Name of Project:

Advancing SRHR of Persons with Disability (PwD) in Nepal 2019-2022

 

Project Summary:

Although an estimated 15 % of the world’s population live with a disability, many of the persons with disabilities (PwD) are marginalized and their human rights are violated. Furthermore, their sexual and reproductive health (SRH) needs or their sexual rights are not fully recognized and acknowledged: they have often been denied their right to establish relationships or to decide whether to have a family, and many have faced forced sterilizations, abortions or marriages. PwD face discrimination and barriers to information and services, and encounter stigma and stereotypes especially when it comes to their sexuality. Negative attitudes, ignorance and misconceptions of the societies, health-care service providers and even family members raise most of these barriers. Furthermore, PwD are more likely to experience gender-based violence, sexual abuse, and emotional abuse, and are more likely to be infected with HIV or other sexually transmitted infections (STI). Many issues regarding SRHR of PwD are equally burdening men and women, but there are many gender specific issues. Taken into consideration that currently low access to SRHR in developing countries and consequent poor SRH outcomes represent one-third of the total global burden of disease for women aged 15-44 years, it is alarming that SRHR of PwD is globally neglected and underfinanced field.

Therefore, this project will bring together five expert organizations on SRHR and/or disabilities to bring about change in three partner countries, Afghanistan, Nepal and Tajikistan, through national activities and rigorous learning and sharing of best practices.

Analysis of the operating environment in Nepal

Sexual and Reproductive Health:

Few people have access to quality health services. The public health infrastructure is wide but due to inadequate human resources, poor infrastructure, and poor management, the quality of public health services is not sufficient. In addition, low status, and low education and literacy levels of women have negative influence on access to health information and services. It is also customary that women lack voice in reproductive health matters, and any decision related to her life and health will be taken by her husband and his family.

Nepal was close to meeting the targets of reducing the maternal mortality ratio (MMR) and increasing the proportion of births attended by skilled birth attendants (SBAs). However, these improvements have not been unfirming and major disparities exist between rural and urban areas and among eco-geographical regions and social groups. The large reduction in the MMR is associated with the fall in the total fertility rate (TFR) from 5.3 in 1996 to 2.3 in 2014. The latter was largely due to married couples ‘increased use of contraceptives from 24 percent in 1990 to 49.6 percent in 2014 (MDG Status Report 2016).

People with Disability (PwD)

The National Population Census 2011 states that the overall prevalence of disability was 1.94 % in Nepal, with 2.2% prevalence of male disability and 1.7% prevalence for females. Whereas the National living standard survey report 2011 has claimed it to be 3.6%. However, both figures are quite low as compared to the 15% disability prevalence rate claimed by WHO and World Bank in the World Report on Disability (2011). These figures are in sharp contrast to studies carried out by specific impairment groups - for example a survey carried out in five districts in 1991 stated that 16.6% of children aged over five were deaf.

According to the National Population Census 2011 physical disability was the most common type of disability, which accounted for more than one third of total disabilities. Disability in rural residents was more prevalent (2.1%) compared to disability in their urban counterparts (1.2%). More than one third of the disabled are less than 30 years old and only one-fourth of disabled persons are aged 60 years or more.

Studies addressing the SRH needs of persons with disabilities are not available in Nepal. However, a survey on Living conditions among people with disability in Nepal showed that most of the health posts/health clinics are not accessible and do not accept the presence of persons with severe disability, although attempts have been made to make newly established hospitals in national as well as district level accessible, at least having ramps. Despite the adoption of the provision of free health care for persons with disability, the survey further claimed that many of persons with disability are either unknown to the services or do not access granted facilities and services, consequently, resulting in the extreme poor health condition of persons with disabilities. The survey also pinpointed even service providing health facilities are not aware of the legislations and policies regarding inclusive health treatment of persons with disabilities.

Project Location:

Province	District
Province-1	Morang
Province- 3	Kathmandu, Bhaktapur & Lalitpur
Province-7	Kailali

Note: The project has been implemented from 2019-2022. In the first year it will be implemented in Kathmandu valley covering Kathmandu, Lalitpur and Bhaktapur districts respectively.

Overall goal and Objective:

Overall goal of the project

• Improving Sexual Reproductive Health and Rights (SRHR) of People with Disability (PwD)

Objectives:

• To Strengthen the life skill and capacities of beneficiaries.
• To raise awareness on PwD and their sexual rights.
• To increase the capacity and engagement of decision makers in PwD SRHR issues and strengthen PwD SRHR policies through advocacy.
• To Strengthen capacity of SRHR service providers.

 

Activities: To meet the goal and objective of the project following activities will be implementing

Output 1: Capacity building of beneficiaries

• Organize trainings to 3 DPOs on sexual rights and advocacy for beneficiaries by ensuring equal participation Man & Women.
• Organize sensitization trainings for parents of children with disabilities
• Identify and Organize 3 days Life skills-based peer education trainings for Peer Educators on PwD SRHR issues. Heavy emphasis on self-esteem and self-awareness.
• Organize trainings for trainers and peer educators on PwD SRHR issues
• Producing 1500 Pcs PwD relevant SRHR material and suppling the SRHR corner of 3 DPOs.
• Peer support programme.
• Expand and strengthen network of PwD in Nepal.

 

Output 2. Changing attitudes in society:

• Partner organization radio audio program about PwD SRHR. Program will be jointly proposed and message will be designed together with the partner DPOs and Radio Audio.
• Organize 6 awareness raising sessions (group discussion) will be organized by trained PEs in September/October. The themes of the community sessions/group discussion will include basic information about sexual rights and available SRH services for PwD. At the same time the needs of the PwD will be identified.
• Build capacity of PwD to raise awareness of SRHR issues in communities
• Train journalists in SRHR issues of PwD

 

Output 3. Advocacy:

• Half day workshop on SRHR of Persons with Disability (PwD) will be organized on Family Planning or Population day in close collaboration with Family Welfare Division (FWD), under Ministry of Health & Population, DPOs, CSO partners, Tribhuvan university, UN agencies etc. The leader of the DPO will be a speaker in the event/events.
• Meeting with FP sub-committee members to convened by Family Welfare Division of the Department of Health services of the Ministry for Health and Population on SRHR of PwD.
• Identify CSO partners and build their capacity.
• Establish a task force to support the social welfare of PwD.
• Networking and joint advocacy with CSO and government partners.

 

Output 4. Quality SRH services are provided for PwD:

• A discussion meeting with senior management of FPAN to sensitize project modality and theory of change.
• Increase accessibility of FPAN clinics (Checklist will be developed and assessment will take place in May or June. Clinics will be physically upgraded to increase the accessibility e.g. Medical equipment (ramps, wheelchairs, Examination chairs to support PwD)
• Capacity building of FPAN’s service providers from each 3 districts on SRHR of PwD.
• Integrate PwD needs into existing SRH service delivery points. (
• Build capacity of disabled couples to became community health workers.
• Training of community health volunteers

Output 5. Learning and sharing:

• Organize yearly partnership meetings to share best practices, build RBM capacity, and learn.