音声ブラウザご使用の方向け: SKIP NAVI GOTO NAVI

CONCLUSIONS AND RECOMMENDATIONS

Based on the analysis of the different CBR programme initiatives in this study the following recommendations are made:

Awareness-raising

CBR programmes have been successful in raising awareness. However, improvements can be made. Awareness-raising initiatives should:

  • Systematically engage persons with disabilities themselves as advocates because the most powerful advocacy tools are living examples of success and personal stories about discrimination and how to overcome it.
  • Evaluate the local situation and target the most influential people (those who have power and/or money). In many cases key change agents in the community are schoolteachers, religious leaders, community leaders, elders, etc.
  • Always be specific about the tasks of the change agents.
  • Use media as a tool - especially radio.
  • Use drama as a tool to make prejudices visible.

Medical care

CBR programmes have not yet been able to make a difference concerning medical care for persons with disabilities. CBR programmes should give more priority to influence health authorities to take their responsibility as stipulated in the Standard Rules on medical care. CBR programmes should increasingly challenge and support the health authorities:

  • To improve competence and capacity of primary health care to make early interventions, correct diagnoses, treatments and referrals.
  • To make referral specialists accessible at regional or district levels.
  • To provide subsidies for medical care.
  • To engage with traditional healers to increase their knowledge about disabilities, their causes and suitable early intervention measures.

Rehabilitation and support services

Rehabilitation and support services have not been provided by the CBR programmes, as was originally expected. CBR programmes should consider developing the following aspects:

  • Social counselling, ADL and mobility training can be effectively carried out in communities but they could be more effective if peers (or parents of disabled persons) who have practical experience from solving various problems were systematically used as resource persons.
  • Physical rehabilitation and production of assistive devices require a level of expertise that is not available in most communities: government funded referral centres at the districts level should be promoted as well as district budgets for assistive devices.
  • Sign language training and training of interpreters should also be the responsibility of the resource centre - in collaboration with the Association of the Deaf.
  • The district referral centre should also play an important role in supporting vocational training initiatives and apprenticeships.

Education

CBR programmes have had a positive impact on education opportunities for children with physical disabilities and minor impairments. For other children the options remain limited to a few special schools. CBR programmes should increase efforts to influence education authorities to take their responsibility as stipulated in the Standard Rules on education. CBR programmes should also consider supporting:

  • Special sign language medium classes for deaf children in collaboration with education authorities and the Association of the Deaf: deaf persons should be offered appropriate training and given priority when employing teachers in these classes.
  • Parent-driven community centres for intellectually disabled children focusing on skills training and care: these parent self-help groups should be supported to develop community-based care facilities as a complement to family care.
  • ADL and Braille training for blind children in collaboration with the education authorities and the Association of the Blind as a complement to the ordinary curricula.

Income maintenance and social security

This has been a successful CBR programme initiative that has impacted on all aspects of quality of life. It could be further strengthened by:

  • Facilitating access to loan schemes outside the CBR programme such as the poverty reduction programmes, NGO programmes and commercial bank initiatives.
  • Involving DPOs in identification of viable business ideas among their members and in monitoring and back-up of loan schemes.
  • Finding new innovative areas for skills training; leaving traditional preconceived ideas behind regarding suitable trades for different groups of persons with disabilities; involving persons with disabilities in the identification of suitable trades.
  • Facilitating apprenticeship and participation in ordinary vocational training schemes.

Government and community commitment

CBR programmes have not yet succeeded in ensuring the anticipated government and community commitment. In general, this commitment has been moral support, but improved quality of life for persons with disabilities requires resources as well. CBR and the fulfilment of human rights of persons with disabilities cannot depend on volunteers and goodwill from NGOs. CBR programmes need to revise their implementation strategies and build on structures that can be sustained, such as:

  • Structures that are mandated and financed by the government: the change of ownership in Ghana seems to be a step in this direction.
  • DPOs and self-help groups that will not lose their commitment because they have self- interest in development of inclusive communities.

CBR programmes must recognize that sustainable change requires government support - both in policy and practice. There is an urgent need for CBR programmes to ensure that governments:

  • Include persons with disabilities in ordinary community development programmes and poverty reduction schemes.
  • Provide community workers with back-up, continuous training opportunities and incentives.
  • Support a referral system at district level.
  • Provide training and resources for education and health systems.
  • Provide assistive devices free of charge or at a low cost.
  • Support sign language development and interpreter training.

Support to DPOs

During the 10-15 year period that the three CBR programmes studied here have been in operation, adjus tments have been made which are based on the lessons learnt. The importance of involving persons with disabilities and their organizations has been increasingly stressed. The revised joint position paper discusses human rights for persons with disabilities, inclusive communities and "CBR with and for persons with disabil ities". This is a positive development from the viewpoint of persons with disabilities but it also raises questions, such as:

  • How will DPOs be involved in this work?
  • Will sufficient resources be allocated for capacity building of DPOs nationally and locally?
  • What will be the roles and responsibilities of the CBR programme and the DPOs, respectively, as the advocacy and empowerment components of CBR become more important?

Although positive trends are noted in some countries, DPOs and persons with disabilities continue to have limited influence in CBR programmes because of

  • limited self-confidence on the part of individuals owing to the discriminatory treatment they have experienced
  • limited capacity and coordination within the disability movement nationally and locally
  • limited recognition as useful resources by the CBR programmes owing to prejudices

CBR programmes should be instrumental in breaking this vicious circle by addressing all three problems. Strong DPOs that can monitor government performance, advocate the rights of their members, advise development programmes and provide peer counselling area precondition for a successful change process. CBR programmes should therefore make it a priority to support capacity building of DPOs and parents' associations, and to promote and facilitate the formation of self-advocacy groups. Many DPOs need support to overcome shortcomings and to become effective stakeholders with a wide support base, a democratic and transparent structure, a strategic approach and a skilled leadership at all levels. CBR programmes need to collaborate with DPOs to develop practical empowerment tools to achieve this.

It should be noted that parents and family members have different perspectives and rights to persons with disabilities themselves. Therefore, parents and persons with disabilities need to form their own separate advocacy groups. DPOs tend to give too little attention to children's issues and to parental problems, while parents' organizations sometimes focus too much on strengthening the family situation, leaving the disabled family member to continued dependence.

General recommendations

The concept of CBR has changed and is now aiming at addressing all areas that are essential for the quality of life of persons with disabilities and the building of inclusive societies. Thus, CBR programmes need to seek alliances and facilitate collaboration among a wide range of stakeholders.

Firstly, it is essential to recognize that social change and fulfilment of human rights will not occur by targeting the community level alone. Neither will they occur by targe ting only central policy-makers and legislators. For sustainable change to happen there is a need to combine bottom-up and top-down approaches in a "pincer movement". Without policy and legislation to support development there is no direction and commitment; without community awareness and empowerment there is no acceptance or drive for change. The district level is emerging as a strategic level because decentralization of power is an ongoing process in many countries. This is the level where the community demands and central directives meet and priorities have to be made.

Secondly, it is important to recognize that development depends on the combined efforts of a number of stakeholders. In "rights-based programming" that has been introduced as a planning tool in the UN system, and by NGOs working in various areas of human rights, stakeholders are divided into three distinct spheres: rights holders, duty bearers and civil society. These spheres have different roles and responsibilities in the change process but they are equally important prerequisites for the success of the process.

Duty bearers have to fulfil their obligations as stipulated in the Standard Rules. In doing so, they will create the preconditions for disabled persons to be empowered. Yet, duty bearers will not move and prioritize disability issues unless monitored and advised by a strong disability movement. The disability movement, on the other hand, will not be strong unless its members have been empowered. Hence, the change process depends on these three events happening. Therefore, it is essential to consider all three spheres when designing a development programme.

Explanation of figure(Text data)
A figure of a CBR program

Consequently, CBR programmes should address all three spheres. As a rule of thumb a programme should invest one-third of its efforts and resources in initiatives aimed directly at disabled persons and their families; one-third in influencing and building capacity of duty bearers; and one-third in the strengthe ning of NGOs, particularly DPOs and parents' organizations. CBR programmes should identify the most strategic stakeholders within each sphere, set measurable targets for the tasks that these stakeholders should perform as a result of the programme and choose the most efficient ways and means to enable them to carry this out.

Thus, a major role of future CBR programmes will be to facilitate input and collaboration among many stakeholders and sectors. CBR programmes that are run by partic ular interest groups or government sectors run a risk of not achieving the necessary holistic and multisectoral approach. It will be a challenge to find appropriate mechanisms to guide and to steer these CBR programmes. Three guiding principles should be followed:

  • Existing political and administrative structures should be used.
  • Government at various levels is responsible for fulfilling the human rights of its citizens to the best of its ability and should be encouraged to take that responsibility.
  • DPOs should have a major influence on priorities and design of programmes.

CBR programmes must prove themselves efficient in order to obtain government support and community commitment. Therefore, it is important to liaise with ongoing development programmes, to make strategic alliances and to cover a whole district rather than spreading resources throughout the country.

Donors and CBR implementing agencies should review their programmes and develop their capacity in the light of these findings - and complementary CBR training material and handbooks should be deve loped to meet the new needs and challenges.

Finally, it should be noted that Community-based Rehabilitation as a title no longer reflects the nature of the programmes implemented because

  • they target many levels of society - not only the community
  • they address all issues affecting the quality of life of persons with disabilities - not only rehabilitation

It will be a challenge to find a new title that better describes the complexity of this approach.

Follow-up of this study

This document is a qualitative study based on a relatively small number of in-depth interviews. Explicit conclusions have been made because the CBR programmes chosen represent a variety of approaches and cultural settings and because the views of the interviewees were extremely congruent. It is however recommended that a follow-up study be made in orderto examine further the findings and to compile more quantitative data concerning the issues raised.