Materials : Country/Review PaperPoverty Reduction
Community Based Work
with People with Disabilities
in Cambodia
Ngy San
Deputy Director and Programme Manager
Disability Action Council
Cambodia
1. Introduction
This paper is prepared to share information on Community Based Work with
People with Disabilities at the workshop on “Community-Based Rehabilitation
and Poverty Alleviation of Persons with Disabilities”, 05-06 July 2005,
organised by the United Nations Economic and Social Commission in Asia and
the Pacific (UNESCAP). This paper describes the situation of people with
disabilities in Cambodia and some programmes involved in community based
work.
2. Situation of People with Disabilities
Cambodia has an extremely high proportion of people with disabilities but
it acknowledges that there is no reliable data and statistic on the exact
numbers of persons.
According with the government sources, there are only 2.4 % of the total
population who have a serious physical disability.[1]
The total number dropped to 1.5% in 1999 without clear explanation.
Using the international average to make a rough estimate that in Cambodia
there are a minimum of 1,003,400 or 9.8 percent
[2] population( of the total
population 13.77, NIS 2003) who have significant physical or mental
disability which affects their ability to function independently.
Based on the most recent findings of a United Nations Survey, the
Disabled Persons total approximately 1.4 million or 15 percent of the total
population of Cambodia.[3]
People with disabilities are perceived in Cambodian culture and the
Buddhist religion as persons repaying a sin in their previous life. Taken as
a whole this means both physical and mental disabilities carry a stigma.
Cambodians with disabilities are amongst the poorest in any community unless
they have a family that is both willing and able to support them.[4]This
often results in a sense of guilt and social stigma that increases the
exclusion experienced by most persons with disabilities. People with
disabilities are marginalized within Cambodia and are often excluded from
mainstream community development.
Although there are many NGOs working in the disability sector most are
focused on rehabilitation, but do not assist people with disabilities to
identify the main causes of their situation, and encourage them to find
their own solutions. This is changing slowly. A sense of hopelessness,
loneliness and a lack of affection from families, relatives and friends,
compounded by isolation are common problems among persons with disabilities
in Cambodia. Even those with the capacity and skills to enter mainstream
society are generally not provided the opportunities to do so and often
resort to begging, and/or become alcoholics and engage in anti-social
behaviour.
People with disabilities are one of the most vulnerable and poorest
groups in Cambodian society. They are generally the poorest among the poor
with very limited access to basic social services, education, vocational
training, job placement, and income generation opportunities, thus
exacerbating their poverty. Many organisations view disability as a
condition of occupational disadvantage that can and should be overcome
through a variety of policy measures, regulations, programmes, and services.[5]
A major factor restricting the full participation and equality of people
with disabilities are the perceptions and practices that prevent them from
functioning as full members of society. Often the abilities of people with
disabilities are not recognised. They face social and economic
marginalization, discrimination, and have very limited access to resources.
Therefore, they find their opportunities for full and equal participation
limited. Public awareness, outreach and mass education campaigns, as well as
efforts to mobilise the private sector and communities to support the
prevention and reduction of discrimination are almost non-existent.
The need to remove social stigma to allow the full reintegration of
people with disabilities into Cambodian society is a long-term issue, which
will require a co-ordinated and global approach. The approach must not only
aim to remove the causes leading to disability, but must also strengthen
training and work opportunitiesfor persons with disabilities, and increase
their social rights, acceptance and dignity. Reintegration must involve
empowerment of people with disabilities at the community so that they can
fulfil their own potential and contribute to the rebuilding of their own,
family, community and country. Among persons with disabilities, some groups
have been more marginalized than others, including women, girls and children
with disabilities.
3. Community Based Work with People with Disabilities
There are models for their ‘rehabilitation’ or ‘special care’ of people
with disabilities in most parts of the world. Community based work with
people with disabilities is increasingly recognised throughout the
developing world as the most appropriate and sustainable approach for the
equalisation of opportunities and inclusion of people with disabilities in
the mainstream development.
However until recently these programmes have also been exclusive in the
sense that they provide assistance to the person and perhaps the family of
the person with the disability but do not include the wider issues of the
overall problems within the community for all those who could be seen as
vulnerable groups also.
This is being recognised as an issue and is slowly being addressed by
encouraging mainstream activities in the community to also include and
involve persons with disabilities. In essence to promote and educate those
involved with community development (both donors programme implementers and
people with disabilities themselves) to realise the full potential and
abilities of those in the community who have disabilities and to accept and
encourage the community to appreciate this too.
The term Community Based Work (CBW) was chosen by representatives from
the sector in Cambodia to describe this type of approach in a simple and
unambiguous way. It embraces the term Community Based Rehabilitation (CBR)
and can include those persons with mental health issues who do not require
rehabilitation but medication and an understanding that the condition is
treatable.
Furthermore, CBW excludes the word ‘rehabilitation’ which suggests a more
technically oriented concept of work with people with special needs.
In Cambodia CBW has been the chosen approach of most of the agencies
working with people with disabilities. Some works with specific types of
disabilities, women with disabilities or children with disabilities. Others
include all age groups and types of disabilities. Despite the heterogeneity
of the agencies, certain aspects of their work are agreed within the sector
to be fundamental to community work with people with disabilities.
These core common elements are included:
- Raising awareness on
disability issues at individual, family, & community level
- Promoting self esteem
and capability of people with disability
- Promote inclusion of
people with disability within the community
- promoting opportunities
for skill training, job mentoring and employment
- Referring on and making
links between people with disability and agencies (Government & non
Government)
- Providing family
support with start up loan or grant
- Promoting income
generation of individual people with disabilities as well as their families
4. Challenges ahead to overcome
Gaps in services for Community Work with Disabled people (CWD) exist both
in the geographical areas covered and in types of services provided.
4.1. Geographical distribution of services
Most CWD agencies are generally working in central, southern and some
western provinces. However, they are mainly only working in districts close
to cities or towns and in secure areas with good road condition. It is
difficult to get access to some areas because of lack of security, poor road
conditions and large distances. This prevents many people with disabilities
living in rural areas from benefiting from programmes.
The areas with no access to CWD projects are:
- All former Khmer
Rouge areas, such as Pailin, Samlot in Battambang, Anlong Veng in Oddar
Meanchey province and Veal Veng in Pursat province
- Northern and
eastern areas such as Kampong Thom, Rattanakiri, Mondolkiri, Kratie, Stung
Treng province
4.2. Type of services
Major gaps have been identified in the following types of service:
Access to credit for people with disability: At this moment most CWD
agencies are not providing credit to people with disabilities. In the past
more agencies provided credit but they have now stopped because of lack of
funds for this kind of project. The interest rates of mainstream credit
agencies are so high that people with disabilities cannot access credit from
them. A further problem is that people in the community often do not allow
people with disabilities to join their credit group because they do not
trust them to repay the loan to the group.
People with certain types of disability: People with learning difficulty,
HIV/AIDS, mental health problems are being ignored because of a lack of
awareness of these kinds of disabilities, and/or lack of knowledge to work
with, or train, people with these types of disabilities.
Skill training for specific groups: Most deaf and blind people living in
rural areas do not have basic education or special training such as Braille
and signing. They are excluded from mainstream development as well as from
skill training provided by agencies in the disability sector. For deaf
people, the situation is made worse because most people do not know how to
communicate with them.
Employment opportunity for people with disabilities: Most employers are
reluctant to employ people with disabilities because they do not meet their
criteria due to lack of education and experience.
Skill level of CWD workers: Agencies are using different methodologies in
how to work with people with disability in the community. Some field workers
have limited and basic skills in terms of community based work.
There is one further area in which the work of CWD sector might be
strengthened. This concerns membership of CWD committee. Some CWD agencies
are not motivated to send their representatives to this Committee. Some
representatives do not come to the meeting regularly because they are very
busy with their own work.
CWD staff and programmes face particular constraints of accessibility. In
the past widespread coverage has been impossible due to political
instability. This is improving, but certain problems remain:
- Security – landmines,
robberies, kidnapping, insufficient staff to travel in pairs
- Transportation – poor
roads, weather conditions, large distances, lack of vehicles
- Lack of co-operation
with local authorities – local politics, lack of transparency, expectation
of gifts
- Decreasing of funding
due to many donors have changed their priority
5. Recommendations
- CWD should expand programmes to reach all people with
disabilities in remote areas to cover more areas.
- CWD agencies should consider starting loan projects
for people with disabilities
- CWD agencies need to promote the inclusion of people
with disabilities into the mainstream of community development programmes and their credit schemes
- Community work with disabled people should be more
comprehensive and reach people with other kinds of disability
- Develop capacity building for people with
disabilities in the community
- Increase appropriate training opportunities
- Expand sign language training for deaf people
- Provide awareness to the community on special needs
for deaf and blind people
- Raise awareness of disability issues among potential
employers
- CWD agencies sector should provide more jobs
opportunities for people with disabilities
- A community work training module is needed which recognise common core skills and provides further training as needed (see Component 10.2 –
Training Community Based Workers for details)
- Lobby the head of CWD agencies to send their
representatives to this committee, and to recognise participation the committee as an integral part of their CWD work.
6. In conclusion
It is essential that we steadfastly promote the inclusion of all
vulnerable groups in the mainstream activities of community development.
How can we expect our communities to live and work together to be a
community and develop community spirit and a sense of solidarity , if we
ourselves in an effort to bring poverty levitation to our society are also
selective in who we include and encourage to participate in community
development activities.
7. Cases study from CARITAS rehabilitation for blind Cambodians
7.1. Hem Sokheoun
Hem Sokhoeun is 40 years old and blind, she lives with her husband and
three children at Takmao, a district of Kandal province on the outskirts of
Phnom Penh. Her family is poor; Her husband is a motordup (motor taxi)
driver. He earns about 5000riels (equivalent to 1 US$ and 25 cents) a day
and this not enough to support the family even for daily eating. The CBR
field worker found her in the village in 1997 and started to work with her
and provide the appropriate training in order to improve her life as well as
her family. They lived in a small house that was nearly falling down. After
the training, she can cook and do everything a housewife can do by herself.
She has planted some vegetables around her house then taken them to the
market with her daughter. She received a loan from CBR to raise a cow,
because there is a lot of grass near her house where she can feed the cow
easily. She collects all the leaves then puts it in a silo for compost. This
family has no farmland. Hem Sokhoeun had paid back the loan in full and the
cow has continued breeding a baby cow.
Hem Sokhoeun`s life with her family has changed and improved. In 2002,
she have got 2000$ from selling 4cows and other savings to build a new
house. She still has 2 cows and grows vegetables around her house. Her
husband still works as a motordup and her 3children are at school.
7.2. Ron Rorn
Ron Rorn is 30 years old; now he is living in Ponhea leu district of
Kandal province. He blinded by mine injury when he was a soldier. He lives
with his wife and seven children who are all young. He goes to the lake with
his young brother every evening to fish by boat with a fishing net. His wife
carries the caught fish to sell. When the rice season comes he, sometimes
goes to the field. He spent a lot of money on the farm, but the result is
not enough for the requirements of his family, so he had to borrow some
money from the neighbours to fulfil the shortage. According to these
problems field worker considered that we should give him a loan for buying a
cow in order to have means during cultivation seasons in the future.
7.3. Uk Tha
Uk Tha is a boy of 14 years old; he got blind from measles since he was 3
years old. He has grown up with blindness. Uk Tha is only son in a farming
family, which there are 6 people in his family, his parents and other 3
sisters. Uk Tha is a clever boy, he can do similar things compare to similar
age of children and he usually play with other children as well in his
village. Uk Tha does not go to any school because there is no school
available where he is living. First meeting with Caritas staff, Uk Tha would
ask for a cow to raise for his own. After the period of counselling and
motivation with some kinds of appropriate training from Caritas staff then
he got a cow from Caritas loan. Uk Tha look after his cow very well such as
lead the cow to the field and back to the house, clean the cattle and feed
the cow .etc.
[1] Socio economic Survey of
Cambodia, MoP/NIS, 1996
[2] Asian Development Bank
(FIT 2002)
3 United Nations and Disabled Persons, Bangkok, 1999
4 Dana Peebles, Women and
Vulnerable Groups Strategy Planner, 1997
[3] Country Profile, Study on Persons with Disabilities (Cambodia),
supported by JICA, DAC Secretariat, Feb 2001
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