Danish Disability Fund

APPLICATION

To be filled in by DPOD
Disability Fund ref. no.
Date received

B: partnersHIP INTERVENTION(max. DKK 500,000)

or small-scale project (max. DKK 1 mill)

1.Cover page

Grant modality
(Insert X) / Partnership intervention: X / Small-scale project:
Danish applicant organisation (financially responsible): / SIND Landsforeningen for psykisk sundhed
Contactperson for the project: / Name:Else Lillebæk Nielsen
Email:
Phone: 21 79 77 00
Other Danish partner(s):
(if relevant) / 0
South Partner(s): / National Organization of Users and Survivors of Psychiatry in Rwanda
Project title: / Organizational Capacity Building og NOUSPR
Country(ies): / Rwanda / Country’s GDP per capita: 1279
Project period: / Commencement date:
1.02.2017 / Completion date:
31.01.2018 / Total number of months: 12
Total amount applied for: / 199.895 Dkr.
Is this a new activity? / [x ] Yes, a new activity
[ ] An activity in extension of a previous project, namely:
Is this a re-submission? / (i.e. a revised version of a previously submitted application).
[x ] No
[ ] Yes, date/year of previous application:
Do you want a response letter in / [ ] Danish or
[x ] English
Insertsynthesisof the project in Danish :This Partnership intervention project is the first in a long term cooperation between NOUSPR in Rwanda and SIND Mental Health. The projects objective is an organizational capacity building of NOUSPR to strengthening the structure and capacity of board and staff to be able to develop strategies e.g. for fundraising to attract more partners to become a sustainable organization in the future.
Date / Person responsible (signature)
Place / Person responsible (block letters)

2. Narrative application

  1. WHAT IS THE CONTEXT AND THE PROBLEM?

1.a. The overall context

Rwanda is located inEast Africa. The country is land-locked and covers 26.336 km2. It is bordered to the north by Uganda, to the east by Tanzania, to the west by the Democratic Republic of Congo and to the south by Burundi. Rwanda is mountainous and is often referred to as ‘the land of a thousand hills’. Although located only two degrees south of equator, Rwanda's high elevation makes the climate temperate.

Rwanda has a predominately young population with amongst the highest density in Africa. The population is comprised of just one ethnic and linguistic group, Banyarwanda. Christianity is the largest religion although there is a growing interest in Evangelical religion. Kinyarwanda is the predominate language with French and English being used as official languages.Rwanda joined the East African Community in 2007.

The Genocide 1994

After the genocide of the Tutsi population in 1994 mainly two things shaped the current form of the disability movement in Rwanda. Conflict and the genocide had resulted in much greater prevalence of disability: soldiers with disabilities from the battlefield, civilians with disabilities through the conflict as well as the effects of landmines and children impaired because conditions for good health had lapsed in some areas during the 4 years of intermittent conflict. People with disabilities were all more numerous and their needs were listed and recognized by the government as the country emerged from conflict and instigated rebuilding and rehabilitation programs.

Economy

Rwanda's economy suffered heavily during the genocide. Widespread loss of life, failure to maintain the infrastructure, looting and neglect of important cash crops caused a large drop in gross domestic product (GDP) and destroyed the country's ability to attract private and external investment. The economy has since strengthened with per capita GDP estimated at $1785 in 2015 compared with $416 in 1994.This growth, however, is predominately (if not entirely) found in urban areas and the vast majority of NOUSPR’starget group live in poor rural areas.

Mental Health Facilities

In Rwanda, only two psychiatric centers exist - one in Ndera and one in Huye - and few district hospitals have been equipped with basic amenities to take care of mentally ill people.

In the national referral hospital, Ndera Hospital, only 120 beds are available, which in reality accommodate 150 patients. An increasing number of patients seek psychiatric services. Records for Ndera show that 20.124 patients were admitted or attended the hospital in 2006 whilst 36.392 patients visited where the biggest percentage were admitted it in 2010. The environment is therefore crowded and far from ideal for people withpsychosocial disabilities. It is expected that the number of people attendingNdera will increase because of a greater awareness of mental health issues. A local approach for providing support is therefore likely to become more important. This is emphasized in the Draft Mental Health Act currently under discussion.

Also, lack of qualified staff re.mental illness is prevalent. Rwanda counts only six psychiatrists and four among them are still following their specializations. So Ndera Hospital relies on only two psychiatrists and one neurologist, who also serve two of the hospitals units (CaraesButare in Huye and the neuron-therapeutic center Icyizere in Kigali). Whenever a person with mental illness is introduced to Ndera Psychiatric Hospital he/she must pay 10000 RWF before he/she is admitted. Most NOUSPR members find this prohibitive and those that have been abandoned by their families find it impossible.

The “Patient Experts:

In 2012 TheMinistry of Health called for more local intervention on mental health. The National Organization for Users and Survivors of Psychiatry in Rwanda (NOUSPR) responded to this and with the help of Voluntary Service Overseas (VSO) Rwanda, The Patient Expert Program(PE Program) was developed.The Patient Expertsarenow one of the core activities in NOUSPR.It consists of self-help groups, led by a person (Patient Expert) who has experienced psychosocial problems. The ideology is that people with psychosocial challenges can support each other through dialogue and conviviality. The group members meet on a regular basis, discuss and support each other in understanding and handling their mental health problems as well as support each other in lively-hood strategies. During time patients, their families and health professionals have started to have confidence and trust in the PEs and they are now often consulted on various occasions.In addition, there has been considerable success in developing working relationships with local leaders.

1.b Specific challenges faced by those groups of persons with disabilities, or their organisations, for whom the project aims to bring about change

Psychosocial disabilities in Rwanda

It is estimated that app. 28% of the 13 million Rwandan population have experienced mental health challenges, much of it attributed to trauma and poverty caused by the genocide in 1994. Mental health problems in Rwanda includeseveral conditions which can be recurring, and extremely disabling. The term ‘psychosocial disabilities’ reflects the challenges that people face as they are often shunned from their communities, exposed to discrimination and abuse as well as challenges in finding work and other responsible duties. Most often mentally ill persons lack the most basic needs. Such discrimination has made them void of normal life as the care of the entire community is missing and to many, mental illness means the end of life.

Patients who are discharged from the hospital will often find that their property has been confiscated by relatives which triggers more disagreements and relapses. Stigma and discrimination have a negative effect on self-perception of even those who have recovered, which consequently impacts their ability to exploit their full potential in contributing to society and providing for their families and themselves.

Limited knowledge and information about mental illness and psychosocial disability, its causes, complications and challenges effect how family members and the community treat peoplewith psychosocial disability. This lack of knowledge has encouraged speculation and superstition about mental illness in Rwanda and has put people with psychosocial disability in a quagmire of discrimination and subjected them to forced treatment or quite often witchcraft/traditional healing systems. Chaining and shackling individuals who have mental health problems are perceived to be violent acts against humanity, but still such behavior dominates the treatment.

Organizational development

NOUSPR is the only organization in Rwanda advocating for people with psychosocial disabilities. The organization has existed since 2007, and has to some extend achieved psychosocial servicescoverage for activities, because that is what there has been an opportunity to raise funds for. Accordingly, the fundamental resources for investment in organizational structure and stability have been absent. After several years working with a VSO volunteer administrative adviser it seems there has been insufficient development of NOUSPR’s organization. There has been a lack of funding to cover the organization’s core costs as well as limited efforts to develop a sustainable organization. There is no strategy for fundraising and for incorporating core costs in the funding for activities from various development partners. Finally, there is no strategy or plans to ensure that the staff as well as the board is capable of meeting and handling NOUSPR’s challenges and mission. All in all, this has negatively influenced the financial stability and NOUSPR’s self-sustainability.

  1. WHICH EXPERIENCES AND RESULTS DOES THE PROJECT BUILD UPON?

2.a Knowledge about or previous experience of cooperation with the South partner

Is the partnership between the Danish applicant and the South partner organisation known to the Danish Disability Fund, i.e. described in (an)other application(s) in previous years?

Yes / X / 129 - 115
No

Does the project’s theme lies within the partners’ normal field of work?

Yes / X
No

SIND Mental Health (SMH) has no previous experience of cooperation with NOUSPR. A team from SMH paid a first visit to NOUSPR in November 2015.The objectives of the visit were to clarify whether NOUSPR meets the information SMH had about the organization and to clarify whether the organization potentially could be a new partner.

Pre-study

A pre-study was conducted with NOUSPR in November 2016 (6th to the 15th). The main objectives were to clarify what the main area for our efforts in partnership collaboration between NOUSPR and SMH should be, that is to identify what are the strengths and the weaknessesof the organization?

  • Initially aprospective analysis to clarify mutual values of the two partners and out-line a long-term partnership program running for the first 7 years of cooperation was formulated.
  • To clarify the organizational capacity of NOUSPR an Octagon analysisand an Administration Capacity Assessment (ASA) were performed.
  • The Logical Framework Approach (LFA) anda problem analysis with the use of The Problem Tree Model was performed to identify the main problems/challenges and their causes.

Based on the above mentioned analyses a clarification of initial projects content and objectives of the partnership was discussed and agreed upon.

Finally, a meeting with some Patients Experts and staff was held in one of the group’s location.The subject was to clarify the PEs situation and activitiesas self-help group leaders and peer to peer supporters.

2.b. Learning of relevance to the application

Already at the first visit in 2015 at NOUSPR, SMH learned that safe guarding the human rights of people with psychosocial disabilities has been central to all NOUSPR’s activities. As members of NOUSPR people with psychosocial disabilities are gradually becoming involved in self-sustenance and improvement of livelihood activities.

SMH learned that NOUSPR has threecore activities in their program and this was verified under the pre-study November 2016:

Peer support is built aroundcurrently 42volunteer Patient Experts, who are leaders of the self-help groups. These groups are the basic membership of NOUSPR, and are supported by the national office.

The economic empowerment is based on shared group activities. Members of the groups support each other in developing and performing lively-hood strategies. Conversation and storytelling among the group members are important therapeutic activities for the members.

Advocacyfor theHuman Rights for people with psychosocial disabilities in order to raise awareness and advocating for inclusion and economic empowerment of people with psychosocial disabilities.In this wayNOUSPR would provide a platform for unified and empowered voice of people with psychosocial disabilities,to be able to achieve the provision of necessary services and to have their interests and human rights fully promoted and protected.

Specific leanings through the pre-study November 2016 were:

Under the process for conduction of a Partnership Agreement (Annex no D),it was found that NOUSPRs and SIND Mental Health’s vision, mission and core values were very much alike, and SMH thus found the foundation for a cooperation in place. Expectations, roles and responsibilities towards each other in the partnership was clarified. The contributions from both partners in the partnership were discussed, and regarding added values the “recovery oriented medical educational method”was found very interesting. An important learning was that making a long-term strategy for the partnership was not one of NOUSPRs main competencies, and in that sense performing systematic strategic plans was in general and in the Octagon as well found to be one of the weaknesses in NOUSPRs organization.

The most important objective of the pre-study was to conduct an Octagon analysis to uncover the strengths and weaknessesof the organization. This was followed by an ACA (Annex G and H). The results from thesetwo analyses showed a need to strengthen the organizational structure of NOUSPR both regarding financial issue and administration in general. Importantly, there is a membership based organizationand a democratic elected board to build upon and not leasteducated and motivated staff in the national office ready to perform their capacities. However, they need training in the mentioned areas -financial, reporting and strategic planning issue - and it is therefore the intention of SMH to support these areas through the first year specificallyand thereafter on identified needs for more support.

Finally, it is important to mention that the Octagon analysis also showed that NOUSPR hasstrength to build upon. The PE program has the force that the PEsare working as volunteers, doing their unpaidjobs out of motivation and compassion for people with psychosocial disabilities. They are paid respect in the communities, including the health providers and the districts health system. The PEs are the direct connection between NOUSPR as an organization and its members. However, registration of members is one of NOUSPRs weaknesses and therefore an issue SMH will considerbeginning in the inception year and fort going.

2.cPreparatory process

Most of the preparation for this application has taken place during the pre-study. The first step was taken with the decision of a partnership, confirmed by the Partnership Agreement. The Octagon and the ACA revealed the challenges which this partnership will meet before significant results can be seen in the districts.Still, SMH finds it of great value to invest in this partnership as NOUSPR is the only organization in Rwanda advocating for people with psychosocial disabilities, and NOUSPR can in SMH expect a partner who will support the organization on a long-term basis.

The type and the approximate size of the application was decided and the first steps for constructing an LFA matrix were taken after the objectives weredecided upon based onthe Octagon and the ACA analysis. Following an introduction of NOUSPR and SMH as well asconstruction of problem/objectives together, outcomes and outputs were drafted.

From the above mentioned learning it was decided, that the first year of cooperation should be based on organizational capacity building,instead of activities in the districts, to construct a platform for NOUSPRs organizational development heading for a sustainable NGO funded through more partners. A professionalized staff in the financial system and a strong communication to potential partners will help create confidence and interest in funding NOUSPRs activities and related core costs.

  1. WHAT CHANGE WILL THE PROJECT ACHIEVE AND HOW?

3.a Change which the project aims to bring about

Through the inception year NOUSPR will work on getting to a level of capacity to be able to deal with the administrative duties on a level of international standards for collaboration with partners.

The organizational structure and leadership is working as board members meet on quarterly basis and through trainings they are fully aware of their duties as responsible leaders of NOUSPR. The board are through trainings in communication representing their members in the communities where they are elected. They are able to take actively part in advocacy for improvement of their member’s treatment and welfare. NOUSPR has prepared their input on the Rwanda Mental Health Bill and have started networking and advocacy on all levels.

The staff in NOUSPRs national office works with their administrative tasks to meetthe requirements of NOUSPRs coming partners. Through trainings and update of the staffs’ educational standards they are on the way to comply with the level for NGOs in financial reporting, narrative reporting and data collection. NOUSPR has a registering system working for registering its members to know the exact number of members and their characteristics.