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UN
ESCAP/CDPF Field Study cum Regional Workshop |
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Programme :Poverty, Disability and Community Based Rehabilitation (CBR) Programme
Disability and Rehabilitation (DAR) Team Like everyone, the needs of persons with disabilities are same but to access it, some might need some extra assistance. They are also part of this society and are protected by Universal Declaration of Human Rights. Like every other field, there are also lot of positive changes even in the field of disability and rehabilitation since last world war and lots of efforts have been made by various stake holders to ensure people with disabilities have equal rights and lead a good quality life. Despite of these efforts, the process of changes are very slow and outcome is not very satisfactory. An estimated 10% of the world’s population - some 600 million people - experience some form of physical, sensory and intellectual disability. The most common causes of disability include chronic diseases such as diabetes, cardiovascular disease and cancer; injuries such as those due to road traffic crashes, falls, landmines and violence; mental illness; malnutrition; HIV/AIDS and other infectious diseases. The disabled population is growing as a result of factors such as population growth, ageing and medical advances that preserve and prolong life. Lack of access to health services also causing lot of disabilities for example an estimated 45 million people worldwide are blind and every year, an additional 1-2 million persons go blind but more than two-thirds of this blindness is treatable and preventable. These trends are creating overwhelming demands for health and rehabilitation services, for immediate environmental changes, and most importantly for attitudinal change. Even today, in many countries, people with disabilities and their family members are fighting to survive, to access basic needs and then to lead a meaningful life. For the majority of people with disabilities and their family members, the root problem is poverty. Poverty is commonly seen as an economic deprivation – lack of income but it has much more deeper causes and consequences. According to UNHCR, Poverty is a human condition characterized by the sustained or chronic deprivation of the resources, capabilities, choices, security and power necessary for the enjoyment of an adequate standard of living and other civil, cultural, economic, political and social rights. People with disabilities and their family members have less opportunities and are deprived of basic human rights – the right to health, education, housing, food and safe water, right to an adequate income and the right to lead a quality life. In any community often the poorest of the poor or people who live under chronic poverty, are people with disabilities and their family members. "Poverty reduction and human rights are not two projects, but two mutually reinforced approaches to the same project" It has been estimated that people with disabilities make up about 20% of the poor in developing countries. There are unique and strong linkages between poverty, illiteracy, poor health care, disability and exclusion is well established. Poverty increases disability and at the same time disability increases poverty especially in poor families. People living in poverty are more likely to acquire a disability than others. People with disabilities living in poverty often put aside their health and rehabilitation needs to sustain a livelihood. It results ultimately in long term consequences such as loss of function and ill health resulting in chronic conditions and premature death. The most vulnerable are women and women and men with severe or multiple disabilities. WHO believes that better health provides an exit route to poverty and that an investment in health, is an investment in economic development. It has been proven that both poverty and poor health care are the major reasons for soaring up the disability number worldwide especially in developing countries. Poverty leads to poor healthcare and which ultimately leads to greater poverty. Poverty increases disability, and at the same time, disability enhances poverty especially in poor family. People living in poverty are more likely to acquire disability than others. World’s poorest group caught in this vicious cycle. For people in poverty, many initiatives have taken place in the last five decade. Most of these, unfortunately are vertical development programmes ignoring poverty. For examples, health personnel concentrated on health, rehabilitation personnel on rehabilitation often medical rehabilitation, teaching personnel on education without realizing people with disabilities especially who are poor to them, "Poverty is the primary issue and rest all is secondary". Experience says that community will not be interested in any other development programme if one does not address the primary problem - problem of "Poverty". Realising the urgent need, to eradicate extreme poverty and hunger and to provide greater access to education and health care, the UN Millennium Development Goals (MDG) have been introduced as an important long term development assistance tool to ensure livelihood, education and good health for people who are living in poverty. There are 8 important MDG’s, 18 targets and 48 indicators to benefit the poor, but there is no mention about people with disabilities. All major development initiatives often fail to include people with disabilities as a target group. In 1969, WHO defined ‘Rehabilitation’ for people with disabilitiesas ‘the combined and coordinated use of medical, social, educational and vocational measures for training or retraining the individual to the highest possible level of functional activity’. Rehabilitation is seen as a first step towards enhancing the quality of life of people with disabilities through a multi-sectoral effort. It was also perceived that those who have access to appropriate rehabilitation services can more successfully alleviate their poverty, meet their basic needs and access equal rights including rehabilitation services. Following second world war, rehabilitation was seen as a specialised service and few institutions, mostly located in capital or major cities, were set up to ensure rehabilitation services for all who needed them. It was soon realised that these services are inadequate and often in appropriate. In 1978, Alma-Ata declaration defines Health as "a state of complete physical, mental and social well being and not merely the absence of disease or infirmity". It also stated to ensure "Health for All", Primary health care should be preventive, promotive, curative and rehabilitative. Following the declaration, there was a realisation about the need for a shift in emphasis from city-based institutions/hospitals to local communities in order to reach the un-reached. A Community Based Rehabilitation (CBR) strategy was developed as a natural consequence of the Alma Ata declaration and from the realisation that for rehabilitation to be successful ‘Communities must recognise and accept that people with disabilities have the same rights as other human beings, so community involvement is essential’. Though CBR was perceived as a part of general community development but the most important development instruments Millennium Development Goals remained silent on disability and importance of including disabled people and their families in these important initiatives. Possible reasons could be:
Many positive changes have taken place since the CBR approach was first introduced in the early 80’s. Now CBR has been adopted as a national strategy for reaching people with disabilities in many countries. Along with the quantitative growth in CBR services, there have been major changes in the way CBR has been conceptualised and implemented. The focus of CBR has expanded towards more comprehensive multi-sector approaches such as access to health care and rehabilitation, education and training, income and participation/inclusion. CBR was further developed as a strategy within general community development for rehabilitation, equalization of opportunities and social inclusion of people with disabilities. The comparative newer terms what are being used today, all are part of an ideal CBR programme like Community development, social capital, empowerment, Human rights, access to information and basic need, inclusive education, health and rehabilitation, open job market, inclusion etc. Recognising the fact that 25 years of practice has enriched people's knowledge and understanding of CBR, WHO organized an International Consultation to Review Community Based Rehabilitation in Helsinki in 2003 involving all stakeholders. The Report of International Consultation to Review CBR (2003) has identified the following aspects as needing to be strengthened to make CBR more effective:
It was unanimously agreed that poverty is the big issue for the majority of people with disabilities and their family members. It was highlighted that a disability dimension needed to be included in all poverty reduction strategies. All national development programmes especially poverty reduction strategy programmes need to make a specific effort to ensure the benefits from such programmes reach the poorest of the poor - people with disabilities and their family members. In order to strengthen those aspects identified during the international consultation and in preparedness for the proposed United Nations ‘Comprehensive and integral convention on the protection and promotion of the rights and dignity of persons with disabilities’, WHO is now taking various measures for Strengthening Community Based Rehabilitation (CBR) Programmes with a focus on poverty alleviation, rehabilitation and equal rights. Most importantly, WHO believes that these measures will enhance the capacity of Member States and CBR implementers to ensure the benefits of the Millennium Development Goals reach people who live in chronic poverty. It is a well-established fact that all communities are different in terrain, culture, their political systems, socio-economic conditions and many other factors. Therefore, there cannot be one model of CBR for the whole world. It may not be the same even within the same country. There are many models of CBR programmes, each unique to its own situation. This is the uniqueness and at the same time the challenge of CBR programmes. However, from experience, it is realised that CBR approach is the approach, which can meet the basic needs of the people with disabilities and can ensure of accessing human rights. WHO with other UN agencies and key stakeholders are developing new sets of action plans which will ensure the benefit of Millennium Development Goals and Poverty Reduction Strategy papers reaches to the poorest of the poor - the people with disabilities who are living in chronic poverty. An organogram of CBR to alleviate poverty and accessing human rights are as follows: For any queries, Please contact: Disability and Rehabilitation Team
Long description of the organogram of CBR: |
