ANNUAL PROJECT REPORT Development Cooperation

Location of the project: ANNUAL PROJECT REPORT 5 (rural) municipalities in Salyan, Development Cooperation 5 (rural) municipalities in Kailali, 5 (rural) municipalities in Bardiya 4 (rural) municipalities in Banke 5 (rural) municipalities in Rasuwa 8 (rural) municipalities Gorkha Reporting year: 2018

Name of the project: School Mental Health Programme (SMHP) Short description of the project current situation1:

This was the first year of the fifth phase (2018 to 2021) program, which was implemented in 32 (rural) municipalities of 6 project districts listed above. This project has covered 70 schools and 22 health facilities (including 11 health facilities of Banke and Bardiya district). This program was implemented based on the Memorandum of Understanding (MoU) signed with Centre for Education and Human Resource Development (Immediate Department of Education) at central level and in approval of the concerned (rural) municipalities. SMHP is financially supported by the Felm, Finland.

This project was implemented to bring the impact in quality learning of the school going children and adolescents through the promotion of psychosocial well-being. This project was designed following the research-based approach and baseline research study was conducted in the beginning of this phase. The major variants of baseline study were the drop-out rate, school attendance rate, learning achievement rate and psychosocial wellbeing of the school going children. After the intervention during this year, the school attendance rate is increased by 6% (baseline 67%) and learning achievement is increased by 15% (baseline 51%). Findings of baseline study showed 17.2% emotional and behavioural problems (EBP) in school going children and adolescents. The changes in EBP and psychosocial well-being because of program intervention will be assessed at the end of academic year (i.e. May 2019) during midline study.

140 focal teachers (one male and one female teacher from each school) from 70 schools received 3 modules training in school counselling. Twenty-eight schools (40% schools) managed a separate student counselling room. 499 students received individual counselling services by trained teachers in this reporting period. Among them 45% students have shown better progress in emotional and behavioural problems (EBPs according to the measurement of the progress matrix and teacher rating form used in each sessions of school counselling. Nine percentage of children with the EBPs were referred for further support to the health facilities for mental health service and 46% students are still in follow-up with psychosocial focal teachers at schools for counselling services. 1095 teachers received basic orientation on psychosocial promotional activities. Promotional boards and positive disciplinary tools are practiced in 258 classrooms of 70 schools by 258 teachers. 4702 school children benefited from classroom based promotional activities. 40% school developed child protection policy (baseline-nil). 6887 adolescents’ students attended adolescent health awareness interaction sessions as a result child marriage is reduced in a range of 64 to 91% in each project schools2. 6823 parents involved in parenting education sessions as a result 27% showed supportive behaviour to their children. Parents participation in attending parenting sessions at schools is increased by 53%.

Forty-one health workers including 8 medical officers received the mental health training and the performance of health workers, including trained is improved by 80% as per the assessment from psychiatrist during mental health clinical supervision. Seven staff nurses received short term psychosocial counselling training and the performance of trained staff nurse, including newly trained is improved by 50% as evidenced by the report of psychosocial supervision. Six staff nurse/social worker received one module of six months psychosocial counselling training. Five self-help group (SHG) formed in this reporting period and 72 SHG members attended training on rights based mental health approach. In this year 1397 (1064 adult and 333 children) received mental health service from trained health worker. Two hundred fifty people having psychosocial problems received psychosocial

1Briefly describe (max 700 characters) 1) the main results achieved during the reporting year 2) any other significant events or processes which took place 3) numbers of rights-holders and duty-bearers / beneficiaries.

2Compared with baseline information and calculated the school-wise percentage of the trend of reduced child marriage

1 counselling service by trained health workers. Four health institutions developed as a referral centre for mental health and psychosocial service for the school children, teachers, parents and other community people.

Similarly, 43% schools received financial support from (rural) municipalities for the promotion of child friendly school environment, which is equivalent to 20% of total cost of promotional materials. CMC- Nepal involved the (rural) municipalities elected representatives and government officials in the project inception meeting, project monitoring, review meeting and MPAC meeting which contributed to understand the importance of the project i.e psychosocial wellbeing of the children by the (rural) municipalities. The regular interaction and lobbying helped to motivate local level to provide financial support for classroom based psychosocial promotional activities. Two health worker/social workers received first module of 6-months psychosocial counselling training and 8 health worker received mental health training through the support of program implementing (rural) municipalities. The third module of school counselling (career counselling) developed and tested in the 20 schools of Gorkha and Rasuwa. Twenty-seven resource persons received training and developed as a local level trainer. They replicated psychosocial promotional activities in 12 non-project schools. CMC-Nepal organized coordination meeting in two provinces (Sudhur Pachhim and Karnali) and involved them in project monitoring, together with the representatives of local level. Two social audits and eight MPAC meetings were organized in this reporting year. The coordination meeting with the elected representatives of all (rural) municipalities of Salyan, Kailali and Rasuwa was also organised, which brought visible impact in replication in Salyan district.

Reporting organisation: Centre Telephone & Fax: Web: www. cmcnepal. org.np for Mental Health and 977-1-4102037 Counselling-Nepal (CMC-Nepal) 977-1-4102038 Address: Thapathali, Kathmandu E-mail: Contact person: Post Box No: 5295 [email protected] Ram Lal Shrestha Executive Director

Budget for the reporting period Amount spent during the Expenditure %: 97 (NPR): reporting period (NPR): 25,700,697.00 24,977,044.49

Section A. Context

1. Project Organisation(s)3 1.1 Briefly describe significant changes which have taken place – if any - within the project organisation(s)/church during the reporting period (e.g. revision of strategies, any organisational development processes, change of key staff etc.).

There is no as such changes in the programme strategy and its key activities during this reporting year. However, there was change is sub-activity of Activity 3.1.2 Review Meeting with Head Teachers and Other stakeholders. 4 head-teachers were included in the head-teacher review meeting in Gorkha with the aim of cross learning and exposure. Likewise, the coordination meeting with all the (rural) municipalities elected representatives were also organised in Rasuwa, Salyan and Kailali under the same activity head (Activity 3.1.2). Activity and budget revision was proposed to Felm, with including these additional sub-activities and approval was obtained.

There were discussions at organisation level of CMC-Nepal about to sensitize to the elected representatives and government officials of the local level in mental health and psychosocial issues and sell the CMC-Nepal’s expertise to them in order to extend mental health and psychosocial service at community level. Even in the project (rural) municipalities, partnership modality was discussed in order to make responsible to the local level in implementation of the project activities, with sharing of the cost in the project. The partnership agreement will be done with the project (rural) municipalities effective from the next year.

There was no change of key staff as well as field staff in this reporting period, who was responsible for this project.

However, there was structural changes in government education system which impacted in organizing national level workshop and regular advocacy and lobbying for mainstreaming teachers’ trainings in school education system.

The plan of developing master trainer at central level and joint monitoring visit from the central level did not complete due to the

1.2 What effects did these changes have on project implementation? The head-teachers review meeting brought change on effective implementation of psychosocial promotional activities and school counselling. In 40% schools, school administration reduced the teaching hours of the psychosocial focal teachers and increased their time for student counselling. This was the visible change after the review meeting with the head-teachers that they felt the importance of student counselling and agreed to increase the time of the psychosocial focal teachers for the students counselling. The coordination meeting among the (rural) municipality contributed in upscaling of school mental health component in all 23 schools of Siddhakumakh rural municipality. In such coordination meeting among the elected representatives and district level agencies, CMC-Nepal highlighted the effects of mental health problems in work performance and leading individuals and families into poverty, homelessness, inappropriate punishment and imprisonment. CMC-Nepal also linked this issue as a human right agenda and appealed them to upscale the mental health service from the available budget of the local level. Two (rural) municipalities of Salyan realized the need of mental health service in their own health facilities and agreed to send their health workers in their own cost in the mental health training, organised by CMC-Nepal.

2. Project context 2.1 Describe any significant changes/processes which have taken place a) in the national/local development context, b) in the project context and c) the operational environment of civil society. Consider for example the social, political (including policies), economic, legal and cultural environment.

The new constitution of Nepal has introduced a three-tier structure of federal government (federal, province, and local) with constitutional power to enact laws, prepare budgets, and mobilize their own resources. There is one federal government, seven provincial governments and 753 local governments in Nepal after the election of 2017. The management responsibility of education and health component is shifted to the local

3Applicant organisation and any other organisation/institution playing a significant role in the project

3 government. There is a District Coordination Committee having specified coordination roles among the (rural) municipalities. There is also presence of Education Development and Coordination Unit and Health Office only in the coordination role.

There was also change in the organizational structure within the Department of Education. The earlier section of Educational Counselling and Disaster Management Section is now merged into the Disaster Risk Reduction Section. The Government of Nepal included psychosocial component in Safe School Policy and Minimum Standard of DiDRR. The Government of Nepal has issued Disability Friendly Inclusive Education Policy and Public Health Act in this reporting year.

Ministry of Health and Population (MoHP) has established a separate section in mental health, called ‘Non- Communicable Disease and Mental Health Section’. There is one psychiatrist, primarily responsible to prepare plan, develop strategy, implement activities and coordinate with the organizations working in mental health and psychosocial field.

2.2 What changes in the project context have occurred in the vulnerabilities of the different beneficiaries who face discrimination? Consider especially in relation to gender and persons with disabilities (two of Felm’s cross-cutting themes).

There were some visible changes occurred in under the Felm’s cross cutting theme of gender equality. In each selected secondary school, CMC-Nepal organized adolescent health awareness interaction based on the existing reference materials of the Government of Nepal in adolescent’s health education. CMC-Nepal developed four groups of adolescent boys and girls in each school and interacted on the following topics i.e. what is marriage? what is the right age of the marriage? health and mental health issues in early marriage, sex and sexual relationship, pregnancy and abortion and alcohol and drug addiction. These interactions helped the adolescent’s girls and boysto understand the negative consequences of early marriage and as a result child marriage rate reduced significantly. Sanitary pad for the girl’s students was managed by the schools themselves in 12 schools after the effects of organizing adolescent’s health awareness interaction at schools. A separate female psychosocial focal teacher is developed inn all 70 program schools to listen and respond the girl’s feelings, emotions and difficulties’ in a confidential manner.

This project itself has mental health and psychosocial component and worked to build the access of mental health and psychosocial service. The referral service is inbuilt in the health facilities of the concerned (rural) municipalities for the treatment of psychosocial and mental health problems. It also worked to prevent mental and psychosocial disability through implementing various primitive activities i.e. parenting education, life skills, child friendly classroom management, positive disciplinary approach etc. Students counselling unit in all project schools is developed to address the emotional and behavioural problems. The children having physical and other forms of disability were considered with special attention in providing psychosocial support by the trained health workers and CMC-Nepal’s mental health social worker trained psychosocial counselling. CMC-Nepal further facilitated in process of accessing the disability card for the people with psychosocial disabilities.

2.3 Have the characteristics/dynamics of the core problem(s) that the project is targeting changed in any way?4 Do the changes require any adjustments to project plan?

CMC-Nepal included adolescents girls health awareness component in this project phase to reduce the drop out and early marriage as identified by the adjustment to change in the project in last year. There is significant change observed to reduce the child marriage. The adolescent’s health awareness component seemed effective to bring the change and observed that it needs to be continued in the project period. CMC-Nepal is not felt the specific adjustments to the project plan in this year.

2.4 Describe the project context in relation to environment and climate change during the reporting period. How did environmental phenomena and/or climate change influence project implementation during the reporting year?

4 For example, if the project was designed to address challenges related to hiv and aids, has the dynamics of the epidemic changed? Or if the project was designed to address challenges related to human trafficking, has the phenomenon and its different characteristics changed?

There was no such effect of climate change and environmental issues in the project locations in this reporting year. There was risk of the flood in the project locations of the Banke, Bardiya and Kailali districts but the flood didn’t bring significant effects in the project implementation in this reporting year.

2.5 Describe the project context in relation to conflict sensitivity during the reporting year. Assess what power dynamics there were in the relationships between different actors (consider both local and international). Were there any tensions or conflicts between the various actors?

In our project CMC-Nepal didn’t observe any conflict in this reporting year. We organized social audit, MPAC and review meeting at local level, which helped to prevent conflict related power dynamics between different actors regarding our project activities.

2.6 How did the tension / conflict affect the project context?

There was no such observation that the tension/conflict affected the project context.

2.7 How did the tension / conflict affect the implementation of the project? There was no visibly tension and conflict in the right-holders and duty bearers at the project location and no significant effect in the project implementation.

Section B. Implementation

3. Overview of implementation

3.1 Briefly explain how you implemented the project during the reporting year.

For a more detailed description on specific activities and outputs, fill in the annexed Felm Results Reporting Tool. In the last column of the tool, describe progress, what was achieved and comment on indicator values. In the same column, also identify which of the planned activities for the first half of the year were not implemented.

CMC-Nepal obtained program approval from the concerned (rural) municipalities of all project districts. The mental health and psychosocial components of Banke and Bardiya districts were continued during this reporting period. The program in Banke and Bardiya districts was handed over to the local level after organizing exit meeting with the concerned (rural) municipalities. The exit plan was shared with the health facilities and local level in the beginning of third quarter in the review meeting and made them responsible to continue the mental health and psychosocial service. In new project locations, CMC-Nepal organized orientation program to the elected bodies and concerned officials regarding the school mental health program. CMC-Nepal developed criteria of school selection for the program implementation and selected 25 schools in each district (Salyan and Kailali) from the shared criteria and consultation with the education coordinator of the concerned municipalities. After selection of the schools, we organized orientation to the head teachers of newly selected schools about the program, its components and modality, role of teachers and schools and so on. In the same orientation program, the head-teachers selected two teachers from each school and the selected teachers were developed as a psychosocial focal teacher.

With the technical assistance of Felm’s mental health advisor and technical director of CMC-Nepal, base line data collection tool developed and collected the base line data in the first quarter of the 2018. Qualitative baseline information was collected following the Focus Group Discussion (FGD) questionnaire with the parents, teachers, students, and School Management Committee (SMC)/Parent Teacher Association (PTA). Base line information regarding the practice on child friendly classroom management and positive disciplinary approaches classroom were observed following observation checklist. Key Informants Interview (KII) was also conducted with head teachers and class teachers for their knowledge on children's emotional, behavioural and learning problems and also their attitude to participate in the school mental health activities. The data of dropout rate, learning achievement, student attendance and school truancy rate were collected from the school’s records and FLASH report. Teacher Rating Form (TRF) was used to assess the psychosocial problems and its' severity in the students (refer the detail report of the Baseline Study, see in annex). The score in different domain of TRF reflects the problem situation and also will guide on psychosocial intervention process to both student and parent.

We conducted first, second and third module training to the selected focal teachers of Salyan and Kailali districts in psychosocial activities and school counselling. After the implementation of first module training, we conducted school-based orientation to all teacher staff on classroom based promotional activities and student counselling. CMC-Nepal strengthened capacity of psychosocial focal teachers and class teachers of promotional board used classes through the supervision and backstopping support. Supervision were focused to bring effectiveness on the implementation of classroom based promotional activities, child club interaction, adolescents’ health awareness interaction, parenting education and conducting meeting with SMC/PTA.CMC Nepal provided promotional boards to 258 classrooms out of 470 classrooms of 70 schools. We also supported stationary and reading materials in all 70 schools for the empowerment of child club and Student Counselling. Tin Trunk Box were also supported in all seventy schools for student counselling room and case documentation.

Under the health component, CMC-Nepal continued mental health clinical supervision and psychosocial supervision and provided basic training in mental health and psychosocial counselling for new health workers, refresher training for the trained health workers. The Mental Health Social Workers (MHSW) involved in creating awareness in mental health and psychosocial issues, sensitizing the people with the mental health problems about to form SHG and facilitate to form the group and their empowerment in rights based mental health. In Banke and Bardiya, CMC-Nepal organized exit meeting among the duty bearers (municipalities and health service providers) and rights holders and handed the program to the concerned duty bearers.

As part of replicating school mental health program approaches in other schools, CMC-Nepal provided training to the resource teachers in Salyan and Kailali and engaged them to replicate the psychosocial promotional activities in 12 schools. We conducted review meeting with head teachers in all project districts and additionally, conducted joint head teacher review meeting in Gorkha involving four head-teachers from Rasuwa. Similarly, CMC-Nepal conducted social audit in Godawari Municipality in Kailali and Chattreshwori Rural Municipality in Salyan. Municipality Project Advisory Committee (MPAC) meeting were conducted in three in Gorkha, three in Salyan, one in Banke and one in Kailali during the reporting period.

CMC-Nepal organized joint monitoring visit in Kailali and Salyan, where provincial level health and education authorities and elected representative and government officials of the concerned (rural) municipality also participated. In Rasuwa, Chief District Officer (CDO), head of education development and coordination unit, head of the health office (district) were also involved in the joint monitoring. The team from Social Welfare Council involved in mid-term evaluation of SMHP in Kailali.

At central level, CMC-Nepal organized one experience sharing workshop with Ministry of Education (MoE), DoE, attended education cluster meeting, participated in development of minimum standard of Disability Inclusive Disaster Risk Reduction (DiDRR)at schools. Similarly, CMC-Nepal developed school counselling reference materials jointly with DoE educational and disaster management section.

CMC-Nepal also focused to build the capacity of field-based project staff and involved them in data management training through the use of SPSS software, parenting education flip chart development and its use at school, teacher’s diary revision and student counselling and documentation. Distance coaching was carried out in each month to support to the field staff through telephone and skype meeting. Monthly, quarterly, semi-annual and annual review meeting continued in this reporting period.

3.2 What % of all of the activities identified in the annual work plan were fully implemented?5 97% of the project activitiesidentifiedin the annual work plan implemented in this reporting year.

3.3. Were there any deviations from the original project plan / annual work plan? Which activities were changed or not implemented? Give reasons.

There was not significant deviation in activity implementation from the original project plan. Originally, review meeting with the head teachers was planned within the district but we realized the need of field/exposure- based meeting for the cross learning. The changes in the activity plan and budget was revised in August 2018 and conducted this event after getting approval from Felm.

The plan of developing master trainer at central level and joint monitoring visit from the central level did not complete due to the structural changes in administration structure in the MoE and DoE. Instead, monitoring was organized from the provincial and local level through organizing meeting and conducting field visits.

3.4 What challenges did you experience in implementing the project during the reporting year? How did you overcome or resolve them?

At program implementation level, CMC-Nepal observed there was still not enough understanding among the head-teachers of the selected schools (30% schools) on the importance of school mental health program and as a result psychosocial focal teacher didn’t receive enough support especially in time and space management of student counselling. To overcome this challenges, CMC-Nepal is planned training to head teachers on the importance of student counselling in 2019.

Nine percent (13 teachers out of 140) of the focal teachers lost their teaching job due to the temporary in nature and there is again need to train another focal teacher.

Seventy percentage of the concerned (rural) municipalities supplied psychotropic medicine, which only covers 40% of total demand. There is still shortage of supply of the medicine in the health facility. CMC-Nepal, together with SHG and Disabled People Organization (DPO) is advocating with the (rural) municipalities to increase their support in the management of the psychotropic medicine.

5 Calculate based on annual work plan and the activities identified in it. Which activities were realized, which were not?

4, Direct and Indirect Beneficiaries 4.1 Direct Beneficiaries – Rights holders

The main right-holders of the project are school children and adolescents, with especial focus on children with emotional and behavioural problems who received psychosocial service at schools and also from health facilities. The teachers, parents and other community people with mental health and psychosocial problems is also considered as main right-holders who are also received mental and psychosocial service from the health facilities.

TOTAL for reporting period

Direct rights- A.20292 holders

Women Men Girls Boys (yrs 18+) (yrs 18+) (yrs 0-17) (yrs 0-17) B.4903 C.3516 D.6254 E.5619

… which include … F. Persons with F1. F2. F3 F4. disabilities (physical 115 88 11 15 and other forms of the disability) G. Ethnic minorities, G1. G2. G3. G4. indigenous peoples, 2895 2109 4510 4108 persons discriminated based on caste

4.2 How did these rights-holders participate in the project implementation during the reporting period? Describe participation by each group of rights-holders.

The children with emotional and behavioural problems have been participated in accessing student counselling service at schools. The children and adolescents received equal attention and opportunities of equal participation in the classrooms through the practice of child friendly classroom management and positive disciplinary approaches at schools. 8143 students received information on child protection through child clubs and adolescent’s health awareness interactions at schools. 6823 parents participated in parental psycho- education events in each quarter of the year and involved in promotion of psychosocial wellbeing the children.

Around 500 people with mental health problems and their families involved directly in creating awareness to reduce stigma associated with mental illness and lobbying at local level to prioritize mental health issues in planning and budgeting of local level.

Direct Beneficiaries – Duty-bearers and other influential actors 4.3 With duty-bearerFelm refers to political decision-makers, officials and other authorities that bear the responsibility of fulfilling and protecting the realization of rights. With other influential actors Felm refers to key actors of civil society, such as cultural or religious leaders, community and opinion leaders, leaders of civil society organizations, who influence and promote the realization of human rights. NOTE: HERE YOU SHOULD NOT REPORT ANY BENEFICIARIES YOU REPORTED IN 4.1 ABOVE.

Teachers and health workers are main duty-bearers of this program, who are providing psychosocial support and mental health service from the school and health facility. The local political leaders, municipalities and civil society organisations are also considered as potential duty-bearers. The central level authorities of MoE and DoE at education and Ministry of Health (MoH) and DoHS (Department of Health Service) are also considered as a key duty-bearers.

TOTAL for reporting period Direct duty-bearers A.2852 and other influential actors

Women A. Men (yrs 18+) (yrs 18+) B. C. 1155 1697

… which include … D. Political D1. D2. decision-makers, 676 1159 officials and authorities F. Leaders or key F1. F2. actors of civil 479 538 society; influential actors from civil society, including from your organization etc..

4.4 How did these duty-bearers and other influential actors participate in the project implementation during the reporting period? Describe participation by each group of duty-bearer and other influential actors. Two teachers from each program schools received three modules training on school counselling and they are practicing classroom based psyhosocialpromotional activities and student counseling at school level. They further involved in facilitation of child club promotional activities and interaction on adolescents health awareness activities at schools. One hundred sixty eight teachers are practicing child friendly classroom managementand positive disciplinary techniques after received orientation and frequent backstopping on it.

SMC/PTA are the influential actors and they participated in interaction of school mental health program conducted four times in year 2018.They supported to the school administation in the smooth implementation of school based mental health program through giving positive encouragement and raising voices at local level to allocate the funds for the promotional activities.Concerned (rural) municipalities elected memebers and government officials participated in orientation and later involved in project monitoring and MPAC meeting. More than 50% (rural) municipalities agreed to include school mental helath components in the coming year

9 planning and budget. Morever, the Chattreshwori rural municipality and Bhajani muncipality allocated and also used one million budget (NPR) for the supuport of promotional activities at schools. Seventy percentage (rural) municipalities supplied psychotropic medicince for the people with mental health problems, which covered 40% of total demand, which is in increased trend in compare to last year (increased by 15%).

Indirect Beneficiaries The indirect beneficiaries are the teachers, students and parents benefitted from the non-project schools from the involvement of resource teachers trained by CMC-Nepal. The community people, who received mental health and psychosocial service from the non-project areas or not directly counted as right-holders even in the project locations, are also considered as indirect beneficiaries.

4.5 Report the total number of beneficiaries who have benefited from project activities indirectly during the reporting period (Cell A). These may include both rights-holders (such as community members) and duty-bearers (for example the wider institution or from adjacent regions). No need for further break down or categorization.

TOTAL for reporting period Indirect beneficiaries A. 5109

4.6 Describe briefly who the indirect beneficiaries were. Community people from non-project location received information of CMC-Nepal’s program and came to the health facilities for mental health and psychosocial counselling service. The number of people received information on the occasion of the world mental health day celebration is also considered as indirect beneficiaries. Similarly, schools’ teachers and students of two non-project schools of Salyan and Kailali benefited from the classroom based psychosocial activities

5. Results

Impact Level

5.1 What signs of impact are evident so far?6 What progress has the project made so far towards its impact statement(s)? How are they visible in the lives of the beneficiaries? What has changed?

The expected impact of this project is “school going children and adolescents have improved quality learning”. Reduced drop-out rate by 1.5%and increased learning achievement rate by 10% from the baseline in program schools considered as indicators to measure the impact’s level changes at right holders. Learning achievement of the students is increased by 15% (baseline 51%, now 66%) as per the basis of the school internal exam reports collected from the schools. Dropout rate of the students is not available during this reporting time as schools only calculate this rate once in year and this is only possible at the end of the academic year of Nepalese school system (within May) once we complete mid line evaluation. However, we can assume the dropout rate is reduced in compare to the baseline through the use of the practice of the classroom based psychosocial activities.

4702 students benefited from the practice of promotional boards and positive disciplinary tools in 258 classrooms of 70 schools (37% of total targets). The activities/approaches i.e. child friendly classroom management, positive disciplinary approaches, school counselling, parenting education, adolescents’ girl’s health awareness implemented in the schools contributed to bring the impact level changes mainly on

6Please note that impact reporting is mandatory already during the implementation of the project, not only at the end of the project phase.

10 academic performance, school attendance and child marriage. 19% schools announced punishment free child friendly school and practiced accordingly in this reporting year. 45% students who received school counselling service from the psychosocial focal teachers, reported improved psychosocial wellbeing. 12% schools included student counselling and psychosocial promotional activities in their School Improvement Plan (SIP) and practiced accordingly. 40% school developed child protection policy (baseline-nil). Similarly, child marriage is reduced in a range of 64 to 91% in each school after the regular interaction with adolescents’ girls and boys in adolescents’ health awareness and child marriage issues.

5.2 What contribution has the project made on the realization of human rights? Analyse changes from the point of view of women and girls, persons with disabilities, indigenous peoples and ethnic minorities, and other vulnerable and discriminated groups. Report on the rights relevant to your project. Note that this is mandatory for all projects. Human Right What changed in the rights- What changed in the duty-bearers holders ability to claim their rights, and other influential actors’ capacity be active citizens and/or in the to fulfil and/or advocate for the realization of their rights? rights? Right to freedom Leadership skills on child club The school management and teachers from discrimination members is strengthened. Child club agreed to practice group participatory members are active in learning, cycling sitting arrangement implementation of child protection and adolescent’s health awareness policy and practice of group which provided equal opportunity and participatory learning environment at attention to all boys and girls. Schools schools. developed and practiced child protection policy. Right to food Not applicable Not applicable Right to health The self-referral for the student The capacity of the psychosocial focal counselling increased. Service teachers and health workers increased seeking behaviour among the people and they involved to fulfil the health with psychosocial disability and rights of the students and other family members increased. SHG community people. realised their right to health service and advocated at local level for the continuity of mental health and psychosocial service. Right to housing and Not applicable Not applicable shelter Right to safe and Not applicable Not applicable sustainable environment Right to social Not applicable Not applicable services Right to education Involved in educating parent and Teachers practiced child friendly communities about child marriage classroom management, positive and its negative consequences. They disciplinary approach, adolescent took initiation to continue the health awareness and career education through reducing child counselling marriage. Right to own Not applicable Not Applicable property Children’s rights The members of child club members Schools announced punishment free participated in the SMC, created schools. Child protection policy was awareness at community level about developed and practiced. The culture child marriage and shared their of listening students feeling was emotions and feeling to the teachers. established. Parent listen their The children have an increased children’s feeling and support awareness on non-punitive and non- accordingly. discriminative environment and

claims such environment in SMC meeting. Women’s rights Adolescent girls realized the needs of schools managed separate toilet for sanitary pad during mensuration the girls and boys. Sanitary paid is period and they started to use it. Girls managed for girls in the time of their students shared their feelings with mensuration. Girls students’ feelings teachers and participate in in are also listened by teachers at adolescent health awareness schools. The teachers further interaction at schools. Female managed rest room for girl’s student in parents have an increased realization the time of their mensuration. Mental on the role of parent in psychosocial health and psychosocial service is promotion and their participation in made available for both male and parenting education increased. There female. The right of participation and is also an increased participation of ventilating their emotions and women in the SHG and they raised difficulties has been ensured through their voice with the (rural) the different forums SHGs, interaction municipalities and other concerned meetings. Women SHG members authorities to support to the people themselves are in the leadership with mental health problems. positions and activity involving to fulfil the rights of the people with mental health problems. Rights of the Indigenous and ethnic minorities The teachers and health service indigenous peoples people are in the SHGs and SMC providers provided mental health and and ethnic minorities and advocated with the duty bearers psychosocial services to all classes of for the rights of mental health care the people without discrimination and psychosocial support Rights of the SHG approached to the service The teachers provided individual persons with providers and (rural) municipalities counselling, emergency support and disabilities for the continuation of mental health linked with parental counselling to the and psychosocial service. children having physical and intellectual disabilities. The duty bearers provided disability card to the people with psychosocial disability. Right to work and The people with mental health There is no such evidence in this year livelihood problems raised their rights of that the duty bearers provided support engaging in work and livelihood and for the livelihood of the people with requested to the SHG and duty mental health problems. bearers (rural) municipalities for the support. Right to freedom of Self-Help Group is formed and there The duty bearers (health facilities and association and is regular participation of the SHG local level) accepted the existence of participation members in the meeting and other SHG. One SHG is listed at local level. events. Right to nationality Not applicable Not applicable Freedom from Not applicable Not applicable inhuman or degrading treatment Freedom from The students are aware on the need The school reduced punishment and violence and of safe and dignified learning applied positive disciplinary tools at physical punishment environment and contributed in schools. practice of chid friendly classroom management and positive disciplinary approach Freedom from Not applicable Not applicable slavery and human trafficking Right to freedom of Not applicable Not applicable religion and thought Other, specify:

5.3 What unanticipated changes (positive and/or negative) has the project produced so far? The collaboration with Educational Counselling and Disaster Management Unit of immediate Department of Education (DoE) for development of reference materials in school counselling from the government funding was not anticipated in this reporting year. This collaboration has brought positive result in the areas of material development in school counselling.

5.4 What impact has the project had at wider society beyond the project communities? What contribution has the project had on policies or practices at regional/province/national level? (e.g. strengthened institutions, changes in legislation, policy change, new rules or standards for service delivery mechanisms, wider inclusion of vulnerable groups, adoption of new tools, strengthened civil society etc.)?

CMC-Nepal advocated with policy level education authorities about to include psychosocial component in school education related plan and policy document. CMC-Nepal further contributed to include psychosocial support component in Safe School Policy and Minimum Package of Comprehensive School Safety Plan, Through the constant effort and lobby of CMC-Nepal with the (rural) municipalities representatives and government officials. Bhajani Municipality in Kailali, Chatreshwori Rural Municipality in Salyan and Kalika Rural Municipality in Rasuwa included school mental health and mental health component in their annual plan and budget. CMC-Nepal’s effort has become instrumental to upscale the school based psychosocial activities in non-project schools of other (rural) municipalities in the initiation of resource persons. Thirteen non project schools practiced the classroom based psychosocial activities in this reporting period. The advocacy meeting with all the (rural) municipalities mayor (or chairperson) helped to sensitize them on the need of mental health service in their (rural) municipalities (non-project location) and they made involved their health workers in mental health training in their own cost. Mental health service is started in two more health facilities of additional two rural municipalities.

5.5 What impact has the project had on the natural environment? Describe the intended and unintended impacts.

Not applicable

5.6 What actions were taken to mitigate any negative environmental or climate change impacts during the reporting year?

The interactions were conducted with the members of the child clubs to mitigate negative environmental impacts during the reporting year. Few schools managed the kitchen garden in the school compound. In CMC-Nepal’s office, paper is less used for printing and maintained digital filing system. Waste paper is sent to the agency for recycling purpose. Not applicable

5.7Analyze and describethe main results achieved during the reporting year for each project outcome.Describe what the most significant changes are that the project brought to the lives of the rights-holders and duty- bearers during the reporting year (describe both). Take care to use change language, i.e. describe the prevailing situation after the change and back it up with evidence (see Felm Project Manual for change language). Do not list project activities. Try to summarize the main points in max 500 words per outcome. Refer to the more detailed Felm results reporting tool annexed.

Outcome 1 School going children and adolescents in program schools have improved psychosocial wellbeing

Outcome 1, mainly focus to bring the improvement in psychosocial wellbeing of the school going children and adolescents. School attendance rate in program schools and percentage of school going children that report improved psychosocial wellbeing were considered as main indicators to qualify the outcome. To achieve this outcome, three outputs i.e. teacher’s capacity to practice child friendly classroom management and parenting education, stakeholders support in promotion of psychosocial wellbeing of children and child protection policy and practice were developed.

School attendance of the students is improved by 6 % (baseline 67%). In 13 % schools, students’ attendance is 100% and in 40% schools there is 80% students’ attendance (source: school records).4702 students benefited from the psychosocial promotional activities conducted at schools. School truancy is reduced by 3% baseline

13 was 7% and the present situation is 4%7.Forty-one percentage schools showed satisfactory level, 37% schools’ average level and 22% schools showed below average performance in regard to the use of classroom based promotional activities.

258 teachers (32% of total target) gained knowledge and skills and practiced psychosocial promotional activities in 258 classrooms (37% of total target). The leadership skills among the students increased, creativity increased and there is culture of developing wall calendar with the best creation of the students. There is also practice of complain box in every classes and school as well. There were also positive changes in the hygiene habit of the students and they became more interactive with the teachers and even with new visitors8.

Parent have an increased realization on their role in quality learning and promotion of good behaviour in their children. Parental participation increased by 53% in parenting session at schools and 27% parents reported they listen their children, support their children in stationary management and morning meal & Tiffin management9. Bhajani Municipality in Kailali and Chatreshwori in Salyan included school mental health and mental health component in their planning and budgeting and further contributed 20% of total budget for the promotional activities at schools. Seventy percentage (rural) municipalities purchased psychotropic medicine, which covers 40% of total demand. CMC-Nepal provided 30% of total demand and patient themselves bought 30%. Bhajani Municipality and Chattreshwori Rural Municipality agreed for the partnership agreement in cost sharing basis from the next financial year as per Nepali calendar i.e. mid July 2019 onwards

Child protection code was developed and practiced in 40% schools. After the practice of adolescents’ health awareness activities, 17% schools’ managed sanitary pad for adolescents’ girls and child marriage reduced in a range of 64% to 91% in each school. Child clubs conducts co-curricular activities at schools and further engaged to create awareness on child marriage at community. In some schools, the child clubs started vegetable garden.

Outcome 2: school children, teachers, parent and other community people have access to psychosocial counselling and mental health services

Outcome 2, mainly focus to develop the access of psychosocial counselling and mental health services to the school going children, teachers, parent and other community people. The number of the children and adolescents receive individual psychosocial counseling at school, % of children in counseling that have improved psychosocial wellbeing and number of students and community people members that receive mental health and psychosocial service at health facility were considered as main indicators to qualify this outcome. To achieve this outcome, three outputs i.e. functioning level of school based psychosocial counselling units, development of referral service of mental health and psychosocial support in health facilities and protection of the rights of the persons with mental health and psychosocial disabilities were developed.

499 children and adolescents having emotional and behavioural problems received school counselling service from the trained psychosocial focal teachers. 45% students who received school counselling service from the psychosocial focal teachers, reported improved psychosocial wellbeing. 5% referred for further level intervention and 50% students are still in counselling sessions. The self-awareness on the need of school counselling service among the adolescent’s girls and boys is increased and 9% students attended in counselling session through self-referral. Self-referral practice indicated in reducing stigma against psychosocial problems and increased acceptance to school counselling services at school.1397 people (1064 adult and 333 children) received mental health service and 250 people received psychosocial counselling service from the health facilities (source: student counselling record at school, HMIS report).

One male and one female teacher developed as a psychosocial focal teacher in each school. 140 teachers received three modules of school counselling training. 40% school managed separate student counselling room10.In student counselling, 20% teacher’s performance was above 60%, 40% teachers’ performance was in average and 40% teachers’ performance is below average11.

7Teachers report & school record 8Observation and teachers report 9FGD with parents 10Student counseling documentation at school 11Teachers performance evaluation checklist

Referral places for mental health and psychosocial service was developed in Lekhpokhara PHC in Chatreshwori Rural Municipality and District Hospital of Salyan, Bhajani PHC in Bhajani Municipality of Kailali, Jibjibe PHC in Kalika Rural Municipality of Rasuwa district and Mirkot HP in Palungtar Municipality of Gorkha districts. Furthermore, the existing 15health facilities of the project districts were strengthened through providing regular clinical supervision and backstopping. 41 prescribers, including 8 medical officer received mental health basic trainings and 7 non-prescribers received psychosocial counselling training in this project period. 20 trained prescribers and 25 non prescribers received additional knowledge and skills in mental health and psychosocial counselling respectively through clinical supervision conducted at health facility level. Around 80% prescribers showed better performance in treating the mental ill cases themselves confidently and 50% non-prescribers gained improved skills to provide psychosocial counselling service12. Thirty-five health workers from the catchment areas of referral health facilities received basic orientation in mental health and psychosocial support and they started to refer the people with mental health problems.

Five health/social workers received 1st module of 6-months psychosocial counselling training at end of this year and further two modules will be carried out in 2019. 45 cases were referred to health facilities from schools for mental health and psychosocial service.

Five new Self-Help Group formed in this reporting year in the project locations. 506 SHG members and DPO members attended joint meeting organized by CMC-Nepal and advocated jointly at local level to include mental health into the local planning and budgeting. After the advocacy efforts of CMC-Nepal along with the SHG and together with DPO and impacts of monitoring visits at project locations, 70% municipalities supplied psychotropic medicines, which covered 40% of total demand. Five (rural) municipalities provided direct budget for SHGs to create awareness on mental health. SHG organized world mental health day celebration in eight different project locations of Salyan, Banke, Bardiya & Kailali where 452 group members and DPOs involved directly to create mental health awareness. More than five thousand people received information during the world mental health day celebration. 580 cases were referred by SHG, FCHV and mother group members to health facilities.

Outcome 3: Government of Nepal replicates best practices of comprehensive school counseling in school education system at national, province and local level

Outcome 3, gives emphasis to replicate best practices of comprehensive school counseling in school education system at national, province and local level. Incorporation of comprehensive school counseling into teachers’ training, development of manual and reference materials jointly with the concerned section of the government and replication of comprehensive school counselling practices in non-project schools are considered as main indicators of this outcome. To achieve this outcome, two outputs i.e. development of master trainer at national, province and local level to replicate comprehensive school counselling and increased collaboration with the Government of Nepal to formulate and endorse comprehensive school counselling policy were ddeveloped.

The reference materials in school counselling was jointly developed with the immediate section called ‘Educational counselling and disaster management of the Department of Education and NCED. The teacher training section (immediate NCED) agreed to develop 5 days training in teachers professional development training package. But due to the change in administrative structure in education sector, the concerned section was merged with another section and it created difficulty to coordinate and further proceed to develop training packages for the teachers as well as other policy level meeting/interactions.

Twenty-seven resource teachers were developed as local resource person to replicate school mental health components in non-project schools. With initiation of resource teachers, classroom based psychosocial promotional activities is replicated in 12non project schools.

The third module (career counselling) of school counselling was developed and tested in Gorkha and Rasuwa in training of focal teachers. CMC-Nepal attended central level meetings and contributed to include psychosocial components in safe school policy and minimum standard of DiDRR package at schools.

12Mental health clinical and psychosocial supervision report

5.8Analyse and describethe progress made under each outcome area against the project indicators and targets during the reporting year. Are you on track to achieve the objectives and targets?

Outcome 1 School going children and adolescents in program schools have improved psychosocial wellbeing

School attendance rate in program schools and percentage of school going children that report improved psychosocial wellbeing are considered as indicators to achieve this outcome.

The baseline of school attendance was 67%, target was expected to increase by end two years intervention was 10% and in this reporting year, the school attendance of the students increased by 6 %.CMC-Nepal is in track in achieving targets of school attendance. The baseline of emotional and behavioural problems was17.2% and expected target of reducing EBPs by 60%within the project period. There is plan to collect mid- line data at the end of academic year as per Nepalese school calendar year and will be reported separately.

Outcome 2: School children, teachers, parent and other community people have access to psychosocial counselling and mental health services

The number of the children and adolescents receive individual psychosocial counseling at school, % of children in counseling that have improved psychosocial wellbeing and number of students and community people members that receive mental health and psychosocial service at health facility are considered as main indicators to achieve this outcome.

The baseline of all three indicators was zero. 499 children and adolescents having emotional and behavioural problems received school counselling service from the trained psychosocial focal teachers. It is only achieved 10% of total targets. This is the four years targets and we only completed first year of the program intervention. Due to the first year of the program intervention, nearly half of the time of this year was consumed in program approval, program inception, baseline data collection and training of psychosocial focal teachers. We are still in the track of achieving this target within this project period. 45% students who received school counselling service from the psychosocial focal teachers improved psychosocial wellbeing by 60%. 5% referred for further level intervention and 50% students are in the follow-up with the psychosocial focal teachers. The percentage of the improvement in number of cases as well percentage of improvement in psychosocial wellbeing will be increased in year 2019.1397 people (1064 adult and 333 children) received mental health service, which covers 28% of total targets and we are in the track in achieving targets (Source: HMIS report)

Outcome 3: Policy advocacy for integration of school mental health into existing education system

Incorporation of comprehensive school counseling into teachers’ training, development of manual and reference materials jointly with the concerned section of the government and replication of comprehensive school counselling practices in non-project schools are considered as main indicators of this outcome. According to the three project indicators for outcome 3, there is not significant improvement in achieving this outcome due to the structural changes at central level. However, there is consensus developed among the relevant stakeholders to design 5 days teachers professional development packages for the teachers. Twelve non-project schools replicated psychosocial promotional activities and CMC already achieved the target stipulated in the result matrix (target:10). School counselling components will be enhanced in the following year.

The detailed description of the project results and project activities is presented in the annex under theFelm results reporting tool.

Organization level

5.9 Describe how your organization’s role as an actor of civil society developed/changed during the reporting year.

CMC-Nepal played role to include psychosocial components in safe school policy and minimum packages of comprehensive school safe safety (included in the Terms of Reference of GESI focal teacher) guideline. CMC- Nepal actively involved in organizing two international conferences (International Conference in Mental Health in February 2018 and International Conference on Child and Adolescent Mental Health in November 2018) in this reporting year. CMC-Nepal presented scientific oral and poster paper presentation based on the project outcome. CMC-Nepal is invited in the development of rehabilitation guideline for the treatment of mentally ill people and drafting standard manual in child and adolescent’s mental health.

5.10 Describe how your organization’s capacity developed/changed during the reporting year because of Felm. What capacity support did you get from Felm during the reporting year?Consider capacity for example as skills and knowledge, awareness of various topics, staffing, equipment and material resources, financial resources including self-financing and other funding resources, time management, leadership and organizational structures, M&E, networking and new alliances/partnerships, ability to advocate, capacity to cope with disasters etc.

Felm-Nepal continued workshops in leader’s wellbeing, including enhancing leadership skills. CMC-Nepal received training in financial management for its finance and program staff. Felm-Nepal also provided training to its project staff in DiDRR. CMC-Nepal has planned to support to the schools to develop school-based Disaster Risk Management Plan in 2nd quarter of the 2019. The training provided in Result Based Management and constant follow-up has helped to produce report in line with RBM matrix and internal monitoring purpose.

6 Mainstreaming Felmcross-cutting issues

6.1 What action was taken to mainstream gender equality in the project and your organization during the reporting year? What changed?

CMC-Nepal developed one male and one female teacher as psychosocial focal teacher in each program school. CMC-Nepal has been implementing a Gender Based Violence (GBV) Prevention and Response Project since September 2016 in funding support of UNFPA/SDC and learning of this project has been widely shared in the half-yearly and annual meetings together with all the staff. A training session was taken for all the staff to sensitize in gender issues and mainstream gender equality in all CMC-Nepal’s project. The content of gender equality issues is included in the overall training plan of the psychosocial focal teachers and delivered accordingly. CMC-Nepal encouraged female parents to participate in parenting education. Interaction on adolescent’s health awareness and child marriage was conducted at schools. The female client and the care takers were encouraged to involve in the SHG and participated in the meetings and training.

6.2 What action was taken to mainstream inclusiveness of persons with disabilities in the project and your organization? What changed?

The board members and staff members were trained in disability inclusive disaster risk reduction (DiDRR). There is non-structural change i.e ramp in the office, disability friendly toilet and signage, stock pile and disability friendly website in the office. CMC-Nepal is in process to review and revise DRR policy with disability inclusive perspective. he joint meeting among the SHG members and DPO representative was carried out to work together to promote psychosocial disability and advocate jointly at local level. CMC-Nepal linked with the people with psychosocial disabilities (intellectual disability, schizophrenia) at local level to increase access of the disability card.

6.3 What action was taken to mainstream environmental protectionand climate change issues in the project and your organization during the reporting year? What changed?

Not significant action taken

6.4 What action was taken to mainstream conflict sensitivity in the project and your organization during the reporting year? What changed?

Not significant action taken to mainstream conflict sensitivity in the project implementation.

6.5 What action was taken to prevent any possible tension / conflict or their escalation in the project and your organization? What action was taken to support peace and stability in the project context?

Review meeting, MPAC meeting, social audit, interaction with SMC and PTA, meeting with SHG was organized regularly. These activities prevented possible tension/conflict in the project.

6.6 How did you take into account the following principles of conflict sensitivity in project implementation: participation, local ownership, impartiality, transparency, accountability of your own activities, coordination, partnership and complementarity?

The duty bearers and rights-holder were included in the program inception, school selection, review meeting, project monitoring, social audit and MPAC. The detailed activity plan, results of the activity and budget was shared during those meetings. Cost sharing basis in partnership is followed to make them accountable in the project intervention.

7. Project Management

Roles and responsibilities

7.1 How was results-based management implemented during the reporting year? Result based management was followed in development of project plan, its monitoring and reporting purpose. The baseline indicators are included in all three levels of results (impact, outcome and output level) and that has made easier to monitor the baseline indicators and targets periodically. Activity level achievement in terms of indicators and targets has been collected from the field staff in monthly, quarterly and semi-annual basis. Program coordinators compile activity level achievement and work further to measure the output, outcome and impact level achievement. There is plan of mid-line and end line evaluation which will be carried out in early (mid-line) and end of the next year 2019.

7.2 In comparison with the project organigram presented with the Project Plan, did any changes take place during the reporting period?

There is no change take place during the reporting period in comparison with the project organogram presented in the project plan.

7.3 Describe briefly what personnel’s role was in the achievement of the objectives.

Technical Director was made responsible for the technical guidance in baseline data analysis, report preparation and in providing technical support in development of manual and reference materials. Program Coordinator was responsible in overall planning, implementation, coordination, reporting, technical guidance and capacity building to the School Mental Health Supervisors through the training, field-based supervision, case supervision, distance coaching et.) and he was further responsible for development of manual and reference material and central level coordination/advocacy.

Mental Health Coordinator and Psychosocial Coordinator was responsible in execution of Activity 2.2.1, 2.2.2 and 2.2.3 and achieving outcome 2 (output 2.2 and 2.3). They were made further responsible in providing technical guidance and capacity building to the Mental Health Social Workers through the field-based supervision, case supervision, distance coaching etc.

School Mental Health Supervisor had important role mainly in achieving activity and output level achievement of outcome 1 (output 1.1, 1.2 and 1.3) outcome 2 (output 2.1) and outcome 3 (output 3.1) through implementation of school based mental health component (training and supervision for the teachers, parenting education, interaction with SMC/PTA/other stakeholders, adolescents health awareness, child club empowerment, coordination at local level).

Mental Health Social Worker had role in achieving activity and output level target achievement of outcome 2 (output 2.2 and 2.3) through the implementation of Activity 2.3.1 (Orientation of school based mental health component to FCHV, traditional healers, mother groups, people with mental health problems and their families and 2.3.2 (formation and empowerment of Self-Help Group).

7.4 Were there any project management challenges and how did you address them? See above section 3.4

7.5 From your point of view, how did Felm succeed in fulfilling its role?

The bi-lateral meeting between Felm-Nepal and CMC-Nepal is organized regularly. Felm partners day and training for staff was organized to clarify the relevant issues i.e. MPAC meetings, social audit, reporting and integration of cross cutting issues. Monitoring visit has become helpful to improve or focus intervention to achieve the results. Furthermore, Felm-Nepal organised wellbeing workshop for the directors, with aim of releasing stress and bring impact in work quality.

Cooperation and coordination with other organisations / institutions in the area

7.6 Describe how you networked and/ or coordinated with other actors (other NGOs, other funding agencies, churches, national, regional and local government, international actors, academia, thematic networks, media etc.) during the reporting period.

CMC-Nepal mainly coordinated with the government stakeholders at local, province and national level for the effective implementation of the project activities. CMC-Nepal further organized orientation for the authorities of Ministry of Social Development of two province of project location. CMC-Nepal coordinated with the experts of child and adolescents in capacity development of child mental health and with international consultant for the capacity building of psychosocial counselling skills.

7.7 What was the result of that cooperation / coordination? Enabling environment developed for implementation of the project activities. The project schools received financial support for the psychosocial promotional activities at schools. People having mental health problems received psychotropic medicine from the health facility. The quality in providing psychosocial counselling service by the program staff is increased.

8. Finance Report 8.1 How much was the total expenditure of the project during the reporting period (Felm, other donors, local contribution and self-financing)?

The total expenditure of the project was NPR 24,977,044 during the reporting period and all the expenditure were from Felm funding.

8.2 What was the share of Felm funding (state explicit %-share) of the total expenditure? Of the total closing balance for the project?

The share of Felm funding of the total expenditure is 100%. The total closing balance of the Felm funding is NPR 474,395.

8.3 What was the variance (%) of expenditure from the total approved budget? 97% of the budget has been utilised in the reporting year so there is only 3% positive variance of the expenditure from the total approved budget. The budget was increased to Euro 210,000 from Euro 200,000 on 30th August 2018.

8.4 How much were the administrative expenses/overheads of the total costs (%)? What cost items do they consist of? The administrative expenses/overheads cost is NPR 2,606,354 (10% of the total cost). There is significant decrease in the administrative expenses after the implementation of common cost guideline. The administrative expenses include the common cost of the central office i.e. salary and benefits of administrative staff, office supplies, utilities and communication expenses, local travel, rental cost, tea and refreshment expenses, audit fee and rent, utilities, supplies expenses of the two field offices l located in Salyan and Kailali.

8.5 How much were the human resource/personnel related costs of the total costs (%)? The human resources/personnel related cost is NPR 7,780,183 (31% of the total cost).

8.6 Have you received funding for the project from other donors? If yes, where from and how much?

Felmis a single funding agency to provide funding in this project. There is no other agency to provide funding for this project.

8.7 Was there a local / community contribution? What was it? What was the monetary value or estimation if possible?

There was local contribution from the local government of Bhajani Municipality of Kailali and Chattreshowri Rural Municipality of Salyan. The both municipalities provided funding directly to the schools for the promotional activities, which was around 20% of total cost of promotional activities. In addition to that 70% of the (rural) municipalities supplied psychotropic medicine directly, which covered 40% of total demand.

8.8 What was the self-financing by your organization?

There was no self-financing by the CMC-Nepal in this reporting period.

8.9 What is the reason for the positive closing balances (if any remained)? (Note that negative balances are not accepted by Felm) The reason for the positive balance were as follows. 1) Activity 1.2.1 – There was less participation of the parent in the Parenting Education in some schools especially in the schools of the Rasuwa. There is seasonal migration of Tamang communities for the work. 2) Activity 1.3.2 – Due to the mid-term exam of the schools of Kailali, we did not manage to conduct adolescent’s health awareness program in all schools so budget has been less consumed than the planned. 3) Activity 2.2.3 – There was plan to conduct at least two modules of the six months psychosocial counselling training to the nurses of the referral health facilities but due to more time needed in preparation and coordination at local level, we only managed to conduct one module of this training. So, budget has been grossly saved in this activity heading. 4) Activity 2.3.2 – There was plan to conduct mental health planning meeting with all the (rural) municipalities of Banke and Bardiya, but due to not availability of time of (rural) municipalities representatives, we cancelled this event in some of the (rural) municipalities so budget under this activity has been also saved. 5) Activity 3.1.1 – There was less participants in the training of resource persons. Some resource persons had been retired and some were transferred so budget of the refresher training of the resource person was saved.

6) Activity 3.2.1 – The printing cost of the counselling manual (3rd module) was less than the expected or planned.

8.10 Indicate which activities that were not implemented (see 3.2 above) caused the positive balance.Make clear reference to the fourth quarter financial report and annual audit report. What was agreed with Felmon how to address these activities? Refer 8.9

8.11 How did you ensure cost-efficiency in the project implementation during the reporting year? What action was taken to maximize cost-efficiency? Give examples. Local staff were mobilised to implement the project activities as per described in 7.3. The school mental health supervisor and mental health social workers capacity was enhanced regularly through field level backstopping and distance coaching. CMC-Nepal organised school-based orientation and supervision meeting at schools.

8.12 Reviewing the project activities completed during the reporting year, how could you improve cost- efficiency of the project activities and implementation? Annex an updated List of Assets for the project showing all capital investments such as furniture, computers or vehicles purchased for the project.

Annex an updated List of Staff showing the names, titles, and Felm share of funding of the total personnel costs for each person (i.e. %-share).

The updated list of Assets and staff has been annexed.

9. Risk Assessment Updated

Assessing the current situation and ahead

9.1 Update the internal and external risks of the project. What is the situation currently at the time of annual reporting looking onwards into the future? In the last column, give more details on what the risks are in specific and how the situations have changed.

Type of risk A. B. Total What are the risks? Describe. Likelihood Impact (AxB) 1-not likely 1-no Also, comment on the numbers 2-low, impact, given. 3-medium, 2-low, 4- 3-medium, considerabl 4- e considerabl 5-high e 5-high A. Project Internal Risks: Project implementation 2 2 4 Only 40% schools have separate and quality of work 13 student psychosocial counselling room. There is risk of maintaining confidentiality in student counselling. There is also risk of losing of the psychosocial focal

13Incl. sustainability of results, targeting the vulnerable, participation, equality of opportunity, relevance, skills and expertise, not increasing workload of beneficiaries, not causing dependency, coordination etc.

teachers due to likelihood of the transfer and temporary jobs. There is also risk that the trained teachers do not consult with CMC- Nepal’s school mental health supervisor for the management of difficult case which brings the children in risks of mental health problems. This risk might occur in future as well. Project management 14 2 2 4 There was only one staff employed for the program of Rasuwa and Gorkha. Due to this reason, coordination with (rural) municipalities and constant supervision at school level was difficult. We have planned to recruit one additional district- based staff and there will be one staff in each district. Organizational 1 1 1 Significant risk is not observed in administration and culture organisational administration and 15 culture. CMC has developed the system of sharing cultures and listening them and conducting meeting at the time of field visits of the supervisors and senior management. They were invited in Kathmandu for the review- planning meeting. Best performance was awarded to the two field staffs which sustained their motivation to bring better result. Financial administration 16 2 2 4 There was improvement in collecting supporting documents from the field staff than the previous years. In some cases, there was still missing adequate supporting documents i.e utilization report. Resources 17 1 1 1 Not significant risk observed in this reporting period.

Action to prevent or mitigate risks? (Must be filled for all issues that amount up to 9 or more in total risk level):

B. Project External Risks: Political situation, 2 1 2 There was no significant political risk observed in this reporting period. Status of the civil society / 1 1 2 There is no significant risk and church organizations impact observed.

14Incl. planning, monitoring, evaluating, learning, meeting deadlines etc. 15Incl. decision-making, transparency, participation, equality, learning organization, making adjustments to plans, cultural and conflict sensitivity resolving conflicts etc. 16Incl. transparency, accuracy, documentation, segregation of duties etc. 17Incl. all financial support, staffing levels, equipment and assets, time, facilities etc.

Changes in legislation, or 2 2 4 The Kathmandu district requirements of administration office asked the registration, permits etc. recommendation letter for the renewal of CMC-Nepal from all the working (rural) municipalities. It took more time however CMC- Nepal succeeded to collect the letters and renewed CMC as usual. Financial / global fiscal 2 1 2 There was no risk observed in the situation implementation of project in year 2018. We received committed fund from Felm, Finland. Physical environment and 2 1 2 There was not significant impact climate observed at project beneficiaries and project implementation due to the effects of natural calamities and climate change effect. It might create difficultly to arrange field monitoring visit in project districts in rainy season. Other related actors and 2 2 4 This project had expected 15% stakeholders contribution from the parents and local government for the psychosocial promotional activities. This year, it was received even more. Possibly, there will be not be risk in getting contribution from the local level in future. Action to prevent or mitigate risks? (Must be filled for all issues that amount up to 9 or more in total risk level):

9.2 Are there any other type of risks that are relevant to the project right now?What risks?

Due to structural changes at central level in education sector, there is risk in achievement of outcome 3. The development of master trainer at central and provincial level might not be appropriate in changed context. The mainstreaming of student counselling in school education system is also challenging to materialize.

9.3 How do you intend to prevent or mitigate the risks identified above during the implementation period? What do you expect from Felm?

We will organise regular coordination meeting at central and provincial level in integration of school counselling into the government education system. CMC-Nepal expects support from Felm to increase linkages among the Embassy of Finland, Government of Nepal and CMC-Nepal for mainstreaming schools counselling into the education system of Nepal.

9.4Did any of the risks that were previously identified for the project realize during the reporting year?

Not applicable.

9.5What was done to minimize their negative effects? Not applicable.

10. Sustainability Analyse the sustainability of project activities/achievements so far from an 1) economic/financial, 2) socio-cultural, 3) political/legal 4) environmental and 5) institutional point of view.

Areas of How is it ensured in the project? What are the main challenges? What sustainability should be done differently to overcome these challenges? What changed during the reporting year? Economic/financi The management of classroom based promotional activities, including child friendly al furniture and counselling room and management of the psychotropic medicine are the main challenges of this project. In this reporting year, CMC-Nepal provided 80% cost of total budget of classroom based promotional activities and concerned (rural) municipalities contributed 20%. In regard to the psychotropic medicine management, the concerned (rural) municipalities managed 40% budget and CMC- Nepal managed 30% budget of total demand. CMC-Nepal will increase coordination at province and local level to overcome these challenges so that contribution either from provincial or local level could be increased in the following years. Importantly, it is necessary to speed up our efforts at central, province and local government level for mainstreaming school counselling at school and mental health into the existing health care delivery system. CMC-Nepal will give priority for this important agenda in the following year. Socio-cultural There was no culture of student counselling, parenting education, adolescent health awareness, child protection policy before the implementation of SMHP but after the start of this project, the practice of student counselling, parenting education, adolescent health awareness interaction, child protection policy, child friendly classroom management and positive disciplinary management is started in program implementing schools. Child marriage is reduced significantly after the practice of adolescent health awareness interaction in the schools. The people with mental health problems are included in the SHG and attended meeting regularly-where they share their emotions, difficulties and further discuss about to approach to the local government to address mental health issues. As highlighted in the outcome section, there is satisfactory level of result that the schools and SHG performed in their own initiation. This indicates that the concerned schools can continue the practice of parenting education, adolescent health awareness, child protection policy, child friendly classroom management and positive disciplinary approach with the minimal support of CMC-Nepal in future. However, the constant advocacy with central, province level government in necessary for mainstreaming school mental health component into the education system is necessary for the continuation or sustainability of activities/practices mentioned above. Political/legal Political commitment and legal provision play key role in the sustainability of the program. The structural changes at central and new structure at province and local level created difficulty to proceed the lobby and get their commitment for the integration of school counselling into the education system. The orientation at provincial and local level and their involvement at project monitoring visit somehow provided opportunity to internalize the need of the program into the school system. However, the constant effort to include mental health perspective, with focus on school counselling in the (rural) municipalities’ plan and budget is necessary at local level and regular advocacy and lobby is required at central and provincial level to work on the school counselling policy, guideline etc. Environmental Dust bin is managed in every classroom and even in school ground in every program schools. Child clubs and teachers involved in awareness campaign about sanitation and environment in schools and communities. The child clubs can continue these practices in future as well. Institutional Parenting education, adolescent health awareness interaction and student counselling is practiced in all schools. Child protection policy is developed in 40% schools. School student psychosocial counselling unit is developed in also 40% schools. Two psychosocial focal teachers is developed to listen and address EBPs of the students. Classroom based promotional activities is practiced in three to five classrooms of each schools and teachers are trained on those practices. Resource teachers are developed as a local trainer and replicate school mental health

24 component in non-project schools. Student counselling component is included in school improvement plan (SIP).

Referral centre is developed for the mental health and psychosocial service and prescribers are involved in providing mental health service and non-prescribers in delivering psychosocial counselling services. However, the constant effort from CMC-Nepal is needed to sustain these activities, practices and service.

Section C. Monitoring and Evaluation

11. Project Monitoring

11.1 Explain how the implementation of the project was monitored during the reporting year.

Project monitoring was conducted at three different levels i.e. activity, outcome and impact level. Activity level monitoring was conducted in monthly and quarterly basis whereas outcome level monitoring was conducted in semi-annual and annual basis and impact level monitoring was conducted in annual basis. Monitoring and evaluation plan and check list was followed for the monitoring of the project implementation.

The knowledge and skill of psychosocial focal teachers and other teachers was monitored through the pre- test and post-test questionnaire, case supervision, classroom observation, interaction with students, parent and the child clubs. Teachers performance evaluation checklist was also used to evaluate the performance of the psychosocial focal teachers. The improvement in the psychosocial wellbeing was assessed through the use of Teachers Rating Form (TRF). The knowledge and skills of trained health workers was monitored through case supervision (paper case and real case) and observation of the case documentation. The effectiveness of the awareness activities implemented at schools and community level was monitored through the Focus Group Discussion with the teachers, parents, adolescent girls and boys, SMC, PTA, SHG members and other community people and no of referrals at health facilities.

Base line report was used to monitor and measure the outcome and impact level results. Outcome and impact level monitoring was conducted through the joint monitoring from the provincial and local level, interaction with the duty bearers and right holders, semi-annual review, semi-annual report and staff performance appraisal. Journalists of the national daily newspapers were also involved to monitor the outcome and cover the news in the media. Felm Nepal’s communication specialist & monitoring and evaluation officer were also involved in the project monitoring. MPAC level meeting and social audit was also organised in the project areas. Furthermore, review meeting with the head-teachers was also organised twice in a year. The school records and FLASH report was used to assess the psychosocial wellbeing (learning achievement, school attendance and school truancy).

CMC-Nepal has established the system of organizing distance coaching and debriefing meeting with the field staff in each month to support in case management skills, supervision skills to trained teachers and health workers. We collected event reports, monthly reports, quarterly reporting from the field staff and uses those reports to monitor the progress situation of targets and indicators.

11.2 What kind of data did you collect, how often was it done, and by whom? CMC-Nepal collected the baseline data at the beginning of the 2018. Base line study of psychosocial promotional activities, psychosocial issues and mental health problems of children, awareness level on teacher, parent and children were evaluated following both qualitative and quantitative measures in the selected schools for the program implementation. Qualitative information was collected from school teachers, members of School Management Committee/Parent Teachers Association (SMC/PTA), parent and students. 171 Focus Group Discussion (FGD) conducted where 1908 people participated. In Key Informant Interview (KII) 43 informants attended. Teacher Rating Form (TRF) was rated to 1545 students in both districts in 46 schools. Quantitative data were collected using TRF to measure the emotional and behavioural problems of the children at before intervention. Samples for the study selected mixed methods mainly convenient samples for FGD and KII while TRF used to all students of the selected grades. Classrooms were also observed following predefined checklist. School Mental Health Supervisors were trained and mobilized to the collect the baseline data.

Teacher Rating Form (TRF) was used to see the progress/impact of the individual student counselling in each counselling session. School flash report and school record were collected to see the changes in school attendance, learning achievement and drop out in each quarterly exam. Classroom observation checklist was used to impact of the classroom based promotional activities. Focus group discussion was carried out with teachers, parents and children in quarterly basis to know the changes in psychosocial situation of the children. The financial monitoring was also conducted in quarterly basis.

11.3 How was project monitoring documented? Project monitoring was documented through preparation of monthly, quarterly, semi-annual and annual report. Event report i.e. training and supervision to the teachers and health workers, school-based teacher’s orientation, orientation to SHG and their families, adolescent health awareness, SMC and PTA interaction, parenting education etc. was also prepared and documented. Similarly, MPAC, social audit and joint monitoring report was also prepared and documented. The minute of team meeting, semi-annual meeting and program management team meeting was also prepared. A separate monitoring report is also prepared and shared to the concerned supervisor and team members.

11.4 How did you use the data for results-based management, decision-making and learning?

Baseline report was used as a baseline information to measure the basis of changes in the outcome and impact level. Scientific article prepared and presented in the international child and adolescent mental health conference. Activities reports, monthly and quarterly report, debriefing report with project team was utilized to review the progress and plan for the next month/quarter.

The feedback and information from head teacher review meeting, semi-annual report review meeting with (rural) municipalities, MPAC and social audit was used to evaluate the effectiveness of the project activities and measure the outcome level changes at duty-bearers and right-holders. The feedback and learning from the review meeting with (rural) municipalities, MPAC meeting, social audit and project monitoring was utilized in revision of plan on strategic and operational level.

11.5 Did information sharing within the project take place as planned? What information did you share? When and how?

CMC-Nepal shared the information within the project as planned through organizing review meeting, MPAC meeting, social audit, coordination meeting with the (rural) municipalities and Ministry of Social Development of Province No 6 and 7. The detail activity and budget, program impact at right-holders and duty bearers, challenges, baseline evaluation report etc. were shared.

11.6 Did you share information with the rights-holders and duty-bearers / beneficiaries? What information? When and how?

We shared the information with the duty bearers as mentioned in section 11.5. Right-holders also participated in the social audit and review meeting organized in the (rural) municipalities where we shared program objective, activity plan and budget, results and challenges of the project.

Reviews and Evaluations 12.1 Did you arrange any reviews or evaluations of the project during the reporting period?

CMC-Nepal arranged baseline study in the beginning of the project period. Baseline report was prepared and already submitted to Felm (refer the baseline study report). There is plan of mid-line and end-line which will be carried out in the next year.

12.2 If so, which evaluation criteria were used in the evaluation (relevance, efficiency, cost- effectiveness, effectiveness, impact, sustainability, management, coordination, coverage, coherence, other?)

Not applicable

12.3 Summarise the main findings and recommendations here and describe how the recommendations will be implemented.

Not applicable

12.4 How did you share the results of the review / evaluation? When, where and with whom?

Not applicable

Section D. Lessons learned & future plans

13. Lessons learned 13.1 What are the main lessons learned during the reporting year? The main lesson learned during the reporting year are as follows.

• It is important to organize exposure for one district teachers to other district to motivate and promote healthy competition among program implementing schools for the effective implementation of the program. • Adolescent health awareness interaction at school is very important to reduce the early marriage problems among the student and reduce drop-out rate of the girl’s students. • Regular orientation and interaction with the elected representatives and government officials of the (rural) municipalities is helpful to replicate the program in non-project areas. • The involvement of key elected representatives in project monitoring and regular MPAC meeting is necessary to promote ownership of the project intervention and move ahead for the sustainability of school mental health components. • The right based social mobilization approach is important to protect, increase respect and fulfil the human rights of the people with the mental problems. The mobilization of SHG in creating awareness and refer the cases at health facilities seems effective approach to increase flow of mental patients in health facilities. The involvement of SHG members in review meeting with the (rural) municipalities and joint meeting with service providers is effective to create the pressure to allocate the budget in mental health. • It is cost effective to involve of MHSW and SMHS in providing psychosocial counselling service jointly with the trained ANMs at the local health facility.

13.2 What new innovations did you develop / discover? Development of parenting flip chart and redesign of star chart in its use as part of promotional activities is taken as new innovation in this reporting year. CMC-Nepal developed stamp star and used even in the students’ classwork and homework copy.

14. Future plans 14.1 Are any changes required to the project plan to ensure that it will meet its objectives?

The outcome and output levels remained the same, but CMC-Nepal made some changes in the activity level and allocated resources a bit differently. Still, the changes were such that they actually support the planned outcomes and outputs even better.

CMC-Nepal has learned that exposure of head-teachers with learning sharing meeting is strategic to motivate and promote healthy willingness among program implementing schools for the effective implementation of the program. That’s why, two events of exposure visit of the head-teaches and psychosocial focal teachers is planned in Salyan and Kailali (Outcome 1, Output 1.1, Activity 1.1.1). Based on the current situation on the need of the training, the training plan for the teachers and health workers was reviewed and revised accordingly. We reduced the cost in following year in this activity heading (Outcome 2, Output 2.1 and 2.2, Activity 2.1.1and Activity 2.2.1). There is significant increase required in monitoring and evaluation under the outcome 3. This project was planned in year 2017 and there was no as such more clarity in the federal structure of Nepal. Earlier there was only two coordination unit in the district (district education office and district public health office). After the practice of federal structure, the responsibility of district level government line agencies has been shifted to the (rural) municipalities. CMC-Nepal will work in 23 (rural) municipalities. It is essential to increase coordination and collaboration with the (rural) municipalities to increase ownership and for the sustainability of school based mental health program. So, we planned to increase the number of review/MPAC meeting with the (rural) municipalities. The revision of the plan and budget is already approved by the Felm.

CMC-Nepal will recruit one additional staff in the position of School Metal Health Supervisor (SMHS) and will be based in Gorkha. The existing SMHS will be placed in Rasuwa as well.

Head-teachers plays the key role in implementation of the school based mental health program and it is important to make them understand on the need of the program and necessary to train them in school mental health. There is also need to develop and print the students counselling posters. Furthermore, the parenting flip chart (part-2) is also needed to develop and print. These changes in the activity plan will contribute in achieving outcome 1 and 2. The need for activity and budget revision will be discussed and obtained approval from Felm.

If so, what are they? Do these changes have any budget implications?

These changes have budget implication. CMC-Nepal will review its budget after the submission of 2nd quarterly financial report and propose budget revision in early of 3rd quarter.

15. Feedback to FELM

Is there any feedback, comments or suggestions that you would like to share with Felm either from your organization’s perspective or as messages from the rights-holders and duty-bearers / beneficiaries?

CMC-Nepal has received appreciation from the local level government, program schools and health facilities and they have acknowledged the contribution of the Felm in the field of school mental health Program. They are requested to expansion of the project in many schools. Even, they have requested to increase support in hard-ware specially to build school counselling rooms and room set-up.

CMC-Nepal has followed result-based matrix and we suggest to Felm to organize training in result-based report writing.

Section E. Project Highlights

16. What are some of the project’s success stories from the reporting period? Please include at least one short human interest story as an annex (for a template see Annex 19 of Part V of the Project Manual), photos or quotes from someone who has benefited directly from the project. How has the project benefitted the person and what has changed in her/his life? Please ensure consent from the person(s). Human interest stories may be used for reporting, awareness-raising, advocacy or fund-raising purposes by Felm.

The project success stories (human interest story) are included in annex-4. The activities photos are kept in annex-5. Some of the quotes from those who benefited directly from the project are as follows.

One teacher (from Kailali) after receiving training from CMC-Nepal, said “In my 30 years teaching career,I took such good training that brought me the feeling of being a good teacher’’

After attended adolescent health awareness interaction at school by one adolescent’s girl (Salyan) said, “I could make understand my parent and I cancelled my early marriage plan’’

Signature: Signature:

Name: Madhu Bilash Khanal Name: Ram Lal Shrestha

Position: Programme Coordinator Position: Executive Director

Date: 28th March, 2019 Date: 28th March, 2019

ANNEXES TO BE SUBMITTED WITH THE ANNUAL PROJECT REPORT: External Audit Report and Management Letter Felm results reporting tool Felm Programme Indicator Data Sheets filled-in with the respective data List of Project Staff (Updated annually) List of Project Assets (Updated annually) Human Interest Story (max 200 words)

OTHER ANNEXES AS APPROPRIATE: Review or Evaluation Reports Field Monitoring Reports Photographs

Annex-1: External Audit Report and Management Letter

ANNEX 2: Felm results reporting tool18 Project: School Mental Health Program Impact Results hierarchy Indicators Baseline Target Indicator Describe progress (2018) (by 2021) value, and indicator reporting values period Original impact Drop-out rate in District Reduced Not Due to effects of the statement: program districts level is by 1.5% available structural changes, School going children not still the compiled data of and adolescents have available the district was not improved quality available. learning Learning 51% Increased Increased achievement rate by 10% by 15% (Source: school in program record) schools

Outcome 1 Results hierarchy Indicators Baseline Target Indicator Describe (20xx) (by 20xx) value, progress and reporting indicator period values Original outcome School attendance 67% Increased 73% School statement: rate in program by 10% attendance is School going schools from improved by 6% children and baseline (source: school adolescents in record) program schools have improved % of school going 17.2% Reduced - The psychosocial children that report EBP by 60% psychosocial wellbeing improved wellbeing will be psychosocial measured wellbeing through the use of TRF at the mid line evaluation at the end of this academic year (April) and result will be reported in May 2019. Output 1.1: # of teachers practice 60 800 258 120 teachers Teachers have the classroom based from the 24 old increased capacity to psychosocial schools (10 practice child friendly promotional activities schools of classroom Gorkha, 10 management and schools of parenting education # of classrooms using Rasuwa, 2 material regularly schools of Kailali 20 700 258 and 2 schools of classrooms Salyan) and 138 teachers from 46

18This should be based on your approved results matrix for the Felm supported project. Add new rows and modify numbering to match your original project plan and its results matrix as well as the annual work plan.

new schools have practiced classroom based psychosocial promotional activities. 32% achieved.

5 classrooms in each 24 old schools and 3 classrooms in each 46 new schools have used promotional materials regularly. 37% achieved. Activity 1.1.1 # teachers from basic 68 800 445 56% achieved in Orientation of schools receive teachers teachers total targets. teachers in orientation from 35 psychosocial basic promotional activities schools in program school # teachers from 295 500 650 (Rural) secondary schools teachers teachers municipality receive orientation from 35 recommended to secondary select all the schools secondary schools so teacher number was increased. 130% achieved. Activity 1.1.2 # of set of material 2 5 2 sets Career Develop new and revised and produced counselling revise previous manual is manual and produced in reference English version. promotional Parenting flip materials19 on school chart (part 1) is mental health produced. Activity 1.1.3. # of sets of 38 700 168 set of 29% achieved. Providing promotional boards promotional promotional boards boards for and other new 168 material to schools classrooms Output 1.2: # parents who are Almost 15000 6823 45% achieved. Parents, and other involved in school- none of parents stakeholders activities the within this increased their parents year support in promotion involve in of psychosocial parenting wellbeing of their education children 50%

19 Academic and career counselling manual (3rd module), parenting education booklet, audio-visuals materials on promotional activities at schools, revision of 1st and 2nd school counselling modules

% of parents that 27% of this year report they practice Almost 27% attended parents supportive behaviour none of (source: FGD towards their children the with parents) at home parents

% of project schools 3% Increased Increased This year target that receive material by 15% to 20% is achieved. or financial support of stakeholders Activity 1.2.1 # of parents receive 600 15000 6823 45% target is Parenting education parenting education parents achieved in one for promotion of child within this year. friendly environment year at home Activity 1.2. Meeting/interaction # of 0 4 events in 4 events in 25% targets of with school meetings/interactions each year each four year or one- management in each school, year target is committee (SMC), school, total 280 achieved. parent teacher’s total events association (PTA), 1120events local government One-year target and other 0 1680 is achieved. stakeholders on # of stakeholders 1017 SMC, need of psychosocial participating in PTA support activities at meetings members schools participated Output 1.3: % of project schools None of 80% 40% The target was Child protection practice child the assumed in total policy and practice is protection policy schools 140 schools. in place in project However, we schools have reported actual progress based on the current schools’ level, which is now 70 schools. Activity 1.3.1 # of child clubs 140child 70 child 50% targets of Empowerment of receive knowledge on clubs clubs (1256 four years is child clubs on child child protection and members) achieved in this protection life skills reporting year.

Activity 1.3.2 # boys and girls 0 12300 girls 6887(3774 29% target is Orientation on receive orientation on and 11332 girls and achieved. adolescents’ girl’s adolescents’ girl’s boys 3113 boys) health awareness health awareness and early marriage and early marriage Activity # of schools that 140 70 Achieved target 1.3.3Orientation to received training of this year. school administration, SMC and PTA about child protection policy Total Felm expenditure for this outcome during the reporting period (refer to financial report): NPR 4,039,918

Outcome 2 Results hierarchy Indicators Baseline Target Indicator Describe (20xx) (by 2021) value, progress reporting and period indicator values Original outcome # children and 0 5000 students 499 students 10% statement: adolescents achieved. School children, receive Project teachers, parent and individual inception, baseline study other community psychosocial and training of people have access counselling at the focal to psychosocial school teachers counselling and consumed nearly six mental health months’ time services so there is less achievement in this reporting year.

% of children in 0 100% 45% 46% counselling that students are have improved still in psychosocial counselling wellbeing sessions so the indicator value is more likely to increase. (source: Student counselling documentation record at school)

28% # students, 0 5000 1397 people achieved in teachers, this parents and reporting other community year. people receive mental health and psychosocial service at health facility Output 2.1: School # of program 23 140 schools In 48 schools 34% target based psychosocial school have schools is achieved. support unit is psychosocial functioning in program support unit school

# of difficult 0 400 45 cases 11% target cases from referred to is achieved. school referred health facilities Refer the to referral health from schools first note of facilities progress of outcome 2. (source: school supervision,

monitoring report, record of health facility) Activity 2.1.1 # of teachers 48 280 teachers 140 teachers 50% Training and trained in school achieved in supervision to based total targets. psychosocial focal psychosocial teachers for support prevention and early intervention of EBP Activity 2.1.2 # school 20 140 70 schools 50% targets Material/technical received support achieved in support in the for psychosocial this year. establishment of counselling unit psychosocial counselling unit at schools Output 2.2: Referral # of referral 2 8 4 referral places 50% target service of mental place developed are developed achieved. health and psychosocial support is developed in health facilities in program areas Activity 2.2.1 # prescribers 10 40 41 health Target is Mental health training receive basic workers achieved. and and refresher including 8 supervision/mentoring training in mental medical officers of the paramedics, health with emphasis on 3 3 children’s mental # supervision/year supervision/year health issues supervision/case supervision by psychiatrist Activity 2.2.2 # of nurses 4 40 7 nurses/ANM 18% Psychosocial receive achieved counselling training psychosocial and supervision of the support/ staff nurse/auxiliary counselling nurse, with emphasis training on children’s psychosocial issues Activity 2.2.3. # of nurses at - 8 5 63% Advanced hospital that achieved. psychosocial receive counselling training to advanced staff nurse of referral counselling hospital to provide training psychosocial counselling service for the referred cases from schools Output 2.3: # of SHGs that - 40 15 38% Self-Help Groups conduct lobbying achieved. protect the rights of meeting with the persons with local mental health and government

psychosocial disabilities Activity 2.3.1 # of people with 80 500 580 Target is Orient person with mental health achieved in mental health problems refer this year. problems and their to health service families members, facilities by SHG and FCHVs on mental and FCHV health issues and social stigma

Activity 2.3.2 (name of # of SHG formed 13 40 5 new SHGs 45% activity) and received achieved. Formation and training support for functioning SHGs … Total Felm expenditure for this outcome during the reporting period (refer to financial report): NPR 7,273,158

Outcome 3 Results hierarchy Indicators Baseline Target Indicator Describe (20xx) (by 2021) value, progress reporting and period indicator values Original outcome National Centre for No Yes Not statement: Education No achieved. Government of Nepal Development (NCED) replicates best practices of incorporates comprehensive school comprehensive school counselling in school counselling into education system at national, teachers’ training

province and local level Manuals/Reference No Yes Yes One materials of reference comprehensive school material counselling developed jointly jointly developed - 10 No of schools 12 replicates comprehensive school Achieved counselling practices

Output 3.1: # of master trainer 30 84 27 32% By 2021, master trainer are developed at national, achieved. developed at national, province and local province and local level to replicate comprehensive school counselling Activity 3.1.1 # events of training 4 modules It was only Training and supervision to and supervision 1 time/year 1module possible to NCED trainers and resource cover persons in comprehensive resources school counselling persons from the local level.

Activity 3.1.2 # review meeting 0 80 11 55% Review meeting with trainers, conducted (5/year/district) meetings achieved in head-teachers, resource Resource exploration this year persons and channelized target (20 events was target in year 2018). Output 3.2: National level No Yes No Due to the CMC-Nepal has increased guideline in school structural collaboration with the counselling developed changes, we Government of Nepal to Policy document did not able formulate and endorse developed to closely comprehensive school School based work with counselling policy psychosocial training the central package developed level authorities. Activity 3.2.1 Third (career and No Yes Yes Achieved Develop comprehensive academic counselling) school counselling component of school manual/reference materials counselling developed jointly with government

Reference materials of No Yes No Will be anti-bullying developed in year 2019 Activity 3.2.2 # coordination 0 8 2 Achieved Organizing regular meeting meetings at central (2/year) with DoE, MoE, NCED at and province level central and state level Steering committee 0 2 0 Not formed and conducts (1 Health and achieved meeting regularly 1 Education) due to structural change Joint monitoring visit in the # of joint monitoring 0 4 2 Provincial project districts from the visits/meetings level central and district level and education lobby to integrate best # of best practices and health practice in school education documented/published 0 At least 1 - authorities and health system by central and district conducted level stakeholders joint monitoring visit in Salyan and Kailali Experience # of experience Once in a year - Instead of sharing/conference/workshop sharing workshop experience with government sharing workshop, CMC-Nepal # of research article 2 in project presented developed and phase its research published based scientific paper in the conference. Total Felm expenditure for this outcome during the reporting period (refer to financial report): 1,524,329

Annex-3: Data Reporting Templates for Felm Programme Indicators

Felm category relevant to A. Total number of B. Number of new people Felm Ref. your project: people (in the named (in the named Felm Felm category category below) below) reached by reached by project project activities activities during the during the reporting reporting year. year. Children and adolescents 11589 11589 2.0.1 *Children and adolescents 499 499 2.0.1 having emotional, behavioural problems and learning difficulties Persons with psychosocial 1397 1397 2.0.1 disabilities Data source and year: Report collected by CMC’s staff from the schools, school records and flash report, school counselling register and Health Management Information System (HMIS) of the year 2018.

*499 children and adolescent is counted twice at it is already included under children and adolescents category .

A. TOTAL number of persons B. Number of targeted PwDs Fel with disabilities (PwDs) that have official disability m targeted by the project status or other certification Ref . directly that grants access to basic services/benefits to the PwDs by the government

5000 (four-year targets) 2.0. 1397 (actual of one year) *25 5 Data source and year: Health Management Information System (HMIS) record of Government Health Facilities and report provided by the SHG of the year 2018.

* Children with intellectual disabilities and people with schizophrenia received official disability cards and received social benefits as per the government policy.

Felm category Number of people in the Felm Felm relevant to your category whose awareness of Ref. project: their rights and/or human rights increased during the reporting year *Community 7396 2.1.1 people, FCHV, traditional healers, teacher, parent,

and child club members **The people with 480 2.1.1 psychosocial disabilities and their families Data source and year: Activity report during the year 2018

*The no of child club members participated in interaction is counted in Felm category 2.0.1 so the number is excluded here. **The number of SHG members having psychosocial disabilities is included already Felm category 2.0.1. However, we have just mentioned that 480 people with psychosocial disability have come in the community group.

Felm category of Number of community Felm relevant to your project: members whose Ref. awareness of the below rights increased during the reporting year *of the rights of Persons 5109 2.2.1 with Disabilities

Data source and year: Activity report

* Community people involved in world mental health day, suicide prevention day and disability day celebration. Furthermore, community people received information on the rights of the people with the psychosocial disability once they come to health facilities.

Felm category relevant A. Total number of people B. Number of people in Felm to your project: in the Felm category the Felm category Ref. that participated in targeted by the project community-based that participated in groups/organizations community-based during reporting year. groups/organizations, new during the reporting year.

Persons with 480 All the people are new 2.1.3 Psychosocial Disabilities and their families participated in Self-Help Group Data source and year: Self Help Group’s register and report submitted by Mental Health Social Workers

Topic: Duty-bearing and/or advocacy New initiatives in the arena of political and or other decision-making that aim at increasing economic, social and/or ecological accountability and duty-bearing, during reporting year. Name of the initiative: Advocacy/coordination meeting with provincial government and local government Topic (what is it related Coming together to address the rights of the people with psychosocial to?): disabilities Objective (what is it The objective of this advocacy/coordination meeting to sensitize the politician aiming to change and and other decision-making government officials on the need of school and by when?) community based mental health program and integrate into the health and education system. Level: (at what level will Village: Local Province/District: √ National: the expected change government: √ take place?) – Tick one or several Whose The provincial and local government included at least few components of mental actions/roles/duties is it health into their planning and budgeting. 70% of (rural) municipalities allocated targeting to change? budget for the psychotropic medicines. Three municipalities directly supported classroom promotional materials to the project schools. Two municipalities of Salyan agreed to extend mental health service in non-project location and trained their health workers in mental health in order to deliver mental health service. Felm Ref: 6.0.1 Data source and year: Activity report, minute of the meeting of year 2018

Topic: Duty-bearing and/or advocacy – Targeted at political or economic decision-makers or duty- bearers Advocacy work conducted by partner organizations during the reporting year. Topic (what is it related Mobilization of DPO in the interaction meeting with the local level elected to?): representatives and government officials

Objective (what is it The objective of mobilizing DPO members in such interaction is to increase the aiming to change and understanding of politicians and decision makers on disability issues along with by when?): mental and psychosocial disabilities Target: Whose The roles and actions of local government was targeted to change. actions/roles/duties is it targeting to change? Level: (at what level will Village: Local District: National: the expected change government: √ take place?) – Tick one or several Impact/effect: (What Around 90% local government has agreed to include mental health into the was the result after the health and education plan of the local level for the next fiscal year (2019/2020) advocacy activities? What changed? Felm Ref: 6.0.2 Data source and year: Meeting minute and activity report

Number of duty-bearers with Felm increased awareness of the Ref. rights of the discriminated and increased awareness of their roles as duty-bearers and influential actors. *Duty-bearers and 2,131 6.1.1 decision-makers Data source and year: Orientation reports, joint monitoring reports, awareness report etc. of the year 2018.

*Duty bearers and decision makers mainly includes elected representatives, government officials, SMC, PTA, media people.

Number of duty-bearers with Felm increased skills and Ref. knowledge on advocacy and other duty-bearing approaches during the reporting year. *Duty-bearers and 451 6.1.2 decision-makers Data source and year: Training and supervision report of the year 2018

*Duty bearers and decision makers mainly includes teachers and health workers who provides school counselling, mental health and psychosocial service to the children with emotional and behavioural problems and people with mental health problems.

Number of duty-bearers that Felm participated in at least one Ref. thematic or sector network *Duty-bearers and 270 6.1.3 decision-makers (MPAC meeting, review meeting) Data source and year: Meeting report of the year 2018

*There is as such networks of decision makers and government authorities but CMC has practiced to organize review meeting among the head-teachers and local level representatives and MPAC meeting. CMC also conducts the review meeting at central level with health and education authorities.

Annex-4: List of Project Staff

Working hrs in this project Ending date % of salary Employed in S.No Staff Name Designation Sex (100% Full time, 50% part of work and funded by CMC time etc) Contract FELM

1 Ram Lal Shrestha Executive Director M Part time 18/08/2003 31/12/2018 40% Technical Director/senior 18/08/2003 10% 2 Dr. Pashupati Mahat Clinical Psychologist M Part time 31/12/2018 3 Madhu Bilash Khanal Program Coordinator M Full time 1/8/2005 31/12/2018 100% 4 Tanka Psd Timilsena School MH Supervisor M Full time 13/12/2013 31/12/2018 100% 5 Lok Bahadur BK School MH Supervisor M Full time 1/11/2012 31/12/2018 100% Mental Health Social 1/9/2015 100% 6 Gita Pahadi Worker F Full time 31/12/2018 7 Yubaraj Gautam School MH Supervisor M Full time 19/05/2017 31/12/2018 100% 8 Bishnu Psd Prajapati MH Coordinator M Part time 18/08/2003 31/12/2018 40% 9 Rajesh Kumar Jha Psychosocial Coordinator M Part time 1/6/2010 31/12/2018 40% Mental Health Social 50% 10 Anat Chaudhari Worker M Part time 17/2/2014 31/12/2018 Sarita Kumari Mental Health Social 100% 11 Chaudhari Worker F Full time 17/2/2014 31/12/2018 Mental Health Social 100% 12 Kali Bdr. Kami Worker M Full time 17/2/2014 31/12/2018 13 Indira Pathak Admin/Finance Officer F Part time 4/2/2005 31/12/2018 30% 14 Srijana Shrestha Admin Officer F Part time 16/07/2012 31/12/2018 40% 15 Rup sundar Shrestha Driver M Part time 4/4/2018 31/12/2018 40% Ram Chandra 18/08/2003 40% 16 Maharjan Office Assistant M Part time 31/12/2018 17 Dharma Kumar Rai Security Guard M Part time 17/10/2004 31/12/2018 40% 18 Laxmi Maharjan Office Helper F Part time 21/06/2010 31/12/2018 50% 19 Bishnu Rai Office Helper F Part time 21/06/2010 31/12/2018 50%

Annex-5: List of Assts

Month: December Year: 2018

Asset Number Description Current Condition Purchase Purchase Currency % Felm Voucher Notes Location When Bought date price Share Number Hon 01 Splender Motorcycle Office From CMHP 29/12/06 101,500 NRS 100% 094 Kailali Office MSI 7 Del Laptop Office From CMHP 13/5/2011 47,500 NRS 100% 1580 Write off in 2018 (Not working) CMC-N Lap 010 Del Laptop Office From CMHP 15/2/013 49,500 NRS 100% 025 Write off in 2018 (Not working) CMC-N Lap 011 Del Laptop Office From CMHP 15/2/013 49,500 NRS 100% 025 At store, slow in performance CMC-N Lap 012 Del Laptop Office From CMHP 30/8/013 55,000 NRS 100% 172 Write off in 2018 (Not working) CMC-N MD02 Epson Multi Media Projector Office From CMHP 30/8/013 78,000 NRS 100% 172 Training hall (Kailali Office) Use by SMH Supervisor - CMC-N Lap020 Acer Laptop Office From CMHP 6/4/015 46,000 NRS 100% 59 Salyan Used by SMH supervisor- CMC-N Lap021 Acer Laptop Office From CMHP 6/4/016 46,000 NRS 100% 59 Kailali CMC-N Lap022 Del Laptop Office From CMHP 30/12/014 49,494 NRS 100% 469 Used by Admin/Finance Officer FELM/CMC Nepal (joint CMC-N VLX 01 Vehicle Scorpio VLX 7417 Office From CMHP 17/12/014 3,260,904 NRS 60% 453 ownership) CMC-N Lap023 Acer Laptop Office From CMHP 21/12/017 45,000 NRS 100% 59 Used by MHSW Salyan Gita In central office, returned by CMC-N Lap034 Laptop Computer Office From CMHPSP 11/09/2017 35,000 NRS 100% 353 MHSW Used by Programme CMC-N Lap040 Laptop Computer Office From CMHP 21/12/017 50,000 NRS 100% 59 Coordinator CMC-N Lap042 Laptop Lenovo Office New Purchase 21/11/2018 48,000 NRS 100% 393 Used by Executive Director Total 3,961,397.52

Rs.99,440 covered by Felm funded project and remaining No. Money Works software Office New Purchase 24/12/2018 223,740 NRS 44% 444 was funded by other donors

Annex-6: Human Interest Story (I)

Organisation name: CMC-Nepal Project name: School Mental Health Name of interviewer: Lok Bahadur BK Date of the 2018 interview:Consent from the ..of being interviewed: person being NO interviewed YES  NO (mark with X): ..of FELM using the story for reporting and/or fund-raising purposes: YES NO

Name(s) of person being Anonymous interviewed (optional): Gender of the person interviewed: One boy and one girl Age of the person interviewed: Boy 13 years and 14 years girl Name of the Salyan District (Bagawati Basic School &Saraswati Basic School) village/location: Type here the human-interest story as told by the person interviewed; e.g. what was the situation before the project started; how did s/he participate in the project activities; how has s/he; her/his family; her/his community benefitted from the project in the short-term and the long-term; why have the changes been significant to her/him? (Max 200 words)

Counseling was even useful to stop the CHILD MARRIAGE

A boy aged 13 from Bagawati Basic School and 14 years girls from Saraswati Basic School had run away after getting marriage. Both side parents had tried to cancel their marriage but they couldn’t convince their children. Then they had reported to district police office. Police also did not able to convince the girls and boys to stop their marriage. Then Chief District Officer (CDO) contacted to school mental health supervisor (SMHS) of CMC-Nepal to provide counselling to both girls and boys. SMHS provided individual counseling to both girls and boys. In the counselling session, the SMHS discussed about why they did get marriage in early age? Which things did encourage them to get marriage? The SMHS also asked them to imagine future life and possible risks like girls trafficking, example of second marriage, financial problems, parents’ rejection etc in future and how they would deal with that risk? During the sessions it was also discussed about the advantages and disadvantages of early marriage. Then they realized the disadvantages of early marriage and they decided to cancel the marriage and continue the study.

After completing the counseling sessions, the girl and boy came out from the counseling room. Police personnel and parents were eagerly waiting the result of counseling. After coming out from the counseling session, girl and boy both said that we don’t do marriage or we cancelled the marriage. Then the police personnel and parents surprised listening the boy and girl’s decision and said that what magic did counseling. This miracle built the trust among community people and government offices about CMC Nepal’s school mental health program, psychosocial program and counselling service.

HUMAN INTEREST STORY (II)

Organisation name: CMC-Nepal Project name: School Mental Health Program Name of interviewer: Anat Chaudhary Date of the interview: 2018 Consent from the ..of being interviewed: person being interviewed YES  NO (mark with X): ..of FELM using the story for reporting and/or fund-raising purposes: YES NO

Name(s) of person being interviewed (optional): Shyamkali Chaudhary (name changed)

Gender of the person interviewed: Female

Age of the person interviewed: 26

Name of the village/location: BhajaniTrishakti Municipality, Kailali

Source of income – Sewing machine Shyamkali Chaudhary (name changed), 26 years old, lives with 5 family members (mother, 3 sisters & himself) in Bhajani Trishakti Municipality. They were living happily but internal war between Maoists& government affected her life also in 2002. Shyamkali's father was the chairperson of Joshipur VDC during that time and he was warned by the Maoist not to run the office. His father continued the office ignoring that warning. Maoist took him in their custody and murdered mercilessly in the office. The incident was not hidden by Shyamkali which badly traumatized. After some days of this incident, she started running away from the house. Whenever she saw red cloth, she used to scream and run away.

Her mother was already in grief from the death of her husband. The worsening situation of her daughter made her situation more devasted. As per the suggestion so neighbour and relatives, she did pray to the god &followed traditional healing practices. But instead of decreasing the problem her suffering was increased more. Her mother spent NPR 150,000 for her treatment. Later, Shyamkali started laughing alone, wandering without any reason here and there, not eating on time, and fighting. Then, her mother took her to Lucknow, India with the help of neighbour for her treatment. After taking regular medicine, her situation was bit improved at that time. There was no one to generate income in the family, their financial situation became poor and she did not manage money for regular medication.

During the supervision visit in Joshipur PHC, we invited Shyamkali for the assessment and treatment of her illness. The psychiatrist assessed her mental health condition and changed the medicine. The MHSW of CMC- Nepal visited family and provided psycho-education. After a month of the medication, there was improvement in her health. After the treatment, Shyamkali started to help her mother in the household chores (eg: cooking, washing clothes, farming etc)

She joined SHG and on the recommendation of SHG, CMC-Nepal provided sewing machine as part of the livelihood support. Nowadays, she sews clothes and earn money to meet the daily needs and medicine. Shyamkali earns Rs. 6000/- per months. Her mother shares that she didn't expect her daughter could sew clothes but after seeing her job she seems very happy. She is now creating awareness and referring the people with mental health problems to the Joshipur PHC.

Annex-7: Photographs

Egocentric sitting arrangement Training of SHG members and Mother group

Children being happy after achieving hero Interaction program organised by Child club of the week to create awareness on early marriage

MH Clinical Supervision Orientation to parents