Project for the Holistic Habilitation of Children with Cerebral Palsy - Mid-term evaluation

Background:
The Holistic Habilitation for Children with Cerebral Palsy Project has its administrative centre in Beijing and covers three different provinces; that of Hebei, Si Chuan and Yunnan Province. The project was started in 2009 and is set to end in 2013. At the end of that 5 year period, the expectation is that the goal of developing a holistic habilitation model within the CDPF network will have been met. The overall purpose of the project is therefore to establish a more effective and locally based habilitation system for children with Cerebral Palsy in China. The project has two areas of focus:
- Develop a model for habilitation of CP children in China, and;
- Build a foundation for the education of professionals within habilitation by working with the hospital and educational system.

The executive organization of the project is the Social Services Guidance Center (SSGC), under the China Disabled Peoples Federation (CDPF), which is responsible for the overall management of the project and its implementation. The role of Buer Consultants is to represent NMAʼs interests and therefore carry out close follow-up and interaction with the implementing partners.

The majority of the funding comes from the Norwegian state through NORAD, which is supplemented by a share from NMA. In total the NMA matching fund is 45%. The local partners provide matching funds of at least 30%.
Purpose/objective:
The mid-term evaluation had the purpose to get an understanding of the starting up process and guidance for the last part of the project period.

Methodology:
In order to evaluate the project, three methods were used:
-Review of all received project documentation;
-Participatory Assessment Activities, and;
-Observations and Interviews during site visits.

Conclusions and Recommendations:
There is a great need for a concerted effort to meet the needs of cerebral palsy children in China. To this end, the evaluation team heartily commends the efforts of NMA, Buer Consultants and the China Disabled Peopleʼs Federation. The evaluation team truly believes that NMA through Buer Consultants are uniquely placed to bridge the gap between the NGOs and the government ministries involved in CP work in China. If they can facilitate the different parties to come together, co-ordinate and strategize, there would be a much greater chance of creating a national system for the holistic treatment of CP in China.

It is the conclusion of this evaluation, that whereas the project plan succeeded in defining the problem of cerebral palsy in China and the need for a system, it is weak on seven major issues:

I. System: No work done on identify the sequential steps needed to establish the system and the time
frame needed for each of those steps;

II. Networking: Lack of networking amongst non-government organizations (NGOs) already working with CP children in China, many of whom have more than decade of experience in therapy, training and management of CP projects;

III. Project Manager: The chosen Project Manager has neither the time, skills or temperament for the
role;

IV. Financial Systems: No clear procedures for developing detailed budgets and financial reports;
V. Qualified & Experience Staff: Real lack of experienced and qualified therapists and teachers,
especially in the rehabilitation stations;

VI. Trained Experts: Lack of experts from the needed disciplines of PT, OT, ST and Special Education, to
provide training and to work as a coordinated team to do the assessments, and;

VII. Conductive Education: Introduction without the experts to effectively implement it and without
considering whether it really is the best approach to therapy for CP children in China.

In light of these conclusions, the recommendations of this evaluation are as follows:
o Carry out a feasibility study to fully understand the resources available within China to provide the capacity building necessary for the fulfillment of the project goal and to determine the best approach to therapy (be it conductive education or otherwise);
o Network across China, with NGOs and government ministries in addition to the CDPF, namely the Civil Affairs Ministry, the Education Ministry and possibly the Foreign Affairs Ministry. The evaluation team truly believes that NMA through Buer Consultants are uniquely placed to bridge the gap between the NGOs and the government ministries involved in CP work in China;
o Facilitate the different parties within China who are involved with CP rehabilitation, to come together, co-ordinate and strategize. If the project can facilitate the different parties to come together (government and NGO), co-ordinate and strategize, there would be a much greater chance of creating a national system for the holistic treatment of CP in China;
o Strategic Planning to gain a far deeper understanding of the system which needs to be implemented and a practical, stage by stage approach to building up the capacity of the system, both in terms of training and resources and therefore develop a more realistic time frame;
o Focus most (if not all) of the resources in one province and first develop the system on a smaller scale. Once that is functioning well, expand to other provinces. From the evaluation teamʼs perspective, the best choice for this would be Si Chuan Province, since they currently have the best resources and longest established rehabilitation centres.
o Re-organize the Leading Group so that it acts more like a board of directors representing all of the stakeholders i.e. CDPF officials and NMA representatives. Seek to expand this leading group to include other relevant parties involved in CP work in China who could become stakeholders e.g. members of NGOs, Civil Affairs Ministry, Education Ministry, etc. The Leading Group would look at the overall design and direction of the project, but would not be responsible for the day to day management and other project management issues.
o Through the newly formed Leading Group, appoint a Project Manager who has the project management skills and experience necessary for the job, but who also had a high degree of integrity, passion and commitment;
o Allow the Project Manager the freedom to create a Dedicated Project Team. This team could be made up of Buer Staff, CDPF staff and others who have the skills and experience necessary to implement and manage the project.
o Training and capacity building needs to take place on all levels i.e. leadership and management training to the leaders, plus occupational therapy, physio therapy, speech therapy and special education to all of the rehabilitation workers. The CDPF leaders need to expand their vision and leadership skills. To that extent, the trips to Taiwan, Hong Kong and Norway have been an excellent start to achieving that goal. However, the project has a good opportunity to input further into the government officials lives and expose them to concepts such as servant leadership. In addition to the higher government officials, the city and county leaders would also benefit greatly from leadership and project management training. For the resource centres and rehabilitation stations, there is an obvious need for training in occupational therapy, physio therapy, speech therapy and special education.
o The project needs to have a well-defined training schedule and curriculum. Moreover, it will need to have a pool of trainers who can provide the necessary training (preferably trainers already within China and Asia) and places for the trainees to go to gain practical experience under the supervision of experienced and mature therapists.

Although there are many challenges which the project team need to urgently address, this should by no means be a reason to stop the project. After all, the project has only been running for a year and a half. However, the issues DO need to be addressed and drastic measures taken, otherwise precious time, effort and money will be wasted.

Comments from the organisation, if any:
The findings in the evaluation have been discussed and investigated. Digni and the Mission Alliance have concluded that the findings related suspicion of financial mismanagement was unfounded.