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Plenary session III Tuesday,September 6 9:00 - 10:30


Chairperson: Hon.Arthur Moody Awori Vice Minister for Tourism and Wildlife(Kenya)
Co-chairperson: Prof.Yuichi Nakamura Professor Emeritus,Japan College of Social Work(Japan)


Task Force on the Rights and Enpowerment of Americans with Disabilities,Washington,D.C.,U.S.A.

I am proud to participate in this historic meeting in my beloved second homeland.

You here today are great pioneers at the greatest of all frontiers,the development of the quality of human life.

Dazai, Fang, Geiecker, Seton, Don Wilson, Acton, Hammerman, great pioneers Magagula,Augustsson, Yashiro, Kasai, Sir.John Wilson, Maruyama, Kondo, great pioneers, Huemann, Winters, Nosek, Zhang, Wilkie, Brigham, Hulek, and hundreds more, great pioneers.

You have participated in a miracle of progress on the field of disability during the past few decades.Yet we all know that people with disabilities throughout the world still suffer massive discrimination,segregation and deprivation that results in unconscionable injustice to hundreds of millions, and unconscionable moral and economic costs to humankind.

We are gathered here today to discuss comprehensive solutions. Nothing less than a profound revolution in our society's traditional approach to disability will even come close to achieving our goal of full,effective rehabilitation services for all people with disabilities. I present to you an outline agenda,and I solicit your guidance.

1. Human rights. Millennia of prejudice and misinformation have resulted in a pervasive,insidious assumption that people with disabilities are less than fully human,and are therefore not fully eligible for services and opportunities that are automatically available to other people,we who have significant disabilities will never receive more than leftover rights,jobs and resources for services until every nation passes and enforces a strong civil rights law stating that people with disabilities must have fully equal access to every aspect of social process.
It has been my priviledge to cooperate with RI Vice President Sandra Parrino, Lex Frieden and others in the development of such a civil rights law. The Americans with Disabilities Act was introduced in the U.S.Congress this year and has been endorsed by both our major party candidates for President.

2. Empowerment. Equality has never been successfully handed down by paternalistic systems.People with disabilities will never be freed from the slavery of segregated dependency until they are empowered to participate fully in the decisions of government and society that control their lives.We of the disability communities must take the lead by involving persons with disabilities fully in the leadership and ranks of RI and of all our agencies and organizations.

3. Education. Attitudes and lack of knowledge are the basic problem. Education is the basic solution.All people with disabilities must have top quality education in the mainstream of the education process.All education media,including the public communications systems,must be utilized to teach all citizens how to prevent disability,and to deal with it effectively when it occurs.There must be required disability studies for all people,in all curricula and at all levels of the school and university systems.

4. Services. We must build on the magnificent pioneer foundation which you have laid to create an accessible,affordable continuum of computer linked services which will enable all people with disabilities to achieve their full potential for productivity,and quality of life in the mainstream of society.

5. Prevention of initial and secondary disability must be made a top priority of every nation.

6. Research and Development must be given the highest priority,also the actual utilization of new technology and methodology on a society wide basis. We must create whole new environments,systems and communities which utilize the power of the scientific method for the benefit of all humans.

This is indeed a revolutionary agenda.We will immediately be told that it is impossibly utopian and unaffordably expensive.


Only if we accept the suicidal assumption that humans are irrevocably irrational.


Are bombs,booze,benzes,cocaine and cigarettes better investments than Beethoven,Roosevelt,Yashiro and Zhang?

20th Century barbarism!

It is our present obsolete policy of maintaining millions of potentially productive people in unjust,unwanted dependency that absolutely guarantees unaffordable economic burdens.Scientific rehabilitation has proven to be immediately and immensely profitable to all individuals and to society as a whole.

But scientific rationality will not overcome thousands of years of ignorance quickly or easily.We have a long hard battle ahead,and RI cannot win it alone.

All people with disabilities,their families' advocates and service providers are natural allies - our destinies are inevitably intertwined.

RI and each of its members must reach out to and join with the disability rights movement in our struggle for justice.

Like Gandhi, like Martin Luther King,we of the disability community must utilize the power of love,the power of reason and the power of truth to overcome our differences and our apathies and to unite in common dedication to the great principles of human justice.

We must unite with millions of our colleagues to create a tidal wave of political and educational advocacy that will establish the equality and empowerment of people with disabilities in the consciousness,in the law and in the everyday life of every nation on earth.

We must make our own declaration to the world: -

That we hold these truths to be self evident.

That the quality and dignity of each human life is equally sacred and inviolable.

That disability is a normal characteristic of the human process.

And that pepole with disabilities have the same inalienable responsibility as other people to participate fully and equally in the government and productive process of society.

Colleagues,your hard work and sacrifice over years have brought us to the threshhold of a great victory for human justice.

We have a sacred responsibility to complete that victory.

We in this room today have accepted,indeed we have sought a profound responsibility to hundreds of millions in this and future generations. We are responsible to potentially pround,productive human beings who exist as outcasts from the mainstream of society,jobless,homeless,penniless,hopeless. We are responsible to uncounted millions of human beings who die years and decades before their time for lack of the most elementary necessities of life.

We cannot betray these people.

We cannot betray our children's children.

We must unite.

Divided we all lose.

United we all win,and all humanity wins with us.

Let us act.

Equality now.

Justice now.


United Nations Development Project IMPACT,U.N.

Shortly after we married,my wife and I lived for awhile in a village hut in a river blindness community in Northern Ghana. It was a strenge community, isolated in its own world of disability,unaware that most of the world could see.

In an environment of extreme deprivation they had achieved a measure of stability,but it was balanced on a knife-edge of survival.Along the river bank were deserted graveyard villages where the only living things were the ticking cicadas.

After some years of research,the onchocerciasis control programme began. helicopters sprayed the breeding grounds of the blinding flies. Now,across seven West African countries,onchocerciasis is under control and a new generation of children is growing up with sight as a normal expectation.

But,for many people already blind,the programme has come too late. For them, farm cooperatives are being established but with the extraordinary difference that this is rehabilitation, not for a life of blindness, but for a life in which they and the next generation will be in a sighted world with its opportunities and challenges.

The point I want to make is that, in meeting the real needs of disabled people in a deprived community, we must seek to promote a continuum of action. In that situation in West Africa an environmental intervention was needed and until that happened, the community had no freedom to deal with its own problems. Once that environment had been changed, the process of rehabilitation and equalization could begin.

This onchocerciasis control programme is part of a systematic global programme for the prevention of blindness. Its aim, by the year 2000, is to bring under control four major causes which together account for two thirds of the blindness in developing countries and to build into primary health systems everywhere an appropriate component of eye care. That programme is making good progress and we have every confidence that it will achieve its objectives.

It was one the basis of this experience that we formed the International Initiative Against Avoidable Disability (which has become known as IMPACT) promoted by UNDP in collaboration with WHO and UNICEF. Its aim is systematic action against causes of avoidable disability which occur in massive prevalence and against which there exists a cost-effective means of control. We see this as an integral part of a world effort to confront the phenomenon of disability through a continuum of action in which prevention leads on to, and merges into, rehabilitation and in which rehabilitation developed skills of independent living leading on to equalization of opportunity and, where possible, the creation of a non-handicapping environment.

The main thrust of the IMPACT programme is at the level of primary health and community action. That is not a simple concept in which the community can be expected by some innate virtue to handle its own health problems. It is a slow process building awareness, confidence, structures. The community must look not only inwards at its own resources but also outwards to support and referral systems, linked to the whole development process of the country and within a broadening opportunity for international co-operation.

The Expanded programme of Immunization is the best example of that process with its aim of immunizing all the world's children against six major diseases of childhood. If - we may now almost say when - this programme is in full operation, it could reduce by at least a quarter childhood disabilities throughout the developing countries.

This year's World Health Assembly endorsed a recommendation that an effort be made, not just to control but to eradicate polio myelities. It represents a major step forward in recognizing that a vertical programme for the eradication of a disease may not be a deflection from, but an effective support to horizontal programmes to build the primary health structure. Indeed, that distinction is an unnecessary abstraction; whether a programme is vertical or horizontal depends largely on the angle from which you view it.

There are more deaf people in the world than blind people. The facts are not yet fully ascertained, but it looks as though at least forty per cent of hearing impairment in developing countries results from a single preventable cause, otities media. Beyond that, though the experts have yet to agree on strategy. I have no doubt, having seen the work in progress in Thailand, India and Kenya, that simplified techniques of microsurgery exist which could restore an effective measure of hearing to a great number of people with middle ear impairment.

The elimination of polio myelities could profoundly change the pattern of physical disability throughout the world, but meanwhile, at least three hundred thousand children each year are incapacitated by polio myelitis. Their restoration to mobility is a challenge to the techniques of rehabilitation and basic surgery. This year in India, I observed the work of a surgical team which, over the past few years, has examined one hundred and eighty thousand children and performed twenty thousand tenotomy operations.

Here again, we run into an abstraction of health philosophy that curative effort might deflect resources from long-term prevention. IMPACT takes the view, which I believe most of you in this audience would support, that this is not an either/or question; in terms of political expendiency, to say nothing of social justice, the disabled of this generation have rights no less than the children who will benefit from the technology of the future.

Another massive, and totally preventable cause of physical disability is guinea worm disease. It is estimated that it affects four million people each year, leaving many permanently disabled. In an IMPACT survey in Mali last year, we found villages where a third of the people are incapacitated by this disease which comes from polluted water. An International effort of prevention is being promoted through the Water Decade. In one West African village, the provision of a new well, costing three hundred and twenty dollars, reduced the prevalence from thirty per cent to two per cent.

Mental and neurological disorders are estimated by WHO to disable two hundred million people in the world. Until recently it was assumed that, in this field, preventive techniques were too complex to be delivered at the community level. Now, a convincing programme of action has been formulated and its advocates believe that it could reduce by a third the prevalence of mental handicap amongst children in deprived communities.

A recent estimate is that six hundred million people live in areas at risk of iodine deficiency, causing sixteen million children in each generation to be born with severe mental handicap. Iodisation of domestic salt is a classic example of prevention at virtually no cost.

These are just a few examples among many activities which could radically change the pattern of disability in developing countries. However, there is another dimension to this task. Though the greatest number of the disabled are obviously in developing countries, the highest prevalence is probably now amongst the rapidly increasing elderly population of industialized countries. Will this lead, as Martin Cramer has warned, to a "rising pandemic of age-related disability" or are we entitled to take the more optimistic view indicated by the Gottenberg and Framlingham studies, that improved medical care might actually reduce morbidity in old age. It is a race between the science that expands the span of life and the science which can influence the quality of that life. In medical research, the optimists are more often right than the pessimists, so, hopefully, this could be a race we can win.

Of course we recognize that there are many causes of disability which are not preventable and the fact that disabled people are actively involved in the leadership of the IMPACT programme emphasizes that disability itself can be a positive, life-affirming, outward looking experience.

Modern technology opens unprecedented opportunities to prevent disability, even to modify the very environment which causes it. Yet, over much of the world, preventable diseases flourish with the virulence of a primeval scourge. Even in the most advanced countries we tolerate a situation in which a significant part of the population is disabled from preventable causes. We have the technology but most of that technology is not being used.

Nor, in any rational sense, should there be a lack of resources. Even in the most impoverished community, disability is not just a consequence of poverty but a significant cause of it. Nor is it anything so simple as a lack of compassion. Rather is it a lack of awareness and of emphasis within rigid scales of priority. Despite gallant efforts all of us have failed so far to create a convincing international network to reconcile the divisions history has created between consumers and service-providers, between professional disciplines and different categories of disability, between prevention and rehabilitation. Only if we can get our act together and recognize that these are all parts of a single commitment, can we hope to place our cause within a real agenda for international action.

In that context, rehabilitation could be seen, not just as a specialized activity, but as part of the essential process of development and conservation, and prevention as one of the most important goals in the advance of science and technology. Participation and equalization could be seen not just as a minority demand but as a basic principle of democracy and social justice. The strategy which integrates these elements could be powered by a philosophy which is liberating, life-enhancing and life-respecting.

But what we have lacked in this work is not philosophy but implementation. For this reason, in the past two years, the international non-governmental organizations have discussed with the United Nations Secretariat the possibility of promoting a global campaign to change public attitudes and to generate the interest and resources needed for real action. This experience of working together has been stimulating and encouraging and, within the United Nations, many procedural difficulties have been overcome.

These discussions will be continuing here in Tokyo with the leadership of Rehabilitation International and Disabled Persons International and particularly with the National delegations whose commitment is essential to success.

It is an ambitious project. It has to be to reach the scale of the task, to create a framework large enough and generous enough to accommodate many different traditions and aspirations and, at a time of competing promotions and priorities, to gear our action realistically to the great mechanisms for change in our modern world.


Handicap International,Lyon,France

It is impossible satisfactorily to define 'comprehensive' rehabilitation for individuals. As an ideal, it is a vague concept and will vary from person to person, as with defining 'perfect health'. 'Comprehensive' can apply to the range of rehabilitation options available to individual disabled people ; the completeness of the infra-structures and referral support systems ; availability to the whole of a national population ; and applicability to all types and degrees of disability.

So we have to be pragmatic (realistic) even in conceptualising rehabilitation. It should encompass universal human expectations of function, but it is unlikely to take account of relative loss of function which remains within 'normal' or 'average' limits. It should encompass personal hopes and aspirations, but is unlikely to realise those that go beyond the 'norm' for the individual's family, class and culture. It should encompass societal expectations, but cannot expect to accomodate to the many variants and dynamic nature of all cultures. A realistic (pragmatic) approach must therefore be an individual approach, in which the problems and needs of each individual are matched to solutions that reflect local cultures and environments. But what level of 'problem' and 'solution' should be the focus for disabled people, and who can best help them ?

Impairments are generally considered to be the underlying problem ; they are often immutable, or correctable only with resources generally unavailable (such as specialist orthopedic surgery). Professionals are mostly trained to think in terms of impairments whereas we need to recognise that the ultimate goals of rehabilitation are mostly in terms of handicap - to reduce the social disadvantages resulting from impairments and disabilities. Occasionally correcting an impairment is solely cosmetic, to improve psychological function,but this is to diminish a perceived handicap,which becomes a real handicap. Sometimes, disability is tackled solely to reduce pain or discomfort, or enhance self-image, but the same applies. Generally, to take a realistic approach to comprehensive rehabilitation, we need to focus rehabilitation on goals relating to handicap, towards which correcting impairments or reducing disabilities are subsidiary goals.

Some doctors, in a variety of specialties are concerned with disability, that is, reduced function, as are some other professionals, including physiotherapists, occupational therapists, speech therapists, specialist teachers, and some nurses. The problem here is the many divisions of professional training, experience and responsibility, with none able to claim overall expertise in 'rehabilitation'. So a realistic approach would not put any one of these professions as such in charge of general rehabilitation programmes, without reor further training encompassing all types of disability and all aspects of rehabilitation. They do need to be available, but as specific resources to be used as required, as part of a wider programme.

Unfortunately, most of the medical and related professions are not much trained in respect of individual social function, or in the structures and functions of society per se. They tend to consider such matters as beyond their competance or even outside their interest. Sociology is not a practising profession and social workers tend to have little biological understanding, which limits their contribution to rehabilitation, but they are important in employment, housing and finance issues, and have often taken a lead in de-institutionalisation and building up support networks for disabled people.

Frankly speaking, it is a mess in developed countries, to a certain extent, and what we have tended to do for developing countries is reproduce our own professional divisions, restrictions and even in-fighting, with some recognition of different economic and cultural circumstances, and little more than a nod in the direction of overall -comprehensive- rehabilitation. No one profession or worker has comprehensive coverage, and much of their training is inappropriate for supervisory roles, only consultant roles.

Who then should direct CBR programmes, and how should they be trained ? It might serve both comprehensiveness and realism best if they are not tied to any of our developed country professions - if they come from one, they should, perhaps, see themselves as moving out of it into 'Rehabilitation'. Realistically, in many countries, they might have no previous professional training ; this is not necessarily a disadvantage as the content of training should be concerned largely with starting, managing, and developing community based programmes, and obtaining and using resources required, including professional skills from others. People skills, communication skills, are paramount ; a community development approach and cultural understanding are essential.

But they must also have a reasonably comprehensive overview of the processes of functional assessment, the techniques of rehabilitation, and their applicability to developing communities. The same needs apply to continuing education as well as basic training of CBR supervisors. Experience in these applications is still very limited, and very variable, and it is difficult as yet to distil the variety of experience into a training programme. It is not economic to send people across the world to one or other of particular notable programmes, and in any case, they are only examples of particular applications.

Two ideas could help to improve the situation over the next few yers. The first is to create training videos for disability assessment and rehabilitation techniques - an excellent medium for these contents, and also able to show cultural and environmental contexts well. The spoken commentary would be relatively easily translated into many languages. This could be funded as a short term project, and would be well worth pursuing. The second is some 'journal' or 'newsletter', or other regular organ of communication to be a forum for debate, discussion and evaluation of CBR throughout the world ; this might help everyone to learn from the experience that is being gained. An established journal could develop this as a special feature, or something new might be started. It would need international funding.

At present, there are many projects, mostly small scale, organised differently, with different emphases, different strengths and weaknesses, different funding arrangements, different relationships with health, education and social service infra-structures. No one way can claim to be the only one, or the 'right' one, as very little evaluation has been done. So we need to learn from each other, and a 'journal' could play an important part.

Formal evaluation in terms of effectiveness and efficiency is needed if we are to know what is worth replicating, and has hardly been attempted. No doubt in part thos is because those involved in CBR rarely include 'academics' or others with research skills, and because evaluation inevitably takes extra time and resources. Clearly, not every CBR project can be expected to do this. So to be realistic, it is therefore necessary for a few well designed evaluation studies -thorough, objective, and long term - to be funded, in settings carefully selected to maximise the general applicability of results.

"Going to scale" is the major challenge. Most CBR projects are small scale, and many are projects without real permanency, not programmes with a permanent infra-structure. The problems involved in 'going to scale', that is expanding from a village project to a widespread general permanent service, are immense, and there is very little experience yet. It requires different approaches to management and training, and it will require very special effort to ensure that the community based approach, and the emphases on community participation and appropriate technology, are not sacrificed. If we are to expand substantially, it is essential that CBR is linked in to the local permanent infrastructures of health, education and social services, though this could be in many different ways. Again special effort will be required to ensure that CBR is not smothered, or straightjacked by existing services in which comprehensive rehabilitation has no tradition,is not understood, and cannot be accomodated.

Linking to 'government' services is often seen as a threat to reliability, creativity and independence, especially if dependent upon 'government' funding. The funding issue is central : permanent funding is not usually possible except through government services, but many NGOs have an almost permanent presence when run by nationals. Some creative thinking is needed to develop relationships /partnerships between governments and NGOs for CBR, which encompass funding, staffing, training and resourcing permanent programmes on a large scale. The transition to a district and national scale must be confronted ; CBR has not succeeded until it is far more generalised than at present.

There won't be any realistic comprehensiveness without improved cooperation and coordination : The nature of CBR is such that many agencies and professions (whether all part of 'government' services or not) must be involved if it is to be both horizontally and vertically comprehensive. By horizontal we mean accessibility to a wide range of options for disabled people within the community in which they live (that community might be small or large, and the options which might realistically be offered in each will vary). By vertical we mean the referral options and supporting personnel and facilities beyond the disabled person's own community (in big towns and cities, there are different circumstances requiring different approaches -who is developing CBR in cities ?).

CBR is not just 'community rehabilitation', but community based rehabilitation. It is not complete, comprehensive or satisfactory, without the secondary and even tertiary referral agencies. It is this pyramid of services with the community base, that constitutes CBR. In many countries it is too much to hope for all aspects of this to be established in the foreseeable future, so comprehensiveness in this sense cannot be accomplished. But a realistic approach demands that what there is, is properly coordinated on behalf of disabled people, and increasing the provision of these secondary resources is not neglected.

Also to be realistic, there should be clear, agreed objectives, responsibilities, tasks, for each agency and professional contributing their part to the whole CBR programme. Only thus will coordination be possible, waste and conflict, gaps and overlaps, avoided. This may seem pretentiously unnecessary in small village programmes, but is essential if they are to cover large populations. Local networking might offer techniques for developing mutual agreements and coordinating activites without stultifying and wasteful bureaucraties. A local CBR newsletter could keep all levels linked.

Should CBR programmes be concerned with all types of disability ? What is encompassed by the word'disability'(or its equivalent)may vary.It seldom includes people disabled by chronic mental illness,though common and neglected.It rarely includes dementias.It often excludes mental retardation.It may be considered unrealistic to encompass all types,but then there can be no pretence that it is comprehensive.Practical considerations in particular programmes in particular communities may dictate initial limitations,but plans for development must surely include all disabled groups.There is a great need to develop appropriate community approaches to 'mental disabilities'.

Should CBR include all degrees of disability ? This is,in a sense,not an appropriate question,since many minor disabilities do not create significant handicap,or are readily overcome by individuals without help.These vary in different communities:the same degree of disability may result in more or less handicap(eg.mild mental retardation in literate and non literate communities). There is also the issue of labelling,which should be avoided for minor degrees of disability.The crucial question relates to handicap,and there can be little doubt that comprehensive rehabilitation would encompass any significant degree of handicap.

The emphasis on handicap is essential.It may be more important for a person with cerebral palsy to learn to read and write and thus gain employable skills,than to improve walking.Vocational skills,employment assistance,and income generation projects are particularly important.But,especially in some cultures,marriageability and the ability to produce children may be more important than employability.Focussing on handicap is the realistic approach,tackling disability only where it will diminish handicap.This focus may also help to avoid missing minor disabilities producing major handicaps,in the presence of major disabilities. For example,a child with polio unable to walk,who might also have a refractive error and need spectacles if he is to become literate.

In practice,a CBR programme which is economically realistic will probably concentrate on the most handicapped individuals,and the most practicable rehabilitation options,at least in the early stages.Such priorities cannot be established without a comprehensive overview initially.

Conclusion:Focussing on handicap will also demonstrate that handicap arises as a consequence of characteristics in the community and culture,as well as characteristics -disabilities- in the individual.Rehabilitation is concerned to establish disabled people in common and valued roles in society,accepted,integrated and participating fully in the life of the community.Ignorance,prejudice,hostility,and rejection are common,and must be changed if rehabilitation is to be successful.Pessimism,fatalism and de-valuation are common,and must be combatted if rehabilitation is going to be promoted and funded.Rehabilitation,or even health,may not be a priority amongst the people,and community education may be necessary.Institutions and professionals may need re-constituting and re-educating into different roles.Administrators,employers,and politicians may need to change in attitude and behaviour.All in all,comprehensive rehabilitation,if it is to be realistic,means changing society as much as changing disabled people themselves.



The title that has been given to me today is "Comprehensive Rehabilitation: Realistic Approaches to Community Needs.What does these words Realistic Approaches entail? The reality on this earth is that military expenditures are ever increasing while local communities are being ravaged be regional conflicts.We can not evade this fact.

No one denies that war and other forms of violence have caused disabilities. In addition to this,the sheer fear of the possibility of war exerts economic and political pressure throughout the world. Under such a pressure, tenacity and destitution are demanded of society.Under such circumstances,the attempt to provide rehabilitation is in vain.If it does materialize,experience has it,that it will favor military personnel.

Reality on this earth has been a given precondition.We have been involved, agitated and mobilized.In short,we have been in the passive voice.

I propose that we now become a part of the active voice in face of this global reality.Let us think together to come up with new ideas and be positive contributors by producing precious values.

"Realistic Approaches to Community Needs" inmplies the correct understanding of the community needs. To facilitate this argument,I would like to share with you a bit of my personal history.After my accident,I did not know if I would ever be able to walk again.When I was discharged from the hospital after six months,long enough to begin to understand what had happened,I was not aware of my potential.It was only after talking with my friends in wheelchairs and traveling around the world,that I began to realize my great potential.

What I mean by this is that at the beginning,my needs were quite limited as I could only consider my immediate needs of daily living.But my needs kept increasing and expanding as my horizons were broadened.People with disabilities tend to underestimate their own needs,considering the barriers of the environment.It should be noted,that only when they step forward do they notice their own gidden needs.Ihave been talking about individual needs,but this applies to the community,region and nation as well.

Meeting an idividuals needs as only recognized by people with disabilities is not enoungh.On the other hand,if social workers define the needs of the disabled and provisions are made available,the disabled person may object to these provisions,saying they are forced upon them.

The identification of these needs,be it on an individual or community level,should be flexible.Rehabilitation should be promoted based on understanding the dynamic involved in identifying the individual needs.

The key to the most efficient development of rehabilitation is through the involvement of people with disabilities.The needs of disabled people are best defined by people having a disability themself.To achieve this purpose,individuals with disabilities should be encouraged to be independent and more assertive as well as to become well-organized so that they may be heard. Their organizations need to be democratic. Being democratic means the majority rules,but in the case of disabilities,individuality should be taken into account. Each disability is different and requires special attention. The organizations should be structured so that the individual needs are respected.The formation of organizations of people with disabilities needs both encouragement and assistance.The disabled person needs to participate at all levels;local,province,and national as well as included in the various processes of planning,implementation and evaluation.

People with disabilities can find the solutions to the problems they are facing and can satisgy their own needs by drawing upon their own knowledge and experiences.The answers are available from the disabled population.

International exchanges have proved thought-provoking and have given us new horizons and targets.They have shown us that we face common challenges, regardless of different cultures and historic backgrounds.The final solutions, however,need to be specific to the disabled person within his or her community It is the disabled person who is best qualified to play the major role in finding these solutions.

I have been discussing the recognition of needs and the development of organizations relative to the knowledge and experience of the disabled person. They all point to one thing,the disabled person needs to assume responsibility for themselves.Thus far,the emphasis has been placed on society to secure rights for the disabled.It is like the pendulum swing,the emphasis first placed on society and is now moving to the individual.

Last but not least,the significance of education should not be underestimated.The education,a long and accumulative process requires both physical structures and well trained staff to respond to the following tasks in the field of rehabilitation.

The first is the education of the disabled.In many countries,people with disabilities have been deprived an educational opportunity,thereby limiting their potential.Their right to academic,vocational or adult education should be established. The disabled person needs to take advange of all the educational opportunities available to them.

The second is the education and training of professionals in this field. The lack of professionals with broad experience and profound knowledge has been a serious constraint in many countries including Japan.International cooperation can take on various meaningful roles in this area.

The third is the need to promoted an accurate understanding of rehabilitation in the regular school systems. The systematic educational approach in developing programs is essential.

The fourth is the education of the general public in furthering their understanding of rehabilitation.

These are all time-consuming processes and that is why we need to start right now.

In education, the focus tends to be placed on the provision of education to children with disabilities. This is very necessary, but there are other issues to be addressed. I would like to conclude by empgasizing the importance of incorporating the issues of rehabilitation within the general framework of the educational system.


Minister of Welfare,Government of India,India

I am grateful to the Rehabilitation International for giving me this opportunity of addressing this distinguished gathering in the plenary session. Observance of the International Year of the Disabled in 1981, to which contribution of Rehabilitation International is significant, has helped arouse world-wide awareness for the cause of the disabled. Like the rest of the world we in India too, initiated, besides undertaking a survey to ascertain the extent of disability, a number of pace-setting scheme to make available basic aids and appliances for restorative rehabilitation and assistance to voluntary organizations for providing care, education, training, placement services and a scheme of scholarship to promote education of the handicapped and a number of concessions and facilities to help their integration in society.

2. Except for a few institutions started with voluntary effort, we had practically no services for the handicapped in India till Independence in 1947. We declared ourselves a welfare State under the Indian Constitution which, besides providing for equal protection of law to all citizens, mandates, in its Directive Principles of State Policy, to promote the welfare of all people including the disabled. Article 41 of the Constitution of India provides that "The State shall, within the limit of its economic capacity and development, make effective provision for securing the right to work, to education and to public assistance in cases of unemployment, old age, sickness and disablement, and in other cases of undeserved want." As per our policy, the objective of the Government of India has been to see that the disabled population is integrated into the mainstream and that they are socially accepted by the rest of the community as productive members of society. It has been possible through constant awareness programs being carried out through both the electronic and print media to remove to a large extent the social stigma which is attached to disabilities. The entire programs of the Government of India are geared towards this basic objective of making the disabled feel that they are wanted and can contribute towards the growth of the Nation as responsible citizens.

3. The extent of disability the world over is estimated at nearly 10% of the population .The profile of disability in developed world, however, is very different from the same in the developing world. For example, while polio is almost non-existent in the developed world, it is a major contributor to orthopaedic disability. Developmental disabilities are not as alarming in our situation as in the developed world. Because of the differences in profile and also the socio-economic environment, an indigenous solution to the problem is imperative. We in India have adopted rather strict definitions so that the benefits of all governmental schemes reach the more needy among the handicapped. Based on these definitions, the extent of orthopaedic, visual and speech and hearing disabilities has been estimated, in 1981, at 11.8 million which is about 1.8% of our population. The number of mentally handicapped is estimated at nearly 2% of the population.

4. Prevention of Disability:

Prevention of disability has been accorded top priority in our program of action as we do realize that appropriate preventive measures can greatly reduce the incidence of all kinds of disabilities. To this end we have a well formulated immunization program to reduce the incidence of polio and other diseases and a National Program for control of blindness which aims at reducing blindness from the present level of 1.4% to 0.3% by the year 2000 A.D. These programs are implemented through a network of Primary Health Centres spread throughout the country. Prevention of accident which is a major factor contributing to disability is also being attended to through educational and enforcement measures.

5. Role of Voluntary Agencies:

Commitment and compassion being a pre-requisite for any program for the disabled, the Government of India, as a matter of policy, promotes effort in non-governmental organizations which have been accorded a primary and pivotal role in the care of the handicapped. There are about 1500 non-governmental organizations working in this area and a very large number of them are substantially funded by the Central Government and the State Governments. We have a Central Scheme of assistance to voluntary organizations under which the Central Government provides to the voluntary organizations upto 90% of the cost of providing services to the handicapped in the areas of preventive, therapeutic, educational, vocational and placement services.

6. Aids and Appliances:

Supply of appropriate aids and appliances is basic to any scheme of rehabilitation. Disability is also often accompanied with poverty. Hence, Government of India has undertaken a major scheme for supply of aids and appliances, free of cost, to poor people, through a network of institutions spread throughout the country. In the Public Sector, we have an Artificial Limbs Manufacturing Corporation (ALIMCO) at Kanpur to produce aids, of standard quality and specifications, for the orthopaedically handicapped, on a mass scale. Many other enterprises in private sector, produce orthotic, prosthetic and hearing aids.

7. Development of Apex Institutes:

My Government has set up four National apex level institutions to develop manpower to render services to the disabled population, to develop model services which can be replicated at the grass root level by non-governmental as well as governmental organizations and to conduct researches on various aspects of disability with a view to evolve appropriate programs of action. These National Centres set up in each major area of disability viz., orthopaedic, visual, speech and hearing, and mental handicap also serve as premier information and documentation centres covering all aspects of information base needed by the disabled people and professionals working for them. These National Centres though set up recently, have been able to provide leadership in their concerned area of disability and are working in close coordination with the voluntary sector and the State Governments. These centres would be happy to share their experiences with similar institutions or organizations the world over especially in the developing world.

8. Education:

It is neither desirable nor possible to cover all the disabled students through special schools. Therefore as a matter of policy we have accepted education of the disabled in the integrated set-up as far as possible. Special schools, however, have their utility in teaching the severely disabled who would not possibly fit in normal schools. Besides providing special teachers and resource rooms in the integrated schools throughout the country we propose to have 400 special schools. To meet requirements of special teachers in such schools our National Institutes have prepared a comprehensive program of development of manpower. In order to standardise courses and ensure quality of professionals, a Rehabilitation Council on the pattern of Medical Council has also been set up.

9. Vocational Training and Placement:

The real test of rehabilitation lies in economic rehabilitation and hence adequate emphasis on vocational training and placement of the disabled is necessary. In India we have a network of 16 vocational rehabilitation centres, 22 special employment exchanges, 40 special cells in general employment exchanges to promote vocational training and placement. A 3% reservation for the physically handicapped has also been provided for in the Government sector. Recently we have undertaken a special drive to recruit disabled people against such reserved vacancies.

10. Comprehensive Rural Rehabilitation:

Realizing that the voluntary institutions are largely located in urban centres, whereas 80% of the disabled population lives in rural India we have set up, under a pilot scheme, District Rehabilitation Centres in ten Districts in the country. The scheme envisages comprehensive identification in this area of operation following which restorative, medical, educational, vocational and placement services are arranged for the disabled. The scheme envisages close integration with the health and educational infrastructure already available at the field level and close inter-action of the community in the rehabilitation process. The scheme is under evaluation after which we propose to expand it to cover more areas.

11. Role of Unicef:

Unicef is committed to the development and welfare of children and is working in partnership with the Government in the programs of childhood disability. Nineteen research projects in diverse areas are being undertaken with full assistance from Unicef. About 50 voluntary organizations are being assisted for carrying out early intervention and comprehensive rehabilitation programs. Unicef has also assisted eight District Rehabilitation Centre Projects. In addition, Unicef has assisted disability prevention programs in a big way.

12. Future Trends:

Although a number of concessions are given to the disabled by the Government, we have realized the need for enacting a comprehensive legislation for the handicapped. A committee set up by the Government of India to go into the scope of legislation has recently submitted its report. Such a legislation will go a long way in securing the long-cherished need of the disabled community to occupy their rightful place in society.

13. Having felt the need of providing timely and correct information to the disabled and their families about various concessions and services which are available either in governmental or non-governmental sector, we have very recently set up a National Information and Documentation Centre on disabilities. The Centre will be computerized and will have total information about various aspects of disability and its management. The Centre will also help us in formulation of policy and will provide much needed information to researchers and practitioners working in the field.

14. Technology can play a major role in making the life of the disabled easier and better. For this purpose we have set up a Rehabilitation Centre for upgradation of aids and appliances and we propose to set up a Technology Development Project which will coordinate the work of research Institutions and Centres of excellence in the area of Science and Technology which are already doing a lot of commendable work which can be usefully harnessed for the benefit of the handicapped population.

15. The mentally handicapped have problems which are quite distinct from those of other groups of disabled. The parents and mentally retarded children are often worried as to what would happen to their children after their death. In the world of today it is indeed very difficult to rely on the charity of close relatives. The traditional social set-up to breaking thorughout the world. In one of our national seminars for the welfare of the mentally retarded there was a strong recommendation to set up a National Trust for the Mentally Retarded which can provide guardianship and rehabilitation services to the mentally retarded children and can even inherit property on their behalf. We are examining the issue and may be shortly in a position to set up such a National Trust.

16. Sports and recreation for the handicapped is an area in whcih lots of work is yet to be done. While international level sports for the orthopaedically and the mentally handicapped are organized, similar efforts may have to be initiated for other categories of disabled persons. I would request Rehabilitation International to give some thought to this.

17. Experience has taught us that given proper opportunities, assistance and guidance, the handicapped can overcome their disability and develop their abilities, like normal persons, to become useful and productive members, nay excel in society. Comprehensive rehabilitation ideally aims at covering all the disabled irrespective of the nature and severity of the handicap, with programs which, while minimizing the impact of disability, maximize the latent potentialities leading to effective integration in society. Such comprehensive rehabilitation indeed is a huge task. This noble objective calls for far great effort, investment, removal of barriers - architectural and others. The biggest barrier, to my mind, is attitudinal which fortunately is giving way, though slowly and imperceptibly. This world meet, I do hope, will considerably influence the process of removal of this barrier and will also provide opportunities for exchange of information and ideas on various comprehensive rehabilitation models that we have in different parts of the world. As Longfellow said, "The Art is long and time is fleeting". This World Congress, I hope will be a significant milestone in the 'Long Art' of comprehensive rehabilitation.

18. I wish the Conference all success.

Plenary Session IV Tuesday, September 6 11:00 - 12:30


Chairperson: Mr.Ib Bjerring Nielsen Chairman of RI Vocational Commission (Denmark)
Co-chairperson: Prof. Ryosuke Matsui The National Institute of Vocational Rehabilitation(Japan)


Chief, Vocational Rehabilitation Branch, International Labour Office (ILO), Geneva, Switzerland

I am sure most of you know about the ILO but I would like to give you a brief introduction about the ILO's activities for disabled persons. My organisation is charged with improving the conditions in the working life of men and women, and with extending the opportunity of employment for those without work. It is natural, therefore, that those who have difficulties in finding or keeping a job because they are disabled should be the concern of the ILO. The ILO is a tripartite organisation with workers' and employers' representatives taking part in its work on equal status with those of governments. From its earliest beginning, the ILO has endeavoured to promote the right of disabled persons, particularly their right to full participation in social and economic life.

The ILO's main efforts in recent years have been directed towards assisting developing countries to establish basic vocational rehabilitation services. At the present time, ILO regional vocational rehabilitation advisers as well as country-level ILO experts and consultants, are providing technical advice and assistance in this field to more than 50 countries of the Third World.

In the area of ILO's standard setting activities, the adoption by the International Labour Conference of the Vocational Rehabilitation (Disabled) Recommendation (No. 99) in 1955 was a landmark; not only did it act as a worldwide stimulus in promoting and developing vocational rehabilitation and employment services for all categories of disabled persons, it also advocated that one of the main aims of any vocational rehabilitation service should be "to overcome in respect of training or employment discrimination against disabled persons on account of their disability".

More recently, the International Labour Conference of 1983 adopted two further instruments - Convention (No. 159), and Recommendation (No. 168), concerning vocational rehabilitation and employment of disabled persons. The Convention stresses that "the vocational rehabilitation and employment policy shall be based on the principle of equal opportunity between disabled workers and workers generally"and that"equality of opportunity and treatment for disabled men and women workers shall be respected".This latter aspect is further amplified in Recommendation No.168,which states that"disabled persons should enjoy equality of opportunity and treatment in respect of access to,retention of and advancement in employment".

The recent economic recession has seriously affected the job opportunities for disabled persons.Even if jobs are available,many disabled persons are employed below the level of their potential.The unemployment rate for disabled persons in most of the western countries is more than 5 times that of the non-disabled.In developing countries,the situation is even worse and job prospects for them in the open labour market are minimal or non-existent.Cynics will say that this is merely a question of lack of opportunity and such a problem should be tackled when economic conditions improve.Such an argument is short-sighted and discriminatory. In this period of economic difficulties,I feel,it is even more important to ensure that some sense of social justice prevails among social planners, to stress that the most vulnerable members of the population,including the disabled,should not suffer an unfair treatment and to insist that the principle of equality of opportunity and treatment is not a luxury to be shelved in times of economic crises.The ILO Convention and Recommendation emphasise this fundamental concept of equality.

ILO standards

Countries ratifying the ILO Convention will be obliged to aim at ensuring that appropriate vocational rehabilitation measures are made available to all categories of disabled persons and to promote employment opportunities for them.The Recommendation(No.168)sets out a number of measures designed to widen employment opportunities for disabled persons, such as assistance and incentives to employers,establishment of various types of sheltered employment,creation of production workshops and co-operatives,elimination of physical and architectural barriers,etc.The new instrument emphasises the need for community participation in the organisation and development of rehabilitation services.In this connection,the important contribution of employers'and workers' organisations as well as that of disabled people themselves is fully recognised and advocated.

Now I would like to explain in some detail concrete examples of measures which have been introduced in various countries to promote equalisation of employment opportunities for people with disabilities.

Legislative measures for open employment

One method which has been adopted by many countries is through legislative measures aimed at ensuring that the disabled have a fair share of job opportunities in the open labour market.These take the form of an obligation on employers to employ a fixed number or a quota of disabled persons.

The United Kingdom, a pioneer in the field of the employment of the disabled,nearly half a century ago,established a quota system whereby any firm with 20 or more staff should have among them at least 3 per cent with a registered disability.Today,out of the UK's 33,000 employers in the 20 or more staff category,only 9,000 or 26 per cent meet this quota.Emphasis has therefore,been placed in recent years by the government on offering incentives to employers to engage or retain disabled workers.Special schemes provide for grants towards the cost of adapting premises or equipment used by disabled people at work,as well as financial assistance to those employers who are able to offer a"job trial"to disabled applicants.Similar incentive schemes operate in France,the Federal Republic of Germany and Japan.

In the United States, with approximately 45 million disabled people, the Federal Government has recently introduced "supported employment" schemes.Supported employment is an emerging service delivery option for persons with severe disabilities.Establishing a supported employment scheme requires that each employment opportunity be developed to include all aspects of a positive work environment(e.g.integration with non-disabled workers,income,benefits,working conditions etc.),and that on-going support services for the individual on the worksite be provided to deal with such matters as transportation needs,progressive training,and other individual needs. Other types of support include the use of a "job coach" or on-the-job supervisor to work along-side the new disabled employee, to monitor performance and to solve problems through weekly or monthly visits as necessary.

Sheltered employment

It is perhaps in the field of sheltered employment that the greatest possibility still exists for the employment of disabled persons. However, the old concept of providing heavily subsidised traditional work for specific groups of severly disabled people is gradually being replaced by so-called"production workshop"schemes.The essential difference between production workshops and sheltered workshops is that the emphasis is on the production of saleable articles of much wider variety on commercial lines and the employees include many categories of disabled people and some able-bodied as well.

In Sweden, sheltered employment opportunities are offered to severely disabled persons by SAMHALL(formerly called Swedish Communal Industries Group).The SAMHALL consists of 24 companies,one per county,with a total of 340 workshops.These workshops represent a cross-section of Swedish small and medium-scale industries.Since its inauguration in 1980,when it employed an average of 22,000 persons, the Group has gradually raised its personnel strength and in 1987 the SAMHALL's personnel strength reached 30,000.

The umbrella assembly factory which ILO experts helped to establish in Ethiopia is a good example of a viable self-supporting production workshop project for the disabled in a developing country. The market needs for umbrellas were first carefully analysed by an ILO expert. Initially launched in an old building employing 18 blind, deaf and physically disabled persons (most of whom had previously relied on begging for a living), it now provides well-paid employment for more than 500 severely disabled men and women; they in turn support some 3,000 dependants. One of the main reasons for the success of this enterprise lies in the fact that workers can become fully proficient in the various stages of assembly with one or two weeks' training and it is significant, too, that the blind working alongside sighted disabled can achieve such high levels of productivity. The viability of the project can be judged from the fact that the factory has continued to expand and operate most successfully two years after the ILO assistance was withdrawn.

Enclave scheme

Another comparatively new development in the field of employment of the disabled is that of the "enclave", which is defined as a group of severely disabled people working together under special supervision in an otherwise ordinary and undifferentiated working environment. This arrangement is particularly suited to supervised groups of the deaf, blind, mentally retarded and the mentally ill.

There is an interesting example in the United States. Mentally retarded persons are given employment opportunities at Sea World in San Diego, California. Since 1985, a joint effort by Sea World and the Association of Retarded Citizens has been successful in finding and training a number of mentally retarded workers, as a group, for permanent jobs. One trainer is assigned to every six student-trainees. There is a variety of jobs and experiences for trainees. Students may take several weeks to learn to clock in on time and to follow other rules. They must learn to check the schedule daily to find out where they are working and to locate the place on a map. They also have to learn to deal with supervisors and fellow workers. The quality of their work is stressed first, ahead of quantity. They progress at their own rate, and within six to eight months they are expected to do the same quality and quantity of work as any other Sea World employee does who holds down the same job. Before the project started, Sea World managers had many misconceptions about people with developmental disabilities, but they kept an open mind and learned from experience.


In Eastern European countries, co-operatives of disabled persons have provided an ideal avenue for their resettlement. In Poland, for example, the Invalids' Co-operative Movement has a central role in providing rehabilitation and vocational services. Through some 470 industrial co-operatives and associated homeworker and service-work schemes, the movement currently employs some 300,000 workers, including 200,000 physically and mentally disabled persons. State support for the co-operatives is both generous and extensive and includes tax reduction, or even tax exemption in the case of those co-operatives recognised as sheltered workshops. Exclusive or priority production rights are granted by the State for some 90 products and services. With this generous state assistance, and through its own efforts, the Polish Invalids' Co-operative Movement is financially self-supporting.


Self-employment may frequently be found to be the best form of employment for disabled persons who live in areas where open employment opportunities are limited, or for those who have difficulty in travelling to work. It is likely that many disabled persons for whom self-employment would be a suitable outlet will not have prior business experience and very little or no capital to commence operations. In such cases, possibilities should be explored for short, intensive training of the disabled persons concerned in small business management at an existing management training centre, commercial college or through evening classes, etc.

There is a growing interest in the United Kingdom in organising such training schemes to help the disabled into self-employment. For example:

- Ford Motor Company has seconded a senior manager to an employment rehabilitation centre to help handicapped people into business.
- The Royal National Institute for the Blind has employed a manager to develop business advisory services and training courses.
- The Disablement Advisory Service, part of the Manpower Services Commission, is developing business start-up courses.

Some of the disabled attending the courses have run businesses before they were affected by their disability but others are considering self-employment for the first time. The ventures they are considering are far broader than the traditional occupations associated with the disabled.

New Technologies

Recent advances in technology have had a tremendous impact, for better or for worse, on world economies, the nature of work and the quality and quantity of employment. The new technologies hold a great potential as well as a threat.

The vocational rehabilitation and training of disabled persons must be in line with the labour market requirements which have been changing rapidly with the advent of emerging technologies. There is, therefore, a need for closer links between vocational rehabilitation and industry. Vocational rehabilitation may not be successful in qualifying disabled workers to meet the challenge of new technologies if such services are undertaken only in specialised institutions. There will be an imperative need for vocational rehabilitation and training conducted in enterprises and in the business world.

Another area with which we are very much concerned relates to "social innovation" namely, changes in attitudes, social infrastructure and concept of equalisation. These do not appear to have kept pace with the rapid development of technological changes. Technology which permits a severely disabled person to work at home would isolate the disabled and lessons the prospects of social integration which is the ultimete objective of rehabilitation.

There is a good example of a partnership programme in vocational rehabilitation and technology. In six cities across the United States, IBM, Goodwill Industries and State Vocational Rehabilitation Agencies have pooled resources and expertise to operate computer training programmes for persons with such disabilities as paraplegia, quadraplegia, muscular dystrophy, severe back injuries and visual impairments, including total blindness. These trainees secure entry-level jobs as computer programmers. Although they compete with college graduates, the employers evaluate the trainees of these 10 to 12 month courses as equal to the college graduate employees with a year's experience in programming.

Opportunities in Rural Areas

The employment creation schemes which I have discussed have particular significance for disabled persons in urban areas. But what of the countless millions of disabled who live in rural areas? What can be done to create employment opportunities for them?

A highly effective approach to delivering basic rehabilitation and income generating activities for disabled people in rural communities is demonstrated in the community-based project in Indonesia in which the ILO and United Nations Development Programme have been associated over the past eight years. Linked to this project is a Disabled Business Groups Scheme introduced by the Department of Social Affairs, which assists disabled people in rural areas to establish kiosks, small shops and businesses. To enhance the effectiveness of the rural rehabilitation programme to the disabled in outlying remote districts, a Mobile Rehabilitation Scheme has also been established. A team of specialists travelling in a specially equipped vehicle offers guidance, training and simple treatment. With its well-developed rehabilitation institutions as a base for staff training and research, the Government of Indonesia has continued to expand community-based rehabilitation efforts for the social and vocational well-being of its disabled people.


"Work" means more than economic rewards. To many disabled persons, work provides them with therapeutic and psychological benefits, social interaction, a sense of participation, as well as self-respect. The opportunity for productive work and sharing in the fruits of economic progress has long been denied to the majority of disabled persons particularly in developing countries. Surely it must be the objective of us all in the years ahead to help provide that opportunity.



Japan Association for Employment of the Disabled, Tokyo, Japan

1. Introductory Remarks

In 1976, the United Nations designated the year 1981 as the International Year of Disabled Persons, and called upon the member States to implement various plans with the theme of "Full Participation and Equality".
In Japan, pursuant to the resolution of the U.N.,the "Headquarters for the Promotion of the International Year of Disabled Persons" was appointed in 1980 with the Prime Minister as its head. It was then resolved that, instead of celebrating the IYDP as a one-year event, the basic stance should be to regard the IYDP as the first year for dealing with the problem of disabled persons yet more actively from a long-range viewpoint, and the "Long-Term Plan for Disabled Persons" was formulated in Japan.

In this plan, while placing the emphasis of employment measures for the disabled on severely disabled, the basic policy adopted aimed at providing closely-nit measures to meet the characteristics of disabled persons with a view to ensuring as much as possible competitive employment opportunities for them, by identifying the factors hampering their employment. Concerning such employment measures, the Advisory Council on the Employment of Disabled Persons recommended in 1982 that "Based on the concept of normalisation, to create a climate which would enable disabled persons having the will and ability to work to work along with able-bodied workers in ordinary enterprises". Thus, we have continued to make efforts to date to put this concept into practice.

As I mentioned above, the realisation of the "Equalisation of Opportunities in Employment of People with Disabilities",which is the theme for today, constitutes the basic objective and idea of the measures for the disabled in Japan.
For the realisation of this objective and idea, however, it is necessary for us to solve various problems and continue making steady and incessant efforts towards improvement of the situation.

From such viewpoint, I would like to present a summary of the measures taken for the disabled in our country, and state my views about the tasks we have to solve in the future. I appreciate your comments and guidance to us.

2. History and Characteristics of Employment Measures for the Disabled

The employment measures for the disabled in Japan are being provided under the "Law for Employment Promotion, etc. of the Disabled"
The "Law for Employment Promotion,etc. of the Physically Handicapped", which is the antecedent of the present law, was enacted in 1960 with a view to promoting the employment of physically handicapped persons. This Law was drastically revised in 1976 in order to enrich the employment measures for the disabled.
The essence of the revision consisted of the creation of an "obligatory employment quota system" which requires enterprises to employ a certain percentage of disabled persons (1.5 % for private enterprises,which was raised to 1.6 % as from April 1988), and the "Levy and Grants System" related thereto.

The "Levy and Grants System" is based on the basic idea that all employers are under the obligation to employ a certain percentage of disabled persons, and it is necessary to adjust economic imbalances between the employers who have fulfilled the said obligation and those who have not. More concretely speaking, a "levy" will be collected from those employers falling short of the quota for the number of disabled persons in short supply, and, having this as financial source, the adjustment grant will be paid to those employers who employ disabled persons in excess of the quota, in order to adjust their economic burdens, as well as to pay various grants to employers to mitigate their financial burdens, such as the expenses entailed for improving some working facilities for use by disabled persons.

In the course of implementing such measures based on the revised Law, the Basic idea of the Law that "All employers have, under the idea of social solidarity, the common responsibility for providing suitable employment opportunities to disabled persons who have the will and ability to work" has been widely understood, with the result that employment opportunities for the disabled, which had been limited to medium and small enterprises, have become available also in larger enterprises.

In addition, another characteristics is that since 1974, the "National Association for Employment of the Handicapped" (the antecedent of the present Japan Association for Employment of the Disabled) was formed as an autonomous national organisation of employers to promote the employment of disabled persons, and this Association has, in cooperation with the Prefectural associations of employers for the promotion of disabled persons' employment, endeavoured to play a significant role in this field.

3. Revision of the Law into the Law for Employment Promotion, etc. of the Disabled (1987)

During the period of about 10 years following the drastic revision of the Law in 1976, the situation surrounding the employment of disabled persons has increased in its difficulty more than was anticipated, due to the progress of technological innovations, changes in the industrial and employment structures resulting from the rapid yen appreciation, etc., and the ageing of disabled persons, and the increase in the number of cases of severe disability.
In taking practical action to realise the equalisation of employment opportunities for disabled persons against such severe background, it has become necessary, besides ensuring their employment opportunities in quantitative terms, to improve the quality of their employment and respond to the varying needs of such persons, as is called for in the ILO "Convention concerning the Vocational Rehabilitation and Employment of Disabled Persons" which was adopted in 1983.

It was against such background that the Law was drastically revised in June 1987.
The substance of the revision related, in the first place, to the expansion of the coverage of the Law to all disabled persons,including physically handicapped and mentally retarded and disabled. In the second place, although the central aim of the Law has so far been to promote disabled persons' employment, the Law as revised incorporated in its basic idea the concept of employment stabilisation, so as to ensure stable continuous employment for disabled persons. The third point is the streamlining of the system of vocational rehabilitation on the national scale.

With reference to vocational rehabilitation services, in particular, in addition to the existing "Regional Vocational Centers for the Disabled" which conduct vocational evaluation and provide vocational counselling, and the "National Vocational Rehabilitation Centers for the Disabled" which provide comprehensive vocational guidance and training, located at 3 places all over the country, it is now planned to open a "Comprehensive Vocational Center for the Disabled" in 1991.

4. Present Situation of the Employment of the Disabled
I would now like to refer briefly to the employment situation of the disabled in Japan.

According to a survey made by the Ministry of Health and Welfare in 1987, the number of physically handicapped persons aged 18 and above was 2,413,000, of which 29 %, or 701,000 were employed.
Besides, a statistical survey of the Ministry of Labour in 1987 showed thatthere were about 40,000 enterprises, each employing 67 employees or more to which the employment quota system was applicable, and these enterprises employed a total of about 172,000 disabled persons, representing 1.25 % of the total employees, in contrast to the obligatory quota of 1.5 %.

Frankly speaking, since 1877 when the obligatory employment system was introduced, the actual rate of disabled persons employed showed a steady increase year after year. In the course of 1981, or the International Year of Disabled Persons, in particular, the rate registered a sharp increase. More recently, however, the actual rate remained stagnant, due to various reasons, including the afore-mentioned changes in industrial structure, the ageing of disabled persons, and the increase in the number of the severely disabled. Such situation points to the need for effecting further improvement in the employment measures for the disabled so that their employment may be promoted, overcoming the said environmental changes.

5. Future Tasks about Disabled Persons' Employment and Possible Solutions
I would now like to state my views about the tasks we have to solve in promoting the employment of the disabled in the face of increasing difficulties.

The first is how to cope with the general stagnancy in the employment in the secondary sector, and the expansion of employment in the tertiary sector.

The secondary sector, or manufacturing accounts for about half of the number of disabled persons employed. However, the growth of the tertiary sector in the industrial structure, as well as the progress of technological innovations, make it difficult to expect the further growth of employment in manufacturing. As in the case of employment in general,it is now necessary to seek to expand employment in the tertiary sector, including finance, insurance, services, and wholesale and retail.

The second is the progress of technological innovations and provision of vocational training to respond to it. In introducing sophisticated technology, enterprises conduct retraining of their employees repeatedly. The need for vocational training of disabled persons is even more keenly felt than for able-bodied workers. One important task confronting us in this field is the development of effective methodology of retraining people with communication handicaps.
In addition, while it is imperative for vocational training programmes to be able to promptly cover trades required by the labour market, it is impossible to arrange for all rapidly changing technology and equipment to be introduced into the existing vocational training institutions. Thus, there is a need for cooperating with enterprises, and make use of these enterprises as training institutions.

The third is the expansion of the fields of employment by utilising the fruits of technological innovations such as micro-electronics, for coping with the ageing of disabled persons and the increase in the number of the severely disabled.

About 78 % of the physically handicapped in Japan are 50 years of age or above, and the tendency toward the lowering of productivity resulting from ageing has become an increasingly important problem. Increases in the number of spinal cord injury cases due to traffic accidents, etc. and persons with severe and multiple disabilities due to sequela of geriatric diseases have also become a grave problem.

For the promotion of the employment of these disabled persons, it is imperative to increase the productivity of severely and older disabled persons, by developing rehabilitation instruments and tools, and ME-based instruments and tools which make use of sophisticated technology and are capable of supplementing and increasing the working ability of the disabled according to the characteristics of their disability, and thereby seek to expand their fields of employment.
The fourth is the encouragement to enterprises for cooperation in the promotion of disabled persons' employment, and for setting up internal arrangements for the employment stabilisation of the disabled.

For the promotion and stabilisation of disabled persons' employment, cooperation of employers is indispensable. To achieve this, our Association has requested the enterprises employing a certain number of disabled persons or more to set up a "Team for the Promotion of the Settlement of Disabled Workers in the Workshop", with the main objective of facilitating the job adaptation and settlement of disabled workers in the workshop.

The fifth is the training and supply of professional staff such as those to be engaged in vocational rehabilitation and counsellors who provide counselling to enterprises, and the improvement of their quality.

In the field of vocational rehabilitation, in particular, the training of professional staff has lagged behind, compared with other professional fields such as medical science and education. Under the Law as revised recently, the legal status of vocational counsellors for the disabled has been made clear. With this as the starting point, it is necessary to take positive measures for establishing the qualifications of professional staff and improving their quality.
The sixth is the promotion of international cooperation.
One of the aims of the International Year of Disabled Persons and the ensuing "Decade of Disabled Persons" of the United Nations is to unify international efforts for the improvement of the situation of the disabled in developing countries.

Our country has been making effort in this field, too. Concretely speaking, we have been cooperating in the setting up of a "Industrial Rehabilitation Center" in Thailand, to which we also dispatched our experts. We also accept trainees from developing countries into our institutions such as the "National Vocational Rehabilitation Center for the Disabled".
In addition, we took the initiative in holding the "International Abilympics" for the first time in Tokyo in 1981, and this was followed by the 2nd Abilympics in Colombia in 1985. The 3rd Abilympics are scheduled to be held in 1990 in Paris. We will continue to play an active role in promoting international cooperation for the cause of the disabled, by supporting the holding of International Abilympics on a continuing basis.

The seventh is the deployment of volunteer activities on a broad scale. If a disabled person as a worker is to work in a factory or office along with his collegues, and lead a normal life in the community, he must in many cases look to the understanding and support of the people around him. This, I think, is all the more important, if we are to work for the realisation of the goal of full participation and equality for the disabled. By creating an environment or community where as many citizens as possible give a helping hand to disabled persons, within the limits of their respective abilities, both at the worksites of these persons and in their day-to-day life, we can hope to make disabled persons as working people lead a more affluent life, both spiritually and materially. This is a time-consuming process, but we have to take a step forward to lay a cornerstone.

6. Concluding Remarks
The equalisation of opportunities in employment of disabled persons is only possible when the efforts of these persons, combined with the cooperation of employers and people around the disabled, have succeeded in creating various conditions which are conducive to their employment promotion.
I realise anew that,for the "Full Participation of Disabled Persons in the Social Life and Equality", the employment problem constitutes the central task. In the latter half of the U N "Decade of Disabled Persons", our mission is, in my view, to make further efforts to deal positively with various problems created by the increase in the number of the severely disabled, ageing of the disabled, and diversification of the kinds of disability in the years ahead.
Although the Japanese economy has made a steady progress, there are many things we have to learn from advanced countries with respect to the employment problem of the disabled, particularly their rehabilitation. I would, therefore, like to close my remarks, asking for your generous guidance and cooperation with us in the years to come.


Bundesministerium fur Arbeit und Sozialordnung,F.R.G.

The right to work is indivisible. Disabled and able-bodied persons are equally entitled to participate in working life. Participation in working life is the key to participation of disabled persons in the life of society as a whole. The permanent integration of all disabled persons into working life in the best possible way therefore has to be the main preoccupation of any policy in favour of disabled persons.

In the industrialized nations the organisation and structure of working life are changing more rapidly and profoundly than ever before. These changes which have been initiated by new technological developments also influence the conditions under which disabled persons can participate in working life. Information, communication and organisation technologies constitute the central areas of this technological change; in addition there are other innovations such as the use of new materials.

For the integration of disabled persons into working life we should adopt a positive attitude towards these technologies. But we must neither subdue to technological development nor should we accept everything that is technically feasible. With respect to new technologies we must face up to the ethical discussion, because technological developments have to serve mankind.

New technologies and all their consequences have an impact on work places but they just do not destroy jobs. Countries which use the opportunities created by modern technologies have gotten a push in employment. Moreover new technologies improve the framework conditions for the relationship between man and machine and they offer new opportunities for the reconciliation of life and work;
- we can better adjust the work places to the worker's individual needs;
- we can organize working hours so that a better coordination between work, family life and leisure time can be achieved;
- we can further reduce hazards to be encountered at the work place and - this is particularly important for disabled persons -
- we can use the new technologies in order to make jobs accessible for groups of persons who had so far been excluded from them;
- in manufacturing but also in administrative processes we can gradually return to more holistic work; therefore the qualification requirements of workers are increasing.

Technology can offset handicaps; some examples:
- Where heavy loads can be moved by cranes and conveyor belts by just pressing a push-button this work can also be done by a person sitting in a wheelchair.
- A computer evidently does not care whether information is fed into it or retrieved from it in long hand, in Braille or via acoustic signals.
- Special keyboards or special control devices like the "joystick" and the "mouse" which have been designed for quite different purposes, give some disabled persons access to a range of new jobs.
- If texts from technical books and magazines are already registered on floppy-disks disabled persons can access them by means of special output devices adjusted to the person's individual disability.

There is a large potential for a humanisation of our working life, waiting to be exploited in order to advance the employment of disabled persons. To create or improve the possibilities for their participation in working life and in the life of society as a whole
- this must be the human factor of modern technology. It is a great challenge for all of us to put these theoretical possibilities into daily practice.

New technologies should provide support, but should not create new barriers:
- Obstacles may arise when technologies are used which are not yet fully mature and thus not usable for disabled persons. Often the user of a computer still has to make quite an intellectual effort - an effort which in fact is supposed to be assumed by the computer. One can drive a car even though one does not know how to adjust the spark plugs; those dealing with micro-electronics today can only dream of such a standard.
- The use of new technologies in working life requires a range of new qualifications, for example understanding complex technical operations or being qualified to meet the increased organisational and planning requirements in the new communication structures. These new requirements act as barriers to groups of persons who already in the past had difficulties in coping with the traditional literacy skills; now they will find it even more difficult to adjust themselves to additional intellectual requirements.

While - thanks to the new technologies - many new opportunities are opened up in particular for physically disabled persons and persons with hearing and/or visual impairments, intellectual and psychological disabilities are increasingly becoming the disabilities which - with regard to access to working life and social life - are now the most difficult ones to overcome. For the benefit of disabled persons we must therefore insist on a "user-friendly" design of new technologies; not only the technical but also the intellectual access barriers should be kept as low as possible. Great efforts will still have to be made to organize our working life in such a manner that suitable jobs can also be found for those with few qualifications.

What applies to the use of new technologies in general should also apply to vocational training. The acquisition of theoretical and practical occupational skills has to be organized so as to help disabled persons gain access to working life - especially when new technologies are introduced. To achieve this objective the following requirements have to be met:
- training and education programmes within the individual trades and occupations must, as far as possible, be of high quality, up-to-date and adjusted to practical demands,
- we have to supplement the traditional occupational profiles by additional qualifications whenever this is necessary on account of the use of new technologies (for example: omputer-aided design for technical designers),
- we have to review constantly and, if necessary, develop the range of trades and occupations selected for the training of disabled persons to ensure that these trades and occupations are suitable for their future employment.
Society must give disabled persons the opportunity to make use of their knowledge and skills to the benefit of society; this is the prerequisite for any effective integration of disabled persons. Our history and culture have been marked by many disabled persons
- as, for example, Homer, Beethoven and Kant. Our present society is marked by disabled persons, too, not only by the strong and successful people shown in the media and in advertising. New technologies can and must help consider the contribution of disabled persons increasingly normal.

It is as true as it is important that disabled persons need ablebodied persons. But it is equally true and important that disabled persons in turn can give able-bodied persons a lot. I would like to conclude by quoting a few sentences from the last christmas speech which our President, Mr. Richard von Weizsacker, addressed to the people of our country: "It is not a merit but a gift to be able-bodied, and this gift can be taken away from us any time. Let us integrate disabled persons and their family members into our own lives in a very natural way. We want to give them the feeling that we belong together. In doing so we do not only help them, but also ourselves. Since it is in seeking their company that we will find out what is really important in life."


Commission of the European Community,Brussels,Belgium

Four years ago, when Rehabilitation International held its 15th World Congress in Lisbon, the first action programme of the European Community to promote the social integration of disabled people had only quite recently been launched. However, cooperation between the European Commission and Rehabilitation International was already established on a sound basis.

Since then their collaboration has continued to find new forms and to prosper. The regular meetings organized by the Commission in Brussels with the Rehabilitation International Secretaries in the twelve Member States guarantee regularity and continuity in the exchange of ideas. Equally valuable are the specialised seminars made available by the Commission, each year in a different country, for Rehabilitation International representatives and experts. No less important than these is the precious advice which Rehabilitation International is to give on the Commission's policy initiatives regarding disabled people.

It is, therefore, that I have found it a pleasure, as well as an honour, to be invited to address the 16th World Congress here in Tokyo, and to bring to Rehabilitation International and its friends the congratulations and good wishes of the Vice President of the Commission of the European Community, Mr. Marin, responsible for Employment, Social Affairs and Education.

Over the last few years one of the most prominent topics of discussion and consultation has been that which is the particular concern of this plenary session, the employment of disabled people.

Ever since its first programme was fully launched in 1982, the Commission has regarded the promotion of employment as the flagship of its activities in favour of the disabled. It has used all three of its principal means of action to bring this about: financial intervention, technical cooperation and policy development.

During this period the Commission has continued and enlarged the financial contribution which is made by the European Social Fund to the vocational training and employment of disabled people. This currently amounts to about 200 million ecus a year. (About 227.8 million U.S. dollars). Technical cooperation organized or supported by the Commission has been widespread in many contexts and at all levels. It has included:

- the intensification of the work of the Community Network of Rehabilitation International Centers,
- a priority for employment in the work of the first Network of Local Integration Projects (the District Network),
- and encouragement to European non-governmental organizations to include the theme of employment among their programmes.

Yet the Commission attaches a special value to its action at policy level,in particular the launching of the Recommendation on the employment of Disabled People, which was adopted by the Council in 1986. This was the first distinct act of policy solely concerned with disability undertaken by the Community.

In the Recommendation we endeavoured to establish the essential measures to ensure that people with disabilities would get a fair chance in open employment, especially in times of economic constraint and uncertainty. At the foundation of policy there must be a social guarantee which ensures, by firm legislation, the elimination of negative discrimination and an element of positive discrimination. In addition, there is a need for a whole range of interlocking measures which promote, encourage and facilitate adding up to a coherent strategy of positive action.

Now, after two years, we are at the point of completing the first Report on the Implementation of the 1986 Employment Recommendation. What is already quite clear is that, while the Recommendation was a necessary and useful first step, it does not go far enough. We must, therefore, consider seriously the possibility that a second policy initiative in this field may be necessary. Yhis is not, of course, because little or nothing has been achieved or is being brought forward in the Member States. On the contrary, we know that further effort at European level must be undertaken precisely because we have more proof of what can effectively be done, as well as how much still needs to be done.

In the European Community countries the rate of unemployment among disabled workers various between one-and-a-half and two times that of the global rate. This takes no account of disabled people who are unregistered or those who, for a variety of reasons, do not enter the labour market. In addition, it does not allow for the increase in the number of disabled people as a result of deinstitutionalization.

We know we must do better if equal opportunity is to be realized in our society.

And I am confident that wen can.

What we shall need first is the determination to put everywhere into practice tested strategies of positive action.

At the stage of vocational training this means more modular courses and other flexibilities regarding age-level, entrance dates, instructional methods, more well planned integration, but also more partnerships between specialized and normal training establishments. The courses must be more relevant to local and national employment needs and contain more financial and environmental backup for the trainees. In the employment market itself, we must first of all give all the encouragement and support we can to employers, demonstrating our successes to those who are hesitant or inexperienced. This means well designed and easily accessible services of information and advice, but it also implies financial compensation for any specific costs of induction, in-house training, adaptation of posts or loss of productivity.

Incentives, where appropriate, should be secured by contractual guarantee. This involves public investment. But never let us forget that against that must be set the economic difference between a lifetime of subsidized inactivity and a lifetime spent as a producer, consumer and taxpayer.

Rest assured, we shall be reviewing the social guarantee aspect of the problem, too.

Fortunately, evidence of negative discrimination in our countries is diminishing, as much because of social pressures as through governmental action. When it comes to positive discrimination on the other hand, and in particular the method of employment quotas, there are interesting developments within the Community countries which demand our attention. Only a few years ago, there was not a great deal that could be seen as positive in the European experience of quota systems, apart from the rather special achievement in the Federal Republic of Germany.

Imaginative recent reforms in three of the Member States have, however, radically changed the scene. Therefore the commission is currently considering another legislative approach.

In bringing forward these new proposals concerning the employment of disabled people we shall continue to insist that employment, for all its importance, must not be treated as an isolated issue. It is one of a number of interacting components in a multisectoral policy to promote independent living, a policy embracing vocational training too, of course, but also education, social security and the environmental sector, for example housing, access and transport. At the same time we shall continue to ensure that our policy initiatives are derived from, and coordinated with, a rich programme of technical assistance and technical cooperation supported by direct financial intervention.

The carrying forward by the European Commission of this comprehensive responsibility and concerted set of activities into the nineties is the task of the second action programme to promote economic and social integration and independent living of disabled people, which the Council of the European Communities adopted in April 1988. Powerfully supported also by the European Parliament, the new programme, under the title HELIOS, will operate for a full four years and will be resourced with about 20 million ecus over that period. (This is about 22.7 million U.S. dollars).

This level of investment to promote a full life for all disabled people is a clear indication of the recognition by the European Community of its responsibilities in this regard. This commitment is now reinforced and definite. Equally important is the spirit of shared endeavour in which the programme will be implemented and which we hope to see extended beyond the confines of the European Community, so as to make itself felt also in the domain of aid to developing countries. This is a task in which the non-governmental organizations will have a prominent role to play.

Over all these fields and throughout this exciting period which lies ahead of us, it is certain that the cooperation between the European Community and Rehabilitation International will be maintained and further extended.

While thanking Rehabilitation International again for the opportunity to address this Congress and wishing every success to the important work to which this great international assembly is devoted, I wish to end by sharing with you the pleasure which the prospect of this collaboration affords me and my colleagues in all Member States of the European Community.



Indonesian Society for the Care of Disabled Children, Jakarta, Indonesia

Indonesia is the world's largest archipelago consisting of about 13,600 islands, of which more than 7,600 small islands are not named and about 6,000 are inhabited. There are 5 big islands; Sumatera, Kalimantan/Borneo, Sulawesi, Java and Irian Jaya. The total land area is about 1,919,443 sq.km. Geograpical spent so wide extending east-west for more than 4800 km across the equator in the Indian and Pacific Ocean and 2000 km from north to south, and it created difficulties in communication and transportation. Number of population in 1987 is about 172 millions, the fifth largest population in the world after China, India, Soviet Union and United States of America. More than 60% of the population are located in Java, where as Java is only 7% of the whole areas. About 80% of the total population live in rural areas and the rest in urban areas.
Based on random survey in 1974 and 1980 there were 3.11% of the total population are disabled, consisting of :
- the physically or orthopaedically disabled
- the visually disabled
- the hearing / speech disabled
- the mentally disabled
- the ex chronically desease disabled (among others leprosy)

Total: 3.11% = 5,349,200 persons

Disabled person have equal right they also have equal obligation. So they have to take part in the building of society. Societies must raise the level of expectation as far as disabled persons are concerned.
The principle of equal rights for the disabled and non disabled implies that the need of each and every individual are of equal importance, and all resources, therefore, must be employed in such a way to ensure, for every individual, equal opportunities for participation.
The active participation of the disabled in the process of rehabilitation will be a condition of achieving successful effort in equallizing opportunities of the disabled in employment.
In the agricultural countries there are always disguised unemployment, this means the job opportunity actually is limited; and in countries where there is a change from agriculture to industry with number of growing industries are limited, and job opportunities are also scarce. In this situation competition in open labour market will be very high.
Rehabilitation Services for the Disabled have to deal with so many aspects, such as : psycho-social, health, social and cultural, education and training, and economic aspects, etc. These services are not merely the government responsibility, but also the responsibility of the community. Therefore, efforts of the Government as well as of the community should be in one line and well coordinated. In this case, the Ministry of Social Affairs, based on the Government Regulation No.36/1980 and the Presidential Decree No.39/1983, is responsible to coordinate all social welfare efforts for the disabled conducted by Government agencies and non-government organizations.
Conqruent to those premises as mentioned above, the Government has set up policies in dealing with problems of people with disabilities through social welfare efforts as follows :
- Every citizen has the right to decent employment and living in accordance with the standard of humanity.
- The participation of the community in rehabilitation services for the disabled should be promoted and developed conqruent to the government policy.
- The disabled may not be treated as an object, but they should be positioned - as a subject of the rehabilitation process.
- Social welfare efforts for the disabled should be undertaken through multi-disciplinary and inter-departemental approach.
- Aware of the scarcity of job opportunities for the disabled and in order to be able to apply the equalization of opportunities in employment, the rehabilitation efforts, therefore, put emphasis on creating job opportunities by self-employment without lessening the enhancement of job placement in factories/industrial firms.
The implementation of those efforts has been conducted through three systems applying community based social rehabilitation services. The systems are :
- Institutional/Residential Social Rehabilitation services;
- Non Institutional/Non Residential Social Rehabilitation services; and
- Social Cottage Settlement.

Condition and situation that have to be taken into consideration in running Social Rehabilitation Services, especially in the attemptto equalize the opportunities in employment of people with disabilities, are as follows :
The large number of the disabled located mostly in rural areas with low educational background and unskilled. They usually also have emotional problems, such as : infiority, very sensitive, and dependence.
The attitude of the family towards a disabled member tends to keep him / her hidden away in family care.
There are still so many people who underestimate the ability of the disabled and treat them as dependent ones.
In Indonesia, the growing number of industrial entreprises is limited and therefore opportunities of job placement are scarce. If there are job opportunities, they require certain skills and appropriate educational background.
The attitude of employers towards the disabled tends to be doubtfull about the capability of the disabled in carrying any job performance. The disabled have to face competition in open labour market.
Based on the government policy, rehabilitation programme for the disabled does not set up an ordinance of applying quota system in employment opportunities. Instead, the programme has been geared to motivate and train the disabled for self-employment or to become a job creator, individually as well as in group.
Two approaches has been developed, i.e :
Firstly, the social developmental approach aimed at developing positive sociatal attitude and growing awareness of the problem of disability as a precondition for the disabled. Through this approach it will facilitate possible mobilization of community participation to take part in the process of rehabilitation services for the disabled on a larger and wider scale.
Secondly, the social services approach aimed directly at providing social assistance and rehabilitation services for the disabled. The implementation of this approach is through three systems :

a. Institutional or Residential Rehabilitation Services.
b. Non-Institutional or Non-Residential Rehabilitation Services at village level. These services are carried out mainly by Social Work Volunteers under supervision of government social workers.
c. Social Cottage Settlement, developed and financed by the Ministry of Social Affairs, is aimed to provide Cottage Settlement for the disabled persons and their families.

The disabled who has been rehabilitated and has a job in informal sector, but still facing housing problems, are placed in Social Cottage Settlement. Specifically for the disabled of ex-leprosy, after they have been rehabilitated and trained in farming, are placed in Social Cottage Settlement with the provision of housing, land for farming, equipment, public facilities and food support for the first year.
Without lessening the improvement of those systems, the emphasis of all measures in the implementation of social rehabilitation for the disabled is on Community-Based Social Rehabilitation Services at the grass-root level or village level. Its main objective is to help the disabled to help themselves to create their own job, supported by participation of the surrounding communities.
Cammunity-based Social Rehabilitation Services has been developed by the Ministry of Social Affairs since the beginning of the second Five Year Development Plan (1975), specially in carrying out the non-institutional rehabilitation services for the disabled. That moment occured essential change in social welfare approach, from institutional care oriented carried out as closed system to non-institutional care, and implementing all institutions as open system through developing community participation.
The Community-based Social Rehabilitation service has been worked out to extensify its operational activities by establishing mechanisms, such as :
- The Base Station (or base of operation) for delivery of community oriented services for social assistance and rehabilitation of the disabled in a given community. It is consisted of building and simple equipment facilities utilized for the activities of local disabled people, such as : training, goods production process, marketing, etc.
- Mobile Rehabilitation Unit (MRU) designed to provide supporting services to the base station and other non-institutional schemes in rural areas, and to reach out larger number of target groups of the disabled in wide spread villages. MRU is a mobile, multi-disciplinary, inter-departemental team of consultant, specialist and technician providing appropriate generic rehabilitation services to disabled people, within their own communities, and making maximum possible use of locally avalaible resources.
Disabled Business Group Scheme (DBGS) or Productive Effort Group of the Disabled has been set up to establish a production cooperative in which trained clients work together on the production of various articles or the delivery of certain services. Although independence in function the DBGS recieves guidance, supervision and sometimes assistance in kind (equipment and material) from the Ministry of Social Affairs. A DBGS can be established when there are a small group of self motivated, trained clients who wish to pool their resources and effort, but who need help with equipment for self-employment. The other activity to self-employment is an individual client creates his own business in informal sector. Beside the DBGS and individual business entreprises, there are also clients who are individually placed in various business entreprises.
Approaches had been undertaken to leaders of difference kind of organizations of disabled people in order to coordinate them in one national organization called the Indonesian Association of the Disabled (Indonesian DPI), and had been successfuly established in 1987 inaugurated by the Ministry of Social Affairs.
The Ministry of Social Affairs has set up a formal cooperation with the Association of Employers.
This cooperation is an embryonic action programme at regional level for job placement of trained disabled persons. The cooperation will be promoted to a national level.

Up to now the Ministry of Social Affairs has built up and run 33 units Rehabilitation Centres for the disabled in 21 provinces, and 55 units of Institutional Rehabilitation Services built up and run by non-government organization in 23 provinces.
The Non-Residential Rehabilitation Services strongly Community-based oriented have been operated in 27 provinces. They are equipped with 8 Mobile Rehabilitation Units for 7 provinces, and 192 Base Stations or Base of Operations in 26 provinces and 3,094 units of Disabled Business Group Scheme in 26 provinces.
The Social Cottage Settlement facilities have been built up and operated for ex-leprosy disabled and their families in 17 provinces, and for another disabled persons and their families in 2 provinces.
The Non-Government Organizations that have activities of running rehabilitation programmes for the disabled have grown up and established 352 organizations and their operations cover 22 provinces.
From the study undertaken by the Institute of Economic and Social Research Education and Information, sponsored by the UNDP/ILO and the Ministry of Social Affairs, has identified 200 different kind of possible job opportunities in rural areas for the disabled.
The results of all those efforts there were 688,750 disabled persons, or 12.5% of the total number of the disabled persons in Indonesia, had been served. Among them 225,037 persons, or 33.65% of the reached out disabled clients, had been individually self-employed (186,623 persons), and by groups (37,528 persons) in the Disabled Business Group Schemes. Beside that, there were 886 trained/rehabilitated disabled persons who had been employed by various industrial firms/factories, including 600 persons being employed by the help of the Indonesian Employers' Association.
Factors facilitate the successful efforts in rehabilitating the disabled persons until they have their own business entreprises, individually or in groups, among others are : sufficient skills mastering, correct marketing strategies and the right situation in relation to the market, good and dynamic simple business management, adequate capital or equipment and material, good leadership, strong self-motivation, and ability in human and social relationships.
Retarding factors that hamper the equalization of opportunities in employment of the disabled, among others are : there is still negative attitude of several families, communities and employers toward the potential and capability of disabled persons, limited job opportunities and hard competition in open labour market, and limited fund for the development of rehabilitation services for the disabled.
Two major issues arised from this experience, they are : (1) how could we reach out larger number of disabled population to be served and rehabilitated and (2) how we do better after care services for those rehabilitated and trained disabled persons so that they could stand on their own feet with strong self reliance and self-sufficient income.

It is believed that there are so many ways to equalize the opportunities in employment of people with disabilities. From the Indonesian experience, the very suitable efforts to equalize the opportunities in employment of the disabled is geared to self-employment and to promote the participation of the employers in job placement for the disabled people.


1. International Labour Office, Genewa
Community-Based Rehabilitation Services For the disabled ; A Pilot experience in Indonesia.
2. International Labour Office Genewa.
Vocational Rehabilitation of Disabled Persons ; Tenth Asia Regional Conference Jakarta, Desember 1985.
3. Rehabilitation hand book.
Basic guidlines for Petugas Sosial Kecamatan ( Sub-district Social Workers ) Project INS/82/011 Department of Social Affairs, Government of the Republic of Indonesia, in association with ILO/UNDP.
4. Soetadi Mertopuspito
Review Achievement at the mid point of the UN decade of disabled persons in Indonesia ( Working paper ).
5. United Nations
World programme of action concerning disabled persons.


State Department for Social Security
Ministry of Employment and Social Security
Lisbon, Portugal

I should like to thank Rehabilitation International, in the persons of the 16th World Congress Chairman and of its President and Secretary-General, for the honour to participate in such an important meeting and for the opportunity given to address so eminent assembly. Therefore I must express, in the name of the Portuguese Government and in my own name, the best wishes of successful results for the problems of rehabilitation all over the world.
I do remember with pleasure the last R.I. World Congress, held in my country in 1984. For us, it was an honour and a source of pride to have hosted, in Lisbon, such eminent authorities from all over the world. It will also be unforgetable the different testimonies expressed by the participating handicapped people, who came to teach us what only first-hand experience of problems can teach.
Although I am going to center my words in a particular issue - the Equalization of Opportunities in Employment -, it does not mean that, my Government and I,we are not well aware of the fact that planning the future needs necessarily a realistic approach of all modern day living issues.
The right of disabled persons to full participation in their communities life and to exercise the rights and freedoms guaranteed to all citizens has been giving way to a critical review of the different areas of social life in order to identify the barriers to their full participation and also to a more general understanding about the goals of the rehabilitation policy in the end of the 80's.
I dare to report, referring to my own country experience, the way we have been going along in order to bring closer to everyone the contents of a rehabilitation policy we wish to be effectively inserted in the setting up of a more human and friendly society.
The portuguese legislation refers clearly the rights of disabled persons. According to the Constitution of the Portuguese Republic, article 71, "physically or mentally disabled citizens shall enjoy all the rights and be subject to all the duties embodied in the Constitution, except for the exercise or fulfilment of those for which their disability unfits them" and "the State shall carry out a national policy for prevention and for treatment, rehabilitation and integration of disabled persons, shall develop a form of education to make society aware of its duties of respect for them and solidarity with them and ensure they enjoy their rights fully..."
This constitutional imperative entails all the different departments within the Administration which are directly or indirectly involved in the different phases of the rehabilitation process according to the nature of the functions they were assigned.
The equality of rights recognized in the Constitution and confirmed by legislation in different areas has been becoming a major trend of the policy adopted by the portuguese Government in this field. This, we believe, leads to achieve an effective equalization of opportunities to disabled persons.
In the framework of European Economic Communities, to which Portugal belongs, and according to its Council Decision on Employment of Disabled Persons, my Government has been carrying out the establishement of specific measures viewing the promotion of vocational training and employment of disabled persons.
The policy guideline designed has been prevailing, within the sectorial measures, the conditions assuring the equality of rights and opportunities of disabled persons including, for each case, specific encouragements or defining regulations adapted to their situation.
It will not be difficult to realize the effort of compatibility that has to be done. To include the conditions clearly protecting the situation of disabled persons within the general labour legislation or in special legislative measures viewing the promotion of employment and the improvement of workers vocational qualification, often implies an adjusted intervention of the different departments of Administration in order to overcome contradictions or to fill existing gaps, such as between Education and Labour and between this last one and Social Security benefits schemes concerning youth vocational training and social-vocational integration process.
In my position as member of the Government in charge of the national department for the definition of a rehabilitation policy and, consequently, for the coordination of all the measures and activities developped by all public and private services interested for the problems of disabled persons, I must point out some of the recent steps undertaken by that department - the National Secretariat for Rehabilitation - viewing the coordination of efforts and the inter-sectorial articulation necessary to carryiing on an integrated policy. Our Government has just approved a Rehabilitation Basic Law which defines the guidelines for the State intervention and aims the effectiveness of the rights namely the right to perform a dignified and remunerative activity within the wider context of all the rights and freedoms granted to any citizen.
In today's societies employment, a carrier, financial independence are the legitimate marks of citizen status.
Disabled persons are very often considered, as to some extent or other, improductive members of society, therefore we are aware that the compensatory process of inequalities is slow and difficult to implement. It is not enough to take political initiatives but on the contrary it is essential the changing of beliefs deeply rooted in the collective mind as well as the changing of individual attitudes and social patterns highly complex.
In Portugal a generalized and compulsory "quota scheme" has not been established. My Government made the choice to draw political measures fevouring the promotion of employment by means of granting technical and financial support, among which we point out: capital compensation benefits granted to entreprises or other entities which employ disabled persons and keep them in activity; allowances viewing architectural barriers removal and adaptation of work places; subsidies for self-employment; taxes reduction due to Social Security by entreprises which employ disabled persons.
Along with these provisions intended to improve the access of disabled persons to working life, a considerable attention has been given to the articulation of regional development programs, to local employment iniciatives and to the promotion of the co-operative system. We assume that the development of these kind of approaches may, in a near future, bring a greater dynamism to job opportunities.
Although we recognize the fundamental importance of equality in employment opportunities, I believe that the personal and social fulfilment of a human being does not merely lay on a working situation in terms of a traditional relationship between employer and employee.
I believe it is necessary to find alternatives which may assure to more severe disabled persons a full integration in their community life.
At last, I would like to express that the carrying out of all measures and provisions should not rely only on the State henceforth running the risk to fall into an immoderate protective system. The will of the disabled persons, the effort of their families and the cohesion of the sociative movement are by themselves the fundamental support for the solutions we altogether must find.
Thank you.



Additional Secretary / Director General of Special Education
Ministry of Health, Special Education and Social Welfare, Pakistan

The major purpose of an education system is to enable children and young people to acquire the skills, knowledge, experiences and attitudes which will enable them to become fully participating members of the society of which they are members. This is no less true of a system of special education which is designed to meet the needs of children and young people who have disabilities or impairments which may affect their potential as learners or may slow the pace of their progress.
"The aims of education are the same for all children"
(The Warnock Report: U.K.: 1978) although the priorities for learning within the curriculum, and the teaching approaches used will undoubtedly be modified by the educational needs arrising from the disability of a individual child. However it is the common aim of preparing children and young people for life which should underpin curriculum planning and the organisation of education services.

In Pakistan we are at the beginning of a long journey towards the provision of comprehensive services for the disabled. Nevertheless the philosophical basis upon which our institutions are planned and developed is in accord with those countries which have reached a level of sophistication in their provision towards which we aim. This is outlined in the National Policy for Special Education and Rehabilitation which has been very recently revised.

Students are selected for training on the basis of school reports and their potential to benefit from the support and courses provided by the centre. There are links with other vocational training centres provided by the National Training Bureau of the Ministry of Labour and a number of students attend normal courses on a part time basis. Facilities currently exist for trade training in six areas. A total of 70 of the registered students are engaged in these vocational courses. The distribution of students by disability between these courses is as follows:

11 2 1 14


Knitting 1 5 1 3 10
2 3 8 13
Bench Fitting 4 11
1 16
TOTALS 5 46 6 13 70

The Centre has the most modern equipment for training the students and their programme includes opportunities for them to develop their basic educational skills as necessary, with an emphasis upon the practical application of information.

It is recognised that the establishment of this one centre in the federal capital is a modest beginning for meeting the needs of a very large number of disabled young people. The need to extend the range of trades in which training facilities can be provided is also acknowledged.


Based upon the experience gained in almost two years, plans have been approved to establish similar centres in each of the provincial capitals thus increasing significantly the number of training places available. These should be operational within the current financial year. In order to broaden the catchment areas served by these centres, it is proposed to provide hostel facilities for students living away from the major areas of population.


The network of more than forty special education centres,which have been established during the past three or four years in Pakistan,provide primary education to pupils within the four broad areas of disability. Plans are already well advanced which will result in the establishment of secondary education programmes within the next few months in every district. It is recognised that this gap in the range of provision which currently exists, creates particular difficulties in the planning of courses for pupils which have both coherence and continuity. Recent advice on the structure of the curriculum emphasises the fact that preparation for leaving school, and the acquisition of appropriate skills and attitudes for life, is a process which must begin, and must be actively planned, from the day that a child enters school. Within the programmes provided by our centres there is suitable emphasis upon the teaching and learning of skills which may be used in later life. However these concepts require much greater refinement, and the provision of in-service training opportunities for teachers given the requirement to establish secondary education programmes in the near future.

Pakistan has an estimated 1.1 million young people between the ages of 14 and 20 who suffer from the effects of some form of disability. The special educational needs of this group include:

- supplementary general education
- vocational skills training
- careers guidance and counselling
- job finding & support

A beginning was made in November,1986 in meeting the needs of this group of young people by the establishment of the National Training Centre for the Disabled in Islamabad. The centre now has 176 registered students who are receiving some form of support from the staff. The distribution by disability and sex of the group is as follows:

Visually Impaired 11 5 16
Mentally Retarded 65 13 78
Physically Disabled 50 7 57
Hearing Impaired 20 5 25

146 30 176

The services offered by the training centres, and the design of their courses, will be improved by the development of short term work experience placements and by a process of aptitude assessment in a variety of trades before a student makes a final course choice. Links with local employers will be enhanced by the designation of a senior member of staff in each centre as a co-ordinator for work experience and job finding. For those young people and adults who will not be able to sustain themselves in open employment, the creation of sheltered workshops is a matter to which urgent attention is being given but which will be constrained by the availability of resources.

The National Council for the Rehabilitation of Disabled Persons has undertaken an initiative to assist those disabled persons who have the potential for self employment by providing grants for the purchase of essential equipment. Co-operation with the ILO in the development of skills centres offers further potential for disabled school leavers and those who acquire disablities later in life to have the opportunity to train and receive guidance.

The strengthening of an existing ordinance which requires public and private employers to reserve a quota of 1% of jobs for disabled persons will create a growing demand for vocational training by disabled young people and adults. Our ability to meet that need will depend upon the development of a pattern of educational provision which has continuity. It will also rely on the extension and growth of a curriculum response in schools which will allow disabled young people to make a smooth transition to further education and vocational training centres. If this can be achieved during the coming years then we will benefit greatly from the presence of disabled young people who are truly able to be active and participating members of the society which is Pakistan.

16th World Congress of Rehabilitation International No.2 P.58-P.98

The Organizing Committee of 16th World Congress of Rehabilitation International

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