Logical framework
No.
G
P
Description
To improve rehabilitation of people with SCI
in Western Nepal
Indicator
SCI clients live to the maximum of their
potential
Means of verification
PFR client visit reports
To shorten the time between injury and
rehabilitation; reduce the incidence of pressure
sores; train hospital staff, SCI clients and their
carers in prevention and management of
complications thereby increasing the efficiency
of the SCI rehabilitation service at GPHRC
To reduce the incidence of secondary
complications in new cases of spinal cord
injury (SCI) by providing health education
and essential equipment to patients in
primary (trauma) care
Make agreements with government and nongovernment hospitals regarding GPHRC
mobile team training visits
Create a mobile rehabilitation team of GPHRC
and PFR staff to visit all/most patients admitted
with a SCI to Pokhara hospitals
Assess all new SCI patients; provide health
education to patients and carers on prevention
of secondary complications; provide essential
equipment as needed, and plan admission to
GPHRC for rehabilitation.
Provide Nepali language health materials for
all SCI patients and carers
Reduce mean time between injury &rehab
Reduce length of admission for rehabilitation
Reduce number of readmissions for complications
Increase overall numbers of clients receiving
rehab
Hospital data
Reduced number of admissions among new
SCI cases
Hospital data
Memoranda of understanding signed with hospital
directors
MoU
Regular and effective visits are organised and a
significant majority of new SCI patients are
contacted
Numbers of patients assessed and given
education on prevention of secondary
complications and amounts of essential equipment
distributed
Better management of GPHRC waiting list
Number of health education material distributed
Reports of mobile teams
and admission data of
collaborating hospitals
Mobile rehabilitation team
data
Number of trauma care staff trained and able to
accurately and effectively teach self care to SCI
patients
New SCI ward provides a better environment
for patients, staff and carers and rehabilitation
activities are more efficiently delivered
Mobile rehabilitation team
data (pre and post training
test data)
Patient, staff and carer
feedback
O
1
A
1.1
A
1.2
A
1.3
A
1.4
A
1.5
Train hospital primary (trauma) care unit staff
in basic SCI care
O
2
To provide better quality rehabilitation
services to SCI clients through building a
appropriately designed 12 bed SCI ward
block at GPHRC
A
2.1
A
O
Build and furnish a 12 bed SCI ward block
Complete construction and furnishing of a wellincluding purchase of 12 new hospital beds
designed ward block at GPHRC within time and
and mattresses appropriate for SCI patients
budget
and 12 beds for patient relatives /carers
2.2
Employ female SCI peer counsellor 3 days per
Suitable counsellor recruited to provide
week
counselling to female SCI clients
No.
Description
Indicator
3
To reduce the incidence of infections and pressure
Fewer re-admissions of SCI patients
Mobile rehabilitation team
data
Tender process and
contract documents
Recruitment process
documentation
Means of verification
GPHRC admission data
Assumptions / risks
Assumes sustained services
provide continuing high quality
services
Assumes cooperation with other
hospitals and effective training of
staff, patients & carers
Risk of busy hospitals being unable
or unwilling to give staff time to
learn new skills
Assumes education is effective
and complications are prevented
Assume most Pokhara hospitals
managing SCI patients agree to
GPH team visits
Assumes that Pokhara hospitals
agree to mobile team visits and
collaborate in project goals
Host hospitals allow time and
space for mobile teams to give
health education
SIRC health material is readily
understandable by semi-literate
patients and carers
High staff turnover may necessitate
repeated trainings
Risk of delays and cost overruns
in construction
Time and costs for construction
can be difficult to manage in Nepal
due to price fluctuations and labour
shortages
Assume suitable candidate
available
Assumptions / risks
Proportion of preventable
sores in SCI patients in the community and thereby
reduce the rate of re-admission and improve their
quality of life
A
3.1
Develop a mobile rehabilitation team to visit all SCI
patients on a quarterly basis in cooperation with
Partnership for Rehabilitation, (PFR).
3.2
Make an initial visit to the patient’s home before the SCI
patients are discharged from GPHRC to assess
accessibility for wheelchair users and make
modifications as needed
Make quarterly home visits in the first year after
discharge to check the health of the client and address
any socioeconomic problems or problems with
accessibility
Maintain a mobile phone ‘help’ line at GPHRC to
provide advice to SCI patients and their carers at home
on managing complications
3.3
3.4
3.5
Train local health post staff and local Community Based
Rehabilitation services on health needs of SCI patients
– this would be done by PFR before a client returns
from GPHRC and reinforced at subsequent home visits
for pressure sore or urinary tract
infection treatment at GPHRC (or
other hospitals) compared with rates
before project started
Mobile Rehabilitation team able to visit
a majority of SCI clients in working
areas every quarter
and PFR client home visit
reports
infections is unknown
PFR client home visit reports
The patient’s home has been modified
to be wheelchair accessible and an
accessible toilet has been made before
patient is discharged home
Client self management is optimal;
socioeconomic issues are addressed
and accessibility issues managed
PFR client home visit reports
Advice given over the phone is practical
and achievable and (simpler)
complications are managed
successfully
Local health post staff able to manage
simple health problems and local CBR
services help clients in accessibility and
social service issues
Help line records and PFR
client home visit reports
Assume accessibility for teams is
optimal; risks of disruption of
services by strikes and civil
disorder. Long travel by foot may
make quarterly visits
unmanageable
Assume accessibility for teams is
optimal; risks of disruption of
services by strikes and civil
disorder
Assume accessibility for teams is
optimal; risks of disruption of
services by strikes and civil
disorder
Assumes that mobile phone
services are accessible to the
majority of clients even in remote
areas
High rates of turnover and
absenteeism at health posts. CBR
services are not available in all
areas where our clients live
PFR client home visit reports
PFR client home visit reports