Community Based Rehabilitation (CBR)                                 In                                                                                                                          The Disability Rights Struggle in South Africa

                 

                 Draft Position Paper

  Disabled People South Africa (DPSA)                                                              2005
 
The People with disabilities South Africa 2004 Biennial General Assembly, held from at Birchwood Conference Centre, Johannesburg from 11-13 March 2004, resolved as follows on Community Based Rehabilitation a vehicle for Independent Living: Noting
·        The success of the CBR Programme in Mpumalanga·        The Mpumalanga CBR Model has shown that real partnerships with communities are essential for sustainable development and empowerment of people with disabilities and 
 
·        That affirmation of people with disabilities contributes to them playing active and leading roles in developing their localities by reducing their marginalisation in society.·        And therefore contributes to independent living
  Therefore resolves that   
·        The CBR – Model in Mpumalanga to be documented·        DPSA need to  lobby national support for the  Mpumalanga CBR Model to be recognized as a best practice·        DPSA need to develop integrated strategies which would orientate national and provincial stakeholders on the Mpumalanga CBR Model·        DPSA to facilitate a process that would enable provinces to implement the CBR Model with local adaptations
 This position paper consolidates DPSA’s views on the direction CBR policy and programmes should take in South Africa, and acts as a supportive advocacy tool to our national, provincial and local structures and representatives.


 

DPSA STATEMENT ON COMMUNITY BASED REHABILITATION

 

Noting that

 v     SA Constitution, INDS etcv     Disability is a development and human rights issues that cuts across a number of sectors.v     The basic civil and socio-economic rights and needs of persons with disabilities are the same as those of their able-bodied persons.v     People with disabilities have the same rights as all other citizens to benefit equally from the development programs v     The world programme of action concerning disabled persons, standard rules on the equalization of opportunities for disabled persons and the disability rights charter of SA provides appropriate guidelines for the equalization of opportunities for disabled person in South Africa. And furthermore noting thatv     People with disabilities do not have equal access to public services as a result of attitudinal, physical and communication barriers v     Mainstream strategies to redress past neglect and promote development and economic growth often unintentionally exclude persons with disabilities, as it does not take cognizance of the above barriers.v     Development programmes need enabling mechanisms and interventions to facilitate full participation by and equalization of opportunities for persons with disabilities.v     Persons with disabilities have the right to represent themselves in issues affecting them, as they are experts in overcoming the day to day barriers they experience in accessing facilities and services.v     Disability is a complex issue - disabled activists as community workers become disability resource persons to public servants, CHW’s, CDW’s and home-based care workersv     Present debates on the merits of a CBR model have not included organisations of disabled persons as equal partners and stakeholders with professionals and academics.   

Believing that

 v     The disability rights struggle advocates for the integration and full participation of person with disabilities in a society for allv     Community based rehabilitation is an enabling strategy for reaching the objectives of the disability rights struggle v     People with disabilities needing specialised rehabilitation should have excess to this in rehabilitation centresv     Preference for funding of CBR projects should be given where People with disabilities organizations have been formed and where accountability structures are already in placev     Rehabilitation is a means to an end and not an end in itself – its an enabling tool and or process to educational and socio – economic development. 

Further believing that

v     Outcomes of programs should be empowerment oriented

v     Development is dynamic and developmental service delivery therefore requires constant adjustment (no blue-prints)

v     It is essential for sustainability and maximum impact of programs that partnership between DPSA and other stakeholders is EQUAL and based on mutual respectv     That meaningful partnerships with DPSA is essential for sustainable socio-economic development, and that affirmation of people with disabilities contributes to them playing active and leading roles in developing their localities by reducing their marginalisation in society.v     Affirmation of people with disabilities is essential - People with disabilities as Community Workers are more effective peer counselors as well as role-models in community development, therefore having a bigger change agent impact  

Therefore resolve that

 The Social Model is the key framework for the development and implementation of Community Based Rehabilitation programs and should be interpreted as follows:1.            People with disabilities organizations should participate equally in decision-making in the development, implementation and evaluation process of CBR programmes.  This will require an enabling process where attitudinal, physical and communication barriers which impact negatively on the participation of people with disabilities, are addressed throughout the process in order to ensure that services are based on the needs as identified by people with disabilities themselves.2.            CBR is as much about focusing on the individual with a disability and his/her family, as it is about changing society.  This requires that CBR programmes focus equally on v     ensuring that people with disabilities are able to maximize their abilities to access regular services and opportunities and to contribute to their communities; andv     activating and mobilizing communities and mainstream interventions to promote and protect the rights of people with disabilities by removing attitudinal, physical and communication barriers that isolate and hinder full participation by people with disabilities.3.            CBR programmes should be an integral part of formalized rehabilitation services, education support, social development programs and economic development initiatives.  CBR programmes compliment specialized and institution-based services, and should therefore be part of the referral systems.  All people with disabilities should therefore have equal access to rehabilitation services at all levels of careThis will require a multi-sectoral approach as well as policy reform.4.            CBR programme implementation should be driven through People with disabilities organizations as the implementing agent.  This will require service level agreements with public and private sector and structures of civil society which clarify expected outputs, outcomes and funding requirements.5.            Investment in capacity building is essential for successful implementation of CBR programmes as an integral part of government service delivery strategies.  This includesv     Transformation of training programmes for service providers at pre-and post graduate level, including reorientation of practicing service providers on the implications of the social model to rehabilitation; as well as v     Capacitation of DPO’s in management and administrative systems to ensure compliance to legislation and sustainability. Furthermore resolves that6.      The Mpumalanga CBR Model, which has successfully integrated the disability rights movement objectives within a service delivery model, and attached as Annexure A, be adopted as the basis for the development of national, provincial and localized CBR programmes. 

ALUTA CONTINUA
BRIEF BACKGROUND

  The first democratic elections in 1994 brought about an era of dignity and hope for South African citizens.  Children and adults with disabilities have the same rights and responsibilities as every citizen under the SA Constitution. These rights include the rights to be treated with dignity and respect, the right to equal access to education, employment opportunities, social grants and health services, the right to safe shelter etcetera. Yet People with disabilities tend to remain the poorest of the poor in their communities due to the persistent ongoing negative attitudes towards, and stereotypes about, persons with disabilities, as well as lack of access to information about disability services and opportunities, human and disability rights and potential of people with disabilities. Much has been said and written about community-based rehabilitation as a socio-political model in addressing marginalization and under-development of people with disabilities. Community Based Rehabilitation is about the empowerment and development of children and adults with disabilities, by giving them the knowledge, skills and authority to take decisions about issues affecting them. The debates around policy formulation and programme development for CBR have to date unfortunately remain the domain of professionals and academics, with little meaningful participation by people with disabilities themselves.  This has to a large extent contributed to the further marginalization of people with disabilities, as well as parents of disabled children, as their voices have been drowned by the opinions of the service providers and academics, and where it can even be said that agreement was often coerced.  

THE DISABILITY RIGHTS STRUGGLE AND CBR

 CBR has been defined in a number of ways. Some definitions emphasize the medical rehabilitation model, whilst others include the equalization of opportunities, depending on the domain from which the definition emanates. The disability rights struggle is a struggle for recognition and promotion of the human rights of the People with disabilities.  People with disabilities South Africa views  Rehabilitation in the 20th century developed as an intervention programme to improve the lives of people with disabilities by ‘doing things for them and imposing interventions on them’’.  Rehabilitation is controlled\dominated by therapists, and is therefore regarded as a predominantly health issue.  Community based rehabilitation was promoted by health therapists in the 1980’s and 1990’s, and has therefore become an extension of the above in South Africa.   The word rehabilitation in CBR tends to reinforce the old perception of disability as a health issue rather than a development issue. It therefore isolates rather than integrates. Both the disability rights movement and the CBR movement advocate for the same objectives and outcomes, but often differ about the tactics and approach to be deployed in achieving this, and in particular, about the right to final decision-making. Both CBR models and the disability rights movement advocates for the following key components to be included in intervention and development programmes: 1.Public awareness and changing of attitudes (Advocacy) v     to recognize and promote the human rights of People with disabilities. 2.Community development-v     Mobilization and organization of persons with disabilitiesv     Representation on community development structuresv     Environmental accessibility-Built environment-Communication e.g. interpreter services 3. Human resource development-v     Early childhood developmentv     Formal education (integrated or specialized education)v     Higher education (university, technikon, college)v     Adult education--Adult basic education and training (ABET)-Adult education (skills training) 4.Economic empowerment-v     Open labour marketv     Small. Medium and micro-enterprises (smmes)v     Sheltered\protective employmentv     Self employment 5.Social welfare-­     Social security (grants) Rehabilitation approachRehabilitation should be an enabling tool that should assist People with disabilities to access the above components e.g. through­     Independence training­     Mobility training­     Provision of information­     Referral to appropriate services­     Community training­     Assistive device provision and maintenance­     Counseling services (professional and peer counseling) The disability rights movement approach Disabled activists and parents of children with disabilities are actively involved in the facilitation of and support to small community based organisations of People with disabilities commonly known as DPO’s. These DPO’s are typically involved in the following activities·        Identification of people with disabilities ·        Basic assessment of people with disabilities (especially children)·        Referral of people with disabilities to the relevant resources·        Health promotion and prevention as well as information dissemination a·        Social rehabilitation in the form of peer counselling and support groups·        Assisting with maintenance and repairs of assistive devices·        Encouraging participation in community activities·        Basic Vocational training of persons with disabilities·        Advocacy and awareness programmes The aims of these activities are  All of these initiatives are community based, community initiated, community managed and community controlled. Community – Based rehabilitation therefore is alive and thriving through the initiatives of People with disabilities and parents themselves.     INTERNATIONAL CONTEXT OF CBR Definition of CBRThe joint position paper of ILO, UNESCO and WHO,2004 recognizes Community based rehabilitation as a strategy within general community development for rehabilitation, equalization of opportunities, poverty reduction and social inclusion of all people with disabilities.  CBR is implemented through the combined efforts of people with disabilities themselves their families organizations and communities and the relevant governmental and non-governmental health, education, vocational social and other services. The History of the evolution of CBRThe conceptualization of Community based rehabilitation started in 1974.In 1978 The Alma-Ata Declaration for Primary Health Care was adopted by all countries. There were four priorities for the Primary Health Care programme, among them rehabilitation.  Today Community based rehabilitation are being implemented in more than 90 countries. It is important to note that along with the quantitative growth in CBR services, there have been major changes in the way CBR has been conceptualised. The focus of CBR has expanded from medical rehabilitation towards more comprehensive multi-sector approaches such as access to health care, education, livelihood opportunities, participation/inclusion and empowerment. People with disabilities International – including DPSA - rejected the earlier concepts of CBR as it had excluded People with disabilities organisations in the development of it. The need to review the concepts of CBR was highlighted during the international consultation process to review CBR at the International Consultation in Helsinki, Finland,2003. This process was organized by WHO with UN organizations, Non Governmental Organisations and People with disabilities’s Organisations. The joint position paper incorporates the recommendations as agreed upon at the consultation. The  2004 Joint Positions paper recognizes the following concepts ·        Disability is no longer viewed as a result of impairment·        Rehabilitation services should no longer be imposed on the users of the services. Users should be provided with all relevant information so that they can make informed decisions regarding what is appropriate for them·        CBR promotes the rights of people with disabilities to live as equal citizens within the community, to enjoy health and well being to participate fully in educational, social, cultural, religious economic and political activities. The Un Standard Rules should forms a guide for all CBR Programs·        CBR itself can be viewed as a poverty reduction strategy within community development aimed at achieving the Millennium Development Goals.·        CBR contribute to the development of inclusive communities. The concept of inclusive communities means that communities adapt to facilitate the inclusion of people with disabilities rather than expecting them to change to fit in. CBR benefits all people in the community, not just those with disabilities.·        People with disabilities organizations are a resource to strengthen CBR programs. It is essential that CBR and disability related programs are planned and implemented with People with disabilities and their representatives.

People with disabilities and their family members can make significant contributions as CBR workers. CBR workers provide information to people with disabilities and their families including advise on carrying out simple tasks, advocate for the inclusion of people with disabilities at schools, training centres, workplaces and other organizations and provide information about services and acts as a liaison between people with disabilities and such services.