6.5.2 Rehabilitation
Rehabilitation aims at enabling people with disabilities to participate in everyday life. While it therefore addresses much more than just the health status of a person, in the PRS context, the health sector could offer a good starting point (although other sectors such as social protection, education or employment are also important for rehabilitation). It is also necessary to compare the situation in the relevant country and check which ministry is in charge of rehabilitation (e.g. in Tanzania the Department of Social Welfare; in Uganda, Community Development).
The global situation
Only 2% of people with disabilities in developing countries have access to rehabilitation and appropriate basic services (DFID, 2000, p.2). Very often the provision of rehabilitation services is shifted from governmental institutions to (I)NGOs, which cannot serve whole states. If there is a lack of rehabilitation, then a situation is created of long-lasting dependence of people with disabilities on others.
Possible solution: Community-based rehabilitation
At the community level, NGOs have been applying the community-based rehabilitation (CBR) concept in many developing countries for 20 years now. This concept attempts to be realistic by acknowledging that specialised institutions (such as rehabilitation centres) are not able to reach all people with disabilities and do not contribute to the real inclusion of such people in society. Therefore institution-based rehabilitation and CBR need to complement each other. Today, CBR is a national strategy in many countries.
According to a joint position paper by the ILO, UNESCO and the WHO, community-based rehabilitation is “a strategy within general community development for the rehabilitation, equalization of opportunities 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.” (ILO, UNESCO and WHO, 2004, p. 2). This approach envisages CBR as a multisectoral strategy that not only addresses the physical rehabilitation of individuals, but also is designed to ensure that certain basic needs are met, poverty reduction is promoted and human rights are fulfilled. Under certain conditions, it is estimated that 80% of rehabilitation needs could be met through the use of CBR (DFID, 2001, p. 10).
Examples from PRSPs
PRSP Armenia, 2003, p. 68:
"Social assistance to the elderly and handicapped: Social assistance programs for the elderly and handicapped are derived from the legislative requirements stipulated in the Law on The Social Protection of Handicapped People in Armenia. These include the prevention of disability, medical, and social rehabilitation and prosthesis, in particular, prosthesis and orthopedic assistance to the handicapped, provision of rehabilitation accessories, social service to single senior citizens and the handicapped."
PRSP Azerbaijan, 2003, p. 11:
"The Disabled
Apart from social benefits to the disabled the main policy direction is to integrate as far as possible the disabled into society. […] Rehabilitation services and centres will be developed, with special emphasis on providing services in the regions."
PRSP Ethiopia, 2002, p. 127:
"Promote community based rehabilitation programmes for disadvantaged groups (elderly, handicapped, commercial sex workers, street children, orphans etc., with full participation of target groups and the surrounding communities, CBOs and NGOs."
PRSP Honduras, 2001, pp. 88/89:
"Provide integral assistance to poor persons with disabilities, through the following actions:
- Create the National Disability Council, with the participation of public and private institutions and associations of persons with disabilities, which will coordinate, direct and guide actions related to integral rehabilitation in Honduras.
- Create the Technical Unit for Integrated Rehabilitation to support for the National Disability Council in creating and implementing the National Policy, the National Plan and the agreements of the Council. A National Information System for persons with Disabilities should also be established.
- Create and implement at local level, integration and rehabilitation plans for persons with disabilities."
More information
ILO, UNESCO and WHO (2004): CBR: A Strategy for Rehabilitation, Equalization of Opportunities, Poverty Reduction and Social Inclusion of People with Disabilities. Joint Position Paper 2004.
Community-based Rehabilitation Network (South Asia): http://www.cbrnetwork.org.in/
International Society for Prosthesis and Orthotics (ISPO): http://www.ispo.ws/
ISPO (2006): Prosthetics and Orthotics. Programme Guide. Implementing P&O Services in Low-income Settings.
ISPO (2006): Prosthetics and Orthotics. Project Guide. Supporting P&O Services in Low-income Settings.
World Health Organization Disability and Rehabilitation (DAR) Team (August 2001): Rethinking Care from the Perspective of Disabled People: Conference Report and Recommendations.
WHO Disability and Rehabilitation (DAR) Team
Department for International Development (2000): Disability, Poverty and Development. DFID Issues. London, February.
