World Education & World Food Programme Project

The Disability Inclusion Initiative:

The core issue that this initiative aimed to address was that children with neurodevelopmental disabilities often go unrecognized until school age or later, missing crucial early-intervention windows. The project aimed to adapt validated screening tools (CDC & Rashtriya Bal Swasthya Karyakram) for local language, train local government health staff, volunteers and school teachers for comprehensive, community-based screening. Children identified with neuro-development disabilities (NDD) were referred for specialized assessment or support, government Disability ID cards, and prioritized for parent and teacher support.

1. Adapted tools were fieldtested on 2,951 children aged 2 to 10 years.

2. Communication materials (posters, flipcharts, fliers) emphasized early warning signs, developmental milestones, referral pathways and parent support.

3. 30 health workers and 34 FCHVs received a 2 day training on tool administration, data recording, and referral pathways to build local capacity.

4. Children identified with potential disabilities were referred to the nearest medical college’s pediatric neurodevelopment section for assessment and parents and lead teachers were oriented to support.

Collaboration between national experts, local government, health workers, school communities, volunteers and NGOs showed it is possible to identify children with neurodevelopmental disabilities even in remote underserved locations. Specifically, it:

1. Accelerated early identification by using localized, culturally relevant screening instruments.

2. Increased community awareness through SBCC materials tailored to Bajura’s linguistic and cultural context.

3. Built local capacity by training FCHVs, teachers, and local health workers to conduct screening and make referrals.

4. Educated caregivers and local government representatives on neurodevelopmental disabilities to foster supportive home and school environments.

5. Established clear referral pathways so identified children can access diagnostic and intervention services.

1. Early Identification: A total of 2951 children were pre-screened, with 826 (28%) flagged for further assessment for possible neurodevelopmental disabilities or disabilities. This is a marked increase compared to 223 persons with disabilities (children and adults) identified through routine, non-systematic disability reporting in the previous year.

2. Capacity Building: 30 health workers, 34 FCHVs and 56 teachers now confidently administer screening tools and record standardized data.

3. Community Awareness: SBCC campaign posters and local radio segments reached all 2951 households having children age 2 to 10 years, sparking caregiver-led inquiries at health posts.

4. Neuro-development Disability Screening Completed: 162 children were screened by a team of national experts and local health workers - 149 at screening camps and 13 children (missed during the camp) screened virtually afterwards.

5. Stakeholder Engagement: For the first time, local government officials pledged to integrate screening for neurodevelopmental disabilities into routine immunization camps, ensuring ongoing outreach.

6. Local Ownership: Post camp, the Municipality has requested FCHVs and health workers to provide lessons on developmental disabilities as part of school health activities, extending reach to children missed during the camps.

1. Screening Coverage: Number of children 2–10 years screened (2951).

2. Identification Rate: Percentage of pre-screened children flagged for follow-up (28%).

3. Training Outcomes: Pre-/post-training assessments showed a 50% average improvement in tool-administration knowledge among health workers and teachers indicating increased capacity.

4. Referral Uptake: Out of 95 Children identified with disabilities (2 to 10 years), 32% of cases were referred to different specialized centers in Nepalgunj, Dhangadi and Kathmandu.

5. Data Disaggregation: All data were disaggregated by sex, age bracket (2 –2.5 years, 2.5–3 years, 3–4 years, 4–6 years, 6–8 years and 8–10 years), and wards (1 to 10), enabling targeted follow-up in underperforming wards.

6. Caregiver Feedback: Post camp surveys showed 88% of caregivers felt more knowledgeable about NDDs, and 80 % reported reduced anxiety about their child’s future.

7. Community Attitudes: Interviews with local leaders noted “reduced stigma” and greater willingness to discuss developmental concerns publicly

Local adaptation of screening tools and communication materials was critical for community buy-in. Investing in health worker and teacher training created a sustainable cadre for ongoing screening. Strong partnerships with local government, hospitals and a medical college ensured referral pathways. Future scalability hinges on embedding screening into existing vaccination, maternal and child health campaigns. For scale-up, it is recommended to:

1. Integrate screening for neurodevelopmental disabilities into all child health and disability screenings linked to meal programs.

2. Integrate recognition of developmental disabilities and disability into training of health workers, teachers, and communication materials

3. In Nepal replicate and expand comprehensive disability screening to all School Meal Program areas in collaboration with local governments.

1. Develop a "training-of-trainers" module so trained teachers and health workers can cascade knowledge.

2. Scaling to other Municipality which is feasible via periodic "train-and-screen" cycles linked to district hubs

3. Digitize screening records for real-time monitoring.

4. Secure budget lines at the municipality level to support yearly follow-up camps.

5. Embed screening into routine FCHVs and school health schedules ensures continuity beyond camps. 6. Provide a qualified physiotherapist at the Kolti district hospital