Associate Prof Theresa LorenzoSchool of Health and Rehabilitation Sciences
University of Cape Town
Definition of Disability - UN Convention on Rights of Persons with Disabilities
Persons with disabilities include those who have long-term physical, mental, intellectual or sensory impairments which in interaction with various barriers may hinder their full and effective participation in society on an equal basis with others (United Nations, 2006)
Community Based Rehabilitation (CBR) A strategy within general community development
forEqualisation of opportunitiesRehabilitationPoverty reduction and Social inclusion of children and adults with
disabilities
Emphasis on human rights
Complex form of change (WHO, 2004)
CBR Implementation
…Through the ACTIVE involvement in decision-making of Disabled persons, Their families and communities
With SUPPORT from appropriate health, education, vocational (Labour) and social services
Involving cross sector alliances and partnerships (WHO, Nov, 2004)
EQUAL OPPORTUNITIES
“The process through which the various systems of society and the environment, such as services, activities, information and documentation are made available to all.”
UN World Programme of Action, 1982
History Of CBR Training In South Africa Linked to Primary Health Care – promotion,
prevention and rehabilitative services (Declaration of Alma Ata)
Three pilot sites: late 1980s – SACLA Health Project, Khayelitsha; 6 months followed by in-service training
Early 1990s–IUPHC, Alexandra & Wits-Tintswalo CORRE Project, Acornhoek
Two years of alternating theory and practical work
CBR Training Registered with HPCSA Board of
Occupational Therapy and Orthotics
Initially no formalised supervision
Later, supervisors’ workshops run in conjunction with CBR training
IUPHC training taken over by CREATE in 1999 till 2006
Who has been trained and By Who? Parents of disabled
children
Disabled people Family members or
neighbours
Community members
OTTs
Rehab therapists
Social workers
Doctors
Disabled people and parents of disabled children
Accreditation – Diploma by Wits
Content of TrainingRemoval of Barriers at an Individual Levels PHC and Prevention of Impairments
Physical impairments – cerebral palsy, stroke, spinal cord injuries, burns amputations, epilepsy
Mental impairments – learning difficulties and mental illness
Sensory impairments – speech, hearing and sight
Provision of assistive devices and equipment
Content of Training (2)
Removal of Barriers at a Societal Level Health promotion
Disability awareness, advocacy and lobbying
Economic empowerment and employment
Project management
Essential Achievements Increased access to information and support
in same language and culture
Increased access to health and social services, education and labour
Poverty alleviation – equal opportunities and social inclusion
Greater coverage of disabled children and adults for assistive devices
Essential Challenges CBR is more than just an extension of
therapeutic services or
Overcome perception of CRWs giving a second rate service
CRWs are not recognised because of professional protectionism
Inaccessible transport is huge barrier
Lessons Learnt Services should be needs-driven and not
professions-driven.
CRWs are change agents who deserve recognition.
Career pathway development of CRWs, with specific focus on capacity development for management and leadership positions, is long overdue.
Lessons Learnt (2) White Paper on An Integrated National
Disability Strategy necessitates national ministries to listen and budget for integration of disability issues at all levels of governance and policy implementation.
But we need to mobilise communities to lobby and advocate for this to happen at local level.
INDS: Policy Guidelines Prevention Public education and
awareness raising Health Care Rehabilitation Barrier-free Access Transport Communications Data, information +
research
Education Employment Human resource
development Social Welfare +
community dev. Social security Housing Sports and
recreation
Principles of CBR (WHO, 2004)
Inclusion
Participation
Sustainability
Empowerment
Self-advocacy
Relevant Disability PoliciesInternational National
World Programme of Action (UN, 1992)
Standard Rules on Equalization of Opportunities for Persons with Disabilities (UN, 1993)
Community based Rehabilitation (WHO, 1994; WHO/ILO/UNESCO, 2004)
Convention on Rights of Persons with Disabilities (UN, 2006)
A White Paper on the Integrated national Disability Strategy (ODP, 1997)
National Rehabilitation Policies (DOH, 2000)
White Paper 6 on Inclusive Education
Employment Equity Act Skills Development Act
UN Convention on Rights of Persons with Disabilities (UN, 2006) 48 Articles
Ratified by South Africa in 2007
Monitoring reports by government in 2010
Alternate reports by civil society organisations
UNCRPD Principles Respect for inherent dignity, individual autonomy
including the freedom to make one’s own choices, and independence of persons
Non-discrimination Full and effective participation and inclusion in
society Equality of opportunity Accessibility Equality between men and women Respect for evolving capacities of children with
disabilities and respect for the right of children with disabilities to preserve their identities
UN World Programme of Action (UN, 1992) Relationship between the disabled person,
the environment and their participation
Focus of WPA
Prevention Rehabilitation
Equalization of opportunities Needs + Rights
Legislation
Capacity Building
Policy Development
By looking
at:
Strategies
United Nations Standard Rules of Equalization Opportunities For Persons With Disabilities, 1993.
Address development needs of disabled peopleDual Approach Need for Individual Support
Need for Barrier-Free Environment
GOAL Integration on all levels
4 Preconditions for Participation
Awareness – raising
Medical Care (health)
Rehabilitation
Support Services (assistive devices and technology)
8 Target Areas for Participation
Accessibility – physical environment, information and transport etc.
Education – early childhood development, primary, secondary and tertiary.
Employment – open labour market, self employment, SMME
Social Security and Income Maintenance
Target areas for participation (cont.)
Family Life and Personal Integrity
Culture (Arts, Cinema, Libraries, Music, Performances)
Recreation and Sports
Religion
10 Implementing Measures
Information and Research
Policy Making and Planning
Legislation Economic Policies Co-Ordination Of
Work
Organizations Of Disabled People
Personnel Training National Monitoring
and Evaluation of Disability Programmes
Technical and Economic Co-Operation
International Co-Operation
INDS VISION
A Society for all
Integration/ InclusionHuman RightsEqual Opportunities
Vulnerable groups
Effective service delivery infrastructure
INDS: PRINCIPLES
People driven/ Self-representation
Democratization = Participation
Integration and sustainability
Vulnerable groups
Vulnerable groups
People with AIDS
Refugees + displaced people
Remote Rural
People with multiple disabilities
YouthElderly
People with severe intellectual disabilities or mental illness
Children Women
INDS: OBJECTIVES
Facilitate integration of disability issues into govt. developmental strategies, planning and programmes.
Develop integrated management system for co-ordination of line functions and tiers of government.
Develop capacity building strategies for implementation of INDS by all levels.
Nelson Mandela
CBR reworded
Community based disability support (CBDS) is a strategy within general community development for the equalisation of opportunities for disabled people and their families…
Through the combined efforts of disabled people organisations, government, civil society and business
Top Related