Transcript CONTEXTUAL ASSESSMENT

Associate Prof Theresa Lorenzo
School 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
for
 Equalisation of opportunities
 Rehabilitation
 Poverty reduction and
 Social inclusion of children and adults with
disabilities
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Emphasis on human rights
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Complex form of change (WHO, 2004)
CBR Implementation
…Through the ACTIVE involvement in decisionmaking of
 Disabled persons,
 Their families and communities
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With SUPPORT from appropriate health,
education, vocational (Labour) and social services
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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
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Linked to Primary Health Care – promotion,
prevention and rehabilitative services
(Declaration of Alma Ata)
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Three pilot sites: late 1980s – SACLA Health
Project, Khayelitsha; 6 months followed by inservice training
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Early 1990s–IUPHC, Alexandra & WitsTintswalo CORRE Project, Acornhoek
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Two years of alternating theory and
practical work
CBR Training
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Registered with HPCSA Board of
Occupational Therapy and Orthotics
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Initially no formalised supervision
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Later, supervisors’ workshops run in
conjunction with CBR training
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IUPHC training taken over by CREATE in
1999 till 2006
Who has been trained and By Who?
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Parents of disabled
children
Disabled people
Family members or
neighbours
Community
members
OTTs
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Rehab therapists
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Social workers
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Doctors
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Disabled people and
parents of disabled
children
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Accreditation –
Diploma by Wits
Content of Training
Removal of Barriers at an Individual Levels
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PHC and Prevention of Impairments
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Physical impairments – cerebral palsy, stroke, spinal
cord injuries, burns amputations, epilepsy
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Mental impairments – learning difficulties and mental
illness
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Sensory impairments – speech, hearing and sight
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Provision of assistive devices and equipment
Content of Training (2)
Removal of Barriers at a Societal Level
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Health promotion
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Disability awareness, advocacy and lobbying
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Economic empowerment and employment
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Project management
Essential Achievements
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Increased access to information and support
in same language and culture
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Increased access to health and social services,
education and labour
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Poverty alleviation – equal opportunities and
social inclusion
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Greater coverage of disabled children and
adults for assistive devices
Essential Challenges

CBR is more than just an extension of
therapeutic services or
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Overcome perception of CRWs giving a second
rate service

CRWs are not recognised because of
professional protectionism
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Inaccessible transport is huge barrier
Lessons Learnt

Services should be needs-driven and not
professions-driven.

CRWs are change agents who deserve
recognition.
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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.
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But we need to mobilise communities to
lobby and advocate for this to happen at
local level.
INDS: Policy Guidelines
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Prevention
Public education and
awareness raising
Health Care
Rehabilitation
Barrier-free Access
Transport
Communications
Data, information +
research
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Education
Employment
Human resource
development
Social Welfare +
community dev.
Social security
Housing
Sports and recreation
Principles of CBR (WHO, 2004)
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Inclusion

Participation
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Sustainability
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Empowerment
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Self-advocacy
Relevant Disability Policies
International
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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)
National
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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)
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48 Articles
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Ratified by South Africa in 2007
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Monitoring reports by government in 2010
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Alternate reports by civil society organisations
UNCRPD Principles
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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)
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Relationship between the disabled person,
the environment and their participation
Prevention
Rehabilitation
Focus of WPA
 Needs + Rights
Equalization of
opportunities
Strategies
Legislation
By
looking
at:
Policy
Development
Capacity
Building
United Nations Standard Rules of
Equalization Opportunities For Persons
With Disabilities, 1993.
Address development needs of disabled people
Dual Approach
 Need for Individual Support

Need for Barrier-Free Environment
GOAL
 Integration on all levels
4 Preconditions for Participation
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Awareness – raising
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Medical Care (health)
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Rehabilitation
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Support Services (assistive devices and
technology)
8 Target Areas for Participation
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Accessibility – physical environment, information
and transport etc.
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Education – early childhood development,
primary, secondary and tertiary.
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Employment – open labour market, self
employment, SMME
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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
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Information and
Research
Policy Making and
Planning
Legislation
Economic Policies
Co-Ordination Of
Work
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Organizations Of
Disabled People
Personnel Training
National Monitoring
and Evaluation of
Disability Programmes
Technical and
Economic CoOperation
International CoOperation
INDS VISION
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A Society for all
Integration/ Inclusion
Human Rights
Equal Opportunities
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Vulnerable groups
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Effective service delivery infrastructure
INDS: PRINCIPLES
 People driven/ Self-representation
 Democratization = Participation
 Integration and sustainability
Vulnerable groups
Women
Children
People with
severe
intellectual
disabilities or
mental
illness
People with AIDS
Vulnerable groups
Refugees +
displaced people
Remote Rural
Elderly
Youth
People with multiple
disabilities
INDS: OBJECTIVES
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Facilitate integration of disability issues into
govt. developmental strategies, planning and
programmes.
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Develop integrated management system for coordination of line functions and tiers of
government.
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Develop capacity building strategies for
implementation of INDS by all levels.
Nelson Mandela
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During my lifetime I have dedicated myself
to this struggle of African people. I have
fought against white domination and I
fought against black domination. I have
cherished the ideal of a democratic and free
society in which all people live together in a
free harmony and with equal opportunities.
Rivonia Trial, 1963
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
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