• ckfËtf Joj:yfkg -/f]syfd, pkrf/ tyf k'g:yf{kgf_

gLlt, /0flglt tyf !) jif]{ sfo{of]hgfsf] ;fj{hlgsLs/0f

tyf

ckfËtf sfo{bnaf6 tof/ ul/Psf] k|lta]bg

k|:t'tLs/0f sfo{qmd

चूडामणी भण्डारी निरे्दशक

कुष्ठरोग नियन्त्रण महाशाखा तथा

अपाङ्गता सम्पकक इकाइक

H]f7 $, @)&$ (18th May, 2017)

• Disability definition & situation

• Disability in constitution

• National Health policy

• NHSS-IP

• Reaching the unreached strategy

• Disability policy, strategy and action plan

• CBR matrix

• Disability Task Force and Report • Partners (EDPs, INGOs, NGOs, Service centres)

• Future action plan (Current year & Coming years)

• Service Delivery in Federal Context

• Hamro Sawal + Update

• Leprosy-Muluki Ain

• MoH/DoHS= Division/ Centre’s role on disability management

• General Issues to be addressed for Disability (Prevention, Treatment & Rehabilitation) Management, Policy, Strategy & 10 years action plan

• Way Forward & Conclusion

• Acknowledgment

विषयसुची

z/L/sf cËx¿ / zf/Ll/s k|0ffnLdf ePsf] ;d:ofsf sf/0f ef}lts, ;fdflhs,

;f+:s[lts jftfj/0fsf ;fy} ;~rf/ ;d]taf6 l;h{gf ePsf] cj/f]w;d]tn] b}lgs

lqmofsnfk ;fdfGo ¿kdf ;~rfng ug{ Pjd\ ;fdflhs hLjgdf k"0f{ ;xefuL

x'g sl7gfO x'g] cj:yfnfO{{ ckfËtf elgG5 .

ckfËtfsf] kl/efiff g]kfn /fhkq, g]kfn ;/sf/åf/f k|sflzt, v08 %^, ebf} @ ut] @)^#

;fn -cltl/Qmf+s ## v+ @_, efu #, dlxnf, afnaflnsf tyf ;dfh

sNof0f dGqfnosf] ;"rgf, g]kfn ;/sf/n] ckfË ;+/If0f tyf sNof0f

P]g, @)#( sf] bkmf # sf] pkbkmf -!_ sf] k|of]hgsf nflu ;f]xL bkmfsf]

pkbkmf -@_ adf]lhd ul7t ;ldltsf] l;kmfl/; adf]lhd “ckfËtfsf]

kl/efiff tyf ckfËkgsf] lgwf{/0f” ;DaGwdf b]xfo adf]lhdsf]

dfkb08 tf]s]sf] 5 .

g]kfn

s'n hg;ª\Vofsf] !=($%-%,!#,@#!_ ckfËtf ePsf JolQmx¿

-/fli6«o hgu0fgf @)^* k|ltj]bg_

ckfËtfsf] cj:yf / l:ylt

ljZjJofkL

s'n hg;ª\Vofsf] !%% dflg;x¿ s'g} g s'g} ¿kdf ckfËtf ePsf -ljZj j}+s / ljZj :jf:Yo ;+u7gåf/f ;g\ @)!! df k|sflzt ckfËtf ;DaGwL ljZj k|ltj]bg_

Physical 36% Blindness / Low Vision

18%

Deaf / Hard To Hearing

15%

Speech Problem 12%

Multiple 8%

Mental Disability 6% Intellectual disability

3%

Deaf-Blind 2%

नेपालको सवंिधान २०७२ मा अपाङ्गताका सिालहरु

विशषेगरी धारा ८४, ८६ र धारा १७५ मा अपाङ्गता भएका व्यक्तीहरुको

राजनवैतक प्रतीवनवधत्िको ग्यारेन्टी हुन पगुकेो छ ।

• (३) राज्यले नागररकहरूका िीच उत्पवि, धमम, िर्म, जात, जावत, ललग,

आर्थिक अिस्िा, भाषा, क्षेत्र, िैचाररक आस्िा िा यस्तै अन्य कुन ैआधारमा

भेदभाि गन ेछैन ।

• तर सामावजक िा सांस्कृवतक दवृिले वपछविएका मवहला, दवलत, आददिासी,

आददिासी जनजावत, मधेशी, िारू, मुवस्लम, उत्पीवित िगम, वपछिा िगम,

अल्पसंख्यक, सीमान्तीकृत, दकसान, श्रवमक, युिा, िालिावलका, ज्येष्ठ

नागररक, लैंवगक तिा यौवनक अल्पसंख्यक, अपांगता भएका व्यवक्त,

गभामिस्िाका व्यवक्त, अशक्त िा असहाय, वपछविएको क्षेत्र र आर्थिक रूपले

विपन्न खस आयम लगायत नागररकको संरक्षर्, सशक्तीकरर् िा विकासका

लावग कानून िमोवजम विशषे व्यिस्िा गनम रोक लगाएको मावनन ेछैन ।

नेपालको संविधान २०७२ मा अपाङ्गताका सिालहरु

१८. समानताको हक

२४. छुिाछूत तिा भेदभाि विरुद्धको हक

३१. वशक्षा सम्िन्धी हक

३९. िालिावलकाको हक

४२. सामावजक न्यायको हक

४३. सामावजक सुरक्षाको हक

५१. राज्यका नीवतहरू

८४ संविय ब्यिस्िावपका

८६. राविय सभाको गठन सदस्यहरूको (पदािवध )

१७६. प्रदशे सभाको गठन

२५८. राविय समािेशी आयोग + काम, कतमव्य र अवधकार

अपाङ्गता सम्बन्त्धी काििु र िीनतहरू

अपाङ्गता सम्वन्त्धी छुटै्ट कािूि र िीनतहरु

अपाङ्गताको सवाल समेत समेटिएका राष्ट्ष्िय कािूि र िीनतहरु

1. अपाङ्ग सरंक्षण तथा कल्याण ऐन २०३९

2. विशेष शशक्षा नीतत २०५३ 3. अपाङ्गता सम्बन्धी नीतत

तथा कायय योजना २०६३ 4. अपाङ्गताको पररभाषा तथा

िर्गयकरण २०६३ 5. अपाङ्गता पररचयपत्र वितरण

तनरे्दशशका २०६५

1. नेपालको सवंिधान 2. स्थानीय स्िायत्त शासन

ऐन २०५५ 3. शशक्षा ऐन २०२८ (पतिल्लो

ससंोधन) तनयमािली २०५९ 4. तनजामती सेिा ऐन २०४९

को र्दोस्रो सशंोधन २०६४ र तनयमािली २०५० को सातौँ सशंोधन २०६४

निरन्त्तर ………… अपाङ्गताको सवाल समेत समेटिएका राष्ट्ष्िय कािूि र िीनतहरु

1. सिारी तथा यातायात व्यिस्था ऐन २०४९ 2. विशेष शशक्षा सञ्चालन सम्बन्धी तनरे्दशशका २०६० 3. िात्रा शशक्षा कोष िात्रितृ्त्त सञ्चालन तनरे्दशशका २०६३ 4. आयकर ऐन २०५८ 5. अपाङ्गता भएका व्यत्ततहरूलाई आन्तररक हिाई यात्रामा

दर्दइने िुट िा सहुशलयत सम्बन्धी काययविर्ध २०६३ 6. नेपाल रात्रिय भिन तनमायण आचारसदंहता २०६० 7. पे्रस काउत्न्सल ऐन २०४८ 8. प्रहरी तनयमािली २०४९ 9. अपाङ्गलाई आर्थयक सहायता सम्िन्धी तनरे्दशशका (शात्न्त

तथा पुन तनमायण मन्त्रालय) 10. शसस्त्र प्रहरी तनयमािली २०६० 11. खेलकुर्द विकास ऐन २०४८ र तनयम २०४९

/fli6«o :jf:Yo gLlt (National Health Policy-2071) df

ckfËtf ;DalGw ;d]l6Psf ljifox?

• k[i7e"ld – dfgl;s ckfËtf • k'g:yf{kgf

• ljBdfg l:ylt – kf]lnof]

• ;d:of tyf r'gf}lt – dfgl;s ;d:of

– Joj;fohGo :jf:Yo

– s'i7/f]u

• lgb]{zs l;4fGtx? – k'g:yf{kgf, :jf:Yo k|j4{g, kx'Fr, /f]syfd .

• gLlt ÷/0fgLlt

!=@ ckfËtf – cfFvf gb]Vg], b[li6 sdhf]/, sfg g;'Gg] nufot dfgl;s, af}l4s

tyf zf/f/Ls ckfËtf ePsf JolQmx?nfO{ cfjZos ;Dk"0f{ :jf:Yo ;]jf

cTofj:os :jf:Yo ;]jf cGtu{t ;dfj]z ul/g] 5 .

!=* b'3{6gf tyf rf]6k6s /f]syfd

•u'0f:t/Lo :jf:Yo ;]jfsf] kx'Fr

•;j{;'ne

•;a} gfu/Lssf] ;xh kx'Fr (UHC)

ljlzi6 tyf cltljlzi6 ;]jf

/fli6«o :jf:Yo gLlt sfof{Gjog ug{' xfd|f] bfloTj xf] ================

Nepal Health Sector Strategy-Implementation Plan

Among 9 outcomes highlighted in NHSS-IP, all are applicable, quality service is related more with disability issue.

NHSS strives towards the goal to ‘improve health status of all people through accountable and equitable health service delivery system’ with 9 outcomes: 1. Rebuilt and strengthened health systems: Infrastructure, HRH

management, Procurement and supply chain management. 2. Improved quality of care at point-of-delivery 3. Equitable utilization of health care services 4. Strengthened decentralised planning and budgeting 5. Improved sector management and governance 6. Improved sustainability of health sector financing 7. Improved healthy lifestyles and environment 8. Strengthened management of public health emergencies 9. Improved availability and use of evidence in decision-making processes at

all levels

स्वास््य सेवाको पहुुँच बाटहर परेकाहरुलाइक समेट्िे राष्ट्ष्िय रणिीनत NATIONAL STRATEGY FOR REACHING THE UNREACHED

वव. स.ं २०७३-२०८८ (2016-2030)

स्वास््य सेवाको पहुुँच बाटहर परेकाहरुलाइक समेट्िे राष्ट्ष्िय रणिीनत NATIONAL STRATEGY FOR REACHING THE UNREACHED

वव. स.ं २०७३-२०८८ (2016-2030)

केही रणिीनतको ववस्ततृ व्याख्या

केही रणिीनतको ववस्ततृ व्याख्या

ckfËtf Joj:yfkg -/f]syfd, pkrf/ tyf k'g:yf{kgf_

gLlt, /0flglt tyf !) jif]{ sfo{of]hgf

Continue….

Continue

ckfËtf Joj:yfkg -/f]syfd, pkrf/ tyf k'g:yf{kgf_

gLlt, /0fgLlt tyf !) jif]{ sfo{of]hgf

@)–@)*@

Role of Different Sectors as per NHSS-IP in Disability Management

Intervention defined in the IP/NHSS Responsibility Status

OP1a1: Health infrastructure developed as per plan and standards

Establish/strengthen rehabilitation department in district (earthquake affected), zonal, regional

and central hospitals

LCD -

OP1b1: Improved availability of human resource at all levels with focus on rural retention and enrolment

Recruit rehabilitation workforce LCD -

OP2.1: Quality health service delivered as per protocols/standards

Update national strategic guideline, operation guideline and treatment protocols for all type of

disability including leprosy

LCD -

Develop and institutionalize national standard for quality in rehabilitation, including SOPs and

protocols for rehabilitation services in districts, as well as zonal, regional and central hospitals)

LCD -

Develop and implement the basic pelvic floor rehabilitation protocol FHD -

OP1b1: Improved availability of human resource at all levels with focus on rural retention and enrolment

Conduct Emergency Trauma Management training to health workers (specialists, medical officers, staff nurses,

physiotherapist)

-

OP1b2: Improved medical and public education and competencies

Deliver continued medical education to various level service providers for all the type of

disabilities including leprosy LCD -

Promote continuous rehabilitation education (including E-learning) among health professionals LCD -

Build capacity of health worker for mass casualty management facilities (zonal and regional)

within one hour along major highways EDCD Few

district

Capacity building of health workers onPEN package PHCRD Few

Role of Different Sectors as per NHSS-IP in Disability Management

Intervention defined in the IP/NHSS Responsibility Status

OP1b1 Improved availability of human resource at all levels with focus on rural retention and enrolment

Develop and conduct modular training on early detection, referral and follow up for disabled women and children FHD Few districts

Incorporate basic pelvic floor assessment, ergonomic care and pelvic floor exercises in SBA training FHD - Conduct training on Pelvic Organ Prolapse NHTC Yes

Conduct training on early detection management and referral of women and children with disability (As per plan of

programme division)

NHTC -

Conduct training on NCD to Health workers NHTC Few

Build training capacity of NHTC/RHTC/clinical training sites on IMNCI, advanced ASRH, CMT/HIV, neonatal care, MLP, RH

morbidity, SAS,

NHTC Yes

Conduct Emergency Trauma Management training to health workers (specialists, medical officers, staff nurses,

physiotherapist)

NHTC Few

OP1b2: Improved medical and public education and competencies

Build capacity of health worker for mass casualty management facilities (zonal and regional) within one hour along major

highways

EDCD Few

Integrate relevant RH Morbidity and ASRH contents in relevant health training packages and preservice curriculum FHD Yes

Capacity building of health workers onPEN package (prog district) PHCRD Yes

OP2.1: Quality health service delivered as per protocols/standards Build capacity of HWs and FCHVs on early detection and management of birth defect and child disability CHD Few

Develop and implement the basic pelvic floor rehabilitation protocol FHD Process

OP3.1 Improved access to health services, especially for unreached population

Integrate early detection and community based management for child with disability in Remote Area Guideline CHD Process

Establish Morbidity management and disability prevention Programme at district EDCD ?

Role of Different Sectors as per NHSS-IP in Disability Management

Intervention defined in the IP/NHSS Responsibility Status

OP3.2: Health service networks, including referral system, strengthened

Strengthen existing referral system for treatment of RH morbid conditions from community/local level health

facilities to designated Hospitals

FHD Yes

Develop referral and cross referral mechanism among primary, secondary and tertiary level health service

providers and public and private medical/rehabilitation service providers for all type of disability including leprosy

LCD -

OP5.2 Improved governance and accountability

Establish Public Private Partnership to strengthen and extend services for unreached population and ensure

accountability of service providers

LCD -

OP4.1: Strategic planning and institutional capacity enhanced at all levels

Capacity building of regional health directorates/district public/ health offices on monitoring quality and

outcomes of rehabilitation services delivered by public and private service providers in the region

LCD -

District Tuberculosis Leprosy Officer assigned as focal person for all type of disability prevention and rehabilitation

activities of the district

LCD Working as focal person

OP5.1 Ministry of Health (MoH) structure is responsive to health sector needs

Organize multi-stakeholder coordination meeting ( intra departmental, inter departmental and related stake

holders) to review National Childhood Disability Management Strategy 2064

CHD ?

Rename the Leprosy Control Division to Leprosy Control and Disability Management and Rehabilitation

Division (LCDMRD)

LCD -

Strengthen HR and resources of LCDMRD LCD - OP9.1 Integrated information management approach practiced

Integrate the disability service data in HMIS MD Process

Integrate the pelvic floor rehabilitation service data in HMIS FHD “

Continue……….

Organizations Responsibility

Ministry of Health (MoH) Policy, Planning Budget

NHEICC IEC

DDA Policy & Facilitation

DoA Partnership Programme

Concerned Ministries 1. MoE 2. MoWCSW 3. MoFALD 4. Home Ministry

Policy Planning Programme Partnership

Future Action Plan on Disability

CURRENT YEAR

– Dissemination at the central level

– Dissemination workshop in 4 region

– Early detection training in Jajarkot

– Service center joint monitoring

– Publication and distribution (eg. Hamro Sawal + other Bulletin)

– General IEC/BCC in mass media in collaboration with partners

– Others

Future Action Plan on Disability

COMING YEARS • Workshop: Review current situation and plan for proposed program (MoH, DoHS,

Divisions, centres, EDPs, partners, service providers and centres)

• Red book (Budget and Program)

• Partners Program

UN organizations EDP’s Disability working group

AIN – Disability working group

National Federation Disabled –Nepal (NFDN)

Disability related all organizations including service providers

• Integrated guidelines, protocol, SOPs, Manual, materials, etc

• Service provision with quality assurance

• Accessibility in health services

• Advocacy

• Coordination with all divisions, centres and ministries

• Programme implementation and monitoring

Proposed Plan/programmes

• Redbook

–Federal संघ –Provincial प्ररे्दश –Local स्थातनय तह

æckfËtf ;DjGwL sfo{bnÆ

ckfËu ePsf AolQmx?sf nflu :jf:Yo ;]jfdf kx'+r a9fpg, :jf:Yo

;]jf ;'lglZrt ug{sf] nflu ldlt @).!!.! ut] dfgGfLo dGqL

:tl/o lg0f{o cg';f/ æckfËtf ;DjGwL sfo{bnÆ u7g ePsf] lyof] .

qm=; Gffdy/ kb ;+:yf

! >L r"8fd0fL e08f/L ;+of]hs lgb]{zs, s'i7/f]u lgoGq0f dxfzfvf

@ >L ;'bz{g ;'j]bL sfo{bn ;b:o cWoIf, /fli6«o ckf+u dxf;+3

# >L /fh' a:g]t sfo{bn ;b:o /fli6«o ckf+u dxf;+3

$ >L u0f]z s]=;L sfo{bn ;b:o :jfnDjg lhjg k¢tL s]Gb|

% >L lgd{nf lwtfn sfo{bn ;b:o g]kfn ckf+u dlxnf ;+3

^ >L cf]d k|sfz aGhf8] sfo{bn ;b:o b[li6L lalxg

& >L ;f]lgsf 9sfn sfo{bn ;b:o :kfOng OGh'/L

* >L a]b/fh 9'+ufgf sfo{bn ;b:o lxdf]km]lnof ;f];fO6L

( 8f= >L ;'lgtf dn]s' cdfTo sfo{bn ;b:o cl6hd s]o/ g]kfn ;f];fO6L

!) >L lasf; yfkf sfo{bn ;b:o Zffl/l/s ckf+u

!! >L lbks zfSo sfo{bn ;b:o Aflx/f ckf+utf

Contents of Report

• Situation analysis

• Workshop Report

• Thematic Subject-wise presentations

• Role and responsibilities

• Implementation Plan

• General suggestions

• Proposed service availability framework

ckf+utfsf] If]qdf ;Djf]wg ul/g' kg]{ laifox?

ckf+utfsf] If]qdf ;Djf]wg ul/g' kg]{ laifox?

ckf+utfsf] If]qdf ;Djf]wg ul/g' kg]{ laifox?

ckfËtf ;DjGwL ;ldlt

;+3 -s]Gb_ = lgb]{zs ;ldlt k|b]z -ckfËtf ;ldlt_

cWoIf – :jf:Yo ;lrj pkfWoIf – k|d'v ljz]if1 ;b:o – dxflgb]{zs, :jf=;]=la ;b:o – ;DalGwt dxfzfvf k|d'v, lzIff dGqfno ;b:o – ;DalGwt dxfzfvf k|d'v, of]hgf cfof]u ;b:o – dxfzfvf k|d'v lrlsT;f dxfzfvf ;b:o– dxfzfvf k|d'v, dlxnf afn aflnsf tyf ;dfh

sNof0f dGqfno ;b:o – dxfzfvf k|d'v–;+3Lo dfldnf tyf :yflgo ljsf;

dGqfno ;b:o – dxfzfvf k|d'v– sfg"g dGqfno ;b:o – ;DjGwLt lgb]{zs, ;dfh sNof0f dGqfno ;b:o – cWoIf /fli6«o ckf+Ë dxf;+3 ;b:o – k|ltgLlw, APHIN

;b:o –WHO-Country office, Nepal

;b:o –UNICEF

;b:o –Chair EDP's Disability Working Group

;b:o ;lrj – lgb]{zs, s'i7/f]u lgoGq0f dxfzfvf

:jf:Yo ;lrjsf] cWoIftfdf pkfWoIf / ;b:o

;lrj–! /x]sf]

– :jf:Yo ;]jf ljefuaf6 / ;+/rgf cg';f/

dxflgb]{zs÷ lgb]{zs, ckfËtf÷lrlsT;f,

s'i7/f]u, hg:jf:Yo, d]8Lsn sn]h, gLlh

c:ktfn, /fli6«o ckfË dxf;+3 / lzIff,

dlxnf afnaflnsf tyf sfg'g dGqfno,

of]hgf AIN –Disability Group –Chair,

k|ltgLlw M WHO, UNICEF ;d]t ;d]6\g]

u/L ckfËtf ;ldlt u7g x'g] 5 .

– k|b]zdf sfo{/t cGo ;+3–;+:yfx? ;ldltn]

yk ug{ ;Sg] .

Way Forward

• End discriminations, prevent & break the barriers

• Strengthen quality services- accessible to all forms of disability

• Prevention, Treatment & Rehabilitation for Disability Management as per Policy, Strategy and 10 Years Action Plan

Conclusion • We have policy, strategy and 10 years action plan with specific

responsibility of stakeholders

• Commitment from high level to implementation level –LCD as a disability focal unit-today’s participation is an example

• Restructuring through federalism, it will be an opportunity to address disability issue but needs more advocacy

• Rich in resources-expertise, specialized services, need, financial resources

- Commitment from NPC, MoF, MoWCSW

- Advocacy at the local & Provincial level is required

• Disability task force has compiled all the reports, issues and recommended for further needs smoothing & implementation (Your comments and suggestions are wel-come)

• Coordination, collaboration and joint efforts are necessary

Acknowledgements Honorable Health Minister Honorable State Health Minister Honorable MP & Chair-Women, Children & Social Welfare/Senior Citizens

Committee/ Parliament Respected Secretary Respected Chief, Specialists, Director General Line Ministry Representatives, NPC DG, (DDA/DOA), DDG, Ex-Directors, Directors: All Divisions & Centres Chair, Chief : Different orgnaizations, institutions, NFDN + Leprosy affected EDPs – WHO, UNICEF Disability related service, centre and orgnizations Disability Task Force Partners on Leprosy All the partners including SIRC & NFDN. All the invitees Media LCD hardworking team

xflb{s wGojfb !

Government of Nepal

Ministry of Health Department of Health Services

Leprosy Control Division Email: lcd@mohp.gov.np, leprosycontrol@gmail.com, cmbgulmi@gmail.com

Phone no: 977-014262009, 4248535 Website: www.lcd.gov.np

mailto:lcd@mohp.gov.npmailto:leprosycontrol@gmail.commailto:cmbgulmi@gmail.comhttp://www.lcd.gov.np/