Holistic Habilitation of children with Cerebral Palsy. Project Final Evaluation Report

Background:
The project “Holistic Habilitatin for Children with Cerebral Palsy” is a continuance of previous rehabilitation work for Cerebral Palsy (CP) children, by the Norwegian Mission Alliance (NMA) and China Disabled Person’s Federation (CDPF). Norwegian Mission Alliance has been working with disabled people in China for the last 15 years. The development of service for disabled people in China is improving year by year, and the government has passed new laws lately that will benefit the disabled. However, the situation is that the services are still fragmented, expensive and not necessarily effective.

Norwegian Mission Alliance (NMA)/Buer Consult (BC), in partnership with China Disabled Persons‘ Federation (CDPF), started the project of Holistic Habilitation for Children with Cerebral Palsy (CP) in three provinces (Hebei, Sichuan and Yunnan) in China in 2009. The project aimed to create a model for a holistic habilitation system for children with CP including education, health care and community based services, which is suitable for China. 2013 was the last year of the 5-year project and a final evaluation was carried out during Oct 21-Nov 2.

Purpose/objective:
This evaluation was undertaken to examine learning from the project to help project design in the next phase and to explore the possibility of promotion of holistic habilitation for children with CP in China. The evaluation assessed the effectiveness of the project in achieving planned objectives and the relevance of the project to the local context as well international trends such as habilitation services for children with CP in other countries like Norway.

Methodology:
The evaluation team consisted of four external consultants, representatives from Buer Consult and Social Service Guidance Center (SSGC) of CDPF. The four external consultants had different roles and focus based on their background and specialty, which covers technical, community, family, project management etc. The team visited all three resource centers and eight rehabilitation stations. The entire excise was carried out in a participatory manner with a methodology that included view of background documents, collection of output and outcome data, activity observation, parent interview, staff interview, group discussion with teachers and family members, discussion with local DPF etc.

Key findings:
• The understanding of holistic habilitation for children with CP by local DPF leadership, staffs, and relevant government members was greatly improved. Major stakeholders from government, private sectors, communities and families were involved in the project to facilitate the social participation and inclusion of children and their families.
• All counties have established functioning rehabilitation stations. This ensures that services are accessible and affordable for children and their families, especially for poor families. However, more attention needs to be paid for children with severe CP.
• 363 children with CP and their families benefitted from the project in the past 5 years in 8 stations. It did not only improve the children‘s physical function, but also improved their community participation and access to other public services like education, livelihood etc.
• The families‘ understanding on CP was improved through various training, counseling and self-help group activities and their attitude was generally changed from negative/disappointed to positive/optimistic.
• All project sites have tried to integrate the project into local DPF‘s work for optimizing resources and sustainable development.
• SSGC (Social Service and Guidance Center) management team is responsible for daily management and coordination of implementation of the project, the evaluation team observed/felt their commitment and passion to the project.
• All resource centers/rehab stations have expressed that they would continue the work even if the project has ended. The project can continue to be a platform to advocate to government and DPF for holistic habilitation.

Recommendations:
• All resource centers and rehabilitation stations have different levels of development and further technical support will help them either to reach sustainable development or to improve quality of services. When planning the next phase of project, it is important to develop a human resource development plan for each resource center and station based on their needs.
• It is important to continue to provide guidance to each resource center and rehabilitation station and have a monitoring system for training results and outcomes.
• It is important to extend services to children with severe CP and their families and to continue empowering families to advocate for their children.
• To consider including potential prefectural rehab centers in the project and build their capacity so that they can become resource centers - this maybe be helpful for expansion of the model.
• To improve the network and cooperation with township hospitals and village health stations to develop system for screening, case identification, referring and family support.
• It is important to build DPFs‘ capacity on community based rehabilitation so they will able to develop strategies for empowering persons with disabilities, families and communities.
• For next long-term project plan, it is necessary to involve key stakeholders in planning process to ensure that the plan fit into reality and project objective is achievable.
• Children with disabilities are vulnerable group. Consider including child protection as one crosscutting issue. 
• BC/NMA is planning to promote the model of holistic habilitation for children with CP in the whole country when it is ready. This should be included in the planning of next phase of the project and the following could be considered:
a. Rehabilitation department of CDPF is in charge of the development of a national 5-year plan for government approval. To involve this department in the project for advocacy purpose may be beneficial.
b. Protocol/details of the model should be worked out and feasibility study should be included in the project.
c. If the aim of promoting the model in the whole country is proved too ambitious, it is worth of trying to promote it in a province once the model is confirmed, e.g. in Sichuan.