Annual Plan Office (APO) 2017

Summary

NLR Nepal got project approval from Social Welfare Council (SWC) for the project period 2016-2020 with joint signatory of NLR & SWC in June 2016. From this date onward NLR Nepal is legally allowed to implement its projects through Boundary Partners (BPs) for next five years fulfilling the requirements set by the Government of Nepal.

Disease burden due to leprosy has not been reduced as expected as more endemic clusters are still to focus, mainstreaming of disabilities due to leprosy to general disabilities is still to be continued resulting in need of continuous training activities; advocacy and lobbying at different areas; changing attitude, behavior, action/policies & relationships of BPs. Newly introduced technology of leprosy prevention, LPEP, will be continued where as further expansion of the districts has been considered and purposed. NLR Roundtable (RT) set four priority areas are fully considered and activities are planned accordingly.

For the administrative & managerial part of the projects; inflation rate of 10.24 in November 2016 and forecasted to be 11.1 in 2017 and the budget constraints in NLR are considered while preparing this plan. Strengthening coordination and networking government and NGO partners and provide technical support to the projects by regular monitoring visits and meetings and workshops are the main activities of NLR staff including representative so that the leprosy patients and PWD/PWDL can get the needed services at their door step. Major part of the NLR fund in leprosy control goes through Government Redbook whereas POID, disability management and rehabilitation are planned to implement by NGOs and NLR supported referral clinic in government hospitals. The developments in the field of health services such as new long term health plan, post MDG strategies for sustainable development, new 5 years plan for leprosy program, developments in the area of disability managements are taken into considerations. The leprosy chemoprophylaxis (LPEP) program achievements has been appreciated in national and international forum; so that; supporting activities through GON/NGO partners are designed accordingly.

NLR Nepal have been engaged in restructuring and recruitment of staff in 2016 and from the middle of the year 2016 the momentum has been taken place to implement the plan based on annual and long tern plan. NLR Nepal has fully adopted Outcome Mapping (OM) as a P M & E tool and the projects planning are done accordingly.

1. Introduction

The APO with budget for 2017 is the result of several meetings and workshop organized at Eastern, Far Western & Central level under the guidance of NLR Nepal team and with the participation of staff from NLF, NFDN, NNSWA, NLR field projects at Eastern & Far Western Region. The separate meetings and workshop were held at project level with boundary partners and related stakeholders. The plan foresees a gradual balance of activities aimed at disease control and disabilities inclusive development.

Current plan is developed on the basis of NLR agreed project document from SWC Nepal on the basis of Outcome Mapping workshop conducted at the beginning of 2016 in Kathmandu facilitated by OM expert. This plan is also based on the recommendations from final evaluation took place in 2015 of NLR projects and NLR 2020 strategies and guidelines from IO. Similarly on preparing the APO for 2017 we have taken the references of many International and National documents, declaration and guidelines such as; WHO global strategy of leprosy 2016-2020, Nepal National strategy of leprosy 2016-2020 (draft), WHO CBR guidelines, WHO ILEP technical guidelines, UNCRPD, Bangkok declaration etc were also taken into consideration. We have planned to implement different activities during 2017 covering the eleven sub projects such as focusing four Key Priority Areas (KPA) such as as prevention of leprosy including post-exposure prophylaxis, disability-inclusive development, mainstreaming through integrated SCG/SHG and reduction of stigma and discrimination through appropriate project management.

The main authors of the plan are Dr K P Dhakal, the Country Director with contribution from Mr N Banstola and Mr H Sigdel, and the finance department of Country Office.

2. Context analysis

Some developments in health sector during 2016 that are directly or indirectly affecting our programs which are mentioned in the following categories:

Government of Nepal has adopted a new long-term health policy where for the first time clearly mentioned about disability as a health issue and it is the concern of health ministry. The Third National Health Sector Plan (NHSS III) of MoHP 2015-2020 is already in place and has shown some sort of continue changes in social consequences of health in Nepal. We have tried to incorporate such reflections in the planning for 2017.

Beside conventional strategy of public health services fully provided by public sector, in implementation of the NHSS, the ministry of health and population is committed, to achieving the MDGs through the strategy of PPM and service purchasing. Recent report published by MoHP on the progress of MDG has recommended for further improvement of health & its consequences in Nepal.

Ministry of health and population is drafting the National strategies on leprosy for 2016 – 2020 in line with WHO global strategies with the inputs from supporting partners including NLR. The national leprosy program has developed the guidelines for MCBR, curricula for different trainings etc. During 2014, the recommendation of MiTLePRA has been available; Bangkok declaration has been adopted. The national program is more interested in continuation of our support to leprosy control as well as on social consequences of leprosy. The National leprosy Program has now focused how to involve the persons affected by leprosy in the program.

LPEP piloting started from three districts, with the support form NLR, is found appropriated in several aspect of leprosy prevention so that GON has decided to

expand few more districts. Three more districts are already expanded and three districts are under planning of 2017. At the same time we have planned to support five more middle and low endemic districts in 2017. The leprosy situation in the country has been changes to some extent with gradually, very slowly but not continuously decreasing the number of new case and other indicators. This shows that the endemicity of leprosy has been now more localized in several clusters. Government budget for leprosy is fluctuating but capacities of health workers for leprosy diagnosis & complication management is already there. We have now given more focus on innovative approaches rather than regular LCP support throughout the country.

The newly formulated constitution of Nepal has addressed the right of people with disability. From this year disability issue has been included in the long-term health policy of Nepal, and quite a number of other developments has taken place in the country. Ministry of Women, Children and Social Welfare has approved the accessibility guideline. The new CBR guideline new disability act is in place. A number of decisions by the Supreme Court directing the government in favor of the persons with disabilities have been made specially to provide the living allowances for PWDs. As the result of extensive activities at community level in the past year, community stakeholders became more aware on their needs, rights to enable them to develop their own planning and seeking support from GON & other sectors. We have aimed to provide some support in this regard keeping in view the benefits for PWDL & leprosy control activities.

Market price has tremendously increased, salary & per diem of GON staff have been increased by 25% and inflation rate is declared to be around 11%. This is the effect of disaster occurred in April 2015 followed by blockade of India immediately after the declaration of new constitution of Nepal. At the same time Ministry of health has increased program budget for leprosy control program (diagnosis, treatment, IEC, health education, rehabilitation etc) little bit more. Similarly, other line ministries have made some mandatory allocations for disability management & rehabilitation.

As the new structure of NLR Nepal has been effect fully form 2016 with the recruitment of staff including the fundraising and communication officer, we have to act proactively in the implementation of planned projects.

The joint project with Karuna Foundation in the area of disability prevention and community based rehabilitation for the persons with disability with focus on children will be continued in 2017.

Figure above shows fluctuating but continually decreasing trend of leprosy in the country. New cases detection rate remained 10.64 per 100000 populations where as registered prevalence rate remained at 0.90 per 10000 populations. Till 2015/2016 a total of 175000 cases have been treated with MDT in Nepal.

2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 2015/160

5

10

15

20

25

30

35

40

45

2.72 3.47 3.16 2.89 3.38 4.42 4.69

32.628.4

31.6 30.8

35.46 36.63 38.35

6.71 5.19 6.264.24

6.33 7.73 7.72

Trend of proportion of G2D, Female & Child among new cases

Grade II disability among newFemale among newChild among new

Figure above shows that all three indicators of grade II disabilities among new cases, female proportion among new cases and child proportion are fluctuating but increasing over the past years.

3. Reflection past year

Office management

Maintaining smooth coordination and cooperation with different ministries, I/NGOs, Donor agencies, field projects and the IO is the main responsibility of NLR Country Office including smooth flow of funds and regular reporting to IO and other stakeholders, National level PAC, activities directed to IF & NIF, technical advices to the national program, regular monitoring visits to field projects and partners are the major activities of NLR Country in Nepal. Realizing this fact NLR Nepal has restructured the existing country office adding two senior level positions to look after technical and program management functions. The finance section has also made strong by centralized functions by pulling the staff from field offices. In addition, there are 3 technical and supporting staff is deputed to LCD for leprosy program support.

Similarly, there are 6 staff in NLR eastern region and far western field offices. The idea behind it is that our boundary partners will implement all our activities and NLR Nepal staff facilitates, guides and monitors the boundary partner’s work.Project Management Committee (PMC) has been created to replace the precious Senior Management Committee (SMT) with added authorities as a governing body of NLR Nepal.

The planning, review and sharing meetings at leprosy control division, regional health directorates and in NLR field projects, implementing and other partners, PMC and PAC meetings are mainly for coordination advocacy, lobby, networking and capacity enhancement of boundary partners and strategic partners. As shown by the final evaluation done by the Nepalese government of the NLR program in Nepal, the ‘connecting’ role is one of the strengths of NLR Nepal and appreciated by many partners.

Funds flow to NLR supported projects are channelized from IO through CO to the projects on quarterly basis. NLR funding for leprosy control goes through GON and rehabilitation go to boundary partners. Since, Government fund has been increased the funding to disease control NLR fund is continually reducing in this part and gradually increasing on

rehabilitation projects. Currently NLR Nepal’s funding is almost solely from its own source, however the considerably big project like LPEP has been funded by Novartis Foundations through NLR IO.

CO and field project staff do routine monitoring during the field visits. These findings are published in annual reports (ARO) every year. SWC conducts mid term and end evaluations of NLR projects in Nepal and the end mid-term evaluation will take place in 2018, with technical input from IO.

Project Implementation

Major part of the NLR fund in disease control goes through Government Redbook. POID and disability management part of leprosy have been implemented by boundary partners and NLR supported referral clinics in government hospitals is run by the Government hospital itself as the ownership of the referral clinic in far west and east has been handed over to Seti Zonal Hospital and Koshi Zonal Hospital where NLR provides salary support, medicines and assistive dives as required. The quality aspect of services is also our major concern, which is felt deteriorated due to hiring new staff by the hospitals and their regular turnovers, motivations and appropriate management.

Delay in budget approval and release from government, differences in fiscal year and reporting timings sometimes the activities implementation is hampered.

Major part of disabilities inclusive development projects is implemented through our boundary partners. Activities implemented by BPs and reporting is acceptable but at the same time our major concern & strategy is to make GON organizations more responsible for program sustainability. So we promote the BPs and related GON organizations working together.

Effectiveness and efficiency of approaches:

We promote cluster focused approach in disease control part giving priority for case finding (contact tracing, index case approaches, DAG mobilization and active search by community volunteers), prevention of impairment & disabilities (reaction & other complication management, surgery, footwear & devices, referral) and self care /self help groups (formation / updating, training, orientation, income generation schemes, saving & micro credit). The case finding activities is backed by the LPEP project which has been considered as the successful project in Nepal. Similarly disability management activities are designed on the basis of CBR matrix (WHO CBR guidelines) covering the five-life domains health, education, livelihood, social & empowerment. Further expansion of disabilities management parts keeping proper coordination & cooperation with related stakeholders. Networking with similar local, national and international stakeholders has been found essential because it opens the way for further collaboration, joint planning up to the level of cost sharing. Beside this joint and collaborative voice might be more effective in advocacy and lobbying compared to the action by one single organization.

For the implementation of leprosy disease control part the GoN organizations (LCD, Regional health directorate, Regional health training centers, D/PHO, health institutions, district & regional hospitals) are the partners. The LPEP project is being implemented by

two off our boundary partners TLMN and NLF. The disability management part are being implemented by other boundary partners located in the project areas (NFDN and their sister organizations, NLF, NNSWA, IRDC and PDF). Apart from these Government and local organizations, NLR Nepal has established a good relation with other national and international stakeholders such as HI, AIN, Karuna Foundation etc. Sharing & review meetings are conducted with stakeholders when new issues are identified.

From our past years experience we found that some of essential events such as such as meeting support cost for DPOs/SCGs are difficult to monitor & evaluate. Another learning is that expected outcome is not achieved from scattered & small funding support for IGP to individuals. So we have modified our supporting strategies, which have produced quite encouraging results like supporting for organizational assessment for good governance of boundary partners & strategic planning of improvement, inclusive education, interaction and sharing meeting of DPOs of different VDCs together, activities related to mainstreaming of leprosy related disabilities to general disabilities and then disability issues into mainstreaming of development (Inclusion). The starting of disability friendly model villages has been encouraged and appreciated by national and international organizations. The will also be implemented as a major project during the year 2017.

Since, we got project agreement very late of 2016, many activities & projects are not properly executed. After getting project agreement with GON, we started to recruit the new staff as per agreed NLR Nepal structure and then did the MoU with Boundary Partners. Some of the projects such as LPEP & Referral clinics support were continued due to their nature but strike in the Terai areas for more than 6 months hampered mainly the monitoring part. For the IF, two proposals have been developed and submitted to related donors during this period. For local fund raising, we are not allowed as an INGO status in Nepal.

4. Program plan 2017

Goals

NLR practices the outcome mapping approach in order to contribute its vision and through its mission and objectives. The overall objective of the project: By the end of project period the project will contribute to the promotion of health status, support to enhance individual ability and work for full inclusion in society for persons affected by leprosy and persons with disability by changing the attitudes and functional behavior of the implementing partners.

The above objective will be achieved by: Leprosy incidence in the project area will be decreased to less than 10 cases per

100000 population and the visible disability among new patients will be less than 1 per million population

Persons with disability including those due to leprosy will be empowered physically, mentally and socio-economically so that they will be able to claim and obtain their rights to contribute to and benefit from the community development activities in their communities.

Baseline situation

NLR Nepal has already adopted “Outcome Mapping” as P M & E tools so that we have already set our monitoring priorities, strategies and organizational practices. We are focusing on “Outcome” rather than impacts that is changes in attitude, behaviour, action/policies and relationship of our boundary partners which are clearly mentioned follows;

Project Disabilities management project NFDNBoundary Partner and function

National Federation of the Disabled Nepal (NFDN) NFDN Advocates to promote disability rights NFDN through its networking & members organizations works with the four pillars as advocacy,

lobbying, networking and capacity buildingBaseline Situation

Less or patient participation of minority disabilities groups; inadequate resources; inadequate attempts to innovations; need to strengthen good governance practices; inadequate recognition with government authorities & ministries or departments; improper understanding of approaches & modalities; not very strong relation between networking & members; still to modify managerial organizational structure & pattern; inadequate relation with strategic partners and other stakeholders; inadequate capacity of the member organization for strategic pillars as defined

Outcome Challenges

The program intends to see Right holders groups and organizations are fully inclusive, resourceful, innovative in acquiring resources, strongly governed, responsive, transparent and widely respected by stakeholders in the disability landscape of Nepal. They are totally inclusive, with an equal approach to all disabilities. They deliberately include all disability types in their board and promote activities that assist all DPOs. Right holders governance enables them to fulfill their role. They establish an internal governance structure of highest standards and disseminate information on process and decisions openly and quickly. They encourage and respond to requests, suggestions and criticism from member organizations and general public. Right holders groups and organizations are continuously developing their capacity to support members; both in their structure and practices and in the skills they have to offer. They approach representation of persons with disabilities from a rights perspective and see their role as empowerment more than control. They have strong relationships, open communication and deliberate coordination with their member DPOs, offer training and support for members to design and implement initiatives and deliberately promote networking amongst members. They continuously reflect on better practice and network with other similar organizations internationally.

Progress markers

Expect to seeMaking full, well ordered minutes of meetings quickly and freely available to allMaking all communication (web documents, books information) openly accessible to allOffering an open and easily accessible system of feedback from members and general public and responds to what is receivedMaking periodic planning of activities with clear vision, mission statementsLike to seeOrganizing (once a year) co-ordination meetings of relevant members/organizationsOffering (3 trainings per year) relevant, accessible and high quality trainings to DPOs for building skills for them to implement their own projects and CSO governanceProviding relevant orientation on procedures, provisions, statute policy and guidelines to member organizationsProviding support to member organizations in activities rather than implementing themselves whenever the member organization is capable of thisRecognizing the need of constitutional amendment and starting the process of amendment.Deliberately operating on rights based agenda, monitors itself on its approach and makes documents relating to this openly available.Participating in an international forum of disabilitiesIncluding persons with all types of disabilities in their executive boardLove to seeDocumenting achievements of DPOs and member organizations and writes more fully on cases of best practice and disseminates thesePublishing a policy guideline that includes all types of disability and all member organizationsOrganizing an international conference on disabilities

Project Disabilities inclusive development project NNSWABoundary Partner and function

Nepal National Social Welfare Association (NNSWA) NNSWA provides rehabilitation services NNSWA promotes disabilities inclusive development at different areas of FWR Nepal

Baseline Situation

Rehabilitation services but limited individuals; all the disabilities types are not incorporated in the services; inadequate resources with inadequate innovativeness for the resources management; many components lacking on good governance practices; inadequate relation with right holders, GON agencies & other stakeholders; very low attempt to ensure equitable resources allocation through GON channel; lacking of right based practices; more skill and capacity to be enhanced on holistic development perspectives and inclusion

Outcome Challenges

The NNSWA intends to see the fully inclusive, resourceful, innovative in acquiring resources, strongly governed, responsive, transparent and widely respected by stakeholders in the disability landscape of Nepal. The utilization of quality services on Physical Rehabilitation of NNSWA totally inclusive, with an equal approach to all disabilities with coordination among the DPOs, VDRCs, SHGs/SCGs and government Sectors. NNSWA have strong relationships, open communication and deliberate coordination with their member DPOs, VDRCs, SHGs/SCGs offer training and support for members to design and implement initiatives and deliberately promote networking amongst members. NNSWA intends to recognize the importance of, and engage in, the planning of resource management activities in partnership with other resource users, mainly the DDC/VDC, in their communities. NNSWA have gained the trust of the other members of the partnership and the recognition of government officials so that they can contribute constructively to debates and decision-making processes. NNSWA able to clearly plan and articulate a vision of disabilities prevention, disabilities management, livelihood, mainstreaming of leprosy & Water sanitation & hygiene activities and goals that is relevant to their context and needs. NNSWA call upon external technical support and expertise as appropriate. NNSWA will act as champions for disabilities friendly model village concepts in their communities and motivate others in the partnership to continue their collaborative work. NNSWA lobby with related stakeholders and then assist to transform the situation that disabilities and marginalized populations in the communities are fully inclusive in existing development program & practices with the provision of equal opportunities in health, education and livelihood. Considering how the partners are relating to one another and who is doing what in the partnership, they establish ideal relationship between the partners.

Progress markers

Expect to seeOrganizing periodic meetings with like minded organizations & related stakeholders and keeping minutesMaking planning for staff capacity development for organizational management & resources managementMaking full, well ordered minutes of staff & boundary partners’ meetings quickly and freely available to allMaking periodic planning of activities with clear vision, mission statementsLike to seeMaking well managed organization with proper staffing & capacitiesRecording and reporting system well establishingEstablishing proper cooperation among the stakeholders with jointly funding efforts for the targeted program and activities in the communitiesHaving proper track records as a facilitator or expert on initiating disabilities friendly model villages, WASH, Leprosy control (including prevention)Having proper recognition of development contributors among othersOffering better information systems of the outputs and changes in the communities on development issues such as disabilities, disabilities inclusive WASH etcMaking initiations for financial resources management of organization & its boundary partners through cooperatives, microcredit & saving schemes and others such as IFPromoting right based approaches of inclusion and disabilities management such as inclusive education, UNCRPD, CBRLove to seeEstablishing the situation having adequate resources for program sustainabilityMaking the situation of proper recognition of the organization among policy makers and stakeholders as influencing one

Disseminating and or publicizing innovative & evidence based practices that made the changes in the societies

Project Disabilities inclusive development project NLFBoundary Partner and function

Nepal Leprosy Fellowship (NLF) NLF coordinates with GON & other NGOs for rehabilitation services NLF promotes disabilities inclusive development at different areas of Easter region of Nepal

Baseline Situation

Inadequate coordinating role with DDC/VDC; not involved in planning phase at local level; inadequate resources with inadequate innovativeness for the resources management; many components lacking on good governance practices; inadequate relation with right holders, GON agencies & other stakeholders; very low attempt to ensure equitable resources allocation through GON channel; lacking of right based practices; more skill and capacity to be enhanced on holistic development perspectives and inclusion; many clear framework still to develop on model villages concepts; SWOT analysis of the organization, stakeholders analysis is not properly done

Outcome Challenges

The program intends to see NLF that recognize the importance of, and engage in, the planning of resource management activities in partnership with other resource users, mainly the DDC/VDC, in their communities. These communities have gained the trust of the other members of the partnership and the recognition of government officials so that they can contribute constructively to debates and decision-making processes. They are able to clearly plan and articulate a vision of disabilities prevention, disabilities management, livelihood, mainstreaming of leprosy & Water sanitation & hygiene activities and goals that is relevant to their context and needs. They call upon external technical support and expertise as appropriate. They act as champions for disabilities friendly model village concepts in their communities and motivate others in the partnership to continue their collaborative work. They lobby with related stakeholders and then assist to transform the situation that disabilities and marginalized populations in the communities are fully inclusive in existing development program & practices with the provision of equal opportunities in health, education and livelihood. Considering how the partners are relating to one another and who is doing what in the partnership, they establish ideal relationship between the partners.

Progress markers

Expect to seeOrganizing periodic meetings with like minded organizations & related stakeholders and keeping minutesMaking planning for staff capacity development for organizational management & resources managementMaking full, well ordered minutes of staff & boundary partners’ meetings quickly and freely available to allMaking periodic planning of activities with clear vision, mission statementsLike to seeMaking well managed organization with proper staffing & capacitiesRecording and reporting system well establishingEstablishing proper cooperation among the stakeholders with jointly funding efforts for the targeted program and activities in the communitiesHaving proper track records as a facilitator or expert on initiating disabilities friendly model villages, WASH, Leprosy control (including prevention)Having proper recognition of development contributors among othersOffering better information systems of the outputs and changes in the communities on development issues such as disabilities, disabilities inclusive WASH etcMaking initiations for financial resources management of organization & its boundary partners through cooperatives, microcredit & saving schemes and others such as IFPromoting right based approaches of inclusion and disabilities management such as inclusive education, UNCRPD, CBRLove to seeEstablishing the situation having adequate resources for program sustainabilityMaking the situation of proper recognition of the organization among policy makers and stakeholders as influencing oneDisseminating and or publicizing innovative & evidence based practices that made the changes in the societies

Project LCP support project LCDBoundary Partner and function

Service providers (LCD, GON agencies, KZH/SZH) Provide leprosy services as well as treatment, surgery and devices Promote integration and reversal integration

Baseline Situation

Inadequate coordinating role with other development partners rather than leprosy related; lacking of inter ministry level coordination; inadequate capacity & knowledge on disabilities and disability management; lacking of clear plan and strategy for disabilities management; linkage with other rehabilitation centers for integration and opening up leprosy centers for reversal integration is clearly lacking

Outcome Challenges

The program intends to see service providers that plan to utilize local resources for activities in partnership with other resource providing centers including GON and I/NGOs. Service providers have gained the trust of the service-users and the recognition of government officials so that they can contribute constructively to development of their services. They are able to plan and articulate a vision of disability friendly services and goals that is relevant to their context and needs of persons with disabilities. They gain the capacities and expertise on disability friendly services including disabilities prevention such as early diagnosis, referrals and treatment of leprosy and other diseases causing disabilities. They call upon external technical support and expertise as appropriate. They act as facilitators for disability friendly services, devices, treatment physiotherapy & treatment need of PWDs, accessibility, and reasonable accommodation and motivate others to continue their collaborative work. Considering how service providers are relating to one another and who is doing what, they establish excellent coordination and complement each other.

Progress markers

Expect to seeParticipating different stages planning process (any appropriate of existing 14 steps planning process) of VDC/DDC to incorporate their activitiesCalculating & making proper estimates of the services needed in their catchment areas (annual)Organizing periodic meetings & reviews with related stakeholders on services, provisions, needs and keeping minutesOrganizing advocacy & lobbying meetings with stakeholders for resources and managementLike to seeMaking systematic provisions to provide the desired & needed services to the right holdersProviding treatment, physiotherapy, counseling, rehabilitation & other services to the right holdersEstablishing the systems and strengthening referral services at different levelMaking proper recording of provided services and timely reportingConducting awareness rising activities to target population on services, provisions & consequencesTransferring the existing services and centers to gender, age & disabilities friendlyAttending different trainings, workshops, meetings and seminars on enhancing & updating skills (capacities) for providing & and other innovative servicesManaging proper stocks of medicine, devices and others to ensure prompt services provisionsLove to seeProviding universal standard quality services to the right holdersEstablishing disabilities friendly services & provisions including physical infrastructuresMaking integration & reversal integration functional at services providing structures

Program plan

NLR Nepal has designed overall program through Outcome Mapping (OM) approach and got approval from SWC. Outcome Mapping is the one of the P M & E tools and focuses on outcome where as Outcome is defined as changes in attitude, behaviour, action/policies & relationship of the boundary partners (BPs). General introduction of OM is attached in annex II in this document. From our main document agreed with GON, we have composed 11 different sub projects with different goals & objectives but our main aim/goal is to make changes to our BPs so that they are following the same with their BPs and finally our interest, the target groups, are changed to achieve their vision.

NLR Operations project: This project is to guide and control administrative and managerial part of the organization. This is as the backbone of the project that further includes financial & administration, fund raising and M & E control. Part of the NLR Nepal Country Office is under this project so that budget is made on the same.

Technical support project NLR: This project is to guide and facilitate technical expects of different sub projects. M & E section of CRO, Technical director, NLR field projects in the Eastern & Far Western Region are under this project. This project is not only to provide technical assistances to BPs but also to take major responsibilities of M & E, explore innovative idea and approaches, projects and amendments etc.

LCP support project LCD: LCP support to government through Red Book system of Nepal is through this project. Since, year 2017, we have decided to support innovative activities rather than regular. For 2017, expansion support of prophylaxis, monitoring & reviews are planned under this project.

LPEP project TLMN/NLF: This is aiming to achieve leprosy prevention and continuing from 2015 as piloting in three districts of Nepal; Jhapa, Morang & Parsa. Achievements of the projects are encouraging so that GON started replicating to other districts. Financial support for the coming couple of the years is from Novartis Foundation so that budget under this project is planned under the column of other funding where as contribution to NLR program is deducted under different projects.

Disabilities management project NFDN: Advocacy & lobbying at the policy level, networking, empowerment and capacity building are the major aims of this project. PWDs can receive the required services such as treatment; devices etc either from Government schemes or existing rehabilitation centers and NFDN can establish the linkage for that. At the current situation NFDN and its network needed to be strengthening for disability rights and advocacy. Budget allocation for 2017 is made on the same principle.

Disabilities inclusive development project NNSWA: Establishment of Disabilities friendly model villages are the main attraction of this project. This project further aims to incorporate disability issues as cross cutting for holistic development schemes. Some organizational enhancement components are added to this project so that this project can influence against stigma & discriminations as well as mainstreaming of leprosy to general disabilities. Some sort of services such as protective devices for person affected by leprosy will be provided under integrated rehabilitation services of the project.

Disabilities inclusive development project NLF: Establishment of Disabilities friendly model villages are the main attraction of this project. This project further aims to incorporate disability issues as cross cutting for holistic development schemes. Some organizational enhancement components are added to this project so that this project can influence against stigma & discriminations as well as mainstreaming of leprosy to general disabilities. Some sort of services such as protective devices for person affected by leprosy will be provided under leprosy specific services of NLF.

Disability inclusive relief & rehabilitation project PDF and Disability inclusive Relief & Rehabilitation project IRDC: These two are the short term projects after devastating earth quake in Nepal mainly supported from SHO in Gorkha district of Nepal. Some sort of

activities will be continued in 2017 so that the budget is planned in other heading.

Hospital support project on leprosy clinical work: Regional Referral centers of Eastern and Far Western region are already handed over to regional hospitals of both the regions. Diagnosis, treatment and complication management are major parts of this project. Until now we are supporting the human resources and additional drugs required. HR support remains continue in 2017. Some negotiation is being done with Damien Foundation for the joint effort to enhancement of services from these centers.

I2C project KFN: This is joint project of NLR and KFN. Disabilities prevention and management are the major aims of this project. This project is continuing in Ilam & Jhapa where as NLR Nepal leads in Jhapa. Three VDCs in Jhapa are already at the stage of phasing out where as another one VDC has been expanded from 2016. No budgetary but only technical support of NLR will be there in 2017 but we will attempt seeking additional funds for the expansion of this project to other VDCs.

Budget plan - 2017

Key priority areasCore fund

Other fund Total

% core % other % Total

Prevention of Leprosy 31205 63036 94241 11 36 21Integrated self-care / combined approach 20345 3915 24260 7 2 5Disability Inclusive Development (DID) 22111 57924 80035 8 33 17(SARI) Stigma approach 14538 1740 16278 5 1 4*Advocacy and lobbying, capacity development 65945 27024 92969 23 15 20Management 128951 22487 151437 46 13 33Total 283094 176125 459219

*Advocacy and lobbying can be defined under DID

Table shows that majority of the program budget (in Euro) goes to prevention of leprosy (21%) followed by advocacy, lobbying & capacity building (20%) and then disabilities inclusive development (17%). This allocation is due to LPEP pilot projects’ budget, our approach of Outcome Mapping and then due to the actual need of the country.

Activities for 2017 are planned under each sub projects and with related Boundary partners on focusing the outcome. Capacity development, advocacy and lobbying, inclusion, equal rights, equal opportunities, barrier free environment are the major focus on disabilities inclusive development where as major support on leprosy goes to prevention expect that LPEP.

Advocacy: Lobby and advocacy is one of our major pillars of the program in 2017 due to country specific contextual factor of Nepal in 2017. Nepal is still under the position of political transformation such as new constitution is recently declared, under the process of federal system and so on. This is first time in Nepal that major disabilities issues including political rights of disabilities are included in the constitution but major effort of the stakeholders is needed to keep it there. We together with NFDN are going to held a big Human Rights submit in December 2016 to bring out Kathmandu Declaration on HR aiming to declare year 2017 as advocacy year on “realization of real rights on disabilities”.

Results and indicators

As per the outcome mapping approach; input, activities & output are within the sphere of control and the results & indicators for that are measured by performance journal, monitoring work sheet for program response and strategy journals. Boundary partners’ are within the sphere of interest and their achievements are measured through outcome journals. All these journals are already prepared in the detail project agreement document. NLR Nepal has set Results and Indicators under the heading “Performance Journal” as follows;

Result 1: Prospecting for new ideas, opportunities, and resources

Indicator 1.1: Number of projects with co-financing by other agenciesIndicator 1.2: Number of new ideas integrated into the work of the programIndicator 1.3: Number of innovative proposals developed & submittedIndicator 1.4: Number of the proposals acceptedIndicator 1.5: Database developed, updated & making proper utilization on IT

Result 2: Seeking feedback from key informants Indicator 2.1: Number of key informants from whom the program seeks feedbackIndicator 2.2: Number of changes made to the program because of feedbackIndicator 2.3: Number of social audits, sharing & feedback sessions conducted

Result 3: Obtaining the support of next highest power

Indicator 3.1: Number of reports submitted to NLR International OfficeIndicator 3.2: Number of sharing meetings on project progress with related ministriesIndicator 3.3: Number of project visits from NLR IO

Result 4: Assessing and (re) designing activities, services, systems, and procedures

Indicator 4.1: Number of reviews held among the program staffIndicator 4.2: Number of significance enhancement made of project execution

Result 5: Assisting BPs on achieving set target Indicator 5.1: Number of BP provided with additional technical assistanceIndicator 5.2: Number of BP provided with quality assurance support

Result 6: Sharing best practices with others Indicator 6.1: Number of publications of “best practices”Indicator 6.2: Number of events/activities where program “best practices” is shared

Result 7: Experimenting to remain innovative Indicator 7.1: Number of new ventures into an area without previous experienceIndicator 7.2: Number of experimental areas that proved successful and were repeated or

institutionalized

Result 8: Engaging in organizational reflection Indicator 8.1: Number of adjustments to the program coming out of a process of organizational reflectionIndicator 8.2: Numbers of staff appraisal done

Program target 20171. Continuation of LPEP as innovative approaches to promote early case detection &

prevention of leprosy and then to continue reduce disease burden due to leprosy2. Mainstreaming of leprosy to general disabilities and then disabilities to cross cutting

issues of holistic development3. Establish disabilities friendly model villages with the focus that WASH to reduce NTDs4. Explore new approaches on rights (human, socio economic & cultural) of target groups5. Support boundary partners on innovative approaches and then to strengthen them for

the proper implementation of leprosy and disabilities related activities (OM Approach)

Organizational target 2017 1. External profiling of the organization2. Institutional fund raising and finance & quality3. Enhancement of technical expertise of program staff4. Outcome mapping approach implementation5. Organizational Manual, M & E system establishment & updating

Target group

Target groups of NLR Nepal are the boundary partners and through them persons with disabilities & persons affected by leprosy are our sphere of interest. Then the target groups are; Leprosy Control Division (LCD), National Federation of the disabled Nepal (NFDN), Nepal Leprosy Fellowship (NLF), Nepal National Social Welfare Association (NNSWA), Koshi / Seti zonal hospital

Program partners (Boundary partners)

Name Role in the NLR program (describe in 1 or 2 sentences)Leprosy Control Division (LCD)

LCD, as leading GON agency for leprosy control program, makes policy decisions and also executes the project activities through GON agencies

National Federation of the disabled Nepal (NFDN)

NFDN is the umbrella network of the DPOs in Nepal having more than 300 DPOs as member organizations. NFDN through its wings and member organizations will take the leading role on disability inclusive development project. Advocacy and lobby is the one of the major pillar of NFDN.

Nepal Leprosy Fellowship (NLF)

NLF, a local NGO, is working in five leprosy endemic districts of Eastern Region. NLF will take active part for leprosy issues as well as disabilities friendly model villages

Nepal National Social Welfare Association (NNSWA)

NNSWA is the local NGO in Far Western Region of Nepal. NNSWA is also running workshop for rehabilitation services in the region. NNSWA will take major part for disabilities management as well as disabilities inclusive development. From the NGO side a small leprosy unit will be established in NNSWA.

Koshi / Seti zonal hospital

Regional Leprosy Referral centers in both Eastern & Far Western Regions are already handed over to Zonal hospitals. They will provide treatment as well as complication management of leprosy.

Sustainability

NLR Nepal support to the boundary partners is the part of their (BP’s) program. From 2016 and onward we developed the strategy or the system that boundary partners will develop their full projects plan and NLR Nepal from its strategy (that is set in “strategy map”) provides the technical or financial or both types of the support where it is needed. It is further expected that after few more years boundary partners will themseves develop their capacities to continue such program & projects. For additional funding needs we will certainly go with the concept of consortia on making the proposals.

5. Organization

Quality AssuranceQuality assurance is the major part of NLR Nepal and already is the major strategy of “Outcome Mapping”. Strategy Map, Organizational practices & monitoring priorities are stages related with this quality assurance. Organizational practices are already covered in result and indicators where as monitoring priorities is attached in annex 4; strategies through strategy maps of different BPs is already set in our project document and it is attached in annex 3.

Security and Risk Management

NLR Nepal has already finalized security policies and published the document where that will be continually updated every year. Security situation in the country is gradually improving to normal but still there are some security concern due political unrest and constitutional issues. Hopefully there will be some elections at the local level that may hamper to execute program activities at different level.

We already have the risks analysis system along with risk management plan for every program execution year. Risks and then management plan for 2017 is attached in annex 1 of this document.

Institutional and Local Fundraising

Fundraising within Nepal is not a priority of NLR Nepal for the reasons the country is not economically developed enough with very weak corporate sector and also an INGO is not allowed to raise funds within Nepal. Advocacy, lobby and capacity enhancing of local partners is still possible to raise the funds for them that sometimes covers activities by NLR but that do not comes to the bank account of NLR, for example some of the projects of NLR Boundary Partner’s is funding by local resources & other donors. This can be seen as a form of cost saving.

It is proposed to invest into development of strong fundraising (resources and time) by the NLR Nepal team and/or external consultants will be able to return the investment. In order to be able to shift within a relatively short period of 2-3 years from an office fully dependent on HO funding to an office that is at least partially independent, NLR Nepal has chosen to focus its arrows on Institutional Fundraising.

With present interest of international donors in Nepal and the limited resources of the Nepalese population, institutional funding seems to provide the biggest opportunity to

attract new funds. Recent disaster caused by the devastating earthquake in the country might bring more opportunities for accessing new funds for reconstruction and rehabilitation. NLR Nepal targets that at least 20% of the total country budget from other institutional donors by 2017 and at least 50% by 2019.Investment need for 2017

Activity 2017 (NPR)Fundraising officer 1,232,000Training of staff in thematic fields 200,000Promotion materials 200,000IF staff training 300,000IF Proposal development consultant/workshop 400,000Pilot project WASH/SRHR 400,000Establish resource center 500,000Seminar NLR 50 years 1,000,000Training research/study/article writing 200,000Exchange visits 200,000TOTAL 4,632,000

NLR Alliance

From our existing experiences and expertise of NLR Nepal, we can either work together contribute to other countries on the following main points;Outcome Mapping: Since the last one-year we are adopting this approach and almost all the projects (that is except LPEP & I2C) are developed under the same. We facilitated our boundary partners and they also started to design projects with this approach.Disabilities inclusive development: We have developed and modified different modalities approaches under this. “Our villages – the model villages”, the property of NLR Nepal, has got well known recognition from many agencies. I2C on the other hand could be the very good example to share.Networking alliances: NLR Nepal is a member of AIN, AIN DWG, AIN Health, NLN, etc and has gain some experiences on working in such scenarios.LPEP: LPEP Program is started in Nepal from 2015 covering three piloting districts. From our in-depth involvement in this program, we have gained quite good experiences on opportunities and challenges.

NLR Nepal is eager to learn from other countries on the following major points;Establishing local NGO: NLR India has very good experience on this and we fill that there is much to learn from their experiences. We can visit or arrange sharing meeting together on this expect.Local fund raising: even though it is very difficult in Nepal due to several reasons, but we are still thinking to learn this from other appropriate countries.Institutional Fund raising: We have started this since the last couple of years and gain some knowledge but we still need support form NLR IO.Advocacy: Strong technical interaction with IO with lesson learning from other countries

NLR Nepal is always seeking on making consortia with other countries on writing the proposals for IF and we will attempt with possible countries in 2017 too. For mutual learning from NLR alliance, we have made some budget provision under Unforeseen but due to certain constraints we budgeted it to other funds rather than core funding.

NLR2020

NLR Nepal understands the need to become independent from NLR IO and wants to create an own local NGO with its own board. However at this moment there isn’t an enabling environment for local NGO’s. Probably it will take more than 10 years before local NGO’s can function on an equal level as INGO’s. At the moment local NGO can’t participate in important networks as AIN and JAR. Therefore there is a need for the coming years to have an INGO next to the local NGO. This is also needed to continue the MOU with the national government (GON). In the future NLR Nepal hopes to hand over all the responsibilities to the local NGO. When we look at the more nearby future (2020) we see the following picture.

INGO Local NGOAccountable to NLR IO Board local NGODecision making Director NLR Nepal, approval

needed of IODirector NLR Nepal, approval needed of local board

Relationship Till 2020 relationship with the boundary partners. INGO will handover this responsibility when local NGO is established and competently functioning

Relationship with boundary partners, relationship with new donors and existing donor

Ongoing relationship with Government and major donors

Staff Not more than 1 or 2 staff, just for institutional fundraising, relationship with government and big donors participating in networks which are not open for local NGO’s

Most of all the current staff

Responsibility Implementing MOU with governmentRepresentation in networksonly open for INGOInvolvement in IF proposals

Managerial decisions and capacityEmployer of staffMonitoring projects/ programsSetting mission, vision and strategy + implementationFundraisingQuality systems

Although local NGO’s are allowed to implement by themselves, NLR Nepal wants to continue the work with boundary partners. In the coming period it is important not only to inform the boundary partners about the change into a local organization, but also to have a dialogue with them about their worries and assumptions. NLR Nepal thinks that boundary partners worries about the financial capacity of the local organization that will undermine the quality. Based on current experiences INGO have more budget available and are able to hire experts when needed. NLR Nepal therefore needs to put all its effort in fundraising and show that as a local organization it still has the same quality standards

and expertise.

For the outside world NLR Nepal wants to present itself as one organization. Only on paper two entities are needed. There are no legal obstacles to have an INGO and a local organization next to each other sharing the same building.Target 2017: NLR 2020

Result areas Action Output To be approved by

Ready by

Governance IO Define MoU / Charter for membership of network

MT, RT, SB Mar-17

CO Chair and board members selected/Ad Hoc committee Dir Mar/17

CO Statutes of Board Dir May/17CO Development ground rules for

working together, procedures and process for coaching, training and assessing new Board HoP Aug/17

Organization CO Process document with profile and process of recruitment and selection first director. IO involved in recruitment process.

Dir Sep/17

CO Appointment director Dir Dec/17Capacity development

CO Capacity development plan developed

HoP2016 - 17

COImplementation activities capacity development plan CD 2016 - 17

CO Assessment of improved capacity based on pre-set capacity development goals CD Dec/17

Note:MT= Management team, RT = Round Table, SB = Supervisory Board,CD = Country Director, HoP = Head of Programs (Gerrit), HoF = Head of Finance (Robert), Dir = Director (Jan)

Annex 1: Risks and Risks management plan for 2017#

Risk Risk AreaLikelihood

DamageLevel

Possible solution you can think of

(describe) (existing or new)

1 Decreasing funding scenario Financial 3 High 3 High CO/IO More focus for Institutional Fund raising

2 Changing beurocratic system in Nepal (New constitution with federal system) Legal 2 Medium 2 Medium CO More lobby and advocacy with related

stakeholders

3 Partners capacity development and proper follow up of OM as P M & E tool

Relationship donors/partners 1 Low 2 Medium CO Need based training & orientation for

boundary partners

4 Security situation of the country can hamper planned activities Damage/security 2 Medium 2 Medium CO Changing districts/places for

implementation of planned activities

5 Many project & activities with limited HR HRM 2 Medium 2 Medium CO Provision of HR to be inbuilt in additional projects

6 Proper improvement of financial management system of NLR Nepal Governance 2 Medium 3 High CO Staff competency and improvement in

financial management system

7 More program coverage with higher demands but low budget scenario

Operational management 2 Medium 2 Medium CO

More focus on institutional fund raising with convincing proposals. Cost sharing approaches also would be helpful

8Additional program expectations and demand by GON/NGO partners out of the set target boundaries (planning)

Financial 3 High 1 Low CO

Clear and transparent guidelines, allocation of small lump sum amount to support if there are the rationale & justifications of certain outcomes

9Boundary Partners' understanding and capacity to replicate projects on the basis of Outcome Mapping as P M & E tool

Relationship donors/partners 3 High 2 Medium CO

Strong monitoring mechanism with proper recording, analysis and follow up to BPs

10 Timely and proper reporting by partners 3 High 2 Medium CO

Amend Budget release system: providing next installment only after receiving the proper report of previous funding & support

11 Proper priorities on baseline information for IF Financial 2 Medium 2 Medium 3 All More experiences to be gained for

proposalsCO's and RO's

situation analysis and identification of appropriate issues

12 High management (administrative) cost Legal 3 High 2 Medium

3 All CO's and RO's

Proper identification and categorization of management cost and program cost, clear definition of admin and program/project cost that coincides with existing GON definitions

Annex 2: Outcome Mapping (OM)Support Project – “Leprosy Control, Disabilities Management & Inclusion

(LCDMI)”Outcome Mapping (OM) – an introduction

Outcome Mapping focuses on one particular category of results - changes in the behavior of people, groups, and organizations with whom a program works directly. These changes are called "outcomes." Through Outcome Mapping, development programs can claim contributions to the achievement of outcomes rather than claiming the achievement of development impacts. Although these outcomes, in turn, enhance the possibility of development impacts, the relationship is not necessarily one of direct cause and effect. Instead of attempting to measure the impact of the program's partners on development, Outcome Mapping concentrates on monitoring and evaluating its results in terms of the influence of the program on the roles these partners play in development.

The Structure of Outcome Mapping

TerminologyBoundary Partners: Those individuals, groups, and organizations with whom the program interacts directly to effect change and with whom the program can anticipate some opportunities for influence. Outcomes: Changes in relationships, activities, actions, or behaviors of boundary partners that can be logically linked to a program’s activities although they are not necessarily directly caused by it. These changes are aimed at contributing to specific aspects of human and ecological well-being by providing the boundary partners with new tools, techniques, and resources to contribute to the development process. Progress Markers: A set of graduated indicators of changed behaviors for a boundary partner that focus on depth or quality of change.

Outcome Mapping Defines the program's outcomes as changes in the

behavior of direct partners Focuses on how programs facilitate change rather

than how they control or cause change Recognizes the complexity of development

processes together with the contexts in which they occur

Looks at the logical links between interventions and outcomes, rather than trying to attribute results to any particular intervention

Locates a program's goals within the context of larger development challenges beyond the reach of the program to encourage and guide the innovation and risk-taking necessary

Requires the involvement of program staff and partners throughout the planning, monitoring, and evaluation stages

Integrating Program Learning, Reflection, and Improvement

Outcome Mapping provides a development program with the tools to think holistically and strategically about how it intends to achieve results. Ideally, monitoring and evaluation would be integrated at the planning stages of a program. However, this is not always the case, so Outcome Mapping has elements and tools that can be adapted and used separately. The full Outcome Mapping process includes three stages. For each stage, tools and worksheets are provided to assist programs to organize and collect information on their contributions to desired outcomes.

Annex 3: Strategy Journal

Work Dating from/to:Contributors to Monitoring Update:Strategy to be Monitored: Strategy Type:

Description of Activities (What did you do? With whom? When?):

Effectiveness (How did it influence change in the boundary partner(s)):

Outputs:

Required Program Follow-up or Changes:

Lessons:

Date of Next Monitoring Meeting:

Annex 4: Monitoring plan8. Monitoring Plan

Monitoring priority

Who will use the information?

Purpose of the information?

When is the information needed?

Who will collect the information?

How often will it be collected?

How will it be collected?

Proposed monitoring tool

Boundary partner’s achievement of outcomes

M & E Officer, program manager, program coordinator, country director

To analyze the progress made, to adopt the alternative or modified strategies if needed

During program’s review meetings or workshops

Program staff (field supervisors) and boundary partner representatives

Once in every four months

Filling of outcome journals and reflection meetings to discuss emerging issues

Outcome journal

Program’s strategy (ies)

M & E Officer, Program coordinator

To identify program’s implementation status, To ensure proper execution of outputs

Every months

All program support team members

Monthly Filling of strategy journals and reflection meetings to discuss emerging issues

Strategy journal

Program’s organizational practices

M & E Officer, program manager, program coordinator, country director

To identify organizational improvement, To keep in tract the organizational performances and practices

Every three months

All program support team members

Once in every three months

Filling of Performance journals and reflection meetings to discuss emerging issues

Performance journal