Proposal for Launching 9 Therapy Centres

THE ASSOCIATION OF PEOPLE WITH DISABILITY

Proposal for launching 9 therapy centres

for 135 children with disability

2014-2015

About APD

The Association of People with Disability (APD) is a non-governmental organization working in the field of disability for the last fifty four years. APD aims to empower persons with disability to become active, contributing members of society. At any given time, through its wide-ranging institutional and district development programmes, APD directly touches the lives of approximately 30,000 Persons with Disability (PWDs) and builds capacity of partners, government officials and care-givers so as to reach another 18,000 beneficiaries. Operating with an annual budget of over Rs. 100 million with 260 staff, APD deploys grassroots rural and urban community programmes that include therapeutic services, mobility aids, integrated education, advocacy, horticulture, mental health and livelihood.

Our “District Disability and Development Programme” is operating in four districts of Karnataka: Chikkaballapur, Davangere, Bijapur and Bengaluru. Here we work with government agencies, self-help groups and other stakeholders on identification, assessment, referral, capacity building, lobbying and implementation of disability rights, to encourage the system to make much-needed provisions for people with disability. Currently APD is working with over 10,000 PWDs in these four districts.

Situation Analysis: Access to therapeutic services in Bijapur and Davangere Districts

It is vital that children with disability (CWDs) are identified early, provided early therapeutic and medical intervention and are able to freely access further need-based therapy services prescribed for their rehabilitation. The incidence of severe locomotor, cerebral palsy, autism or other multiple disabilities is of considerable concern in these districts where access to rehabilitation services remains a huge challenge. Census and other survey figures lead us to estimate that there are at least 1500 children with disability in Bijapur Taluk and about 1200 in Davangere Taluk who need rehabilitation support. The lack of therapists and other health providers and the prevalence of poverty and malnutrition mean that almost 80% of children with severe disability are unable to attend school.

The capacity of children with severe and multiple disabilities to access regular therapy and rehabilitation is limited or non-existent because of several factors:

·  PHCs do not generally offer therapeutic services. Therapy, if at all, is only available at the District hospitals which can be as much as 35-60 kms away from the villages

·  Most rural families are dependent on daily wage labour and find it financially untenable to take their disabled wards to the district hospitals for therapy or to access services at the nearest private hospital

·  Stigma, lack of awareness about disability, rehabilitation and use of aids and appliances are huge social constraints to seeking therapeutic services and assistive devices.

·  Further, the prevalence of consanguineous marriages in some areas has been shown to be a significant cause of disability

·  Government programmes though visible are not sufficiently effective. While early identification has been stepped up, early intervention and follow-up remain a challenge. Cluster Resource Centres of the Department of Education do not function in many locations which impacts the learning potential of these CWDs.

APD’s District Therapy Programme

APD‘s philosophy has always been to work with the most under privileged and marginalized children with disability to ensure their rehabilitation and inclusion in mainstream education. For the last three years we have been operating education and therapy programmes for children in Bijapur and Davangere districts and have reached close to 3336 CWDs

With our experience and understanding of the gap that exists between the need for therapy services and the actual delivery of rehabilitation services by the system, in 2014-15 we plan to establish 9 new district therapy centres in the taluks of Bijapur and Davangere. The centres will reach a minimum of 135 CWDs this year and will be run as model centres that can eventually be handed over to the community to be run under the guidance of the District Disability Resource Centres (DDRCs) of respective district administrations. This is in line with our approach to enabling communities to become self-sufficient in providing sustainable disability solutions.

Key Activities

1.  Identification: Based on our own surveys and using data provided by government, the project will identify 75 children with severe and multiple disabilities in Bijapur Taluk and 60 in Davangere Taluk, in the age group 0-16, in an area roughly 2-3 km around each proposed therapy centre.

2.  Set up therapy centres: District administration buildings will be identified and permission sought from concerned authorities for operating therapy centres. This will be done in 5 locations in Bijapur Taluk (Ittangihal Tanda1, Tikota, Bijapur Urban, Shivanagi and Jumanal) and 4 locations in Davangere Taluk (Siramagondanahalli, Mayakonda, Hadadi and Belavanuru). Each centre will need to be fully accessible and have suitable toilet facilities, and will be equipped with adequate therapy equipment and material. Five centres will be operational in June 2014 and the remaining 4 in September 2014. The team will undertake to create awareness and publicity about the services offered by the centres through radio, local newspapers and TV channels and distribution of pamphlets.

3.  Network with the existing ecosystem: A through mapping of existing resources in each area in terms of PHCs, sub-centres, anganwadis, health/ASHA workers, medical professionals, emergency support etc. will be conducted to understand the health and nutrition ecosystem that can be leveraged to provide support to the identified CWDs. The team will actively network with the DDRC with a view to leverage their support and to eventually hand over the running of the centres to them after a period of 2-3 years.

4.  Capacity Building: Orientation workshops will be conducted for parents, ASHA workers, ANMs, anganwadi workers etc. 135 parents/ caregivers will be trained on disability and rehabilitation. Parents will be taken on recreation and exposure visits. Monthly parents’ meetings will be conducted to update them on the progress of their wards. APD had trained 35 Community Therapy aides for a period of 7 months last year. These therapists will be provided necessary refresher training through 3 day workshops conducted twice a year. This will prepare them to work effectively as therapists in their communities. Two therapists will work three days a week at each centre providing services to the identified CWDs. 18 therapists will be taken for exposure visits to Bangalore or Koppal to give them a practical idea of how therapy centres operate.

5.  Therapy Services: Clinical assessment will be conducted for all 135 CWDs and Individual Rehabilitation Plans (IRPs) will be developed. Based on the IRPs, children will be able to access therapeutic interventions, medical or surgical support from government or private hospitals and mobility aids and appliances through donors or under the DDRC schemes. All CWDs will also be enabled to access various government schemes and entitlements like pension, insurance or support under 3% reservation fund. Medical professionals (physicians/ paediatricians/ specialists will pay a monthly visit to each centre to support the health of the children.

·  135 children will get regular therapy three times a week and improve their Activities of daily living (ADLs) and progress in their rehabilitation, improve social skills and gain some measure of independent ability

·  40 children will be admitted in mainstream schools or enrolled in anganwadis or in the home based education plans of the SSA (Sarva Shiksha Abhiyan)

·  10 children will get support for surgery

·  90% CWDs will access entitlements and social security schemes

6.  Events and Camps: A get-together of children from all centres will be conducted in each district once a year. This will encourage peer-to-peer interaction and give the parents a forum to interact and discuss common issues.

Proposed Activities & Expected Outcomes

Activities / Key Actions / Expected Outcomes
Identification / ·  Identify children with severe and multiple disabilities in the age group 0-16, based on survey and government data, 2-3 km around each centre / ·  75 CWDs will be identified in Bijapur Taluk
·  60 CWDs will be identified in Davangere Taluk
Set up Therapy Centres / ·  Identify district administration buildings for operating therapy centres.
·  Ensure each centre is fully accessible and equipped to function effectively
·  Create awareness about the centres through radio, local newspapers and TV channels and distribution of pamphlets. / ·  Locations will be identified for 5 centres in Bijapur in Ittangihal Tanda1, Tikota, Bijapur Urban, Shivanagi and Jumanal
·  Locations will be identified for 4 centres in Davangere in Siramagondanahalli, Mayakonda, Hadadi and Belavanuru
·  All 9 centres will have accessible infrastructure and toilets and be equipped with adequate therapy equipment and material to support 135 CWDs
·  Five centres will become operational in June 2014
·  The remaining 4 centres will start functioning in September 2014.
Networking with the ecosystem / ·  Identify existing resources in each area in terms of PHCs, sub-centres, anganwadis, ASHA workers, medical professionals etc.
·  Network with the DDRC with a view to leverage their support and to eventually hand over the monitoring of the centres to them after a period of 2-3 years. / ·  Resource mapping of health and nutrition ecosystem in each location
·  Work with local donors and the DDRC to provide mobility aids and appliances to the CWDs according to their need
Capacity Building / ·  Provide orientation to parents and ensure monthly parents’ meetings are held.
·  Provide refresher training to Community Therapy aides / ·  135 parents will receive training
·  Parents’ meetings will be held on a monthly basis
·  Parents will be taken for exposure visits to improve their understanding of disability
·  Two 3-day workshops will be held to provide refresher training to 18 community therapy aides working at the centres
·  Therapy Aides will be taken on 2 exposure visits to Bangalore and Koppal
Therapy and Advocacy Services / ·  Conduct clinical assessments and develop Individual Rehabilitation Plans (IRPs)
·  Ensure CWDs are able to access therapeutic interventions, medical and surgical support, mobility aids and appliances
·  Ensure CWDs are enabled to access various government schemes and entitlements
·  Facilitate monthly visits by medical professionals to each centre / ·  135 IRPs will be developed to monitor the rehabilitation of the CWDs
·  40 children will be admitted in mainstream schools/ anganwadis/ home-based education
·  135 children will get regular therapy and improve ADLs, social skills and gain functional ability
·  10 children will get support for surgery
·  90% CWDs will access entitlements and social security schemes
·  CWDs will be able to access mobility aids and appliances based on their need.
Events and Camps / ·  Conduct group events for children from all centres to encourage peer-to-peer interaction and give the parents a forum to interact and discuss common issues. / ·  One event will be conducted in each district involving children from all locations in the taluk.

Monitoring and Evaluation

Following quantitative measures will be adopted by the organization for programme oversight and control:

·  Number of centres launched

·  Number of CWDs at the centre receiving therapeutic intervention

·  Number of CWDs receiving medical support/ mobility aids/ surgical support/

·  Number of CWDs accessing government schemes and entitlements

·  Number of CWDs referred to mainstream schools/anganwadis/home-based education

·  Number of parents trained/ parents meetings held

Project Governance will be ensured through monthly review meetings of progress and fund utilization by the project manager, monthly reports submitted to the Director-District Operations, annual review by the Executive Director and feedback reports from parents of CWDs.

Budget Estimate

Expense / Details / Employment Led Training
Salaries and Honorarium
Project Leader (part salary) / 10000 p.m. X 10 months / 1,00,000
Therapists(2) (part salary) / 8000 p.m. X 10 months / 1,60,000
Animators (18) / 2000 p.m. X 10 months / 3,60,000
Staff Welfare / 10,000
6,30,000
Programme Expenses
Therapy Material for 9 centres / 15000 per centre*9 / 1,35,000
Accessibility modifications for 9 centres / 10000 per centre*9 / 90,000
Parents meetings/ exposure visits/ get-togethers / 1,45,000
Monthly Medical Assessments and medication / 75,000
Refresher training for therapy aides / 35,000
Publicity and Documentation / 10,000
4,90,000
Administration Expenses
Field Travel / 90,000
Printing and Stationery / 18,000
Centre maintenance/Housekeeping / 69,000
Telephone/Water/Electricity / 24,000
General Expenses / 18,000
2,19,000
GRAND TOTAL / 13,39,000