CBR Effata 2018-2021

CBREffataisasmallDutchnon-governmentalorganizationactiveinruralsub-SaharanAfrica.CBREffataaimsathelpingpeoplewithdisability toliveindignitybycreatingawarenessandfacilitatingrehabilitationandadvocacy.

2

CBREffataBackgroundPeople living with a disability in rural sub-Saharan Africa have poorer health outcomes, lower educationalsuccesses, less economic participation and higher levels of poverty than people without disability. In sub-SaharanAfricaanestimated10-15%ofthepopulationisdisabled.

Efforts towards reducing the burden of disability remains challenging due to social and political instability,poverty, stigmatization,poorhealth care system infrastructure, scarcityof trainedmedicalpersonnel andasevereshortageofrehabilitationspecialists.

Community-basedprogramsimproveaccesstotreatmentandincreaseawarenessinresource-poorsettings.TheWorldHealthOrganizationspecificallyadvocates theuseofcommunity-based rehabilitation (CBR)servicestoequalizethesocialintegrationofpeoplelivingwithadisability.CBRisthereforethemethodologyusedtohelppeoplewithdisabilitiesinourprograms.

MissionThe mission of CBR Effata is to improvephysical,mental, and socialwellbeingofdisabledpeople in sub-SaharanAfrica.Specificallythesegoalsarepursuedby:1)providingdirectmedicalcaretotreat/curephysicaldisabilityorepilepsyifpossible,2)providingmeansoflivingwithdisabilityifcurecannotbeattained,3)creatingawarenessofdisabilityinthewholesociety,4)removingandpreventingstigmatizationofdisability,and5)achievingthesegoalsbyuseoflocalresources.Altogether, these goals are directed towards integration of disabled individuals in society, and theirrecognitionandacceptancebythecommunity.

MethodCBREffataisacommunity-basedrehabilitation(CBR)program,indicatingthatthelocalcommunityformsthe basis of all activities. Rehabilitation is implemented through the combined efforts of people withdisabilities, their families and communities. Closely involved are relevant government and non-governmenthealth,education,vocationalandsocialservices,includingtheWorldHealthOrganization.IntheworkingareaofCBREffatathisisrealizedasfollows:i)immobilizedpeoplewithdisabilitiesarevisitedandifpossibletreatedathome,ii)familyandcommunitymemberarealwaysincludedintherehabilitationprocess,iii)schools,churchesandvillagemeetingsareattendedforawarenessactivities,andiv)educationalandvocationaltrainingtakeplaceatvillagelevel,throughasystemofapprenticeship.Finally,aftersuccessfuldevelopment,programpartsaretransferredforlocaladministration.

FocuscountriesCBREffataisactiveinsub-SaharanAfrica,withfocusonNigeriaandGuinea-Bissau.InNigeriaCBREffataislocatedinIzziLocalGovernmentArea,EbonyiState,oneofthepoorestregionsofthecountry.InGuinea-BissauCBREffataislocatedintheruralOioregion.

CollaborationToenhancetheeffectivenessandsustainability,CBREffatahasestablishedcollaborationsatnationalandinternational level. In Nigeria we have formal contacts with two general hospitals in Ebonyi State, Lilianefoundation inAbujaandseveral localprimaryandsecondaryschools.Both inNigeriaandGuinea-Bissauwecollaboratewith theMinistryofHealth,EducationandSocialWelfare, local churchesand theWorldHealthOrganizationandwithUNICEF,forinstanceinthemasstreatmentprogramagainstriverblindness.

Contacts and effective collaborations have been established with the Governor of Ebonyi State (Nigeria),Enablement (NL), Stephanos Development Foundation (Canada) and Plan and Handicap International(Guinea-Bissau).

CBR Effata contributes to the development of a smartphone application to improve community-basedrehabilitationinresource-poorsettings.TheappiscalledRehApp(alphaversioninGooglePlayStore)andthe

3

main developer is our partner Enablement. CBR Effata is primary responsible for the chapter on activeepilepsyandmayalsocontributetothepilottesting.

RegistrationCBR Effata was founded in 1996. It has officially been registered with the Kamer of Koophandel, TheNetherlands, and has been registered as a charitable organization (ANBI). Its official website is www.cbr-effata.org. In Nigeria CBR Effata is registered at Federal as well as at State level as a Christian, non-denominational,non-governmentalorganization.InGuinea-BissauCBREffatawasrecently(2014)registeredasanon-governmentalorganization,calledReabilitaçãodaBaseComunitária(RBC)Effata.ItisregisteredasamedicalNGOattheMinistryofHealth,Bissauin2016.

FinancialpositionThe total annualbudgetofCBREffataspendin2017was€118,599.ThisbudgetispredominantlyspendontheprogramsthatfallunderdirectresponsibilityoftheDutchBoard,andonsustenanceoftheprojectadvisor.Aminor part (<2.5%) of the budget is spend on activities of theDutch Board. Themain responsibility andadministrationof theotherprograms iswithour similarlynamedNigerianpartnerorganizationCBREffata.The work of CBR Effata depends on financial support from official sponsors and private donations. Theprograms are mainly supported by Jars of Clay Foundation, Board of Special Needs (GereformeerdeGemeenten, The Netherlands) and Stephanos Development Foundation (Canada). We receive privatedonationsforallrunningprograms.

MonitoringandEvaluationThe projects are monitored and evaluated by means of quarterly reports, annual narrative and financialreports,monthlyteammeetings,quarterlyBoardmeetingsandstaffevaluation.Aseniorconsultant(generalpractitioner,NL) supports theprograms inNigeria on a yearly basis for fourweeks andprovidesdedicatedtraining in reporting, professional donor contacts, transparency and long-term vision and strategydevelopment.

ManagementStructure

CBREffataconsistsofseveralprogramseachwitha localBoardatnational level,aProgramAdvisor (Mr.F.vanderMaas),andanoverarchingDutchBoard.The localboardsof individualprogramsareadvisedbytheProgramAdvisor.TheDutchBoardhasbeenparticularly involved indevelopmentofnewprograms.Equallyimportant is working on a sustainable environment in the existing programs. As a guiding principle in ourorganization programs become independent from the Dutch board after successful development andevidence for independent operation of the program. The local board is in this case responsible for theprogram,butcontinuestoreceivetrainingandsupportfromtheProgramAdvisor.ThisisfurthersupportedinNigeriabya seniorphysicianconsultant (Mr.T.Dorresteijn)duringhisannual fourweeksvisits.Asa result,CBREffataconsistsofanumberofprogramsunderresponsibilityoftheDutchBoardandtheProjectAdvisor,andanumberofindependentprogramsthatareadvisedbytheProjectAdvisor.

4

NigeriaBackgroundNigeriaIzzi Local Government Area, part of Ebonyi State, has a population of approximately 250,000 inhabitants.Ebonyi isprimarilyanagriculturalproducing region. It is themostunderdeveloped territory in southeasternNigeriawith relative little development assistance from international agencies, comparedwith neighboringstates.Theaveragelifeexpectancyis45years.AParticipatoryRuralAppraisalreportconductedsomeyearsagostatesthatthepercentageofpeoplewithlessthanUS$1adayinEbonyiStateis70%.Mostpeoplewithdisabilities remain at home, untreated. HIV/Aids in Nigeria are additional problems to people living withdisabilities.PeoplewithdisabilitiesareinparticularvulnerabletocontractHIV/Aidsduetolowsocioeconomicstatusandrelateddependency.AlthoughthereisaworldwideattentionfortheinstabilityduetotheactivitiesofBokoHaram,thesouthernpartofNigeriaisatrelativepeace.TherecentoutbreakofLasavirusinthefirsthalfof2018has,apartfromperiodsofmandatoryschoolclosure,notaffectedanyoftheprograms.

CBREffataProgramsinNigeriaCommunity Based Rehabilitation (CBR) Effata started in 1996 with an Eye Care Unit, an Orthopedic andEpilepsyUnit andaVocationalTrainingUnit, located inOmorodu Iseke.CBREffataworks closely togetherwithCBMwhosendsaneyesurgeonevery fiveweeks.Anorthopedicsurgeonvisits theprojecteverythreemonthsforconsultationandoperation.In1999CBREffatawasexpandedwithaSpecialSchoolfortheDeaf(primaryeducation),locatedatOnuenyimIseke,andin2002withanAIDSMinistrylocatedatNwofeAgbaja.Currentlytheseprojectsareadministeredbylocalboards,andadvisedbytheProjectAdvisor.

In2012,CBREffatastartedaPrimarySchoolcalledBethelinNwofeAgbajatogenerateincomefortheotherprogramsandtoprovideinclusiveeducation.Toimprovetheaccessibilityofsecondaryeducationfordisabled,CBR Effata launched Berea, a Secondary School with Inclusive Education, actively supported by the localgovernment.BereastarteditsfirstsemesterinSeptember2014,withbothdisabledandnon-disabledchildrentakingpartinthecurriculum.DuetotherecentinitiationBereaisstillunderresponsibilityoftheDutchBoard.

IndependentCBREffataprogramsinNigeriaCBREffatahasanumberofindependentprojectsinEbonyiState,Nigeria:• EyeprojectinOmoroduIseke• OrthopedicprojectinOmoroduIseke• VocationaltraininginOmoroduIseke• InclusiveprimaryschoolEffata,inOnuenyimIseke• InclusiveprimaryschoolBethelinNwofeAgbaja• AidsMinistryinNwofeAgbaja• WaterprojectinNwofeAgbaja

TheeyeprojectTheeyeprojectcombinesoutreachwithmonthlyvisitsofanophthalmologistforconsultationsandsurgery.The local workers visit villages to treat people at the spot or refer them to the center of CBR Effata inOmorodu.Personswhoarenoteligibleforsurgeryareofferedamobilityandorientationtrainingtopromoteindependence.Theaveragenumberofconsultationsisaround7,000peryear.Thenumberofeyesurgeriesisbetween450and500peryear.

TheorthopedicprojectFororthopedicconsultationsandprocedures,CBREffataisvisitedfourtimesayearbyanorthopedicsurgeon.The local workers perform regular visits to six outreach centers in the Izzi area. The yearly number ofconsultations and surgical procedures are 1,400 and 100 respectively. Children with cerebral palsy receivespecific support and many people are being helped with crutches and braces. If needed, wheelchairs andartificial legsareprovidedforfree.Thetreatmentofepilepsyispartoftheorthopedicproject.Thisisduetothefrequentcontracturesand injuriesasa resultof fitsandfalls in fire.Permonthanaverageofahundredpeoplearetreatedwithmedicinesforepilepsy.

5

VocationaltrainingPeople with disabilities who finish school or are too old to attend classes are able to follow professionaltrainingintheirchosenprofession.Theseareprofessionssuchashairdressersandcarpenters.Blindstudentsare supported at the Blindschool in Iboko. Students with physical disabilities receive financial and mentalsupportinordertofollowtheregulareducation.

InclusiveprimaryschoolEffataFrom1999,CBREffatagivesprimaryeducationtochildrenwithdeafnessorhearing impairment.Thepolicychangedin2015.Insteadof"SpecialEducation","InclusiveEducation"isnowgiven,whichmeansthatchildrenwithandwithoutdisabilities receive lessons in thesameclass.The totalnumberof childrenenrolled in thisschoolisaround200ofwhichatleastonethirdisdeaf.Threeteachersarealsodeaf.

InclusiveprimaryschoolBethelThis school started in2010andhasclose to500pupilsenrolled.Aminority isphysicallydisabledand thirtyorphansfromtheAIDSprogramalsoattendclasses.

AidsMinistryTheAIDSMinistry started in2003.Today600HIV rapid testsarecarriedoutannually.Close to fiftypeoplereceivehelpwithantiretroviraldrugs.ThereisanactiveSupportGroupforHIV-positivepeople.TheSupportGroupgatherseverymonth.Aidsorphansarehelpedwitheducationandlivelihood.Intermsofawarenessandpreventionanannualyouthcampisorganizedwith250participatingteenagersofwhichhalfisdisabled.

WaterprojectManydisabilitiesinNigeriaaretheresultofpoorhygiene.Wethereforeconsideritimportanttoalsoworkonpreventivemeasures.Onewaytoimprovehygieneisbyofferingcleandrinkingwater.CleandrinkingwaterisabigprobleminIzziduringthedryseason.Duetothesuccessoftheconstructionof5000-literwatertanksinGuinea-Bissau, we have introduced this concept in Izzi. It also offers employment opportunities for youngpeoplewithdisabilitieswhohavecompletedthesecondaryschoolandwanttosettleindependently.Currentlytwentymasonsaretrainedofwhicheightaredeaf.

6

Guinea-BissauBackgroundGuinea-BissauGuinea-Bissau,locatedinWestAfrica,isoneofthepoorestcountriesintheworldandhasoneofthelowestscoresonthehumandevelopmentindex.Politicalinstabilityfurthercontributestothecontinuingpoverty.Asa result the country lacks basic health care facilities and has a relative high burden of people living withdisabilities. Although no statistics on disability are available for Guinea-Bissau, extrapolations from theneighboringcountrySenegalestimate that 10%ofpopulation suffers fromdisability. In2010we initiatedaCBRprogramintheNorthofGuinea-Bissau.InitiallythelocalcommunityinBissorão,Oioregionwasincluded.TheworkhasrecentlyextendedtothemorecentrallylocatedcityBulaandIngoré.TheCBREffataprograminGuinea-Bissau is under responsibility of theDutchBoard and advised by the project advisor. An importantaspectoftheworkinGuinea-BissauisprovidesufficientPortuguesesignlanguageteachingmaterialandBiblestoriesinPortuguesesignlanguage.Thisismainlydonewithsmallvideo'scompatiblewitholdmobilephones.

Figure.MapofNorthGuinea-Bissau.CBREffata'swork locations in2018areBula,Bissorãand Ingoré.TheprogramwasinitiatedinBissorã,butthelocationofBulaismuchmorecentral.TheofficewillthereforeberelocatedtoBula.Thetraveldistancefromthecentrally-locatedBulatothecapitalBissau(insertA)isthirtyminutes-idealforpatientreferral.Bissorã(insertB)andIngoré(insertC)arefortyminutestravellingbycar(Max.onehourbymotorcycle).ThenewlocationthatwillbeincludedintheprogramisthevillageCanchungointheWest,markedwitharedarrow.

7

Aimsandlocation2018-2021Generalaims Relevantfor

Tocontinueprovisionofcommunitybasedrehabilitationforchildrenandadultswithvisual,physical,mentalandhearingimpairments.

NigeriaandGuinea-Bissau

Tofurtherimproveeducationalopportunitiesforblind,hearingimpaired,mentalandphysicaldisabledchildren.

NigeriaandGuinea-Bissau

Toincreaseeconomicindependence(livelihood)ofpeoplewithdisabilities.

NigeriaandGuinea-Bissau

Tocreatefurtherawarenessamongthegeneralpopulationaboutprevention,treatmentandrehabilitationofpersonswithdisabilities.

NigeriaandGuinea-Bissau

ToeffectivelysupportorphansandvulnerablechildrenaffectedbyHiv/aids.

Nigeria

ToreacheconomicindependencebyownIncomeGenerationandprovideinclusiveeducation.

NigeriaandGuinea-Bissau

Toincorporatespiritualsupportintheprograms.

NigeriaandGuinea-Bissau

Guaranteesufficientqualityinallprojects. NigeriaandGuinea-Bissau Specificaims Contributetodevelopmentofcommunity-basedrehabilitationsmartphoneapplicationRehApp(withEnablement)

NigeriaandGuinea-Bissau

Toobtainpermanentresidencepermitforprojectadvisor.

Nigeria

Construct100watertanksinIzzi. NigeriaEquipschoollibraryofBereasecondaryschoolwithsufficientbooksforallsixclasses.

Nigeria

Organizeannualyouthcampsforschoolpupilstoaddresslivelihoodskills,reproductivehealthandHiv/aidsknowledge.

Nigeria

ExpandoutreachprogramtoCanchungo,WestofBula.

Guinea-Bissau

ImprovePortuguesesignlanguageteachingmaterialandacquirevideo'swithBiblestories.

Guinea-Bissau

Establishsmall,centralofficeinBula. Guinea-Bissau

8

PhotosfromtheNigeriaprogramsin2017

InclusivesecondaryschoolBerea,inNwofeAgadja.Twopicturesfromclass0.Class0isaspecialclassfornewstudentsnotfamiliarwiththeAmericanSignLanguage(ASL).ThecrashcourseASLhelpstogetthebaselinecommunicationskillstoasufficientlevelbeforethestudentsentertheregularinclusiveeducationprogram.

Eyeproject,inOmoroduIseke.Mostpeoplewitheyeproblemsarehelpedwithsurgeryandrehabilitation.Thosewithpermanentdamagemayselectanartificialeye(lef).TheprogramiscoordinatedbyJobNwibokowholivesonthecompoundwheretheeyeprogramislocated(right).

Orthopedicproject,inOmoroduIseke.ThenumberofpeopleapplicableforsurgeryintheIzzivillagesisnotdecreasing.AnimportantproceduretohelpchildrenwiththebirthdefectclubfootisthePonsetimethod(left).Amethodtocorrecttheclubfootwithoutinvasivesurgery.Rehabilitationmaterialisproducedlocallyasmuchaspossible(right).

9

Vocationaltraining,inOmoroduIseke.Vocationaltraininghelpspeoplewithdisabilitiestobecomeindependent.Manyfindajob,withsupportfromamicrocredit,inthelocalmarket.Forinstanceinproducingandrepairingclothing’s(left:deafgirl,alsoenrolledinBereaeducation)orasabarber(right:deafboy,alsoenrolledinBereaeducation).

InclusiveprimaryschoolBethel,inNwofeAgbaja.Bethelisafullyfunctionalinclusiveschoolforalldisabilitiesexcepthearingimpairments.Childrenareenrolledinnursery(left)untilclass6(right;duringmorningprayer).

InclusiveprimaryschoolEffata,inOnuenyimIseke.TheinclusiveprimaryschoolEffataisspecializedinprovidingeducationforchildrenwithhearingimpairments.Theprogramcontainsformalelements(left)aswellasmoreinformalelementssuchasgamestofullyintegratechildrenwithandwithoutdisabilities(right).

10

AidsMinistry,inNwofeAgbaja.Hiv/aidsisasensitivetopic.Properknowledgeisimportant,inparticularforvulnerableyoungpeople.LifeskillstrainingandreproductivehealthareintegratedintheregularbiologyprograminsecondaryinclusiveeducationprogramBerea(left).ManyaidsorphansareincludedintheprimaryEffataprogram,anonymously(right;pictureistakenfromrandomsetofpupils).

Waterproject,inNwofeAgbaja.TheIzzipeopleareveryenthusiasticabouttheconstructionofwatertanks(left)toprovidedrinkingwaterinthedryseason(right).TheconceptistakenfromGuinea-BissauandintroducedinNigeriain2017-2018.Constructionteamswillbeinclusive.