Associate Prof Theresa Lorenzo School of Health and Rehabilitation Sciences

1. Associate Prof Theresa Lorenzo School of Health and Rehabilitation Sciences University of Cape Town Community Care Worker SymposiumKopanong, April 2010community REHABILITATION WORKERS: AN ESSENTIAL ALTERNATIVE

2. 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)

3. 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 • Emphasis on human rights • Complex form of change (WHO, 2004)

4. CBRImplementation …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)

5. EQUALOPPORTUNITIES “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

6. 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

7. 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

8. 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

9. Content of Training Removal 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

10. Content of Training (2) Removal of Barriers at a Societal Level • Health promotion • Disability awareness, advocacy and lobbying • Economic empowerment and employment • Project management

11. 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

12. 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

13. 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.

14. 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.

16. 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

17. Principles of CBR (WHO, 2004) • Inclusion • Participation • Sustainability • Empowerment • Self-advocacy

18. Relevant Disability Policies • 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 International National

19. 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

20. 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

21. UN World Programme of Action (UN, 1992) • Relationship between the disabled person, the environment and their participation Prevention Rehabilitation Focus of WPA Equalization of opportunities  Needs + Rights

22. Strategies Legislation By looking at: Policy Development Capacity Building

23. 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

24. 4 Preconditions for Participation • Awareness – raising • Medical Care (health) • Rehabilitation • Support Services (assistive devices and technology)

25. 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

26. Target areas for participation (cont.) • Family Life and Personal Integrity • Culture (Arts, Cinema, Libraries, Music, Performances) • Recreation and Sports • Religion

27. 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

28. INDS VISION • A Society for all Integration/ Inclusion Human Rights Equal Opportunities • Vulnerable groups • Effective service delivery infrastructure

29. INDS: PRINCIPLES • People driven/ Self-representation • Democratization = Participation • Integration and sustainability

30. Vulnerable groups Women People with AIDS Children People with severe intellectual disabilities or mental illness Refugees + displaced people Vulnerable groups Remote Rural Youth Elderly People with multiple disabilities

31. 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.

32. Nelson Mandela • 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

33. 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