August 03, 2018

Weighing up the scales: an interview with Betteke de Gaay Fortman about the Inspire2Care model

Karuna Foundation has developed the Inspire2Care model, which helps local governments and poor communities to organise long-lasting quality healthcare and include children and adults with a disability and their families in society. After those three years they will continue the activities with their own resources to build a society in which people with disabilities are not left behind. Additionally, Karuna believes that it is essential to prevent birth defects and (childhood) disabilities as much as possible. The local committees, together with the existing health facilities, organise pre- and postnatal check-ups, safe deliveries and awareness so that communities will make an effort to reduce the number of birth defects. The committee  hires a local facilitator and trains him or her to provide different services to people with disabilities and their family members.

We spoke to the Director of Karuna Foundation Netherlands, Betteke de Gaay Fortman, about the Inspire2Care model, its principles, how it is looking to replicate the model and the short-term goals of the foundation. Here is what she had to say.

Inspire 2 Care Png V5

The Inspire2Care model has a leading principle which is “leave no one behind – each child and every pregnant woman in the community should be reached”. How is it possible for the Inspire2Care model to reach this objective when your organisation has another founding principle of the model being “cost-effective and adapted to the local needs and capacities”?

‘Leave no one behind’ means that we aim to reach 100% of the target group (children and adults with a disability and their families, children below 10 years old and pregnant women). When our local counterpart Karuna Nepal goes into the villages, they enable the local people to go to every household to find the persons with disabilities. For that, local committees are trained and coached for three years. Karuna Nepal uses M-Health technology to identify pregnant women and provide them access to the required health services during pregnancy, delivery and after delivery. This way Karuna makes sure that no one is left behind.

Besides our principle to leave no one behind, the principle of replicability (thus, cost-effectiveness and efficiency) is important, not only because it generates the most impact, but also because it is fairer. If we would implement good but expensive projects, these couldn’t be followed by other communities and this would create further inequality. Therefore, we are very keen in effective utilisation of resources. But this does not mean we compromise to reach the target group and quality of the care. Cost-effectiveness means using the resources in a very wise manner. We support to strengthen the local system and invest only in those areas where the need is high and rational.

In other words: one principle does not exclude the other; on the contrary it complements each other.

Inspire2Care also has a principle that the people must develop themselves while your model supports them to develop their potential. Part of your assessment places requirements such as communities must have a capable team and be willing to bear the costs for this model themselves. What have you learnt from communities bearing their own responsibilities? Have there been any pitfalls and lessons learnt while implementing this part of the process?

The principle that people develop themselves means that we inspire community leaders and local committees to take responsibility for the activities and resources needed for their development. People and the (political) leaders often are ready to take this responsibility, but they need coaching and more knowledge. We help them come to their full potential by training those leaders, instead of Karuna Nepal executing the programme with its own people and funds. The latter manner would only increase the already so embedded dependency, the top-down approach of development practices that has been common in the last 70 years.

Our approach in this sense has shown to be amazingly fruitful. It makes people proud and confident not only about their own capabilities and achievements, but also proud at and optimistic about their communities’ future development. Eventually, they take matters, also beyond disability, in their own hands because they have learned that they can achieve this themselves, independently from external organisations or donors. This positive effect is also seen in the money allocated from government and local community people to improve the quality of life of persons with a disability and to prevent birth defects and childhood disability. Karuna Nepal signs a business-like agreement with the villages. The first 2 years both Karuna and the local governments contribute 50% of the program costs. From the 3rd year onwards the costs are fully covered by the community. This exit strategy has proved to be successful. After 3 years of intervention, 80% of the communities continue the program with their own resources.

We have also learned it the other way around: in some villages we have experienced that the leaders were not committed, not capable to mobilise their community or not willing to allocate local resources. The programme didn’t come off the ground well and therefore, after careful considerations, we decided to stop the programme in those particular villages. If there is no commitment from the community, it would not be sustainable and would probably cause more harm than good. After this lesson learnt, we have developed a readiness protocol in order to assess the commitment and political willingness of the local leaders before the start of the programme.

Karuna Foundation is aiming to replicate the Inspire2Care model in large parts of Nepal from 2018 to 2024. Your organisation is looking to align five like-minded organisations, that each contribute € 1,5 to 2 million for the replication plan (approximately € 250K per year). What organisations are you looking to partner with and what is your criteria for selecting collaborators?

We are looking for organisations with venture-philanthropy or entrepreneurial roots who aim to create big impact. We would like organisations to join that not only want to contribute financially, but also strategically and creatively. Organisations that are keen to learn but also share their knowledge and technologies. 

The consortium supports the local NGO Karuna Nepal, who bears the responsibility for the implementation of this Inspire2Care scaling venture. Besides the financial support, the consortium has a role as a ‘think-tank’ to guide and support Karuna Nepal.

The replication plan focuses on creating long-lasting systemic change in the field of disability inclusive societies and the prevention of birth defects and maternal and infant mortality in Nepal. Inspire2Care is implemented in partnership with the government of Nepal and the aim is that it will proof to be also cost effective at larger scale, so that the Government can relatively easily Inspire2Care in the rest of the country after some years.

Three philanthropic funds, among whom Karuna Netherlands, have already expressed their intention to support this plan for the coming years, and UBS intends to match the funds by 10%.  For a diverse and effective consortium there is a need for one or two more members. Are you aiming to create big impact and become a game changer. Then you are very welcome to join the Inspire2Care consortium.

Here you can find the success story and leaflet that we published last year, giving more details about the social impact of this project and the support Karuna Foundation has provided.

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