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