Poverty and disability often go hand in hand. 80% of all people with disabilities live in developing countries. Nepal is one of the poorest countries of the world. The large majority of persons with a disability receive no care, nor education. Besides, this group of people faces various types of discrimination, exclusion and negligence, often based on religious, cultural or misinformed ideas. This largely hinders their rights and equal access to basic services and inclusion in society. The negative impact on the independence and income of the individual, it also leads to unused human capital and gross losses in economic development.
In 2007, Karuna Nepal launched Share&Care – a community based health insurance programme, sharing risks and costs of healthcare and caring about children with disabilities and their families. Then, in 2011, Karuna Nepal launched Inspire2Care to ensure inclusion of the most vulnerable groups within the communities. It aims at the prevention of disabilities and the community based rehabilitation of children with disabilities. From the beginning Karuna encourages poor rural communities to take leadership andresponsibility. Within the existing government system Karuna establishes a local committee and trains a community rehabilitation worker in communicative, medical and physiotherapy skills in every village. He or she is on the pay roll of this local committee and together with the parents, he or she establishes rehabilitation goals and carries out a yearly intervention plan for every child and adult with a disability. Local auxiliary health workers are also trained in prevention of disabilities and supported in establishing a more effective maternal child health care system, such as the mobile tracking of pregnant women and their required antenatal check-ups and delivery preparation.
Thanks to Karuna’s awareness events and lobbying activities and the strong collaboration with the local authorities and political leaders, the health workers and civil servants also feel increasingly responsible for reaching out to this forgotten group and to allocate funds for their cause. After three years, the local committees are independent from Karuna and continue the activities with their own resources. This way, the system changes permanently.
KEY SOCIAL IMPACT FIGURES
Number of lives of children with a disability are being improved. They fully participate in the society and have access to education and (specialised) healthcare. 70% of the children and their families experience a significant improvement in health, education, income and social participation.
Child birth professionally guided increased from 3% to 60%.
Reduction in the development of disabilities before, during, or (up to five years) after birth. 500 children prevented from having birth defects and disability in all project villages since the beginning of the project.
Percentage of children with a disability who have an ID card in 2017 compared to only 11% in 2009. This gives them access to social protection, allowances and increases their social participation, recognition and acceptance.
VENTURE PHILANTHROPY CONTRIBUTION
How it started
From the beginning the Dutch entrepreneur René aan de Stegge had the ambition to improve the lives of children with a disability and their families in such a way that local leaders would take responsibility and local resources would be allocated for this cause. The goal was to develop a community model that would be both sustainable and replicable.
During the first visit to Nepal in April 2007 the founder and the director of Karuna Foundation Netherlands met two Nepalese social entrepreneurs, with a strong vision on how to bring positive and long lasting change in their country. Karuna Foundation Nepal was born. Between 2008 and 2013 this core team developed and piloted Inspire2Care, a model encouraging poor communities to take care of children with a disability and their families, as well as strengthening existing mother-and childcare. It was all about learning by doing while always keeping in mind their mission: “saving children from disability, one by one”. They adopted an entrepreneurial approach and were very strict on cost-effectiveness and the exit plan from the very beginning, even before the start.
In 2014, based on an independent research by the Royal Tropical Institute in Amsterdam showing the high cost-effectiveness of the programme, they decided the scale up Inspire2Care to a whole district, from 3 pilot villages to 55 villages today (2017).
Karuna Netherlands has supported Karuna Nepal both financially and technically to develop and implement programmes such as Inspire2Care and Share&Care. Since 2016 Karuna Foundation Nepal is a local organisation with its own board. The key element for the VPO is to guarantee the entrepreneurial mind-set, to strategically coach the team in Nepal, and to jointly develop a replication plan. Both the organisations share the ambition to replicate Inspire2Care in whole Nepal and beyond.
In 2011, Karuna Nepal launched a pilot programme in 7 villages and spring 2015 Inspire2Care was being implemented in 18 villages. The running costs are shared between Karuna Nepal and communities in the ratio 80%-20% in the first year to 50%-50% in the second year and 30%-70% in the third year (see graph below).
This approach strongly focussed to local resource mobilisation and embedding the program in the yearly plan and budget of the Rural Municipality has led to sustainability and successful replicability.
In the acceleration phase, between 2015 and 2017, aimed at implementing Inspire2Care in an additional 37 villages, other investors came on board and invested €1,540,000. Karuna Foundation Netherlands invested a €886,000 grant. This phase of scaling up Inspire2Care in one district is ongoing and will finalise in 2019.
In the next phase, which is the nationwide replication of Inspire2Care in Nepal (2018-2027 plan), an investors consortium will be set up. In this consortium Investors will grant a total of €15,000,000 to scale up nationwide and implement the programme in 1,000 villages across the country. This investors consortium is now in the process of being formed.
Non-financial support at a glance
Management Team and CEO Support
Theory of change, Impact Strategy & Impact Measurement
As of September 2017
Baseline (before Inspire2Care)
Decrease the of preventable birth defects and childhood disabilities
% of birth defects and childhood disabilities
Between 2005 and 2009, 48 cases of children with a birth defect or disability occurred
62% decrease of cases of birth defects and development of disabilities during the programme compared to the number of cases in the 5 years before. In total 500 birth defects and disabilities have been prevented so far.
Increase the percentage of pregnant women going for the required 4 antenatal check-ups.
% pregnant women going for 0, 3 or 4 antenatal check-ups
49.8% had 4 visits, 22.2% had 3 visits and 28% never visited for antenatal check-up.
80% of the pregnant women go to 4 antenatal check-ups
After programme intervention, 83.3% had 4 visits, 11.1% had 3 visits and 5.6% had no visit.
Improved quality of life for children with disabilities
% of children experiencing improved quality in health, education and social life and livelihood.
Before the programme almost all children suffered exclusion and neglect in health care, education and social life. Often families were poor, which increased their vulnerability and its effects in their daily live. They used to perceive disability as a matter of shame. Parents used to hide their children with disabilities.
50% of the children with a disability experience improvement of their lives.
70% experience moderate to significant improvement in their health and education condition
72% mentioned that I2C has brought a moderate to significant improvement in their confidence
65% of the families with a child with a disability have moderate to significant improvement in their livelihood condition.
What they think
“With the treatment and moral support provided through the Inspire2Care programme, I am able to get back to normality again. I am now encouraged to do more in life by learning knitting and sewing and want to open my own shop”.
Rekha Chaudhary, 19-year-old woman with a physical disability from Dumraha, Sunsari, Nepal
“The support I received through Inspire2Care programme has been immensely supportive to take my life to the next level. I not only received medical treatment but also the moral support through which I believe I am empowered and am able to participate in various activities. Without Inspire2Care being implemented in my village, I would not be able to be the person I am today.”
Suman K Chaudhary, 20-year-old burn victim, from Dumraha, Sunsari, Nepal
“The motivation, ideas, entrepreneurial approach and inspiration which Karuna Foundation Netherlands have brought to Nepal, along with long term financial commitment, has brought durable changes in the lives of many families and has prevented hundreds of children from having a disability. Thanks to an equal partnership, we have jointly developed a programme which has the potential to be scaled up in larger parts of the country, so that systemic change will happen.”
Deepak Raj Sapkota, Executive Director, Karuna Foundation Nepal
“Only through equal and inspiring partnerships and having a clear joint vision and ambition you can achieve great things. I am grateful that with our colleagues from Karuna Foundation Nepal we built a solid and entrepreneurial organisation with qualified leaders. And I’m proud of the results achieved: in the Inspire2Care village leaders take up the responsibility for inclusion and rehabilitation of children with a disability and their families and ensure maternal and child health is improving. These are excellent fundaments for nationwide scaling up.”
Betteke de Gaay Fortman, Director, Karuna Foundation Netherlands
Karuna Foundation Netherlands through establishing an investors’ consortium supports Karuna Foundation Nepal to develop and implement the 10-year plan, setting ambitious targets for 2025:
scaling up I2C nationwide in Nepal, which means implementing I2C in 1,000 villages,
reaching 1.8 million women and children under 5 years old, and
ensuring community-based support to 25,000 children with disabilities.