This article is based upon a learning circle call with a diverse group of partners serving communities to grow their wellbeing, and captures the main insights.
Karuna Foundation is working in the field of disability prevention and rehabilitation, in Nepal. It started a ‘Share and Care’ program with health insurance with two village development committees. Every village managed its own health insurance scheme. In all the villages there is a balance between yearly income and expenditure. The program then developed into an ’Inspire to Care’ approach in all villages in that district. Karuna’s approach is rooted in community participation, they consider it as a prerequisite to ownership and sustainability. Also this program, like all others, have direct involvement of the target groups as well as local governments from the stage of planning, to assure a successful exit.
Moving from family support to community approach
It’s starts with mapping all families with members living with a disability and all expectant mothers – to prevent disability. For the pregnant women, delivery plans are made. For the families living with a disabled person, individual intervention plans are made. Then the support moves to health management system and disability management systems in the village. This is done by training a village-based professional rehabilitation worker. This is a facilitator who is the backbone of the community-led programming. This leader is not only selected from the community and trained, s/he is key to sustaining the inclusion of people with disabilities and prevention of disabilities, cared for by the community.
Cost-sharing is a testament to the level the communities are willing to participate
One key element in the approach of Karuna Nepal is their attitude to holding (local) government accountable, and building on existing infrastructure. One way to do so is to include local government from the start, and to support the community members to claim access to existing health care services. Core to the success of Karuna’s programs, in not just this, but also the true ownership of the community, when Karuna exits (usually after a few years). To get to this point, that a community fully owns the prevention programming and support for people living with disabilities, cost-sharing from the start proofed to be an effective strategy.
Cost-sharing with governments to assure sustainability
Cost-sharing is not only very effective as a tool to guarantee commitment from the community, and grow ownership. It also supports in assuring sustainability, that the prevention and rehabilitation activities continue also after a supporting partner leaves the community. Karuna Foundation asks the provincial government and municipality to chip in 1/3rd of the costs of the program from the start. On average 30-50% of the total income came from local resources. The other 50% was from Karuna Foundation, only in the first two years. This helped to successfully exit the communities. At present, 70% of the Share&Care villages are continuing independently after the exit of Karuna Foundation Nepal.
3 questions to ask yourself constantly – affirming agency of a community
As a partner to communities, it of utmost importance that you focus on building community leadership and community ownership. These are the questions to ask yourself continuously: “are people ready?”, “do they appreciate what we bring?” and “are we not creating more dependency?”.
Having an exit strategy before you enter a community
Sustainable change, is most of the time carried by behavioral change. Once the people have changed, the changed attitude, the new ways to support pregnant women and families with a member living with a disability, will sustain. For this to happen, it’s important to have an exit strategy, when you – as supporting partner – will leave the community and end your support programming. Not just that, it is also important to communicate this, from the start.
Where can you start as a community?
It starts with identifying all the persons with a disability in your community. Make a plan how to create access to health care, education. Try to have positive results in the lives of people living with disabilities, and show case these examples. That helps to engage local government officials. Try to bring together the local community leaders, elected mayor, political leaders, and create consensus.
Strengthen local government structures is key
Once policy makers, bureaucrats and community members are in one room, facilitate the discussion and continue it over the years. Development aid can not/never support long-term, that’s why embedding all activities in local structures, is so important. The insurance scheme from Karuna Foundation was build on the existing government schemes – on top of the free health services provided. Minimum level of quality health care services in the vicinity of the community, of course, should be available. Which is not always the case, we all know.
We hope you enjoyed the insights and can take some learnings forward. Our Learning Circle conversation was rich, so have a look at the full recording! You can find it here: