that, in addition, delivers
such 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 made
in this report will help the organisation’s leadership as they seek to make CBRS even more effective. It is our hope too
that CBRS’ funding partners will continue to support this valuable work, through which the lives of clients are transformed
and the attitudes of society are challenged.

3
 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 project’s aim, objectives and activities is given in a semi - Logical Framework format in table 1
below.

Table 1: CBRS aim, objectives and activities

Aim improved quality of life for young people with disability

Objectives 1. clients achieve 1. clients have supportive 1. clients are integrated 1. clients have livelihood
physical and mental and knowledgeable into their communities opportunities
potential families and supported by
society

Activities • home visit therapy • home visit advice
• weekly counselling day • weekly counselling day
therapy advice
• appliances • parents group
• income generation for
parents
• skill training for parents
• school awareness • education of clients in
programme local schools
• local awareness • some basic education of
programme clients during home
• raising professional visits.
awareness • vocational training of
• home visit awareness clients
raising

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
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 November

2003 and involved five main stages as follows.

Stage No. Days Activity

Planning
Meetings with stakeholders in
Kaski and Syangja districts.
Writing draft report
Discussion of draft report
Finalising report
1 Evaluation planning and review of project documents
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 or
structured discussions with groups, as well as simply observing activities in action,
such as SAP, LAP, PG and home visits.
3 Office-based
1 Meeting with CBRS Management Team and discussions with CBRS consultant
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 being
evaluated 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.

5
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 CBRS’s 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

organisation’s 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 organisation’s 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.
• 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

Description

Rukhmaya signs her name on the
CBRS home visit register
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 many
more 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.

Evaluation

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

8
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.

Recommendations

• 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

Description

Chart 1: Referrals to CBRS

CBRS data show a range of different referral routes. It is
health interesting to note the relatively low percentage of referrals
others
service
21% from the medical profession, both government and private
27%
(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
SAP / LAP
neighbours seek significantly more clients at present.
& staff clients &
13%
24% parents
15%

Evaluation

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.

Recommendations

• 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.

10
2.4 Weekly Counselling Days (WCD).

Description

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.

Evaluation

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

Recommendations

• 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

Description

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.)

11
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.

Evaluation

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

Recommendations

• 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

Description

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.

12
Evaluation

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.

Recommendations

• 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

Description

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 Nepal
have 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

13
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.

Evaluation

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.

Recommendations

• 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 in
disability 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)

Description

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

14
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.

Evaluation

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.

Recommendations

• 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 aren’t 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).

15
2.9 Local Awareness Programme (LAP)

Description

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 Discussing a possible new client contact after a LAP

programme. Many of those present could not read and

write and were therefore not able to participate in this.

Evaluation

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

Recommendations

• 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)

Description

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

16
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.

Evaluation

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.

Recommendations

• 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 children’s clubs that are being
planned.

17
2.11 Income Generation (IG)

Description

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.

Evaluation

The impact of IG activities is mixed. The buffalo scheme is generally working well. Some IG loans are being
successfully 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.

Recommendations

• 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

Description

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.

18
Evaluation

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.

Recommendations

• 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 employment
and 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

Description

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.

Evaluation

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:

19
• 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.

Recommendations

• 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)

Description

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.

Evaluation

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

20
Recommendations

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

Description

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.

Evaluation

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.

Recommendations

• 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.
3.2 Support Staff

Description

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.

Evaluation

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.

Recommendations

• 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)

Description

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.

Evaluation

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

23
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).

Recommendations

• 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)

Description

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.

Evaluation

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.

Recommendations

• 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.

24
• 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)

Description

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 meets
outside 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.

Evaluation

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

25
their work remains weak. Some members that we met explained that this is partly because they don’t 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.

Recommendations

• 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 committee’s 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

Description

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

26
• 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.

Evaluation

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.

Recommendations

• 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 consultant’s 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

Description

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.

27
Evaluation

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.

Recommendations

• 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 above
Professional 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

Description

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 CBRS’s core activity of home visits (for example, how many new
clients can CBRS accept this year or how can RF’s manage an increasing workload?).

Evaluation

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.

Recommendations

• 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

Description

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 PWD’s as resource

29
people. However community involvement is generally weak with little community participation in the
organisation beyond the attendance of family members at meetings.

Evaluation

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.

Recommendations

• 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-

30
 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

Description

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

Evaluation

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 on
increasing impact rather than increasing resources.

Recommendations

• 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.

31
3.12 Teamwork

Description

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.

Evaluation

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

Recommendations

• 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.

32
 Part

4
Appendices

4.1 Outline Programme Log Frame

Narrative Summary Indicators How will indicators be Assumptions

measured or collected?

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).
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 migrated
from 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 this
problem he went to school at grade one. His parents tried many medical sources of help but he was not
cured. Medical clinics gave lots of vitamins in the name of making strong muscle. His father also took him
Manipal medical college and was advised that he needed surgery. He decided not to follow their advice. In
the end they went GP Hospital and were referred to CBRS Pokhara. It took almost 6 months to come in
right place.

A year ago before they met CBRS, Rosan could not walk due to muscular dystrophy. But now Rosan is
walking and playing with friends - a good sign of progress expressed by parents. When we reached his
home, Rosan was not there – he soon came to meet us from across the road. Rosan looks like a happy
child. He does all exercises by himself in the morning and evening as per advice given by CBRS staff. His
parents 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 be
due to a male facilitator. His mother described that in the beginning of this problem, his father always
blamed 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 CBRS
staff. This was greatly appreciated by them. His father is thinking to send him to school with his younger
son.

During our home visit other neighbours also came and observed what Rosan was doing. His two best
friends also came and supported him. They are really helpful. An old man who has worked in India as Indian
army and now retired appreciated the service at home and encouraged Rosan's parents to send him to
school. While asking what problems are faced by Rosan in relation to social discrimination then the old man
expressed " f he goes to school he might have lots of problems on the way or at school but now he does not
face 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 younger
brother. 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 a
village which is 2 to 3 hrs distance from Shyanga Bazzar. 3 years ago they migrated to Shyanga Bazzar
and found out about CBRS from a neighbour.

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

During home visit of CBRS staff; both father and mother were involved. Father is retired Ex –Army. As per
assigned 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 sometime
beaten and from whom he does not receive love and care. Tek's parents expressed that if they had met
earlier then there may have been more progress with physical rehabilitation.

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4.3 Evaluation Terms of Reference

Background/Development Objective (Goal)

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

Specific Objectives
CBRS 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, in
the direct neighborhood, and the wider community. (This is in order to enhance disabled people and their families
finding 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 and
activities of the project. (This is done through shared activities, organisational structures, and by the participatory
working style.).
4 To provide information and resources for disabled people, their families, other individuals, organisations and the
genral community (Information, skills, and knowledge and technical materials are available in the Resource Referral
Centre).
5 To initiate and strenghten networking with other organisation, within the diability sector and within the community
based development sector, especially at local and regional levels.
6 To maintain effective and efficient management and administration to all the programmes and resources for the
above, 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, and
finances.

Activities

The activities to achieve these aims can be broadly divided into social communication (awareness), rehabilitation, and
promotion 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 the
region/society in general. This is done by posters, video, media , signboards, newsletter, website, teachers
training and school awareness programmes.
- Parent groups. There is a parent group in each district and they meet every two months. The group is open to
parents 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 of
the 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 works
with the management team in formulating, prioritising, planning, implementation, and monitoring of project
activities.
- Home visits and weekly counseling days. The rehabilitation facilitatiors conduct home visits for direct support to
the client and family. The main emphasis is on the clients’s own daily life and on the practical and/or social
problems faced by the disabled child/young adult and the family. The weekly counselling days are held on a
weekly basis and are attended by clients outside the home visit area, by new contacts, or for clients requested
to 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 informally
via other contacts and visitors.
- Training. CBRS conducts several training courses for staff, disabled adults, parent groups, local network
organisations, teachers etc. It is therefore an important activity. It is also one of the two national training
organizations for CAHD Approach.
- Management and administration. The organisation is constantly working towards improvement. Team
approach 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 to
recommendations (based on the findings) towards the different programmes/activities , the management and
CBRS 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 of
the 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 strategies
and their inherent strenghts and weaknesses).
• Explore and assess the organisational strength and capacity in handling and building up effective relations
with donors, the government, other NGO's and relevant institutions. Also indicate further possibilities for
lobbying and cooperation.
• Describe the internal organisational structure and assess its strenghts and weaknesses in terms of its
operation system (organisational structure and culture, checks and balances, management systems such
as finances, budgeting process, PME, communication and its decision making procedures). Assess the
role 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 other
projects.

Programme:

ƒ Assess the effectiveness and sustainability of all CBRS activities in relation to the objectives as set out, revised
or 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 mentioned
above with the general objectives.
ƒ Illustrate any positive changes and unintended benefits or negative effects from the individual activities.
ƒ 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.
ƒ Assess to what extend the interventions follow a rights based approach i.e. have a gender perspective and
whether 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)
− Describe the impact and effectiveness on the participants and the local communities.
− Describe the income generating activities, its participants, the procedure and the effectiveness.
− Assess the constraints, as experienced by the parent groups and observed by the evaluator.
− Assess whether the parent groups are capable of taking over the tasks of the Local Awareness
Programme and describe/lay out a strategy to achieve that capacity.

Awareness

- Assess the impact (behaviorial/attitude change) and effectiveness (in terms of time and money invested) of
the posters/billboards/newletters on the Nepalese society, the regions CBRS works in, local communities
and local/national NGO’s.

Home visits

Assess the impact and effectiveness of home visits on the beneficiaries (attitude, physical constraints,
moral support etc.) the parents/family and the local community.

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 Weekly counselling day

Assess the impact, effectiveness and the accessability for clients and disabled people that are not a
member.

Schooling program
- Assess the attitude change of teachers and students and the possible constraints (cultural)
- Assess the possibilities for disabled people to go to school and their possibilities at school.
- Assess the socioeconomic possibilities for the disabled children after school.

Local awareness programm

Assess the impact of the LAP on the attitude change and awareness of the local community and possible constraints.

Equipment
Assess the effectiveness of the equipement for the disabled people. Assess the possibility for the disabled to be involved
in making the equipement.

Training

- Assess the impact and effectiveness of the training given by CBRS to parents, staff, schools and other NGO’s. as
percieved by the participants and the evaluator.
- Assess the impact and effectiveness of the training for the disabled, till 18 years and for those between 18 and 25 years
old. Take into account their individual abilities, possible income generating activities and their relationships in society.

Implementation of the evaluation/Methodology

The evaluation will be considered as an external evaluation. Hence the external evaluator will be the sole responsible
person for the end result of the evaluation itself. This does not mean that the external evaluator will conduct the
evaluation all by itself but he or she needs to be able to form their own and independent view. In fact the evaluator will not
be able to do the whole evaluation by her/him self and therefore the help of a local consultant will be most appreciated.
Both beneficiaries and CBRS staff at all levels are primary scources of information to the evaluators and will be consulted
during the entire process. Apart from primary scources, secondary sources of information are needed (reports,
documents, papers, audit reports, policy papers etc.) and other organisations such as other NGO’s, the government etc.
with whom CBRS has close contact.

For preparatory and transparancy purposes an evaluation committee may be formed, consisting of CBRS central and
project staff and representatives of the beneficiaries (disabled persons and their parents). This committee can be
instrumental in facilitation, delivering information as required and logistical matters during the evaluation process.

The final methodology may not be included in the TOR but will be communicated with ICCO on completion.

Evaluation team

The evaluation team should consist out of one expatriate and one or two local consultants. The expatriate consultant
should probably be someone with an expertise on disability development issues. One of the local consultants should
have expertise of organisational development. Experience in lobby and networking is important. Further details may not
be included in the TOR but other requirements will be considered when selecting a team.

Time Frame

Normally this kind of evaluation will take about 15 days. A suggestion for a time frame might look like:
- Preparation including finalisation of methodology, work plan (and study instruments and training, if needed): 2 days
- Interviews with CBRS central staff and project staff: 3 days
- Interviews with direct beneficiaries (disabled people, parents) and indirect beneficiaries (non- clients): 3 days
- Interviews with relevant NGO’s, government, other institutions.: 1 day
- Reviewing secondary sources: 1 day
- Drafting report: 2 days
- Discussion draft report with evaluation committee and core staff: 1 day
- Final preparation of final report and submission: 2 days

Debriefing and Reporting

The evaluation team needs to provide a final report (digital and hard copy) that contains the folowing chapters:
- Main document in English, not more than 25 pages:

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- Findings of the evaluation and detailed recommendations presented in a logical way. The recommendations should
be comprehensible and feasible
- Summary
- Main conclusions
- Main recommendations
- Appendixes, including TOR, names of the evaluation team, itinerary, list of staff, beneficiaries and organisations met,
questionnaire (if any) and other relevant information.

The reporting procedures must ensure a participatory discussion on the key findings of the study with
the staff and beneficiaries of CBRS. The draft report should be in the form of a presentation to CBRS staff. The views of
CBRS staff and the beneficiaries will be taken into due consideration while finalising the evaluation report. The evaluators
will discuss a draft evaluation report with the evaluation committee and their comments will be considered while finalising
the evaluation report.
The final report will be send to ICCO not later than 10 days after the end of the evaluation by the evaluation leader.

Follow-up

Based on the outcome of this evaluation ICCO will decide on continuation of the support to CBRS beyond the present
project phase.

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4.4 List of Stakeholders Consulted in Evaluation

FIRST BLOCK

DATE REMARKS
22 September Work Plan/Methodologies Preparation and finalization, (this will also include CBRS activities
Monday presentation)

first hours = own time for planning, discussions with MT to provide secondary information
3:00 pm =CBRS activities presentation

23 September Discussion/ Interaction with Direct/Indirect beneficiaries of CBRS Kaski field

Tuesday E.g. H/V in Kaski [Also SAP Observation]

First hours = own time

11:00 –1:00 pm =Home visits in Kaski (separately)
2:00 pm onwards = SAP at Dharmasthali school-Parsyang
Back to office

24 September As above (Direct/Indirect beneficiaries of CBRS) Observation of Kaski PM (PM Kaski)

Wednesday
Is GPH informed?

10:00 – 11:00am = discussions with MT

11:00 am to 1:00pm = PM Kaski observation and meeting with small sub group of PG (8 members)
2:00pm onwards = visit to a secondary school to talk with pupils and staff about a previous SAP.

25 September Travel to Syangja/Walling Discussion/Interaction with Direct/Indirect

Thursday Introduction with staff beneficiaries of CBRS- Syangja field Syangja RF to
Meeting/Discussion with Walling Municipality E.g. H/V in the field come this day at
9:30 am

8:00 am = Travel to Syangja office (with one MT member)

LUNCH IN SYANGJA BAZAAR / Introduction with Syangja Staff
10:30 am = Travel to Walling
12:00 – 1:00 = Meeting with Walling Municipality
1:30 pm onwards = home visits separately with field staff
Back to Syangja/Pokhara

26 September Discussion/Interaction with Syangja Team + LAP Observation WCD Observation

Friday Support Staff Back to Pokhara

Leave for Syangja at 9:00 am

11:00 – 2:00 pm = LAP Observation
2:00 pm = Return back to Syangja Office
3:00- 4:30 pm = Discussion/Interaction with Syangja RF's and support staff
Travel back to Pokhara

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SECOND BLOCK

8 October Discussion/Interaction with Support Staff + With MT and AG (Are AG Members

Wednesday Disable Adults Kaski informed?)
(Are Adult clients
informed?)

Firs hours = own time

10:30 am- 12pm = Discussion/Interaction with AG members
1:00-2:00pm = With MT
2:00-3:30pm = with Disabled Adults (resource people for CBRS)
3:30-4:30pm = with Support Staff- Kaski
4:30 onwards = own time

9 October Meeting/Discussion with relevant NGO's, Govt., and other institution- Kaski (Local
Thursday Network Organizations)

First hour = own time

10:30 –11:30 am = Regional Health Office at WRH hospital
11:30 – 12:30am = DDC office (LDO)
2:00 - 3:00pm = Green Pastures Hospital Orthopedic Unit.
3:00 – 4:00pm = Local Education Officer
4:00pm onwards = Back to office and own time

10 October Discussion/Interaction with CBRS Committee Discussion/Interaction with Kaski To remind CBRS
Friday Members Team Committee Members

First hours = own time

11:00 - 12:00pm = with Kaski RF's
1:00- 2:30pm = with NGO Committee Members
2:30 – 4:30pm = with MT

11 October Reviewing Secondary Sources Meeting/Discussion with MT

Saturday

9:00 – 1:00pm = debriefing with MT and outline / discussion of major recommendations.

4.6 Acronyms

AG Advisory Group NDUP National Disability Uplift Programme

CBR Community Based Rehabilitation NGO Non Governmental Organisation
CBRS Community Based Rehabilitation Service NGOC NGO Committee
DEO District Education Office NSMP Nepal Safer Motherhood Programme
HI Handicap International PABSON Private and Boarding School’s Organisation of Nepal?
IG Income Generation PG Parent’s Group
INF International Nepal Fellowship PWD People With Disability
LAP Local Awareness Programme RF Rehabilitation Facilitators
LF Logical Framework SAP School Awareness Programmes
MT Management Team VDC Village Development Committee
WCD Weekly Counselling Day

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