EXECUTIVE SUMMARY

PROJECT INS/99/D26:
TRUSTFUND FOR THE DISABLED :

Evaluation of Community Based Rehabilitation
for the Disabled in Indonesia*

I. BACKGROUND

Indonesia is the fourth largest country by population. The country consists of 17 000 inhabited and uninhabited islands. If we follow the WHO criteria, the country with its 203 million population in 2000, has more than 20 million people with disabilities. The Government of Indonesia indicates that the number of the people of disabilities who require rehabilitation services is 3,11 % of the total population, or around 6 million in number.

In cooperation with UNDP/ILO, the Government of Indonesia (GOI) represented by the Ministry of Social Affairs, launched a series of projects on community-based rehabilitation (CBR) for the disabled people since 1979. The three consecutive phases of the projects were respectively the INS/79/023, INS/82/011 and INS/88/020 - "Community-Based Rehabilitation for the Disabled". The projects aimed to strengthen the capacity of the GOI in developing community-based rehabilitation infrastructures and mechanism at grassroots level.

Phase I, project INS/79/023 has successfully initiated the establishment of the first four community-based sheltered workshop & vocational training center or the Loka Bina Karya (LBK), respectively at Palembang (South Sumatera), Probolinggo (East Java), Praya (West Lombok, West Nusa Tenggara) and at Gowa (South Sulawesi). The LBK which was initiated and only four in number in 1979, has now been multiplied into 273 in numbers at the end of 2000.

Phase II, project INS/82/011 has been very instrumental in strengthening the rehabilitation institutions and its human resources, especially through the establishment of a permanent training facilities in the premises of "Prof.Dr. Soeharso Rehabilitation Center" at Solo. 45 batches of training for different rehabilitation personnel were conducted during the project life, to cover the directors and managers of all rehabilitation centers for the disabled, the managers of the LBKs, sub-district social affair officers (PSK) and manager of the small business /cooperatives of the disabled (KUP PC, this term was later to be terminologically uniformized into KUBE).

While the closing phase III, project INS/88/020, emphasized on the empowerment of small business entities of the disabled, and the provision of cheap and appropriate prosthetics for rural disabled people. A special cooperation has been developed between the Solo "Prof Dr Soeharso Rehabilitation Center" and the Jaipur Rehabilitation Center, a center in India which is known with its cheap and very practical rubber prosthetics. A special "credit guarantee scheme" was provided by the Bank BRI for selected small business group of the Disabled (KUP PC), whereby an amount of guarantee fund was deposited by UNDP.

The success initiatives of the UNDP/ILO assisted project, especially the establishment of the first four Loka Bina Karya and the strengthening of the rehabilitation centers, was subsequently followed by the Japan Overseas Economic Cooperation Fund (OECF) and the Japan International Cooperation Agency (JICA). The Japanese development agencies provide further support to the rehabilitation centers and the LBK, especially in vocational experts, in appropriate vocational technologies and equipment, including building reconstruction.

Furthermore, the success of the Indonesian CBR for the disabled has long been utilized for a training ground on CBR under "technical cooperation among developing countries" (TCDC). Under the coordination of the Coordinating Committee for International Technical Cooperation (CCITC), the Cabinet Secretariat, groups training for rehabilitation personnel from Africa, West and South Asia, South East Asia, Latin America and South Pacific, has long been organized every year for respectively two months period.

However, as time went by and as the environment changed gradually or drastically, the CBR activities has to encountered with some internal as well external problems, including the current monetary crisis, which very likely influence its effectiveness. Therefore, with the support of the United Nations Trust Fund for the Disabled, ISDS jointly with the Ministry of Social Affairs (which was then deleted under President Gus Dur regime, and reorganized into he Social Affairs National Coordinating Board or BKSN, but was later re-established under President Megawati), take the initiatives to review the current status and the effectiveness of the CBR program. The review project aims to review the effectiveness of the current CBR program, to find out the roots of the courses of the ineffectiveness if it does occur, and provide recommendations on promotional measures required.

II. OBJECTIVES

To evaluate the institutional capacities of the community-based rehabilitation for the disabled program and its support network, the effects of the current monetary crisis, and to define the promotional measures and policy recommendation required for the continuation and promotion of the rehabilitation services.

Specific objectives :

To review the effectiveness of the community-based rehabilitation services provided by the community-based rehabilitation infrastructures.
To review the effectiveness of the internal and external support system to the community-based rehabilitation services for the disabled.
To evaluate the effects of the current monetary crisis to the sustainable livelihood of the disabled.
To provide measures and recommendations required for the promotion and sustainability of the community-based rehabilitation for the disabled services.

III. ANALYSIS

1. Effectiveness of CBR infrastructures.

The CBR program which was initiated jointly by the Ministry of Social Affairs and UNDP/ILO, was indeed a remarkable break through in providing rehabilitation services for the disabled, especially those residing in remote areas. However, there has been confusions in understanding the community-based rehabilitation concept and its strategic approaches.

The Ministry of Social Affairs defines that the outreach institutional services emanating from the rehabilitation centers which is known as "mobile rehabilitation unit" (MRU), and the non-institutional services provided by the PSM (indigenous social development workers), PSK (sub-district social officer), LBK (community-based sheltered workshop for the disabled) and KUBE (small business group of the disabled) are community-based rehabilitation services or CBR. Confusion also takes place on the community-level services and community-based rehabilitation services. The bias in understanding the CBR concept has hampered the implementation of the original spirit of the CBR which has to be a bottom up and people centered approaches, involving the persons with disabilities themselves, their families and communities in a certain localities.

It is clearly noted that the PSK is a social affairs officers designated at sub-district level, while the LBK is a governmental entity with full personnel and budgetary support from the central government administration.

The first generation of PSM were trained during the REPELITA I (1974 - 1979). While it was apparent that the PSM are very instrumental in rendering the day-to-day CBR services to the disabled persons at the village level, but there is no clear information on the current status of the former generations of PSM. A number of 23 730 PSM have been trained since 1974, but no information on the degree of their individual continued services in the CBR activities. The situation will undermine the future sustainability of the CBR services.

The PSK, currently 1354 in numbers, are the government front liner of the CBR services. Despite their minimum understanding in disability-related issues and facilities, they indicate their dedication to support this program.

The KUBE, the "small business group" of the disabled, is the core of the CBR economic activities. Currently 4 481 in numbers, the KUBE were predominantly developed by the government facilitation, in terms of the training for the KUBE members / chairman and provision of seed capital to start up the small business.

Despite the goodwill from the government in facilitating the establishment of the KUBE, but the predominantly government facilitated KUBE, will undermine the development of the entrepreneurial, self reliant and competitive spirit. Moreover, the uniformity of the skill training has reduced the capacity of the disable persons to develop the right business commodity which suit their market environment.

Considering the levels of decision making and it approaches, it is strongly recommended that the CBR has to take precautionary measures in the empowering of the groups at the community level, including the promotion of institutional and entrepreneurial capacities.

Meanwhile, the Loka Bina Karya, which is an intermediate level support system in the development mechanism of the CBR, has not been able to develop its entrepreneurial function and promote its role as the focal point of the productivity network for the KUBE at the community level.

2. Effectiveness of internal supports system.

By design, the "mobile rehabilitation unit" or "Unit Pelayanan Sosial Keliling (UPSK) should have a very important role to disseminate early detection and rehabilitation services to the people with disabilities in remote areas. However, the very short and ad hoc visit of the UPSK, with nationally standardized services, has in fact made the UPSK much more a sympathetic, charitative and instant touch instead of providing systematic rehabilitation services.

The budget allocation (Rp. 8 000 000.00 or equivalent to US $ 1000 per operation cycle), despite the support of a comprehensive professional team, could not really fulfill the coverage and magnitude of the disability cases. Moreover if the activities are to be implemented on a "project" approach, which usually has a more physical target orientation.

The rehabilitation centers for the disable person have a more permanent and structured organization. Therefore the rehabilitation centers are playing the most important role in support the CBR. The most important role is to train qualified disabled human resources that are ready to undertake self help entrepreneurial activities at the community level. There are many success stories of persons with disabilities trained by the centers.

3. Effectiveness of external support system.

The Puskesmas (Sub-District Health Center) does not provide specific measures to the person with disability. Puskesmas is not a rehabilitation unit, but focus more its services to curative and preventive aspects. As a basic health services provider at sub-district level, a Puskesmas simply provides general services to all community members, regardless they are normal or disabled.

The Balai Latihan Kerja (BLK or Vocational Training Center), under the Ministry of Manpower, is to be provided with more advanced vocational training facilities. Therefore in many cases, they provide additional vocational capabilities to persons with disabilities, including those who have basic vocational skills provided by the LBK and rehabilitation centers.

A Memorandum of Understanding between the Ministry of Social Affairs and the Ministry of Manpower has already been signed. However, the implementation of the document at the field level will not take place automatically, but rather need special local creativity, because each BLK has their respective vocational priority.

With regards the NGOs, it was noted that only a small amount of NGOs indicated their interest in rehabilitation of the disabled. Out of 25 NGOs contacted, 8% only indicated their interest in rehabilitation for the disabled issues and programs.

The significant involvement of special education with the CBR is very low for two reasons. First, that the special education only focus to basic formal school curriculum, and second, the special education are mostly located in the district capital cities.

4. The effect of the current monetary crisis.

The current monetary crisis has significantly affected the KUBE and the continuation of the CBR in general. However, the monetary crisis was not the only affecting factor. The low entrepreneurial spirit of the CBR components, namely the LBK, KUBE, PSK and PSM is another factor, because the CBR itself is a predominantly government initiated and facilitated program.

IV. HUMAN RIGHTS AND REGIONAL AUTONOMY

The first degree of the human right of the disabled is the recognition of their individual right as a community member and civil society. Just like in the rest of the world, this process is taking place gradually. The enactment of the UU No. 7 (1997) on Disable Person and PP No. 43 (1998) on the Promotion of the Welfare of People with Disabilities indicate the recognition of the basic right of the disable person.

However, the recognition of the first degree of the human right will mean nothing if this spirit could not be materialized at the real daily living situation. Therefore, the second degree of the human right is the fulfillment of their basic need, especially their access to fulfill their need for foods, housing, education, job opportunity, education et cetera. Despite the government efforts to provide the basic need services, more disable people are in fact still untouched by the services due to budgetary and infrastructures limitation.

There is an urgent need to redefine the concept of CBR into a more bottom-up approach, instead of the top-down and predominantly government facilitated approaches. The common misunderstanding that non-Panti approach, which in fact is an out-reach and extension services of the Panti, is equal with CBR, has to be redefined in order to integrate the first and second degree of the human right of the people with disabilities.

The enactment of Public Act No. 22 (1999) on Regional Autonomy has the following serious implications to every effort in promoting the welfare of the disabled:

First, to what extend the existing national policy framework, if this has already been well defined by the central authorities, could really be well interpreted, absorbed, elaborated and implemented at the district or municipality levels.
Second, to what extend the people with disabilities could be really integrated to the mainstream mobilization of the civil society.
Third, to ensure that the local authority will really provide equal opportunity and services to the persons with disabilities, and not to regard them as unproductive community members and will be considered as not a regional development priority.
Fourth, the implementation of the CBR programs administered by the central authorities so far, give some lesson learned which refer to several precautionary measures, which have to be undertaken at regional level, especially with regard to the availability of clear and well documented regional policy guidelines, the empowerment of local community self help organization and its networks, and the provision of support access to the self help efforts. Otherwise the CBR will be considered as "voluntary" charitative program which could be or not to be implemented by the local authority.

V. CONCLUSION & RECOMMENDATIONS

CONCLUSION

The implementation of the community-based rehabilitation program under the Government of Indonesia - UNDP/ILO cooperation, respectively the projects INS/79/023, INS/82/011 and INS/88/020, was indeed a break through and important mile stone in the history of rehabilitation of the disabled, not only nationally, but also internationally. The Indonesian achievements in the CBR have been well noted by international rehabilitation community through the "technical cooperation among developing countries" training program facilitated by UNDP.

The initiation of the program in 1979 and its continued implementation up to early 90's, is really worth noted and an interesting ground for further review and studies for several reasons. The long duration of its implementation, which encountered several changes in the community at macro and micro level, is subject to further review and evaluation for redesigning the required policy and operational approaches and its guidelines.

However, despite its remarkable and historical achievements in the CBR-related program, but it need continuos adjustment to the changing situation occurring at the macro and micro level, very especially the current monetary crisis. Otherwise the CBR program will lost its historical momentum.

The review indicates that the CBR break-through which was successfully made some 20 years ago could not sustain its effectiveness. There are some internal and external factors which influenced the inefficiency, and accordingly there are some corrections and promotional measures have to be undertaken in order to regenerate the CBR concept and its further operations.

Grateful to the United Nations Department of the Economic and Social Affairs (DESA) at the United Nations Secretary General Office, who provided the financial assistance required for this study. The financial assistance which come from the Trust Fund for the Disabled, we are aware, has to be effectively used for the purpose of promoting the future implementation of the CBR program in Indonesia, which we believe will eventually benefit the international community of the disabled.

RECOMMENDATION

1. Redefinition of CBR concept.

The overall CBR concept, moreover in the spirit of the enactment of the Public Acts on the Rights of Persons with Disabilities, on Human Rights and on Regional Autonomy, has to be redefined, by means of changing its strategic approach from top-down and predominantly government supported, into a bottom-up and community-group based approach. Special empowerment measures have to be undertaken especially at group, community and locality levels. The provision of the services of the indigenous para-professional facilitator (PSM) has to be reassured. Promotional measures in commitments and entrepreneurial skills for the PSK, KUBE and LBK have to be made, i.e. through localized training, apprenticeship or benchmarking program.

2. Internal support system.

Rehabilitation center has basically very important role in preparing and dispatching skill disabled workers to the community. There are strong evidences on the individual success of the disabled workers in self-help activities. However, continued attention and competitive support for the placement of the disabled workers is required.

Instead of keeping the ad hoc operation and functions of the UPSK as it is now, which is much more for providing charitative, instant and initial approach to the disabled in remote areas, it would be wise to stop its operation, and shift its function for strengthening the out-reach extension services of the rehabilitation centers. This kind of decentralization approach is very much relevant to the spirit of regional autonomy.

3. The role of external support system.

The integration of the former Ministry of Social Affairs (BKSN) with the Ministry of Health, which hopefully will bring about a synergetic process, undoubtedly is a good start for empowering the external support system. Again the spirit of the regional autonomy, requires, that the empowerment and networking efforts are to be made at local or district / municipality levels. The role of NGO is important, including as catalyst in this synergetic networking.

4. Human rights aspect

The human rights of persons with disabilities as disadvantaged group who are mostly in productive minus conditions, is heartfelt and more sensitive issue as compared to those of the normal people. In addition to the promotional measures which need to be applied in the CBR-related system, in-depth and continued studies from different perspective of human rights need to be undertaken. CBR program in Indonesia, which has been so far well noted internationally through the technical cooperation among developing countries (TCDC) program, could also simultaneously promote the human rights performance and image in this country.

5. Regional Autonomy and its challenges.

The implementation of Public Act (UU) No. No. 4 (1997) and Government Regulation (PP) No. 43 (1998) has to be directed in support to the implementation of UU No. 22 (1999) and PP No. 25 (2000) on Regional Autonomy. Adequate communication, information, socialization and proper policy as well as technical guidelines have to be sufficiently developed. In the meantime, a new paradigm in partnership between the local government authorities, the private sectors and the civil society, which is much more easily to be implemented at operational and basic needs level, has to be proactively pursued. The empowerment of the business-oriented or entrepreneurial aspect of the CBR programs has to be strongly addressed, in order to directly promote the income generating capacities of persons with disabilities, and indirectly support the empowerment of the fiscal management (pendapatan asli daerah or PAD) of the local administrative.

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* Presented at the "Expert Group Meeting on Persons with Disabilities", Jakarta, 15 - 17 January 2002, by Dr. Sudibyo Markus, Chairman, Board of Directors, Institute for Social Development Studies (ISDS). Markus_sudibyo @ rgmi.com; isds2020 @ yahoo.com