Sandhya A Singh Director: Chronic Diseases, Disabilities and Geriatrics Department of Health

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.