annual report - icrc...

ANNUAL REPORT 2015

The 2015 ICRC Special Fund for the Disabled (SFD) budget was based on

the objectives set in the Annual Appeal designed to cover both field and

headquarters activities from 1 January to 31 December 2015.

The SFD published its Mid-term Report summarizing activities and

the financial situation after the first six months of the year (January to June).

The Annual Report, like the Annual Appeal, the Mid-term Report and the

report of the external auditors (Ernst & Young), is part of the SFD standard

reporting to donors. In addition, on request from donors, the SFD produces

ad hoc reports.

AFRICA

activities of SFD regional offices in Tanzania and Togo

ASIA - VIET NAM

activities of the SFD regional office in Viet Nam

ASIA - TAJIKISTAN

activities of the SFD sub-regional office in Dushanbe

LATIN AMERICA

activities of the SFD regional office in Nicaragua

The operational programme support provided by the SFDs headquarters

in Geneva and the costs for financial management and administration

have been added on a pro rata basis to the four field budgets.

For more information on the SFD and related ICRC programmes, see:

SFD 2015 Appeal SFD 2014 Annual Report Ernst & Young 2015 Audit Report ICRC Physical Rehabilitation Programmes: Annual Report 2015 ICRC 2015 Special Mine Action and Disability Appeal

www.sfd.icrc.org provides further information on SFD activities.

The SFD was awarded SGS NGO Benchmarking Certification in 2013.

ICRC Special Fund for the Disabled Headquarters

19, avenue de la Paix

1202 Geneva

Switzerland

Tel: ++ 41 22 730 23 57 / 24 01 / 31 35

Fax: ++ 41 22 748 91 61

Email : [email protected]

www.sfd.icrc.org

Cover photo: The first step toward rehabilitation is recovering dignity (beneficiary during

a training at Comprehensive Community Based Rehabilitation in Tanzania (CCBRT)).

1 | SFD ANNUAL REPORT 2015 | CONTENTS

CONTENTS

ABOUT THE SFD 2SFD modus operandi 2The ultimate goal 2An alternative technology 2Funding and financial control 2

HIGHLIGHTS 3Figures 4Financial situation 5

ACTIVITIES BY REGION 6Africa 6Asia 19Tajikistan 24Latin America 29

ANNEX I 382015 SFD structure 38

ANNEX II 392015 budget and expenditure 39

ANNEX III 40Ernst & Young audit report 40Financial Statements 41

LIST OF ABBREVIATIONS AND ACRONYMS 46

ABOUT THE SFD

The ICRC Special Fund for the Disabled (SFD) was created by the

International Committee of the Red Cross (ICRC) in 1983 to ensure

the continuity of former ICRC programmes for populations affected

by conflict, and support other physical rehabilitation centres in low-

income countries.

While the SFD activities are not included in the ICRC budget and

are funded independently through the SFD yearly appeal, the ICRC

provides the SFD with logistical and administrative support.

SFD MODUS OPERANDILike other development organizations aiming to enhance national

capacities, the SFD implements projects that stretch over several

years. The SFDs assistance is geared towards maintaining and

increasing access to rehabilitation services, and improving the

quality and sustainability of these services. This is mainly achieved

through capacity building and training together with technical,

material and financial assistance. At SFD-supported centres, the

actual physical rehabilitation work is carried out by the local

partner. From the start, project ownership is and remains with the

partner. The SFD provides advice and coaching not only in technical

matters but also for the management, innovation and further

development of services. In addition, the SFD directs advocacy

efforts at the authorities concerned, and seeks to mobilize other

actors and foster networking and cooperation with them. Formal

education remains fundamental to the training of professional staff.

The SFD offers scholarships and supports a number of prosthetic/

orthotic and physiotherapy training institutions worldwide in order

to maintain high education standards. This includes promoting

the use of the polypropylene technology and appropriate clinical

training, organized in collaboration with local schools. The SFD

also encourages and supports training in other fields such as

management and quality control.

The duration of SFD support is directly linked to the local partners

commitment to developing their own capacities to provide

rehabilitation services and their ability to become self-sustaining, in

line with the recommendations and assessments provided during

SFD monitoring visits.

THE ULTIMATE GOALThe entry into force of the United Nations Convention on the

Rights of Persons with Disabilities (UNCRPD) in 2008 and the 2011

recommendations of the World Disability Report (World Health

Organization, World Bank, 2010) have brought further support to

the SFDs ultimate goal of promoting socio-economic integration

for people living with physical disabilities, while still focusing on

their initial needs. The aim is to remove or to reduce as far as

possible restrictions on activities and thereby enable people with

physical disabilities to become more independent and enjoy the

highest possible quality of life. Various measures, such as medical

care, physical rehabilitation including physiotherapy, vocational

training, social support, and programmes promoting economic

self-reliance, all come into play. Networking with other providers of

services in this field is indispensable and the SFD therefore seeks

to develop its partners understanding of the overall rehabilitation

process.

AN ALTERNATIVE TECHNOLOGYThe technology for manufacturing orthopaedic devices

favoured by the SFD is based on the polypropylene technology

developed by the ICRC. This technology is now standard practice

for the production of prostheses and orthoses in many low-

income countries and is being used by a significant number of

organizations involved in physical rehabilitation, including the

projects and centres supported by the SFD. It combines accessible

standard components (i.e. prosthetic feet, knees, etc.), and raw

materials (mainly polypropylene) that are locally available. Using

this technology has considerably enhanced the technical skills of

professionals working at SFD-supported physical rehabilitation

centres, and thereby improved access to quality services for people

with limited resources.

FUNDING AND FINANCIAL CONTROLThe SFD relies exclusively on voluntary contributions to cover its

costs both in the field and at headquarters. Its donor base consists

of governments, National Red Cross and Red Crescent Societies,

foundations and private donors. The SFDs accounts are examined

yearly by an external auditor. SFD projects are regularly evaluated

by internal and external assessors.

ABOUT THE SFD | SFD ANNUAL REPORT 2015 | 2

HIGHLIGHTS

3 | SFD ANNUAL REPORT 2015 | HIGHLIGHTS

The present report will give an overview of the activities and

objectives achieved in the four regions where the SFD is active.

Each chapter is composed of a list of the main facts and figures

for each region, followed by highlights on sustainability, quality

access and social inclusion achievements and challenges faced

by the SFD in the field.

In 2015, the SFD supported 30 projects in 17 countries, 15 of which

have signed and/or ratified the United Nations Convention on

the Rights of Persons with Disabilities.

It also good to note that 5 of the countries were SFD supports

projects (El Salvador, Nicaragua, Peru, Somalia and Tajikistan)

were among the States Parties to the Anti-Personnel Mine Ban

Convention that had acknowledged their responsibility for a

significant number of landmine survivors; most of these projects

were government-run centres. For example in Vietnam and

although the conflict is over for decades, 56% of the overall

total of user of the physical rehabilitation centres supported by

the SFD (3,695 people) have a disability related to war injury

(mine, explosive remnant of war, gunshot, etc.).

Access to physical rehabilitation services is still a major concern

across the region and is reported difficult by service users due

to multiple barriers, the main ones being distance to services

and related transport costs and the cost of services due to the

absence of social protection mechanisms. Although a survey

conducted in Tanzania showed that most of service users judge

rehabilitation very important to earn a living, transportation,

lodging and cost of services, are insuperable impediment that

affect the majority of persons with disabilities (PwD) living in

rural area. The SFD response, in addition to reimbursement of

services costs, creates synergies with national societies and

disabled people organization, (good example in Vietnam), to

set up mechanisms (including financial support from SFD) for

identification and referral of persons in need of services.

Joel Niniger, Head of SFD project in Asia, signing a cooperation

agreement with the Disabled People Organisation of Danang

aiming to enlarge the network of organisations participating to the

identification and referral of destitute persons with disabilities who

cannot access physical rehabilitation.

Aiming at developing sustainable services, our team work on

the reinforcement of national capacities. For instance, senior

leaders from the health and other ministries, service providers,

and members of organizations for persons with disabilities

and National Societies took part in training organized by LMG

(Leadership, Management and Governance organized by

Medical Science for health and Yale University), in partnership

with the ICRC and the SFD. This training programme, established

in 2013 in Tanzania and Zambia, was extended to participants

in Madagascar, Togo and Vietnam, which led to the creation

of national platforms on physical rehabilitation. In turn, these

national platforms helped promote various issues, such as access

to services and the need for increased financial support from

governments. In Togo, the ministry of health granted a budget

increase for the Centre National dAppareillage Orthopdique in

the capital, Lom.

A number of documents were published and disseminated

locally with the support of the SFD. The ultimate goal is to

inform authorities on difficulties faced by service users due

to poor geographical coverage and lack of local coordination

mechanisms.

HIGHLIGHTS | SFD ANNUAL REPORT 2015 | 4

Prosthetics and orthotics technical institutions in El Salvador,

Rwanda, Tanzania, Togo, and Viet Nam received support in

organizing clinical and technical training on the provision

of prostheses/orthoses and physiotherapy, to the benefit of

360 professionals and students. The SFD also enabled

4 trainees from supported centres to successfully complete

their prosthetic/orthotic training in regional schools, and

11 technicians to participate in a multi-year distance-learning

course that allowed them to bolster their professional capacities.

Other specialized pilot training sessions were organized

in Vietnam; 76 members of organizations for persons with

disabilities received training in identifying and referring people

in need of physical rehabilitation services in rural areas.

The SFD field team, composed of nine physical rehabilitation

experts, including three physiotherapists, continued to promote

a multidisciplinary approach among the staff of the centres it

supports. They also helped develop cooperation with regional

physiotherapy schools, for instance in Benin, Tanzania and Togo.

The SFD team conducted field visits outside of the regional

offices and used regional expertise, whenever available, to take

part in regional training or to assess the quality of services in

centres managed by local authorities. It did so, for example, with

physiotherapists from Benins Ecole Suprieure de Kinsitherapie,

and with a prostheses/orthoses specialist from the VIETCOT

school in Hanoi, Viet Nam.

Sports wheelchairs, sponsored by the SFD to Tanzania Paralympic

Committe, presented during the International Day of People

with disabilities.

In regards to physiotherapy, the role of the SFD team has been

determinant to offer a wider response to physical rehabilitation

from upgrading treatment working areas in Madagascar,

Tajikistan, Togo and Tanzania (renovation, new equipment,

material, etc.) to strengthening local professional capacities

with adapted training session in various areas related or not to

P&O services. For example in Africa, the team consolidated local

professional knowledge for the treatment of Cerebral Palsy

children (training mother on basic exercise for their children)

or backed up school physiotherapy department to review

existing curriculum (ENAM Lom, Togo) or to develop new ones

(curriculum for physiotherapist assistant at Moshi KCMC).

Although the SFD does not implement socioeconomic

projects, it continued to promote the capacities of its partners

governmental agencies and other organizations to respond to

the socioeconomic needs of persons with disabilities. In Vietnam,

for example, the SFD organized a pilot awareness session on

disability for the private sector, which helped straightaway

three persons with disability find employment. Other initiatives

in Tanzania consisted in supporting the Sport Paralympic

federation to acquire sport wheelchairs or in Vietnam to fit

athletes with appropriate equipment.

FIGURESThe SFD supported projects provided services for over 51,700

people ; produced 4,981 prostheses and 12,976 orthoses;

and distributed 532 wheelchairs and 2,200 pairs of crutches.

Out of the total number of prostheses delivered, 1,415 were

for mine/ ERW survivors (28%). Most of these were provided

in centres in Nicaragua, Somalia and Viet Nam.

5 | SFD ANNUAL REPORT 2015 | HIGHLIGHTS

CCBRT end of training: A smile is also a performance indicator!

In 2015, the SFD facilitated the participation of over 500 professionals

and 100 family members to various trainings.

PHYSICAL REHAB. SERVICES51741

Male

PROSTHESES4981

ORTHOSES12976

Female

ChildMale

Female

ChildMale

FemaleChild

As a result of SFD evaluation (2014) the SFD team provided

a management response including a recommendation

implementation plan. Together with its board members, the

SFD continued to examine different avenues for its new strategy

and one of them being strengthening the cooperation with Red

Cross Red Crescent national Societies. To that effect the SFD team

in the field explored possible partnership with National Societies

(Nicaragua, Togo and Tanzania), based on the Red Cross and Red

Crescent Movement Strategic Framework on Disability Inclusion

which was adopted during the last International Conference in

Geneva.

Support to three projects were terminated in 2015. In Mali, due

to conflict developing, the ICRC reinforced its presence and took

over SFD support in the course of the year. In two other countries

(Dominican Republic and Peru) the SFD support in 2015 was

limited to scholarship as part of the end of the support package.

NUMBER OF SERVICES PROVIDED BY SFD PARTNERS

FINANCIAL SITUATIONIn 2015, the SFD welcomed among its donors group three new

donors, the Italian Government, the Canton Geneva and the

Pro Victims Foundation. This resulting of the diversification

strategy to ensure a more stable funding base. Thanks to this

additional support as well as the increase of contribution of some

of our major donors, the total income of the year amounted to

4,584 TCHF, corresponding to an increase of 11% compared

to 2014.

The development of a larger donors base takes time and, at

the beginning of the year, due to the SFD negative report from

2014 and the lack of firmly pledged engagements for 2015, the

SFD board decided to manage the expenditures and avoid

a negative result at the end of the year. All operations were

concerned and some of the planned activities had to be put on

hold. The result of this control was that the actual operational

expenditures for 2015 amounted to 4,497 TCHF. Details of the

expenditures, balance sheet and income table can be found in

the annex section III of this report.


Male

PROSTHESES1040

ORTHOSES6671

FemaleChild

MaleFemale

Child Male

Female

Child


AFRICA | SFD ANNUAL REPORT 2015 | 6

REGIONAL OFFICELom, Togo

SUB-REGIONAL OFFICEDar es Salaam, Tanzania

OVERALL SUPPORTMaterial and financial assistance was provided to 14 service

providers and 2 training institutions in 9 countries

SFD PERSONNEL1 Head of Africa Regional Office

2 Regional P&O Advisers

1 Regional PT Adviser

3 Administrative staffs

2 Disability Programme Officers

1 Supporting staff

TRAININGMANAGEMENT TRAININGS: 2 (MANAGEMENT AND UNCRPD)

Number of participants sponsored by the SFD: 94

Nationality of the participants: Tanzanian (17), Togolese (77)

CLINICAL TRAININGS (P&O, PT): 10


Participants from 20 nationalities

HAMBISELA TRAININGS: 11

Number of participants sponsored by the SFD: 90 mothers

Nationality of the participants: Togolese

OADCPH TRAININGS: 4


Nationality of the participants: Togolese, Beninese, Ivorian

ONLINE TRAINING: 1


Nationality of participants: Togolese, Tanzanian, Rwandese,

Somalian

SERVICES, PROSTHETIC/ORTHOTIC DEVICES AND MOBILITY AIDS PROVIDED BY THE SUPPORTED CENTRESOverall physical rehabilitation services for 17245 people with

disabilities, including 114 for ERW/mine incident survivors

Devices for mine incident survivors: 75 prostheses and 39 orthoses

Devices reimbursed by the SFD: 317 prostheses and 106 orthoses

Crutches (pairs) delivered: 2019

(Statistics do not include centre of Galkayo Somalia from

September to December)

AFRICA

2015 BUDGET in CHF Expenditure Budget

Material (including transport) & financial assistance

870,840 1,505,310

Tuition & staff-related costs 1,080,978 1,101,490

Premises, equipment, general supplies, audit costs

317,967 300,020

Operational programme support, financial management & headquarters administration

303,674 260,165

TOTAL 2,573,460 3,166,985

7 | SFD ANNUAL REPORT 2015 | AFRICA

SUSTAINABILITY In Togo, we signed a three-year memorandum of

understanding with the Ministry of Health (MoH). Among

others, it covered support for our main partners in providing

services (the Centre National d'Appareillage Orthopedique

et de Reeducation, or CNAO) and in conducting training (the

Ecole Nationale des Auxiliaires Mdicaux, or ENAM, in Lome).

Following LMG training, a national advisory committee for

physical rehabilitation was established, composed of senior

staff from CNAO, ENAM, the Federation Togolaise de Sports

pour Personnes Handicapes (FETOSPHA), the Ministries of

Finance, Health, and Social Action, and the Togolese Red Cross.

One of the committees first initiatives was to lobby for a bigger

budget for CNAO in 2016, which was validated by the MoH.

Tanzania established a national advisory committee for

physical rehabilitation with representatives from associations

of the disabled, the MoH, service providers, and the Tanzanian

Red Cross; work began on plans for the next three years. We

also sponsored the creation of an association of prosthetists

and orthotists, to further promote the establishment

of treatment protocols to be validated by the MoH. At

Comprehensive Community Based Rehabilitation in Tanzania

(CCBRT), we held a train-the-trainer course for CCBRTs new

physical rehabilitation team. Originally planned for 2014, the

course covered data-management tools that we had provided

them with, in order to help CCBRT measure key managerial/

technical indicators. CCBRT management was involved in

following up the implementation of these tools.

In Madagascar, senior staff from the MoH and our partner

service providers attended LMG training with our support.

This aimed to strengthen their management skills and foster

the creation of a national advisory committee for physical

rehabilitation, to be led by the MoH.

With the help of the Fdration Africaine des Techniciens

Orthoprothsistes (FATO), we assessed our past partnerships

in Benin and Cte dIvoire. Although one of the

recommendations was to strengthen partnerships with the

respective governments, discussions held at the end of the

year did not allow the SFD signing the agreement this year.

In Zambia, the departure of SFD-trained staff, along with a

change in directorate, interrupted our work with the Zambian

Italian Orthopaedic Hospital (ZIOH). In the meantime, we

supported the MoHs efforts to reorganize its services

countrywide, including advice on the construction/renovation

of physical-rehabilitation centres.

QUALITYThe Centre de Rducation Motrice de Madagascar (CRMM) in

Madagascar, with supervision from one of our field officers,

began providing P&O services after we helped it renovate

its manufacturing area and provided it with equipment/

machinery. Two people were selected for a three-year P&O

training at ISTM Valence in France, which we co-financed with

the institution. Together with the Iranian Red Crescent Society,

we organized a two-week training course on orthotics for

14 people from our partner service providers in Madagascar.

However, the resignation of one technician whose training

was sponsored by the SFD hindered one of our partner

centres efforts to provide people with services.

MAIN ACTIVITIES AND ACHIEVEMENTS

In 2015, Africa continued to be the region in which we were

most active, particularly in terms of training and technical

support for service providers. Moreover, some progress

was made in advocating for and supporting the creation

of national advisory committees for physical rehabilitation

with representatives from all sectors, with a view to lobbying

for legislation in favor of persons with disabilities. Various

developments, however, hindered work in a few countries;

SFD-trained staff were no longer part of some of our partner

organizations, and in Mali, the security situation necessitated

the handover of activities to the ICRC.

The relative of an hemiplegic patient receives indication

from CCBRT P&O to improve the management of its orthotic brace.

Trainings are an essential part of the SFD approach to strengthen

the physical rehabilitation sector. In 2015, the SFD sponsored

28 trainings for 417 participants in Africa.

In Tanzania, the assignment of a permanent physiotherapist

at the CCBRTs P&O clinic ensured a multidisciplinary approach,

with the fitting of lower limb prosthesis being jointly conducted

by the physiotherapist and the prosthetist/orthoptist. One

of our physiotherapists also provided coaching and on-the-

job training in the first half of 2015. In addition, we held three

P&O training sessions in collaboration with the Fredskorpset

exchange programme and the Tanzania Training Centre for

Orthopaedic Technologists (TATCOT); technicians from Benin

and Somalia attended these sessions along with local staff.

Lastly, we helped TATCOT modernize its training methods by

helping acquire computers and internet access, which improved

students and teachers access to educational material.

Regular exchanges and meetings were held with the Somali

Red Crescent Society and the Norwegian Red Cross in Nairobi

to improve the supply chain of material and to strengthen

professional capacity of physiotherapists in Somalia.

A pre study was conducted together with the physiotherapy

department of The Kilimanjaro Christian Medical College to

launch a new training level (physiotherapy assistant) to train

large group of Somali students.

In collaboration with the Organisation Africaine pour le

Dveloppement des Centres Personnes Handicapes, the

ENAM in Togo regularly delivered SFD modular/short courses

for professionals from the region, including ENAM teachers.

Along with the MoH, we co-financed the renovation of ENAMs

school building. This helped improve the quality of training

for instance, by allowing to redistribute space according

to activities, and to prepare three classrooms for internet

connections. We also supported ENAM in implementing

recommendations from ISPO and ISTM, which were made

in 2014 and 2015, respectively. Two assistants were recruited

for ENAM's P&O and PT departments, to improve its overall

administration.

ACCESSFollowing the LMG training, the participants in Madagascar

began preparing a comprehensive study on access to services,

with a view to encouraging the MoH and other stakeholders

to adopt a national strategy for assisting people in rural areas.

With the MoH, we discussed the feasibility of including material/

components related to physical rehabilitation in national

procurement lists. Activities with Foyer Akaninny Marary were

drastically reduced after its management dismissed three

technicians.

In Tanzania, we supported the renovation of CCBRTs

treatment hall for Cerebral Palsy, which enabled it to

accommodate families and a greater number of children.

In Togo, we provided CP-affected children with support for

obtaining treatment on a monthly basis. We also held 11 four-

day training sessions for 90 mothers of such children; at these

sessions, they learned, through the HAMBISELA method, basic

skills to help them care for their children in a way that would

maximize their development.

We provided our partner centres in Benin and Ivory Coast

with P&O material to ensure the continuity of their services.

In Mali, however, the ICRC had to take over our support for

PROPHETE because of the security situation. To help ensure

a smooth transition, we provided the centre with one last

donation of material, using earmarked funding from the

Monegasque government.

SOCIAL INCLUSIONFurther to its national policy on disability inclusion, in

December 2015, Benin decreed that people with disabilities

should comprise at least 5% of employees in all government

offices. It also created a national organization the Fdration

des Associations de Personnes Handicapes du Bnin to work

on disability-related concerns.

Together with the EU, we helped Madagascars Paralympic

Committee organize a one-week regional sports event, in

which Comoros, Mauritius and Reunion also participated. This

event helped raise awareness of disability among government

officials and the general public.

In Tanzania, we provided the Paralympic committee with

financial and technical support for procuring sports wheelchairs.

We also supported SHIVYAWATA a federation of DPOs in

acquiring tricycles, as part of a pilot project to help three people

with disabilities launch small businesses. Six children continued

attending primary schools thanks to full scholarships from

the SFD; this support, which started in 2014, was set for five years,

and covered, among others, medical devices and uniforms.

In Togo, we established a partnerships with the Fatire

des Units Coopratives dEpargne et de Crdit du Togo

and lAssociation des Parents et Amis des Personnes

Encphalopathes. This led to the provision of loans for small

business for four patients identified at CNAO. In December, we

sponsored a wheelchair basketball game, which helped raise

awareness of disability among officials and the general public.



Sikugua, 27 years old lives in Mbagala,

Temeke district of Dar es Salaam, which

is close to the International Airport. She

smiled when we asked if she lived far away.

It is no far, but it takes 3 hours to reach

CCBRT Taking the bus is a battle, it is not

accessible, they often stop in the middle of

the road next to another bus and they

are always in such a hurry.

When she was 8 years old, Sikugua lost

her left leg due to a snakebite. She is

amputated above her knee and moves

around with one (auxiliary or shoulder)

crutch. Her left arm and shoulder are blue

from the pressure. It is painful, she said.

I need a leg, so my arm can heal.

Only when she was 9 years old she received

her prosthesis. She nicely explained how

a good Samaritan sponsored her first

prosthesis. She felt sad when she explained

that the man died. Only after 17 years she

finally received her second prosthetic leg.

Life is hard for Sikugua and her younger

sister. Both live with their grandmother

who can barely support herself. Sikugua

suffers from unemployment and was

hoping that she could learn to work in a

tailor shop. I am not sure what to do.

Children require a new socket between

every 3 to 6 months. It is clear that after

6 months, due to natural growth, Sikugua

prosthetic device did not fit any longer.

Stricken by poverty, Sikuguas family could

not afford rehabilitation services.

THE STORY OF SIKUGUA, MBAGALA, TANZANIA


ACTIVITIES AT SFD -SUPPORTED CENTRES IN AFRICA IN 2015

Country PartnerSustainability Quality Access Social Inclusion

2015 objectives Achievements 2015 objectives Achievements 2015 objectives Achievements 2015 objectives Achievements

BEN

IN

Service de Kinsithrapie et d'Appareillage Orthopdique, SKAO, Parakou

Centre dAppareillage Orthopdique du CNHU de Cotonou

Sign a multi-year framework agreement with the MoH that supports service providers.

Contract external evaluator to prepare the ground for setting up a national strategic plan.

Develop coordination mechanisms and review sector policies.

Increase management (budget, recruitment of professionals, PMS and cost calculation used).

Organize 4 visits and meetings with high-level authorities and services providers.

1 field visit to Cotonou in March to meet the MoH and Ministry of Family to discuss framework agreement.The second visit initially planned for November 2015 did not take place.

Evaluation conducted by FATO in April 2015 at CNHU, SKAO, Ministry of Health and Ministry of Family. Report has been submitted to SFD.

Not achieved, as no follow-up visit took place after the first contact taken in March. See above.

Budget allocation increased for materials; it also allowed the recruitment of a new P&O (training sponsored by SFD, diploma in 2013).

Costs for the renovation of the P&O unit covered entirely by CNHU.

Ensure that 1 professional attends P&O and Cat. I training.

Check that 80% of assessed devices match SFD quality standards.

Check that 80% of patients are satisfied with services.

2 P&O staff members from SKAO received OADCPH short training in Lom in August 2015 (scoliotic braces & ischio-containment socket). CAT Itraining posponed.

For security reasons related to Boko Haram, SFD staff could not visit SKAO in Parakou this year.

The beneficiary and technical assessment questionnaire (BFTA) survey has not yet been carried out in Benin.

5 staff members from CNHU received OADCPH short training in Lom in August 2015 (scoliotic braces; ischio-containment socket; transradial prosthesis & stock management).

Support SKAO and CNHU to facilitate access to physical rehabilitation services for 300 people.

Check that 70% of staff match productivity standards and PT treatment standards.

Raw materials and components delivered through OADCPH (CHF 8,000) to the P&O association on their Open Day, allowing 30 vulnerable persons to be fitted for free. No agreement being signed for 2015, no other support was possible.

For security reasons related to Boko Haram, SFD staff could not visit SKAO in Parakou this year.

Raw materials and components delivered through OADCPH for the P&O association (AOPB) during Open Days in various rehabilitation centres in order to fit vulnerable people for free.

Total services: 532

Map and record collaboration opportunities with Red Cross/Red Crescent National Societies (NS) and DPOs.

A partnership request was addressed to SFD by the Benin Red Cross to support their physical rehabilitation centre. A visit to Benin is scheduled for February 2016.

CTE

DIV

OIR

E

Vivre Debout, Abidjan

Sign a cooperation agreement with MoH including a strategic plan for the physical rehabilitation sector.

A one-year extension was signed with Vivre Debout. Discussions with MoH postponed until after review of external evaluation by FATO.

Improve the partners multidisciplinary approach by recruiting a physiotherapist.

The SFD encouraged Vivre Debout to resort to the services of the physiotherapists from the University Health Hospital of Yopougon (located next door) as an alternative to costly recruitment. Discussion between the 2 institutions still underway.

Support financially the purchasing of materials through OADCPH.

Raw materials and components delivered through OADCPH.

Map and record collaboration opportunities with NS and DPOs.

Process interrupted, to be restarted in 2016.





CTE

DIV

OIR

E

Contract external evaluator to prepare the ground for setting up a national strategic plan.

Organize 2 assessment visits (Lom team) and 1 follow-up visit (FATO).

Evaluation conducted by FATO in April 2015 at Vivre Debout, Ministry of Social Affairs and DPO. Review of report with partners postponed to 2016.1 combined field visit made in April 2015 by SFD Lom & FATO (assessment visit at Vivre Debout). Report available.

Train 5 professionals (3 P&O, 2 PT using the services of ENAML).

Check that 80% of devices match SFD quality standards.


2 P&Os received short training in Lom in August 2015 (ischio-containment socket). PT not yet recruited.

Not assessed during the only SFD visit to Cte dIvoire in 2015.

Ensure that 1,200 people have access to services during the year.

1,483 beneficiaries have received services, including a device, with the support of SFD.

MA

DA

GA

SCA

R

Foyer Akanin'ny Marary, AM, Ambositra

Support AM in diversifying its funding sources and better supporting cost of services for economically vulnerable groups.

Ensure that SGS undertakes an NGO benchmarking of AM.

Advocate the integration of AM in the National Coordination body led by MoH.

Throughout the year AM faced management difficulties and during the last quarter of 2015 the president and the executive director changed. Consequently no improvement was noticeable regarding better support for services for economically vulnerable groups, and SFD support in materials remains crucial.

Postponed due to lack of resources and uncertainty about the situation at AM.

Participation in 1 training course organized at CAM on procurement of materials, and discussion with the MoH to keep AM in the loop of the decisions taken for the other centres, including those regarding material support. However, the lack of communication on the part of AM to MoH central level does not facilitate the integration of AM into the national picture.

Develop multidisciplinary approach by the allocation of physiotherapy staff.

Reinforce the capacity of professionals (P&O, PT) through coaching and tailor made training.

Check that 80% of devices match SFD quality standards.

By end of 2015 only 1 staff member was left at the workshop (1 resigned and 3 weredismissed). The production slowed down (5 devices in December) and no multidisciplinary approach was possible.

No technical supervision possible by MoH staff (P&O) following MoH refusal in January 2015.

The quality of products has declined. The lack of skilled staff and the non-implication of AM management has considerably influenced the production output and limited the quality control exercise.

Support financially the purchase of materials through OADCPH.

Ensure that 300 people have access to services.

No order made in 2015 due to lack of managements implication following an SFD request to have a plan of action to define the activities and the collaboration. Funds used for a main order for the CRMM instead.

Support AM in revising its approach on vocational training (farming, agriculture and promotion of self-employment) to benefit up to 50 persons with disabilities.

Promote the enrolment of 24 beneficiaries of services in the Paralympic Federation as basketball players; SFD provides sports wheelchairs.

Despite changes in the management of the centre there is no motivation to develop the approach to vocational training.

2 meetings organized with Paralympic Federation. Financial support for 1-week event around International Day of Persons with Disabilities (Coupe des club des champions Ocan Indien).

AFRICA | SFD ANNUAL RAPORT 2015 | 12




MA

DA

GA

SCA

R

Centre de Rducation Motrice de Madagascar, CRMM, Antsirabe

Review the current strategic plan and implement coordination mechanisms.

Plan of Action under development for CRMM.


At CRMM the P&O unit renovation is finalized, SFD delivered all necessary equipment and materials. The production of P&O devices started in October 2015. As part of the Senior Leadership Program, the LMG team supported a need-for-services assessment and beneficiary satisfaction survey in a limited area of the country. Patient satisfaction survey to be introduced next year. One training session was organized at CAM on appropriate foot devices. Needs evaluation (working environment, equipment, etc.) carried out in 2015 by SFD at CAM.

Support MoH in mapping rehabilitation centres and assessing barriers faced by PwD.

MoH not ready yet to carry out a national mapping exercise but support was given by SFD to the LMG team and a mapping has been carried out in one specific region of the country. Order made for CRMM to be received in January 2016.

Facilitate the adoption by MoH of a multi-year plan of action for service providers and national coordination body.

Underway. The first draft has been sent by the MoH. Follow-up meetings with MoH and SFD partners due to take place beginning of 2016.

Facilitate external coaching (100/120 days) to allow CAM to improve quality and diversify services.

Ensure that 250 people have access to services.

Annual order made by CAM and received by end of Dec 2015 to ensure continuous production.

Total services:2,794

Centre dappareillage de Madagascar, CAM, Antananarivo

Kick-start a central purchasing unit in Madagascar.

Discussions were held with the MoH central medical procurement unit in Antananarivo. The terms of the collaboration between SFD and MoH have not yet been validated. Standard list of items needed for the sector, and the link with the demand (based on P&O services statistics) is being drawn up. CAM evaluation done by external consultants and plan of action in its finalization stage.





MA

LI

PROPHETE, Bamako

Owing to the current circumstances in Mali, the ICRC will take over SFD support starting in January 2015. To facilitate the handover, the SFD will organize a field visit including an assessment of services.

Raw materials and components delivered through earmarked donation from the Monegasque Cooperation, using the services of OADCPH.

RWA

ND

A

University of Rwanda College of Medicine and Health Sciences, UR-CMHS, Kigali

Support efforts by UR-CMHS to obtain accreditation for their P&O Cat. II training by ISPO.

Following accreditation by ISPO and its recommendation, SFD has proposed a draft plan to set up mechanisms for support in 2016.

Consultation with UR-CMHS to develop academic procedures i.e. examination procedures and supplementary course content according to ISPO recommendation.

Work with ENAML and TATCOT to implement the use of existing training manual.

Upgrade working environment for students clinical placement.

A new MoU between UR-CMHS and TATCOT is under discussion.

Pending, due to MoU not being signed yet and to the choice of location for the clinical placement not being finalized.

Support focuses exclusively on strengthening the training programme.

Pending signature of agreement (draft submitted). The School recruited 2 teachers to align classroom ratio with ISPO recommendation.

The partner being a school, no activity planned.

SOM

ALI

A

Somali Red Crescent, SRCS, Hargeisa

Somali Red Crescent, SRCS, Galkayo

Sign a tripartite agreement with the Somali Red Crescent and the Norwegian RC, setting the conditions to reinforce the management capacity of SRCS.

Participate in the organization of 2 management training sessions by Norwegian RC/SFD (Nairobi) and one field visit (annual coordinating meeting).

An agreement was signed, covering a three-year period of collaboration.

Coordinating meeting attended in Nairobi. Management training initially planned for October has been postponed to March 2016.

Organize 2 technical training sessions for 3 professionals (PT and P&O) in Dar es Salaam.

Select 3 physiotherapists to enrol in a BSc course at the UR-CMHS.

1 PT and 1 P&O participated in the orthotic training in January 2015 in Dar es Salaam.

Two meetings held with physiotherapy school and KCMC including the Dean of the faculty to draw up a curriculum for the training of physiotherapy assistants (PTA). The development of this more basic training is still being discussed as the professional PT association is keen to protect its level of expertise and therefore not in favour of creating a lower level of qualification.

Advise SRCS and Norwegian RC on acquiring necessary materials and equipment, through the services of OADCPH.

Ensure that a total of 2,200 people have access to services at the 3 centres managed by SRCS.

Done.

Donation of materials and components by Norcross made according to the target expected. Materials delivered to two centres (not Galkayo).

Encourage SRCS to include this aspect in its programme.

Under development.





SOM

ALI

A

Somali Red Crescent, SRCS, Mogadishu

Ensure that 3 people are enrolled as Cat. I students at TATCOT.

2 applications in process with NECTA (National Examinations Council Tanzania). Two students enrolled in the BSc course at TATCOT. Two P&O professionals participated in ad hoc training seminars at CCBRT.

Total Services: 4,119

TAN

ZAN

IA

Tanzania Training Centre for Orthopaedic Technologists, TATCOT, Moshi

Follow up the implementation of the multi-year framework agreement signed with the MoH which includes support to three centres and one school.

Support the MoH in improving its coordination role and participation in the drawing up of a plan of action for each one of SFD-supported structures.

Organize 10 meetings with the working group composed of senior officials from MoH, services providers and civil society to set recommendations on the implementation of UN CRPD.

Set up the CCBRT/TATCOT faculty-training unit.

Follow-up discussions with MoH are carried out by the Platform on Physical Rehabilitation (composed of the LMG Bongo team and SFD) Discussions are mainly related to the MoH roles and responsibilities in the platform so far.

Underway through the Platform on Physical Rehabilitation (or Bongo Team). Terms of reference are shared and discussed with professionals of the physical rehabilitation sector to introduce a plan of action.

Seven meetings with senior MoH officials to discuss these recommendations. As a first outcome, the Platform on Physical Rehabilitation was recognized by MoH as an official advisory panel.

All procedures have been completed. The construction started during the last quarter. The training unit/faculty will be operational as of April 2016 (owing to technical delays).

Ensure that a centralized intranet database (teaching materials, guidelines, timetables and key organizational documents) is regularly updated and accessible to staff members.

Complete the editing of all of training manuals.

Support the organization by the CCBRT/TATCOT faculty of 4 training sessions.

Organize 4 visits to TATCOT.

Hardware installed and accessible throughout the school. Initial database with teaching materials for first intake of Diploma year students is available. School underwent an evaluation before the 12-month induction course with the British Council, to update teaching methodology and exercise the use of MOODLE platform (Intranet).

One manual for Diploma students in orthotics, materials science and workshop technology has been completed.

3 training sessions at the faculty delivered. Norwegian Fredskorpset exchange, ischial containment and lower extremity orthotics.

8 visits carried out.

Support MOI and KCMC to reach an agreement to accommodate clinical placements for TATCOT that will indirectly provide access for physically 120 disabled people.

Mode of support for MOI and KCMC has been discussed with TATCOT. Plan to provide materials for services at KCMC during clinical placements.


15 | SFD ANNUAL RAPORT 2015 | AFRICA




TAN

ZAN

IA

Review the cooperation between SFD, MoH, CCBRT and TATCOT under MoH authority.

Put in place and check tools to improve the management of services (PMS, product cost calculation).

Introduce financial indicators to measure the evolution of the proportions invested by partner and SFD.

One review session took place and the discussions were still ongoing at the end of December 2015.

At CCBRT PMS is used although data loss has occurred on one occasion. Cost calculation is reviewed by CCBRT on a yearly basis.

Not yet in place. postponed to 2016.

Ensure that 2 SFD staff members participate in end of year exam as external examiners.

1 SFD staff member participated as external examiner and 2 SFD staff members were solicited as external research supervisors for BSc students.

Comprehensive Community Based Rehabilitation in Tanzania, CCBRT, Dar es Salaam

Analyse data recorded from interviewing 120 disabled people according to the SFD questionnaire (quality, access and inclusion).

Provide 2 physical therapy scholarships for training in Rwanda.

Promote the multidisciplinary approach through training of professionals (combined team of 8 P&O/ PT from other African country).

72 interviews have been conducted using the SFD questionnaire at the service centres, and 2 interviews carried out over the phone. 20 home visits using the questionnaire have been conducted by Shyviawata (DPO). Analytical report was produced highlighting needs and trends in patient satisfaction and impact of services.

Subject to MoU signed with Rwandan authorities.

On-the-job training for 1 PT assigned to the P&O side at CCBRT. Support was given to improve clinical assessments using a multidisciplinary approach. Restructuring underway to reinforce the link between CBR activities and the physical rehabilitation department (multidisciplinary approach).

Ensure that 300 people (Dar es Salaam outskirts and rural areas) have their treatment costs subsidized by SFD.

Ensure that 1,200 physically disabled people have access to services.

Ensure that CCBRT builds a dormitory dedicated to persons with physical disabilities undergoing treatment.

50% implementation. 144 beneficiaries have received appliances and PT treatment subsidized by the SFD; they represent 6% of beneficiaries receiving services at CCBRT.

1,300 PWDs received services; 2,418 services were given at the Rehabilitation Unit in 2015 (including 70 prostheses, 1,192 orthoses and 656 PT treatments).

Under discussion with CCBRT management. An existing building has been identified and plans drawn up to renovate the premises.

In collaboration with CCBRT social services, support SHIVYAWATHA (a DPO) to ensure that 10 persons with physical disabilities access employment (i.e. launching small business initiative like Baja taxis).

Sponsor 6 disabled children to access education.

8 PWDs have been referred to the CCBRT employment desk. 1 woman was employed. 2 women received Baja taxis to start their own business as part of a micro-economic initiative. This initiative is currently on stand-by because of the unreliability of the partner (Shyviawata).

SFD supported 6 full scholarships that include medical devices and uniforms to attend school for five years. Support continues with follow-up and evaluation of childrens wellbeing.





TAN

ZAN

IA

Set up the OADCPH central purchasing unit for East Africa at CCBRT.

Stand by waiting for report on OADCPH Lom, efficiency.

Muhimbili Orthopaedic Institute, MOI, Dar es Salaam

Kilimanjaro Christian Medical Centre, KCMC, Moshi

Physical Rehabilitation Centre, Zanzibar

Assess possible partnership.

Pending. A survey report on rehabilitation services for PWDs in Tanzania including Zanzibar constitutes a baseline to take decisions on possible partnership. The draft report was sent to SFD end of December 2015.

Total services: 1,327

TOG

O

cole National des Auxiliaires Mdicaux, ENAML, Lom

Sign a multiyear framework agreement with the MoH which includes direct SFD support to CNAO and ENAML.

The MoH in Togo and the SFD signed a cooperation agreement in May 2015 with the aim to implement physical rehabilitation activities, in line with the related articles of the UNCRPD. The agreement includes SFD support for FETOSPHA, ENAML and CNAO.

Ensure that all clinical placements are centralized in the unit managed by CNAO and coordinated by both ENAML and CNAO.

Translate all TATCOT curriculums into French.

Implement ISTM (French training institute) recommendations and measure progress on management and methodology.

Monitor short regional P&O modules under ENAML management and responsibility.

Participate in the PT curriculum update.

Unit under construction and co-financed by MoH and SFD. However clinical placement continues at CNAO.

Underway.

During training of students, the materials provided are used to offer P&O services. Subsidize the cost of 300 services.

Special order of materials and components through OADCPH for ENAM students at CNAO during clinical placements (CHF 30,000) to allow them to receive proper training.


Support the MoH in improving its coordination role and participation in the drawing up of a plan of action for each one of SFD-supported entities.

Although the sector of physical rehabilitation benefits from one focal person at Ministry level (part time), technical coordination mechanisms are not yet in place. Discussions have been held with the new Minister of Health and Social Protection (July 2015) on how to further promote efficient coordination mechanisms.

SFD sponsored 1 secretary at ENAML, employed to foster efficient working relationships between SFD and ENAML and to reduce administrative workload for teachers. Note that ENAML will take on the costs in 2016.

Facilitate the setting up of a working group including senior officials from MoH, services providers and civil society with support from Yale/MSH (Senior Leadership Training; based on Tanzania experience).

A working group which has recently become known as the Physical Rehabilitation Platform is in place, including senior staff from MoH, Ministry of Social Action, Ministry of Finance, DPO, and the Togolese Red Cross with the support of MSH/LMG.

32 participants from Benin, Cte dIvoire and Togo sponsored by SFD to participate in training co-organized by ENAML & OADCPH in August in Lom.

Limited development.

17 | SFD ANNUAL RAPORT 2015 | AFRICA




TOG

O

Centre National d'Appareillage Orthopdique, CNAO, Lom

Centre Rgional d'Appareillage Orthopdique du Kara, CRAO, Kara

Review twice a year the cooperation between SFD, MoH, ENAM and CNAO under MoH authority.

Review was not possible at MoH level, but was done at the school and service providers.

Ensure that the training unit is adequately equipped and offers clinical placement for 20 students.

All clinical placements centralized at CNAO. CNAO registers patients to serve as models for the students during clinical placement activities. ENAML teachers, with the collaboration of CNAO staff, monitor 18 students.

Subsidize the cost of 300 services.

SFD support to CNAO continues according to 1-year addendum signed in 2015 to ensure the reimbursement of services to CNAO for 300 vulnerable disabled people. Only 132 devices reimbursed to CNAO by SFD as at December 31. Delays are due to late start and the difficulties CNAO experienced in conducting the beneficiary survey. Project extended until March 31, 2016.

Check that beneficiaries identified by FETOSPHA are provided with wheelchairs.

12 sports wheelchairs provided to FETOSPHA to ensure athletes can compete in international tournaments.

Put in place tools to improve the management of services (PMS, product cost calculation).

Cost calculation reviewed at CNAO. The centre is using a different tool for data recording (not PMS).

Introduce financial indicators to measure the evolution of the proportion of funds invested by the partner and the SFD.

Not yet in place. Postponed to 2016.

Continue cooperation with the French Institut Suprieur de Technologie de Montplaisir to improve the overall management of ENAML.

Recommendations of the French Institut Montplaisir are progressively implemented at ENAML. Leadership Development Program (LDP) modules completed with ENAML administrative staff and teachers.

Check that 80% of devices assessed match SFD quality standards.

The technical part of the beneficiary satisfaction questionnaire is not implemented yet, and should be implemented in 2016.

Ensure that 4,000 physically disabled people access services at CNAO.

Cost calculation of devices made at CNAO. Raw materials provided through OADCPH to benefit rehabilitation of PWDs.

Move the basketball court to ENAML premises.

FETOSPHA basketball court designed, but the most relevant location in terms of inclusion has not been selected yet.

Consolidate CNAO management and technical capacity to allow smooth coordination of services at regional level.

Formal decision from MoH is necessary. However this issue is currently under preparation and discussed in the Physical Rehabilitation Platform.

Organize specific SFD training on PT for 12 mothers of children with physical disabilities.

11 training sessions for 90 mothers of CP children took place at CNAO Lom under supervision and with support from SFD.

Ensure that 100 children and mothers from rural areas are referred to CNAO for two weeks training.


Facilitate the identification of 14 service users from CNAO by the Togolese Paralympic sport federation and provide them with sports equipment.

6 new disabled athletes have been registered on International Day of Persons with Disabilities (D-Day) and joined the basketball team. SFD gave FETOSPHA a small donation towards organizing a demonstration of wheelchair basketball on December 3rd.





TOG

O

Encourage provincial health directorate, MoH and CNAO, to support Kara centre.

The Physical Rehabilitation Platform addressed at the end of the year a plea for an increased allocation for CNAO.

Support the recognition by the World Confederation of Physiotherapists (WCPT) of the physiotherapy association (AMKITO) congress.

AMKITO received accreditation by WCPT during the Singapore WCPT Assembly meeting in 2015.

Cooperate with FETAPH to improve its capacity and further promote social inclusion in its programme.

A referral programme set up by the SFD is being implemented by APAPE & FUCEC (Members of FETAPH) to facilitate access to micro-credits for people with disability.

Out of the 33 beneficiaries identified, 4 have been selected to receive a small loan to start a business.

Train staff on the use of PMS and cost calculation tools.

PMS not ready yet. To be tackled by Geneva headquarters (PMS) and CNAO (cost calculation).

Analyse data collected from interviews of 120 disabled people according to the SFD questionnaire (quality, access and inclusion).

Out of the list of 71 PWDs provided to APAPE, 37 persons have been interviewed according to SFD questionnaire. Data have been analysed and a report produced.

Ensure that Kara benefits from CNAO technical back-up and coordination.

Under discussion with MoH and CNAO.

ZAM

BIA

Zambian Italian Orthopaedic Hospital, ZIOH, Lusaka

Analyse the impact of past SFD support, including the outcome of the LMG working group.

LMG group has fostered a community to introduce the new data tool in the Health System.

The LMG team piloted a new upper- and lower-limb amputation assessment tool in 2 hospitals.

It has tested the new assessment tool for construct validity.

The data collection tool will be embedded in countrys Health Management Information System (HMIS) in mid-2015.

Assess the PT services within the multidisciplinary approach.

Less than 5% of clients in ZIOH benefit from a multidisciplinary approach including physio involvement.

Ensure that 500 physically disabled people have access to ZIOH.

According to figures received by the center, 316 PWD received services at ZIOH thanks to materials provided by the SFD. No visit has been carried out in 2015.

19 | SFD ANNUAL RAPORT 2015 | ASIA

REGIONAL OFFICEHo Chi Minh City, Viet Nam

SUB-REGIONAL OFFICEDushanbe (covered by a separate section in the report on p. 24; statistics for the sub-regional offices activities are not included below

OVERALL SUPPORTMaterial and financial assistance was provided to 4 service providers and 1 training institution in Vietnam

SFD PERSONNEL1 ortho-prosthetist1 project assistant3 administrative staff (1 person at 50%)

TRAINING 4 clinical training sessions for 19 professionals P&O 4 information session on physical rehabilitation for 76 members of DPOs

1 seminar on the need for a multidisciplinary approach in physical rehabilitation for 14 General Practitioners.

1 Disability awareness session for 10 participants from corporates in Vietnam

SERVICES, PROSTHETIC/ORTHOTIC DEVICES AND MOBILITY AIDS PROVIDED BY THE SUPPORTED CENTRES Overall physical rehabilitation services for 3,295 people with disabilities

Devices for mine incident survivors: 1,249 prostheses

Devices reimbursed by the SFD: 1,333 prostheses and 35 orthosis

ASIA



237,662 382,225

Tuition & staff-related costs 296,224 315,786


41,975 120,245


77,044 73,235

TOTAL 652,905 891,491


Male

PROSTHESES2510

ORTHOSES1197

Female

Child

Male

Female

Child

Male

Female

Child


ASIA | SFD ANNUAL REPORT 2015 | 20

SUSTAINABILITY During several meetings and workshops with the Action

Centre for Community Development (ACDC), the Ministry of

Health (MoH), Ministry of Labour, Invalids and Social Affairs

(MoLISA), the Vietnamese Training Centre for Orthopaedic

Technology (VIETCOT) and other stakeholders, we discussed

ways to include prosthetics/orthotics in the list of items

covered by State health insurance. At years end, the orthotic

devices were set to be included in the list, pending the

Minister of Healths approval.

With a view to having State health insurance extended to

cover physical rehabilitation, we, alongside MoLISAs Social

Protection Department and the MoH, began to work on a

national study regarding mobility devices in particular,

by hiring an external consultant to help coordinate the

study with local counterparts and researchers. A tripartite

agreement was drafted and discussed with the pertinent

parties, to be signed in early 2016.

We opened an additional office in Hanoi, which helped us

improve our contact with governmental bodies notably

the MoH and MoLISA and other organizations. This office,

located inside the VIETCOTs premises, facilitates the sharing

of our expertise with the institution; it also makes it easier for

them to raise concerns related to service quality, sustainable

development, their strategy, and training. Our agreement

with the MoLISA and VIETCOT was extended for three years,

in line with our mutual commitment to developing the

physical rehabilitation sector.

With our support, representatives from ACDC, the MoLISA,

VIETCOT and the hospitals that we work with attended

an LMG course in Cambodia, with a view to strengthening

their leadership and management skills, and improving the

sustainability of the physical rehabilitation sector in the

country.

QUALITYA total of 243 users of prostheses had their devices checked

by SFD and VIETCOT using a MoLISA-approved quality

control protocol that we developed; 91% of devices were

found to meet SFD standards. VIETCOTs involvement also

allowed to make recommendations to the service providers

we visited, and helped them build their reputation and role

in the sector.

In September, we supported VIETCOT staff in organizing a

training session for 14 general practitioners from hospitals

in Can Tho and Ho Chi Minh, which helped them improve

their ability to prescribe services for prosthetics/orthotics.

Furthermore, we helped them conduct two training sessions

on the manufacturing of prosthetics using the cost-effective

polypropylene technology developed by the ICRC. The

sessions were attended by local and foreign students,

including two from Laos, two from Myanmar and two from

Namibia.

Based on our recommendations, prosthetic/orthotic

technicians from the Ho Chi Minh Rehabilitation Centre

began to manufacture trans-femoral prostheses using

the Ischial Containment Socket technique, which led to

better-quality devices. This training was extended to two

technicians in Can Tho and three in Da Nang.

ACCESS

In addition to the Red Cross of Viet Nam, two organizations

of disabled people one in Can Tho, the other in Da Nang

took part in identifying and referring people in need

of rehabilitation services and mobility devices. After we

organized training in this regard for key staff/ members of

each DPO, 46 such people were identified in Can Tho, and

38 in Da Nang. In Can Tho, 11 were referred to hospitals to be

fitted with prosthetics, and 19, orthotics. In Da Nang, patients

were set to have access to similar services starting in 2016.

Out of the 3,295 people received services at centres/

hospitals supported by the SFD, we subsidized the cost of

services for 1,292 vulnerable people with disabilities, nearly


In Vietnam, we worked extensively with the

authorities and other partners to help develop the

countrys physical rehabilitation sector, lobby for

the inclusion of prosthetic/orthotic services in State

health insurance coverage, and ensure that people

received services when necessary. Some 22% of

the people assisted by service providers that we

supported were survivors of mine/ERW; this was the

largest percentage among the regions we worked in

globally.

21 | SFD ANNUAL REPORT 2015 | ASIA

meeting our target of 1,300 for 2015. They were fitted with

mobility devices at four MoLISA centres/hospitals that

we supported, and at VIETCOT. Out of these beneficiaries,

734 were ERW/mine survivors.

The ACDC published 18 articles (in both English and

Vietnamese) regarding physical rehabilitation on its

newsletter, social media accounts and website. These articles

helped disseminate information on disabilities and the

services available for disabled persons, while also increasing

the SFDs visibility in the country. With our support, the

ACDC also held a photography contest that highlighted the

importance of mobility devices for the disabled.

A train-the-trainer session on physical rehabilitation services

was conducted by VIETCOT and attended by 10 senior staff

from the ACDC. The session helped participants increase

their understanding of the challenges faced by people

with disabilities, and the role of physical rehabilitation.

They, in turn, conducted an adapted version of the training,

including advocacy techniques, for 29 leaders/key members

of organizations of disabled people in Hai Duong, Hai Phong,

Hanoi, Thai Binh, Thai Nguyen and Quang Ninh.

SOCIAL INCLUSIONTogether with the ICRC and the Swiss ambassador to

Vietnam, we organized a disability awareness session for

10 Swiss corporations based in the country, which enabled

them to learn more about disability-related issues. As a

result, three SFD beneficiaries were recruited by one of the

companies.

We worked with the Hanoi Sports Training and Competition

Centre (under the Ministry of Culture, Sports and Tourism),

Otto Bock (a German prosthetics company) and VIETCOT

to fit three athletes with orthopaedic devices adapted for

sports. The manufacturing of these devices also enabled

VIETCOT personnel to improve their skills through the

technical supervision of an Otto Bock specialist. Two of the

three athletes fitted with these adapted devices went to the

8th ASEAN Para Games held in Singapore.

Owing to a lack of funds, we were unable to help people avail

themselves counselling services or livelihood support. During

interviews with our beneficiaries for articles, nevertheless, they

shared that the services we helped them obtain had enabled

them to regain their mobility and in turn, enabled them to

have access to education, employment and health care.

3rd price of the photo contest on Mobility,

under the cooperation with the disabled people

organization ACDC and launched by the SFD.

"We are the wheelchair users whose legs are

replaced by devices (wheelchairs) but sadly we

are unable to get passed the difficult routes

(stairs). If we do not have support we cannot

access the places we want to go to. Seeing the

accessible roads and means of transportation

(bus) in other countries is what we wish for.

One day people with disabilities will be able to

access every place in our country".

Title: Overcome together - Author: Mr. N. Van Dai.

Young Lai Thi Ngoc Anh was born in the Thi Cau district of Bac

Ninh province in the autumn of 1992. When Ngoc Anh was 10

years of age, she unfortunately fell to the ground from a great

height while playing at her grandmothers house and this

resulted in her left lower limb being amputated. Soon after this

accident, Ngoc Anh was referred to the VIETCOT centre for her

first plastic prosthetic leg. Despite the restoration of her mobility

given by this prosthesis, she faced much hardship because of

her loss of limb. At school she was often teased because of her

prosthetic leg. However, she did not let the teasing affect her

but instead became more confident in herself.

In 2012, Ngoc Anh started sports with other people with

disabilities. Very soon after initial training, she participated in

her first national sports competition and won 2 gold medals

in the 100m and 400m relay-races. In 2013 Ngoc Anh went on

to win another 2 silver medals in the 100m and 400m races.

These achievements helped her to be selected by the National

Team and take part in the 7th ASEAN Para Games in Myanmar

in 2014. During her first international competition, the young

athlete won a silver medal in long jump for the Vietnamese

team. Throughout the process of training and competing, Ngoc

Anh was in serious pain because the hard plastic prostheses

was rubbing against her stump. She was at times reluctant to

put it on, and with the pain and the strength training in extreme

weather conditions, she often thought about giving up sports.

Thanks to all the encouragement from her family and her own

courage, Ngoc Anh nevertheless pursued her career in sports.

In 2015, the SFD decided to become involved in sports for people

with disabilities within the framework of its Orthopaedics and

Physical Rehabilitation project. Visiting the National sports

centre in Hanoi, the SFD team was impressed by Ngoc Anh's

capabilities when she was training despite the limited function

of her plastic prosthesis. Ngoc Anh was therefore selected

by the SFD with two other athletes from the Hanoi centre to

receive orthopaedic devices specifically designed for sports.

The SFD cooperated with the VIETCOT centre and the Otto Bock

company in South East Asia to produce an advanced prosthesis

for Ngoc Anh, made of ultra-light and durable carbon material.

She immediately noticed a significant difference between

the new and the old prosthesis when training, thanks to the

way it fitted snuggly around the stump and had a high spring

effect. Ngoc Anhs fitting with this new prosthesis took place

just before she went to compete at the 8th annual ASEAN

Paralympic games in Singapore in December of 2015.

The result was that Ngoc Anh received 3 medals in all 3 of the

disciplines she participated in, namely a gold medal in the long

jump, and a silver and a bronze medal in the 100m and 200m

races respectively. Ngoc Anh is very happy with her new sports

prosthetic device and her achievements in the games. The

young athlete now has plans to train for bigger tournaments

to assert her capabilities and thereby, in her own way, repay

everyone's support and encouragement.

THE STORY OF LAI THI NGOC ANH, BAC NINH, VIET NAM

ASIA | SFD ANNUAL REPORT 2015 | 22

23 | SFD ANNUAL REPORT 2015 | ASIA

ACTIVITIES AT SFD -SUPPORTED CENTRES IN ASIA IN 2015



VIET

NA

M

Vietnamese Training Centre for Orthopaedic Technologists, VIETCOT, Hanoi

Rehabilitation Hospital, Can Tho

Rehabilitation Hospital, Da Nang

Rehabilitation Centre, Ho Chi Minh City

Rehabilitation Hospital, Quy Nhon

Organize 4 meetings with partners and authorities targeting Universal Health Coverage.

One ACDC-SFD meeting to place to plan for activities in 2015.

Five brainstorming sessions held with participation of relevant persons from MoLISA, VIETCOT, MoH and an external resource to discuss how to include P&O devices into the list of items covered by State Health insurance (SHI).

In addition:

one training session for trainers on physical rehabilitation was delivered by VIETCOT in May for 10 staff members from ACDC (DPO).

one follow-up training session on mobility and advocacy was delivered by trained ACDC staff for an audience of PWDs in the North.

Collect users feedback through interviews done in cooperation with DPOs and VNRC.

103 beneficiaries were interviewed by VIETCOT in May at 4 rehabilitation centres/hospitals while 140 users were assessed by SFD's expat in Nov. 6 beneficiaries, identified and referred by DPO, were followed up by DPO while 114 were followed up by VNRC.

Support 1,700 persons through subsidies for the cost of services.

1,292 destitute PWDs fitted with orthopaedic devices including 1,333 prostheses, 35 orthoses and 2,570 crutches at four MoLISA rehabilitation centres/hospitals and one MoLISA P&O school throughout the country (734 are war victims including 636 men, 95 women and 3 children).

Participate in the development of P&O services dedicated to physically disabledathletes with VIETCOT to ensure that 5 athletes are identified by the Paralympiccommittee and provided with appropriatedevices.

A four-parties agreement between VIETCOT, Paralympic committee, Otto Bock and SFD was signed in June 2015.

Three athletes were fitted with prostheses (2) or orthoses (1) and participated in the 8th ASEAN Paralympic Games in December 2015 (one female athlete received Gold, Silver and Bronze medals while another one was awarded first class for high jump).

Ensure ACDC publishes 12 newsletters to raise awareness of issues related to physical rehabilitation services.

11 newsletters have been published including six articles on physical rehabilitation, three case stories of SFD beneficiaries, three brief papers on LMG SLP (management) workshops, three articles on the organization of a mobility aid awareness session for PWDs and on disability awareness for corporate businesses and three articles on SFD's support for fitting athletes with adapted devices.

Check that 70% of services comply with quality standards among samplings selected in the different SFD-supported centres and assessed by VIETCOT.

The individual user assessments carried out by both VIETCOT and SFD at 4 SFD-supported centres show that 91% comply with quality standards.

Ensure selected DPOs, VNRC and Spanish Red Cross participate in the referral of PWDs in need of services.

Two bilateral MoUs were signed with Can Tho DPO and Da Nang DPO for the identification and referral of PWDs to SFD partner's project.

Spanish Red Cross programm ended but collaboration with VRCS continues.

Organize disability awareness information for private companies regarding employmentof disabled people and measure theoutcome.

Thanks to the support of Swiss Ambassdor in Hanoi, General Consulate in Ho Chi Minh and ICRC, the SFD organized a disability awareness information session for 10 top ranking representatives of Swiss companies in July. As a first result three beneficiaries of SFD were employed by one Swiss company.

Validate with the authorities the terms of reference for the assessment of the P&O sector, identify external resources and launch the study.

After discussions with many different governmental officials, the terms of reference and a study plan have been adopted by MOH and MOLISA . MoLISA officially assigned Social Protection Department to work with MoH and SFD on the study.

One external consultant was hired by SFD and a preliminary discussion was held with the General Statistics Office (GSO), selected national researchers and VIETCOT.

In December WHO was approached for possible collaboration.

An MoU with VIETCOT for 2016-2018 was signed in October with mutual responsibilities to develop the P&O sector. VIETCOT's director actively contributed to the SFD's Universal Coverage objective.

Support the organization by VIETCOT of 2 training sessions on PP technology.

Establish the revised multidisciplinary treatment procedure at 4 centres.

Ensure that 40 physicians have improved their skills for P&O services prescription.

Two clinical training sessions were organized by VIETCOT for its students (including 2 from Myanmar, 2 from Laos and 2 from Namibia) .

Not implemented due to budget limitation.

One training session organized by VIETCOT on P&O treatment prescriptions for 14 doctors from Can Tho and Ho Chi Minh cities.

Engage with private companiesto initiate contributions to services costs for the most vulnerable persons.

Although meetings were held with corporate businesses no results were obtained in terms of contributions to services costs.


Ensure that social workers counselling reaches 500 services beneficiaries and offers opportunities for education, vocational training or micro-credits.

Not achieved due to budget limitations.

TAJIKISTAN | SFD ANNUAL REPORT 2015 | 24

REGIONAL OFFICE

Regional SFD office in Ho Chi Minh City, Viet Nam, with

support from SFD headquarters in Geneva

SUB-REGIONAL OFFICE

Dushanbe, Tajikistan

OVERALL SUPPORT

Technical assistance was provided to 1 service provider

SFD PERSONNEL

1 ortho-prosthetist

1 Physiotherapist

TRAINING

Single discipline P&O training at the VIETCOT

for 4 participants from Tajikistan sponsored by the SFD

SERVICES, PROSTHETIC/ORTHOTIC DEVICES AND

MOBILITY AIDS PROVIDED BY THE SUPPORTED

CENTRES

Overall physical rehabilitation services for 2507 people with

disabilities, including 19 for ERW/mine incident survivors

Devices for mine incident survivors: 20 prostheses and orthoses

Crutches (pairs) delivered: 81

TAJIKISTAN


Male

PROSTHESES352

ORTHOSES781

Female

ChildMale

Female

Child MaleFemale

Child



17,609 182,312

Tuition & staff-related costs 326,348 360,634


55,518 57,000


53,446 53,696

TOTAL 452,921 653,642


25 | SFD ANNUAL REPORT 2015 | TAJIKISTAN

SUSTAINABILITY With assistance from several national and international actors,

the MoHSP drafted a national plan for meeting the needs of

people with disabilities. The plan, for the period 20162020,

was submitted for approval in late 2015.

We helped drafting and finalizing the SEOP project proposal

for the renovation of its branch in Khujand, which had not yet

reopened. This proposal was submitted to various potential

donors, including the Japanese embassy, who decided to

financially support the project. In December, we were also

requested to support the MoHSPs efforts to assess their

branch in Kulyob, with a view to developing its services for

users of prosthetics/orthotics in southern Tajikistan.

At the MoHSPs initiative, the profession of physiotherapist

was recognized by the government for instance, in terms

of required certification and official pay scales. Similar efforts

were under way for prosthetists/orthotists.

QUALITYThe last batch of SFD-supported personnel from SEOP (four

in 2015, and seven in all) returned from training at VIETCOT in

Viet Nam with ISPO-recognized diplomas. Such support has

helped improve the quality of its devices, and SEOP was able

to produce 34% more orthotic devices in 2015 than in 2013.

We regularly coached SEOPs physiotherapy team, which

helped them improve their services, as well as their filing/

recording system and other working procedures. This support

contributed to an increase in the number of people that SEOP

was able to serve in 2015.

We also helped SEOP open a department for the production

of mobility aids, particularly for children; the production of

these devices, such as custom-made walkers, started during

the year. To improve SEOPs ability to maintain its services

during winter, we supported the installation of heaters as part

of its efforts to renovate its physiotherapy and prosthetics/

orthotics sections.

SEOP personnel improved their knowledge of spinal

orthotics at a seminar we organized, which was conducted by

instructors from the Iranian Red Crescent. This helped SEOP

offer new products/services related to lumbar and thoracic

spinal orthotics.

ACCESSWheelchair users were able to enter SEOP more easily after

we helped install a ramp for them. We also worked with SEOP

on ways to coordinate the flow of patients from remote areas,

with a view to maximizing the usage of its 40-bed dormitory.

We advocated an increase in the MoHSPs budget, and

provided them with technical support for planning their

budget for importing materials. Their budget remained the

same, even as foreign exchange and inflation rates increased.

We regularly met with the Red Crescent Society of Tajikistan,

with the goal of facilitating the re-establishment of

collaboration between them and SEOP. Such collaboration

would focus on promoting awareness of physical rehabilitation

services in remote regions, and on setting up identification

and referral mechanisms to improve peoples access to SEOP.

SOCIAL INCLUSIONAs part of our dialogue with the MoHSP, we advised them

to establish a department for social services at the SEOP. In

the meantime, people in need of such support were referred

to Imkoniyat, which disseminated information at SEOP

regarding Imkoniyats services. Our discussions with the

Paralympic Federation also paved the way for collaboration

with them in 2016.


Our sub-regional office in Tajikistan, which is under the Asia

regional office in Hanoi, Viet Nam (see p. 19), continued to

support the Tajik authorities particularly the Ministry of

Health and Social Protection (MoHSP) in their development

of their national physical rehabilitation sector. We provided

support for, among others, developing policies, mobilizing

donors, and training personnel from the State Enterprise

Orthopaedic Plant (SEOP).

Adim, now 18 years old, lost both his legs

(above-knee) in 2006 in a car accident i

annual report - icrc...

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