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Implementing Rehabilitation Programmes: Improving Quality of Life for Children, Youth, and Disabled Persons

This briefing discusses the implementation of rehabilitation programmes to improve the quality of life and status of children, youth, and disabled persons. It covers the underlying policies, barriers to access, national and international context, comprehensive rehabilitation services, and the role of various sectors in creating access to rehabilitation. The goal is to promote social integration and enable individuals to reach optimal functioning.

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Implementing Rehabilitation Programmes: Improving Quality of Life for Children, Youth, and Disabled Persons

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  1. Implementing Rehabilitation Programmes: Briefing to the Joint Monitoring Committee on Improvement of quality of life and status of Children, Youth and Disabled Persons. Sandhya A Singh Director: Chronic Diseases, Disabilities and Geriatrics Department of Health 30 May 2008

  2. Introduction • Access to health care creates equalization of opportunities. • Comprises various components including rehabilitation. • Prevention is integral – all levels • Rights-based service delivery • Barriers experienced are noted • Persons with Disabilities are within health system • Implement policy to improve quality of lives.

  3. The outline of the presentation.. • Underlying policy • Policy must benefit those in greatest need • Disability and rehabilitation exclusion • Comprehensive rehabilitation service • DOH creating access to rehabilitation services • Barriers are noted • Conclusion

  4. Legislation and Policy underlying service delivery… • National Context • National Health Act (No 61 of 2003) • Mental Health Care Act (No 17 of 2002) • National Rehabilitation Policy • Free Health Care Disabled People at Facility Level. • Child Youth and Adolescent Mental Health Care Policy Guidelines. • INDS (1997)

  5. International Context…. • U N Convention on the Rights of Persons with Disabilities • Translate into the proposed National Disability Policy Framework • Articles • Cross Cutting eg Prevention, Access to Information • Health, Rehabilitation and Habilitation.

  6. Policy must access those in greatest need…. • DOH recognizes a rights-based definition • Supports the Cabinet proposal (1995) • Disability is the loss of opportunity due to barriers • Compliant with the ICF • 2001 Census – “Reported impairment” • Impairment based • How do we measure barriers?

  7. In attempting to benefit those in need….. • Disability results in further Exclusion … • Poverty • Difficulty accessing basic services in general. • Difficulty accessing rehabilitation • Vulnerable to disease • Women • Mothers or caregivers • With disabilities • Low levels of literacy

  8. Comprehensive Rehabilitation…… • Various levels of prevention • Goal-orientated • Time limited process • Enable person to reach optimal functioning • Social integration

  9. CBR is a Philosophy first… • Based on CBR as a Philosophy • Person with Disability/Family and/or Caregiver is central to all decision making processes • Rehabilitation occurs “with” and not “for” • NDPF recommends the development of inter sectoral policy on CBR

  10. What comprehensive rehabilitation includes….? • Primary Prevention • General Public • Information must be in an accessible mode and format • Healthy lifestyles • Prevent Onset • Secondary Prevention • Early Identification and Intervention • Referral sytems • ECD • Inter Sectoral Collaboration

  11. Comprehensive rehabilitation…. • Tertiary prevention – Rehabilitation • Inter sectoral and Multi-Disciplinary • All levels of care • Provision of Assistive Devices,Technology,Surgery • Provinces vary in terms of their capacity to issue • Eg – November 2007 • Gauteng • 1717 manual wheelchairs • Eastern Cape • 1453 wheelchairs

  12. Changing profile observed… • Increasing demand from persons with acquired impairment and disabilities • HIV and AIDS • Neuro-anatomical,sensory • Diseases of lifestyle • Stroke • Diabetes related • Amputations • Blindness

  13. DOH creating access to rehabilitation toward improving quality of life….. • DOH Strategic Plan 2008/09-2010/11 • Free Health Care at Facility level • Accessibility of health facilities • Physical • Communication • Access – point of public transport to facility • Waiting period for wheelchairs • Policy • Orientation and Mobility Services

  14. Creating Access….. • Intra Sectoral Collaboration eg: • MCWH • Foetal Alcohol Syndrome • Care and Support • Step down Facilities • Geriatrics • Rehabilitation @ old age homes • Facilities Planning • Building accessibility

  15. Access….. • Inter Sectoral Collaboration • DOE • Collaboration on implementing WP 6 • ECD • DOSD • Disability Grant Assessment • ECD • RAF • Propose that assessment tool for serious injury is based on the concept of ICF – impact of injury

  16. Access….. • Information/ Education • SABC/ local radio education programmes • Basic sign language and interpretation training for health service providers • Provinces exploring training of Deaf persons as VCT counselors • Making HIV &AIDS education accessible to all. • Community Service for therapists • Access to services by many communities for the first time.

  17. Access…. • Economic Development • Persons with Disabilities to repair wheelchairs • Located at wheelchair repair sites • Receive remuneration in various forms • SLAs with NGOs • Paid directly

  18. When there are barriers to access… • Within the health system • Services at a local level? • Lack of or limited resources • Recruitment & retention of Therapists • Transport to reach patients in the community • Budget • Assistive Devices/ Other technology • Consumables – Nappies, linen savers

  19. Barriers… • When resources exist.. • Limited space available • Provincial budget system • Centralized vs decentralized • Difficulty to sustain • NGO initiated – integrate into the health system • “priority” competing with other programees • Difficulty to apply systems to rehabilitation – seen as something different outside health

  20. Barriers…experienced by the person • No support/assistance • Children • Adults and older persons who are not independently mobile. • Public Transport • Cost • Basic availability • Models of service delivery are inappropriate • “do for” • CBR – common Understanding???

  21. Thank You. Sandhya Singh SinghS@health.gov.za Cell 0828825012 Tel (w) 012 312 0472/3

  22. In conclusion…. • Rehabilitation often provided under very difficult circumstances • Rural doesn’t mean poor quality • Commitment by service providers must be recognized. • HOWEVER! • Recognize GAPS! • Accessibility to rehabilitation by all communities-EQUITY • Assistive Devices/technology • Reinforcing Human Rights approaches • Strive to create optimal environment • We must work together.

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