CBR NEWS UPDATE Volume 5, Issue 3 November 2008 CREATE PO Box 100275 Scottsville 3209 South Africa Phone/Fax: +27 (0)33 3455088 Email: firstname.lastname@example.org Website: www.create-cbr.co.za What is the future of CBR in South Africa? At the end of 2006, CREATE saw the end of their training of community rehabilitation facilitators (CRFs). This was due to changes in the training requirements for mid-level rehabilitation workers within the Health Professions Council of South Africa (HPCSA). CRFs formed a major role in the implementation of CBR, however now that CBR training has come to an end, what is the future for CBR in South Africa? Definition of CBR Over the past three decades, CBR emerged as an effective method of providing rehabilitation services to people with disabilities and their families. According to the ILO, UNESCO and WHO Joint Position Paper (2004, p2.), CBR is defined as ‘a strategy within a general community development for the rehabilitation, equalisation of opportunities, poverty reduction and social inclusion of all people with disabilities’. Unlike conventional rehabilitation programmes, CBR places equal emphasis on inclusion, equality and socio-economic development as well as rehabilitation of all people with disabilities. Implementing CBR The implementation of CBR differs from country to country. In order to capture the different ways in which CBR is implemented the WHO (2005) developed a matrix that incorporates the topic areas which an effective CBR programme may contain. The 5 topic areas (health, education, livelihoods, empowerment and social) each have 5 key elements, which inform the implementation of CBR. Both the topic areas and their elements are underpinned by the principles of participation, inclusion, sustainability and self advocacy. According to the WHO (2005), these principles should inform and affect the activities within each of the topic areas. In using this matrix, CBR programmes do not have to cover all these areas but can choose some of the topic areas and different elements depending on local circumstances. For example, in South Africa, many of the CBR programmes are set up through the Department of Health and focus on the topic area of health but also include other elements such as early childhood development, income generation programmes, political empowerment and self-help groups. This demonstrates how topic areas can be inter-related. The matrix provides a great way for CBR programmes in South Africa to look at different ways in which they can expand their capacity in terms of implementing CBR. Taking CBR forward Since CREATE has no longer been able to offer CBR training, the CBR matrix has enabled us to expand the organisation’s capacity. For instance, as an organisation we continue to remain committed to the promotion of inclusive education and community disability awareness. We have also started a basic business training course for parents of children with disabilities in an attempt to increase their livelihoods. Furthermore, with the ratification of the UN Convention on the Rights of Persons with Disabilities, CREATE has been running several workshops to introduce the Convention to people with disabilities, community leaders NGOs and government departments. These workshops aim to empower people with disabilities and encourage their social mobilisation. To help gain further perspectives about the future of CBR, telephone interviews were carried out with the national department of social development and KZN department of health. The results of these interviews can be found in this newsletter. The implementation of CBR in South Africa still has so much potential. But as quoted by Joel Barker, ‘Vision without action is merely a dream. Action without vision just passes the time. Vision with action can change the world.’ (Written by Paul Chappell, CBR Trainer—CREATE) CBR and the Department of Social Development How are the Department of Social Development currently implementing CBR? At the moment we are in the process of developing a policy on rehabilitation, which will cover both institutional facilities and community/home services. We recognise however, that community services are important and that CBR should form a major component of that service. Following several consultation workshops with NGOs and disabled people organisations (DPOs) in different provinces, we are now checking to see that we have the right resources to meet the needs of our service users. We feel that this information dissemination is crucial, especially in trying to ensure that services are inclusive to all people with disabilities. What barriers do you think prevent the implementation of CBR? I think the biggest barrier is in defining the role of care attendants (i.e. mid-level workers). We don’t have enough funding at the moment to really investigate this issue. One thing for sure, is that we want to make sure we are in line with the UN Convention on the Rights of Persons with Disabilities. We also recognise that NGOs have usually carried the main responsibility for implementing CBR, often without adequate funding and support from government departments. How do you see CBR being implemented in the next 5 years? As a department we are very committed to providing rehabilitation at a community level. Rather than using an outreach approach, we believe CBR provides the opportunity to create inclusive services to all people with disabilities. At the moment we are still looking at various best practice models in terms of how best to implement CBR. For instance, the use of CBR workers as developed by Disabled People South Africa (DPSA) in Mpumalanga and also the use of community rehabilitation facilitators, as developed by CREATE in KZN. The only way CBR can really be developed in the future is by reaching out to the NGOs and DPOs who already practice CBR and learn from their experiences. (Telephone interview with Manthipi Molamo-Rahloa, Disability Director—National Dept. of Social Development) CBR and the KZN Department of Health How are the Department of Health currently implementing CBR? Currently, the department gives out service level agreements to different NGOs and disabled people organisations to establish support groups and capacity building of people with disabilities. We also support CBR workers employed by Disabled People South Africa (DPSA) who work very much at community level. These CBR workers are usually people with disabilities or parents of children with disabilities. They assist health professionals by identifying other people with disabilities, carrying out peer counselling (especially for those disabled after accidents) and identifying barriers that prevent people with disabilities accessing health services. Another project we support is the orientation and mobility training of person’s with visual impairments. What impact do you think the discontinuation of CBR training will have? Primary health care centres need to be fully inclusive of disability issues. However, the CBR workers employed by DPSA do not receive any training and only work from their own experiences of disability. This could reduce chances of inclusivity as the CBR workers only have knowledge about their own impairment and not know of the requirements for other impairment groups. Furthermore, without the training of mid-level workers at community level, it may create a gap between consumers of health services and the actual Department of Health. What barriers do you think prevent the implementation of CBR? I think the major barrier is the current institutional philosophy that exists throughout the various clinics in our communities. For instance, CRFs only work in these institutions and are not really community-based. Instead they only provide outreach work and do not really involve families or groups of people with disabilities in their work. How do you see CBR being implemented in the next 5 years? I think the key to this question revolves around the allocation of resources within the Department of Health. Firstly I believe for CBR to be taken seriously, it needs to become a key resource area. This will ensure the dedication of the Department to implement CBR and the appropriate allocation of resources. Secondly, there needs to be a full commitment to the training and development of personnel specifically within the field of CBR. (Telephone interview carried out with Mncedisi Mdunyelwa, Disability Advisor – KZN Dept. of Health) How do you see the future of CBR? Now you can see what different government departments think about the future for CBR in South Africa. What do you think about this? Do you agree with what they say? If not, how would you like to see CBR being implemented in the near future? Write to us at CREATE and share your comments and views about the future of CBR. Mobilising for social change! Casual Day is well known in South Africa as a fundraising project aimed at benefiting people with disabilities throughout the country. However, a CRF along with a group of people with disabilities in Mpumalanga province, saw this day as an opportunity to lobby for social change. Call for action In the small rural area of Bushbuckridge, Casual Day is usually facilitated by ABSA bank who run a series of different events to celebrate the day. Following several discussions with my local disabled people’s organisation, we realised that this particular branch of ABSA bank is not accessible. A decision was therefore made to hold a march to the bank on Casual Day to raise awareness of this issue. A march for change! After informing the local municipality, police and emergency services, we held our march on the 5th September. Altogether, around 200 people with disabilities and government workers marched to the ABSA bank where a memorandum was given over to the bank manager. On the same day, a braai was organised for all the people who took part in the march. This was organised by Tintswalo hospital who awarded the tender to carry out the braai to a person with a disability. Creating new opportunities As a result of the march, ABSA bank have agreed not only to make the local branch more physically accessible, but also to send one of their employees to be trained in sign language. This will definitely be of great use to customers who are Deaf! The local ABSA branch have also agreed to help raise funds for local groups of people with disabilities by setting up a car wash service. I have learnt from this experience that by working with local disability groups, so much can be done to advocate for change in our communities. Change that will really benefit the lives of people with disabilities. (Written by Yolanda Zitha, OTT—Tintswalo Hospital, Mpumalanga) Skhumbuzo Emmanuel Zulu Unfortunately in July this year, Skhumbuzo Zulu, who was a CRF working in Centacow, KwaZulu Natal, tragically passed away. This is such a great loss to us at CREATE as well as to the many people with disabilities with who he had worked with. We wish to pass on our thoughts and prayers to his family at this sad time. May he rest in peace.
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